杏吧原创

TWO minutes, 58 seconds. Two minutes, 59 seconds. Three minutes. One blue line or two? Our lives are full of moments where we hold our breath, waiting, our future in the balance. Whether it is three minutes for a pregnancy test, three months for an exam result or three years to find out what will happen with Brexit, time spent waiting for the news that could change everything can be filled with excitement and hope, or fear and anxiety.

Now though, we are starting to understand how our capacity for coping with such uncertainty varies, and the toll that not coping well can take on our physical and mental health. With that comes the revelation that our ability to tolerate periods living in limbo has actually decreased over the past few decades. That has profound implications for many aspects of our lives 鈥� from the medical advice we are given and choices we make about it to how we cope with times of personal struggle, political upheaval and even longer-term existential threats like climate change.

Thankfully there are ways to identify how tolerant we each are to spells of uncertainty that invade our lives, and methods we can use to manage and build resilience to them. It may be true that nothing in life is certain, but we can all learn how to traverse life鈥檚 limbos better and emerge from them relatively unscathed.

鈥淚t鈥檚 more stressful not knowing if a shock is coming than knowing you鈥檒l definitely get zapped鈥�

Limbo is, of course, the first circle of hell in Dante鈥檚 Divine Comedy. It is a place where people have no hope yet live in longing. It is described as a gloomy, dimly lit wood 鈥� dark, deep and foggy. What are first mistaken for cries of anguish are in fact sighs of sadness.

Not knowing isn鈥檛 nice. We are curious. We like to know what is going on, what might happen and what the long-term effects of our actions might be. Our brains are geared towards predicting the future; our very perception of the world is generated by combining memories of our past with information from our senses, to make an educated guess about what is about to happen. Experiencing uncertainty makes us feel very uncomfortable.

In fact, we find uncertainty so unsettling that people would rather know they are going to receive an electric shock than wait for the possibility of one. This was shown when researchers at University College London got people to play a computer game where snakes were hidden behind certain rocks. Each time participants found a snake, they got a small electric shock. The computer measured uncertainty using the players鈥� guesses and their stress response based on how much they sweated and their pupil size. People were more stressed if they were uncertain whether a shock was coming than if they knew they were definitely going to get zapped.

鈥淚t鈥檚 the state that uncertainty generates,鈥� says Benjamin Rosser at Liverpool John Moores University in the UK. 鈥淚f you鈥檙e in a situation where something bad is definitely going to happen, you know what you鈥檙e dealing with and you can start thinking about ways of coping. If you are in a situation where the outcome could be positive or negative, you鈥檙e in a preparatory frame of mind and you鈥檙e less prepared for either outcome.鈥� Think about a time of recession 鈥� in some ways it can be more stressful waiting for the possibility of lay-offs at work than just being told 鈥測ou鈥檙e sacked鈥�.

We all differ in our ability to cope with not knowing how things will turn out. 杏吧原创s call this trait our 鈥渋ntolerance of uncertainty鈥�. Where we sit on a spectrum of intolerance affects how we experience everyday situations, from waiting for a bus to waiting for news of a loved one in hospital. 鈥淚t means that in life鈥檚 ambiguous scenarios, two people with the same information can react in two completely different ways,鈥� says Rosser.

Say your partner should have been back from work 20 minutes ago. Those with a low intolerance of uncertainty will assume they are stuck in traffic. A person with a high intolerance of uncertainty might immediately think they have been involved in an accident and worry until they arrive home.

Of course, sometimes having a high intolerance of uncertainty is a good thing, says at Concordia University in Montreal, Canada. 鈥淭here are certain jobs where it鈥檚 a benefit. Obviously, you don鈥檛 want your air traffic controller to say, 鈥榳ell I don鈥檛 know what鈥檚 going to happen, but that鈥檚 OK.'鈥� Equally, if you are a detective or a brain surgeon, a high intolerance for uncertainty is critical for some aspects of the job.

But for the most part, an extreme dislike of the unknown is undesirable. It can provoke fear, anxiety and a perception of vulnerability. People who are less tolerant of uncertainty will engage in 鈥渟afety behaviours鈥�, says Dugas. 鈥淭hese are strategies that prevent undesirable outcomes in our future 鈥� phoning your partner all the time to check in with them, is a prime example.鈥�

While some safety behaviours allow us to minimise uncertainty and the associated anxiety, too many, paradoxically, just make things worse. 鈥淪afety behaviours in the absence of a realistic threat are actually maladaptive,鈥� says Dugas.

This has been demonstrated in a lab experiment. Healthy people were told to engage in daily safety behaviours to prevent the spread of germs 鈥� washing their hands every time they touch a door handle, for instance. At the end of a week, they showed in contamination-related tests, and overestimated contamination threats. Too many safety behaviours mean that we never learn that uncertainty isn鈥檛 always dangerous, and if you never have to experience negative outcomes, you never realise how good you might actually be at coping with them, says Dugas.

It is hard to put a figure on exactly how many people have extreme intolerance to uncertainty 鈥� it isn鈥檛 in psychiatry鈥檚 diagnostic manual as a condition in its own right. Instead, it is what doctors call a 鈥渧ulnerability factor鈥� for other conditions, such as . It is the most important factor contributing to whether people develop anxiety disorders in the first place, and whether they persist. These disorders affect 1 in 20 people.

Worst-case scenario

So how can you work out how well you deal with uncertainty? You could use a scale developed by Dugas and his colleagues, in which you decide to what extent you agree with 27 statements such as 鈥淚t鈥檚 unfair that life is uncertain鈥� (see 鈥淗ow much do you fear uncertainty?鈥�, for a short version).

Another technique that therapists use is called a 鈥渃atastrophising interview鈥�, in which you are asked to consider a current worry, such as the outcome of a job application. They then ask you what it is that worries you about this situation. You might say you need the extra money. They would then ask you what worries you about that. 鈥淲hat if I can鈥檛 pay my rent?鈥� you say. They ask you what worries you about that. 鈥淲here would I borrow the money from? What if I default on my credit card? Would my children have to move schools?鈥�

鈥淲e continue to drill down into the details of your worry until we get to the bottom of it,鈥� says at the University of Sussex, UK. 鈥淲e note how many 鈥榳hat if鈥� scenarios you generate from your initial worry, how many future negative outcomes you imagine. The more you have, the higher your intolerance of uncertainty.鈥� Normally, this test is used before and after an intervention to see whether it is working, says Meeten, rather than using it to figure out how uncertainty might affect your life.

Many factors can influence how uncertainty affects us. 鈥淚t鈥檚 like any other personality trait,鈥� says Dugas. 鈥淭here鈥檚 an interplay between our traits and our life experience. If I鈥檓 quite intolerant of uncertainty but my life is extremely predictable, I won鈥檛 have any problem. If my life is chaotic, I might experience severe anxiety from the same level of intolerance.鈥� (See 鈥�Paralysed by the unknown鈥�)

There are, however, wider medical implications of intolerance of uncertainty. 鈥淚t鈥檚 influential for all kinds of health outcomes,鈥� says Paul Han at the Maine Medical Center Research Institute.

For a start, your doctor鈥檚 personal uncertainty threshold has huge implications for your health. For instance, women are more likely to end up with a caesarian section if their doctor has a low intolerance of uncertainty. This trait also makes doctors more likely to offer a new genetic test, prescribe generic drugs, adopt a cutting-edge therapy and to patients about grief and loss.

However, doctors who are more intolerant of uncertainty are more likely to termination following abnormal results from prenatal genetic tests, and are less willing to use newer therapies, such as cognitive behavioural therapy, for eating disorders. Doctors may also give different advice depending on how well they think their patients can cope with uncertainty 鈥� in some cases even withholding information or not offering interventions with uncertain outcomes.

Your own intolerance of uncertainty can also affect health outcomes. For instance, people who have a high tolerance of uncertainty have better emotional well-being after a cancer diagnosis and experience less distress after receiving genetic test results. It is also associated with a better quality of and , as well as and fewer motor symptoms in Parkinson鈥檚. On the other hand, a high intolerance may make people to adhere to their medication.

It also affects people鈥檚 ability to cope with particular treatment regimes, says Han. Sometimes, men with localised prostate cancer can choose a 鈥渨atch and wait鈥� approach, whereby they have regular scans rather than immediate treatment that can have side effects including incontinence and impotence. This approach means enduring long periods of limbo between scans. Several men in this position, who spoke to New 杏吧原创 confidentially, described this choice as one of the most difficult decisions they鈥檇 ever had to make 鈥� and one that sometimes caused a rift with loved ones, whose ability to cope with uncertainty differed from their own.

Contending with the unknown can place great strain on relationships, says Dugas. When couples with a high intolerance of uncertainty have difficulties, they might leave each other immediately rather than wait and see what might happen, he says. Or people have difficulty developing relationships in the first place, because they aren鈥檛 prepared to go through that initial period of uncertainty 鈥� will they call, do they like me, should I ask them out to lunch? 鈥淭his makes them very hesitant to form relationships, and when they do make the effort, they want too much certainty about the future from the start, which scares the other person off.鈥�

The good news is that our discomfort with the unknown can be manipulated, so we can learn how to boost our resilience. In one experiment, students were told to read a story in which the main character had either a high or low intolerance of uncertainty and try to put themselves in that person鈥檚 mindset. Their own intolerance of uncertainty was then tested. After the manipulation, the group reading about a character who is more rattled by uncertainty in subsequent catastrophising interviews about their own real worries.

In the real world, you need to treat your intolerance of uncertainty as you would a phobia, says Dugas. 鈥淚f you鈥檙e scared of dogs, we鈥檇 expose you to them slowly and carefully to help you develop the understanding that most dogs are not dangerous. The same holds true for intolerance of uncertainty.鈥�

To cure people鈥檚 fear of uncertainty, we get them to experiment with their safety behaviours, says Dugas. He describes one person who was overanxious about her son going out by himself. She made him call her as soon as he left the house and stay on the phone while he was on the bus, until he reached his friend鈥檚 house. Dugas encouraged her to let her son hang up when he got on the bus and call back when he arrived. The next time the son just called when he arrived, then finally didn鈥檛 call at all. 鈥淭here鈥檚 no magic bullet, it鈥檚 about putting ourselves in a situation where we can learn that uncertainty isn鈥檛 dangerous, and we know this leads to a decrease in anxiety over time.鈥�

Minimising safety behaviours without outside intervention isn鈥檛 easy. 鈥淚t鈥檚 not impossible, but it鈥檚 difficult,鈥� says Dugas. 鈥淪afety behaviours are really sneaky, they鈥檙e hard to identify and we mostly don鈥檛 realise we鈥檙e doing them.鈥�

Silver linings

We are using safety behaviours more and more, though. Over the past two decades, our intolerance of uncertainty has increased significantly, according to Nicholas Carleton at the University of Regina in Canada and his colleagues. Their recent analysis of 52 studies of students showed that intolerance .

The team believes cellphones and internet access, which both grew rapidly over the same period, might be to blame 鈥� increasing safety behaviours by offering us immediate access to emergency services, loved ones and information that isn鈥檛 always helpful. 鈥淐ellphones nourish our safety behaviours,鈥� says Dugas. To practise what he preaches and minimise his own safety behaviours, he doesn鈥檛 own a cellphone. 鈥淵ou know what, nothing awful has happened yet,鈥� he says.

There are strategies to help you cope with uncertainty that don鈥檛 involve ditching your phone or resorting to professional help (see 鈥�How to build resilience when life is in limbo鈥�). Throwing yourself into an engrossing task can provide a welcome distraction and make time pass more quickly, for instance. And practising mindfulness meditation can help , stopping you from agonising about future outcomes.

Don鈥檛 forget that a degree of intolerance can be useful, however. It helps to lower your expectations. Bracing for the worst can , but timing is everything. To avoid unnecessary worry, you need to assume the best for as long as possible before bracing for the worst towards the end of the wait, says , Riverside.

Finally, it may be helpful to concentrate on finding the silver lining in any potential bad news. In the 2016 US presidential election, Hillary Clinton supporters who being elected were less shattered when he won, Sweeny found. But be cautious, this strategy can backfire: Trump supporters who tried to find an upside to Clinton winning were less thrilled when their candidate did.

Alongside the everyday uncertainties that we face, many of us are living in a particularly uncertain time. In the UK, Brexit has loomed large for more than three years, putting the future of the country in the balance. Could the perpetual uncertainty about the nation鈥檚 ties with the European Union be causing the population harm?

鈥淲ith Brexit there鈥檚 an enormous amount of uncertainty, so you might find there are more people having to deal with more uncertainty and more anxiety as a result,鈥� says Dugas. 鈥淏ut it might go the other way and make people less anxious, because they go on with their life even though they are experiencing more uncertainty. They realise they can cope with this big, long-term limbo, so the small things are also easier to cope with.鈥�

Deal or no deal, pass or fail, two blue lines or one 鈥� one thing is for certain: uncertainty isn鈥檛 going away. If you need to build some extra resilience to it, Meeten has some final advice: Instead of weighing yourself down with worry or trying to problem-solve every eventuality, try sitting with that uncertainty for a while. You鈥檒l see that, most of the time, nothing particularly bad happens. And talk to others about how they cope. 鈥淭aking a step back and realising that your way of dealing with uncertainty isn鈥檛 set in stone, that others might not feel the same way about that same situation, that it鈥檚 a personal perspective that is changeable, is one of the strongest messages we can give people.鈥�