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Let's Talk About CBT

Cognitive Behavioural Therapy: what it is, what it's not and how it can be useful.


May 7, 2020

We're all living through uncertain times at the moment. What does research from CBT tell us about what tends to help people tolerate uncertainty? Dr Lucy Maddox interviews Professor Mark Freeston about what might help.


Show Notes and Transcript

For more on BABCP our website is

For Mark's research survey follow this link:

A preprint of Mark's research paper on coronavirus and uncertainty is available here:

If you feel like you're struggling here are some resources:

The register of BABCP accredited CBT therapists is here:

Photo by Katie Mourn on Unsplash

Episode edited and produced by Lucy Maddox

Music by Gabriel Stebbing


Lucy: Hi and welcome to Let’s Talk About CBT with me, Dr Lucy Maddox. This podcast is brought to you by the British Association for Behavioural and Cognitive Psychotherapies, BABCP. It’s all about CBT, what it is, what it’s not and how it can be useful.  

Today in another post-pandemic special episode I’m speaking remotely to Professor Mark Freeston from Newcastle University. Mark’s research is about how intolerance of uncertainty relates to anxiety and he spoke to me about how findings from this research can be relevant at this current, very uncertain time.  

Mark was clear that feelings of anxiety and distress in response to the current pandemic are totally normal.  

Mark: Anxiety problems that we see in mental health services have an element that is recognised to be excessive about them. But what we’re looking at at the moment, which is anxiety and distress in response to the coronavirus pandemic doesn’t necessarily have this excessive element about it. So it’s not a disorder, it’s just a lot of very anxious and distressed people.  

Lucy: How is your research particularly relevant at the moment?  

Mark: Since the early 90s, we’ve been looking at a thing called ‘intolerance of uncertainty’. This is particularly timely given the high level of uncertainty that’s going on. Some people find not knowing, the unknownness of things as particularly difficult to manage.  

Lucy: It’s quite an existential problem almost, isn’t it? It’s quite a human problem that we all might have at different moments.  

Mark: The evolutionary theory, so some very clever evolutionary psychologists and they say that everyone is probably born to be intolerant of uncertainty, but to greater or lesser degrees we become more able to tolerate uncertainty. So it’s not like a personality trait that is sort of stuck at the same level all your life. When different things happen your ability to tolerate the unknownness of things is likely to change, not necessarily on a day-to-day basis, but you may have periods of greater tolerance or intolerance of uncertainty.  

Lucy: Is it that intolerance of uncertainty which leads us to feel very anxious?  

Mark: Eventually, yes. The way we’ve been looking at it in our current research and we’ve been working on this for over a year, because we’ve been thinking about before the pandemic came along, we’d been thinking about caregivers of people with dementia or people living with chronic and fluctuating illnesses. And so we were thinking about a lot of different types of contexts where there’s both scary things happening and a lot of uncertainty going on at the same time.  

If you are intolerant of uncertainty and there is real uncertainty around, you are going to probably perceive the situation as being more uncertain than it is. So you start off not liking uncertainty, then when things are uncertain, not only do you not like it, but you see the situation as even more uncertain. And you probably also look at the things that might happen, particularly the bad things that might happen as more likely. It’s that combination we think, that makes people anxious.  

Lucy: And then at the moment, do the same things apply, might some of us feel more anxious in response to what’s going on with the pandemic than others?  

Mark: Yes, and obviously people who have got more at stake, so people who are at greater risk, also about financial things. It’s at multiple levels that there’s lots of uncertainty going on and some people find this more difficult than others.  

Lucy: Mark told me about some research which suggests that over the last 30 years we’ve all been finding uncertainty harder to tolerate.  

Mark: What we found is that intolerance of uncertainty scores have been going up since the 1990s.  

Lucy: Oh really?  

Mark: Yeah, so essentially year on year. One of my colleagues in Canada, Nick Carlton did a very nice study where they looked at all the published North American studies of similar types, examples, and then they looked at the extent to which people had mobile phones or high speed broadband.  

And so if you think from the early 90s through until the mid-2015s, then there’s been a massive increase in our degree of connectedness, the access of information. And so one of the ideas is that the more information that we have available, the less certain we are about things.  

Lucy: This research suggests that sometimes too much information can be unhelpful, can make us more uncertain.  

Mark categorised information about Coronavirus into three types. Information that we need to know, like the current rules that we’re all expected to follow. Information that might be interesting to know, like answers to responsible questions that are being asked about what’s happening. And then less helpful information which is unreliable or even malicious.  

Even the responsible questions might sometimes be problematic because they’re often unanswerable, so they might just generate more uncertainty.  

Mark: There’s a lot of people working on the assumption that the answer is out there if only I can find it. From the point of view I’ve been working from, we can’t information our way out of this, out of feeling uncertain.  

Lucy: We will likely all have had other times in our lives when things have felt uncertain and when it’s felt difficult to tolerate this.  

Mark: I was reflecting on my own life and I’ve emigrated three times in my life, okay? From the UK to New Zealand, from New Zealand to Quebec and Quebec back to the UK. And so obviously they tend to be very uncertain times because you don’t quite know what to expect.  

So things like emigration or becoming a parent for the first time or moving in with a partner for the first time. So it’s not just bad things, but these are just things where you don’t know what it’s going to be like because you haven’t done it before.  

Everyone has had experience of big changes, sometimes they’re chosen sometimes they’re imposed. And there’s only so much you can find out, the rest you have to wait and see and that’s an uncomfortable state to be in. But the belief that drives people to try and get more and more information is that the answer is there, but it probably isn’t. It would be nice to say that the information is there, but it’s not.  

Lucy: What do you know about, from your research, into intolerance of uncertainty that might help people at this time?  

Mark: I think there’s two main things to do at this time. I think one thing is people really thinking about their use of information and where they’re getting it from and is that being helpful or not. Those are the things you want to manage the intake.  

But there might be other types of information that might be worth finding out, that might put a bit more balance back into things. Are the birds still singing? What are some of the things that people are doing to help each other out?  

Rather than stories about all the things we don’t know, there’s plenty of stories about people who are actually getting on and doing things, groups of people getting organised. So being a bit more selective in what news you go looking for.  

Lucy: I really like that. The birds are still singing in Bristol, happily! (Laughs) 

Mark: They’re still singing here in Whitley Bay as well and as usual, as for every year, we’ve got a particularly noisy group of sparrows that have taken up residence and I’m pretty sure the starlings will be under the eaves and they’ll be making noise for the next few months. That bit hasn’t changed.  

Lucy: So managing information could be about restricting input of stuff that’s not so helpful, but also looking for information that balances the picture out a bit, it’s really nice.  

Mark: Yeah, certainly. And I guess that looking for information, that balances things out a bit leads onto the next point, which is the thing about intolerance of uncertainty is that we need the presence of safety rather than just the absence of threat. So if we don’t have the presence of safety, that’s when we feel uncomfortable and that’s when intolerance of uncertainty kicks in.  

So it’s not just that there’s no possibility of bad things happening, it’s about the presence of signs that things are okay in very small ways. Hence are the birds still singing? That’s an example.  

We know how disrupting the pandemic has been at all sorts of levels, but it’s very easy to focus on the big disruptions, right? So people cannot go out, they cannot socialise, they cannot go to school, but there’s probably lots of little disruptions that people don’t even notice as much. Small routines of everyday life.  

Lucy: One of the everyday routines that Mark has made sure to keep the same is his morning cup of coffee and a new small thing he’s noticed is that he started to eat Marmite again, which he hasn’t had since he was a boy.  

Mark: So I guess it was one of the signals of safety that would go back a long way. It’s these small routines that can help us feel safer, even when there’s a lot of uncertainty.  

Lucy: That’s really nice because that’s something we have some control over actually isn’t it?  

Mark: Yes.  

Lucy: Whether we can keep some of those small routines in place.  

Mark: Many, many, many people have been taken, if you like, out of their comfort zone. What are the different things that help us feel settled and safe? And then that means that if we can get those, our perception of uncertainty will go down, our perception of danger will go down a bit and we’ll be a little less distressed and anxious.  

Lucy: So two things there which might help at this time based on the research that Mark has done. Number one, thinking about which information we seek out and how often. And number two, thinking about how we signal to ourselves that we’re safe. Perhaps in quite small, but still significant ways.  

Mark: There’s other types of information that says the world is still as we know it and that’s sort of the link between feeling safe and information management. That’s where the two come together.  

Lucy: Although we’re all experiencing uncertainty at the moment, Mark acknowledged that some people may be finding things extra hard if they have personal experiences in their past which resonate with what’s happening at the moment in some way.  

Mark: There’ll be things happening, whether it’s due to isolation, whether it’s medical threat, whether it’s seeing one part of your life being disrupted. This is going to, I guess wake up or trigger things that you might not have thought about for a long time.  

So I think it’s being able to recognise that it isn’t just what’s going on outside in the world, it’s what’s going on inside your own mind as there’s a degree of match between some of the things that you’re being exposed to, that we’re all being exposed to, and things that we’ve lived through in the past.  

Lucy: If you feel like that’s the case for you at the moment, do please try to reach out and seek help, whether from friends and family or from professional sources of support.  

I’ve put some links in the show notes to some different resources and also to the BABCP register of accredited CBT therapists. Also in the show notes is a link to the survey that Mark has been sharing and a recent journal article that he’s written.  

If you liked this episode, there are loads more you can listen to at the Let’s Talk about CBT website, or wherever you get your podcast from. There’s a short episode featuring Jo Daniels about anxiety in relation to coronavirus and a new episode about CBT bipolar disorder too.  

If you have ideas for other episodes, feel free to get in touch at 

Meanwhile, stay safe and stay well. We spoke in this episode about how the birds are still singing, so I thought I’d leave you with a little bit of birdsong recorded just outside of Bristol after the theme tune plays us out.