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“When you accept uncertainty, you can live in the present.”
Dr Jon Grayson
Life is uncertain.
Consciously or subconsciously, we live with the reality that we do not have control over our futures every day. While we may know this on some level, we often look for certainty.
Looking for certainty is particularly appealing in the current state of the world, when there is a lot of challenges around climate, war, and human suffering.
Yet, despite our desire to want to control outcomes, I’m sure we can all come up with examples as to when life happened and we weren’t expecting it.
While the reality that we do not have total control of the outcome can be very scary, it is also freeing.
More specifically, if you’re struggling with obsessive compulsive disorder (OCD) or an eating disorder (ED), your brain is trained to notice everything problematic and potentially scary. Any physical or mental compulsions or obsessions then become ways to keep yourself safe, to manage uncertainty.
Yet, these behaviors and thoughts contribute to more anxiety, depression and fear.
Coping with uncertainty is not just an OCD or ED problem. We all have thoughts and behaviors that protect us from the not knowing of life.
This blog post is designed to give you ideas on how to practice sitting with uncertainty and tolerating discomfort, while you recover from ED and/or OCD.
Connecting Uncertainty with Food & Body
It is normal to be very uncomfortable with not knowing.
We are routinely faced with questions like:
What will my weight be after pregnancy?
Will I develop diabetes?
Did I say the right thing to my boss?
Will I sustain an injury that keeps me out of my sport?
What is causing my abdominal bloating and distention?
The feeling of uncertainty can come with feelings of anxiety, guilt, shame and worry. If these feelings are hard to sit with, you may turn to things to help to tamp those feelings down and find short-lived relief or a faux-answer.
Ways you may deal with uncertainty using food, body or movement are:
Counting calories or macros
Cutting out all gluten and diary before you get answers about your bloating
Setting rules around when to have certain foods or how big meals should be
Being strict about how much exercise you do each week
Google-ing physical symptoms to figure out if you need to go to the doctor
Asking others for reassurance about whether you have gained weight or eaten too much
Binge eating or compulsively exercising to numb yourself from feelings
Looking in the mirror to see if you look ‘as bad’ or ‘as good’ as you think
Trying to ‘optimize’ your diet
5 Steps to Sitting with Uncertainty
Doing the hard thing - the thing causing anxiety - and then sitting with the uncertainty of what will happen next can lessen anxiety in the future. Exposure can be one effective way to handle uncertainty, and for people with OCD and EDs, reduce compulsions and obsessions.
Exposure and Response Prevention (ERP), together with Acceptance and Commitment Therapy (ACT), are effective evidence-based therapies.
By doing experiments, as I like to call them, you can disrupt our normal pattern and change your thinking and behaviors.
Here are five practical steps to use ERP/ACT so you can work towards accepting uncertainty.
Identify what behaviors you do that help you avoid sitting with uncertainty. Write a list.
Identify your top 3-5 values. Values are a guidepost that can help ground you while making decisions and sitting with uncertainty of those decisions. Take a look at a list of values, and consider listening to this 28 minute podcast to help you determine values.
Decide on an experiment. Now that you have a few values that resonate with you, choose something that is hard for you to do. Consider what you are willing to do. Being willing will help you tolerate the discomfort. Identify what you are willing to try, write it down and then also write down why trying this experiment is in line with a value identified earlier. Maybe you…
Avoid all desserts because of fear of weight gain and the goal is to have one dessert in a nice environment this week. This is in line with your value of connection because you enjoy having dessert with your kids sometimes.
Are counting calories for fear of weight gain and ultimately, to manage fear of being worthy, and your goal is to not do this for one day. This is in line with your value of freedom, which is what you will get when in recovery from your eating disorder.
4. Be present, reflect and create a response prevention plan.
Be present and drop into your body: What are your emotional feelings before, during and after? Physical sensations before, during and after?
Reflect: What did you think was going to happen and did it? If it did happen, were you able to handle to tolerate the discomfort? How did doing this experiment get you closer to the way you want to live your life? Did doing this open up any moments of joy?
Get the most from the experiment and do response prevention. For instance, if you had dessert one night this week, it means you do not restrict food the next morning or cut out all dessert the rest of the week. Then, the experiment is all for naught. 5. Practice. Keep doing the experiment. Be curious. You may learn that you can sit with uncertainty. That being in the present is actually better than being distracted by your fears of what could happen next.
Closing Thoughts
Doing experiments may be hard but they may free you from your own fears and anxieties.
In the spirit of tolerating uncertainty, I will end this today by saying - I am willing to send this blog out and sit with not knowing what you think about what I wrote or if it is even helpful for you because it is in line with my value of being helpful as a clinician.
The present is all we have.
Embrace it (even when it’s tough)!
With hope,
Kate
Resources:
Podcast: Your Anxiety Toolkit Podcast
Interesting Read: Are OCD and ED the same thing? (I would argue, does it matter?)
Research on ERP/ACT:
Effects of acceptance-based strategies on psychological responses to disorder-relevant stimuli in inpatients with obsessive–compulsive disorder: An experimental study. Kolar, et al. J of Behav Ther and Experimental Psych. 2023.
Acceptance and Commitment Therapy in the Treatment of OCD: A Systematic Review. Philip and Cherian, J of Obsessive-Compulsive and Related Disorders. 2021.