Leahy, Chansky, Gelatt & Accepting Uncertainty

For someone who is not a worrier, I am surprised that this is the 21st post in this series. I am still in Stage 3 “Analysis and Liking”. I can see 10 or 12 more posts before completing Stage 5 “Commitment, Planning, and Action“.

I have learned a lot from Leahy, Chansky, and Gelatt. They have shown how to take uncertainty and, in stages, learn how to tolerate it, accept it, embrace, and ultimately viewing it as positive.

Leahy states in Second Week: Accepting Uncertainty to End Your Worries on the following web site, published on September 19, 2008

http://forum.psychlinks.ca/anxiety-and-stress/20330-accepting-uncertainty-to-end-your-worries.html

We have found that … (Accepting Uncertainty to End Your Worries) … is a very powerful technique for some of our patients. We ask them to repeat slowly, while observing the thought, “No matter what I do,  it’s still possible something terrible will happen”.

I had a patient a few years ago who worried about cancer.
He had been a chronic worrier about cancer for 45 years.
He had regular checkups – there was nothing wrong with him.
But because he believed that he had to have complete certainty, there was no medical exam that would suffice.

Using uncertainty training, he began to replace his worry about uncertainty with repeating uncertainty.
… I told him that whenever he had the intrusive worry, “Maybe I have cancer”, he could either worry about it by seeking reassurance,
or he could repeat the worry 200 times, very slowly, “Maybe I have cancer”.

Initially the thought about having cancer increased his anxiety – but after he repeated it about 50 times, very, very slowly, he found the thought boring.

“Ironically, repeating a worried thought hundreds of times takes the power away from the thought. When you repeat the thought – like a zombie, slowly, methodically – the thought loses its power.”
~ Robert L. Leahy

Cover of "Freeing Your Child from Obsessi...

Cover via Amazon

Similarly, Tamar Chansky in Freeing Your Child from Obsessive-Compulsive Disorder, Crown Publishing Group, 2001 suggests sitting with the discomfort of uncertainty:

http://forum.psychlinks.ca/obsessive-compulsive-disorder-ocd/20328-the-uncertainty-paradox.html

This is the concept of habituation: if we simply allow ourselves to sit with the discomfort of uncertainty and accept it, the discomfort and anxiety will decrease all by itself.

It’s like jumping into a cold swimming pool. At first, the coldness is extremely uncomfortable, and our brains send us messages of “This is too cold. Why don‘t you get out?” If we stay in the pool, we get use to the cold and the water seems to warm up.

We have habituated ourselves to the discomfort of the coldness. This habituation concept is at the crux of OCD (Obsessive-Compulsive Disorder) treatment and is applied through a process called exposure/response-prevention (ERP), an especially effective form of cognitive behaviour therapy (CBT).

I like the paradoxical principles introduced by H.B. Gelatt in, Positive uncertainty: A new decision-making framework for counselling. Journal of Counselling Psychology, 36(2), 252-6 (1989).

http://depts.washington.edu/apac/roundtable/10-23-06_positive_uncertainty.pdf

Several posts ago I introduced his two new attitudes:
Accept that the future is uncertain — and will always contain uncertainty despite any efforts to make it more certain; and

Be positive about this uncertainty — because things are not determined in advance, there is room for you to make a difference

Recognizing that one size cannot fit all, the next steps are grouped into four paradoxical principles:

Be focused and flexible about what you want.
Being focused on your goals can help you achieve what you want but it can prevent you from discovering new goals and taking advantage of unexpected opportunities.

Be aware of and wary about what you know.
Obtain and make good use of information in making your decision, but always be aware that information is usually limited, often incomplete, sometimes irrelevant and frequently misleading.

Be realistic and optimistic about what you believe.
Your beliefs will influence what you perceive when making a decision and your commitment to following through on that decision. Be aware of their influence on your decision making. Ensure that your beliefs are a bridge and not a barrier.

Be practical and magical about what you do to decide.
Become aware of your own decision strategies. Explore alternative strategies in order to be in a position to choose the best approach for each individual decision.

“Use both your head and your heart.”
~ H. B. Gelatt

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