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Generalised anxiety (GAD)~15 min

Facing uncertainty: step ideas

Step ideas to choose from with your therapist for facing uncertainty, from small everyday choices to dropping checks and trying new things. Based on Hebert and Dugas (2019), Dugas et al. (2022) and Craske et al. (2014): a list of graded practice ideas for facing uncertainty, with safety behaviours to drop and steps to carry to the uncertainty hierarchy.

Written by Tarun Vermani, Trainee Clinical Psychologist Updated

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This sheet gives you ideas for facing uncertainty, one small step at a time. Read through the ideas and tick any you could try, including ones that feel hard right now. Ticking an idea does not mean you have to do it. You will not do any of these steps on your own or before you have agreed them with your therapist. Together you will choose the steps that fit what you fear and add them to your uncertainty hierarchy. That is where you rank them and plan when and how to practise. Write the ones you choose in the last section. Therapist note: Use with clients whose worry is driven by intolerance of uncertainty, once they have the rationale. The columns of the last table match the uncertainty exposure hierarchy, so rows carry straight across; the tolerating uncertainty practice record logs each practice. Before each step, help the client write a prediction about what will happen and how they will feel.

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How facing uncertainty helps

When not knowing for sure feels hard to bear, it makes sense to check, plan, ask for reassurance or put things off until you feel certain. But these habits stop you finding out what really happens when you leave things open, and how you cope.

Each step on this sheet is a chance to test what you fear, for example that something will go wrong if you do not check, or that the not knowing will be unbearable. Before a step, you and your therapist write down what you expect to happen and how you expect to feel. Afterwards, you write down what did happen. Your distress does not have to go down before you start or before you stop: what matters is finding out.

Practise each step more than once, and vary it: a different time, place or length.

Only practise steps you have agreed with your therapist, and leave out anything that would put your health or safety at real risk.

Small everyday choices

These ideas leave a small choice to chance or to someone else. They run roughly from easier to harder, but what is hard differs from person to person.

Choices I could make without being sure

Letting go of checking and planning

These ideas are about not doing the thing that usually makes you feel sure. Tick the ones that fit you.

Checks and plans I could let go of

Trying something new

New things always carry some uncertainty. These ideas are bigger steps for many people, though what is hard differs from person to person.

New things I could try

Safety behaviours to drop

Safety behaviours are things you do to feel safer, like checking or asking for reassurance. They can stop you finding out what really happens, so dropping them is part of each test. Tick the ones you use.

Choose which safety behaviours to drop with your therapist. Keep precautions that protect your real health or safety. Do not stop or change any prescribed medication on your own; talk to your prescriber first.

Safety behaviours I use

Steps to add to my ladder

With your therapist, write down the steps you would like to try and what you fear will happen in each. Then rate how much distress you expect to feel, from 0 (none) to 100 (the most distress you can imagine).

You and your therapist will add these steps to your uncertainty hierarchy, where you rank them and plan your practice.

#Step I could tryWhat I fear will happenExpected distress (0 to 100)Actions
1
2
3

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When to use ‘Facing uncertainty: step ideas’

‘Facing uncertainty: step ideas’ is an interactive cognitive behavioural therapy (CBT) worksheet, most often used in CBT for generalised anxiety (GAD).

It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device or download it as a print-ready PDF.

How it works

Most people work through it in around 15 minutes. It moves through six short steps:

  1. How facing uncertainty helps: When not knowing for sure feels hard to bear, it makes sense to check, plan, ask for reassurance or put things off until you feel certain.…
  2. Small everyday choices: These ideas leave a small choice to chance or to someone else. They run roughly from easier to harder, but what is hard differs from person…
  3. Letting go of checking and planning: These ideas are about not doing the thing that usually makes you feel sure. Tick the ones that fit you.
  4. Trying something new: New things always carry some uncertainty. These ideas are bigger steps for many people, though what is hard differs from person to person.
  5. Safety behaviours to drop: Safety behaviours are things you do to feel safer, like checking or asking for reassurance. They can stop you finding out what really…
  6. Steps to add to my ladder: With your therapist, write down the steps you would like to try and what you fear will happen in each. Then rate how much distress you…

Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.

The CBT approach behind it

In common with other CBT methods, ‘Facing uncertainty: step ideas’ works by gradually and safely facing avoided situations so anxiety can subside (exposure). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.

Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.

Evidence & sources

This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:

  • Craske, M.G., Treanor, M., Conway, C.C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23. doi:10.1016/j.brat.2014.04.006
  • Hebert, E.A., & Dugas, M.J. (2019). Behavioral experiments for intolerance of uncertainty: Challenging the unknown in the treatment of generalized anxiety disorder. Cognitive and Behavioral Practice, 26(2), 421-436. doi:10.1016/j.cbpra.2018.07.007
  • Dugas, M.J., Sexton, K.A., Hebert, E.A., Bouchard, S., Gouin, J.-P., & Shafran, R. (2022). Behavioral experiments for intolerance of uncertainty: A randomized clinical trial for adults with generalized anxiety disorder. Behavior Therapy, 53(6), 1147-1160. doi:10.1016/j.beth.2022.05.003
  • Dugas, M.J., & Robichaud, M. (2007). Cognitive-Behavioral Treatment for Generalized Anxiety Disorder: From Science to Practice. New York: Routledge. doi:10.4324/9780203891964

For use alongside professional support

Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.

If you need urgent help now:

  • Emergency services: 999 — if you or someone else is in immediate danger
  • NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
  • Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
  • Samaritans: 116 123 — free, day or night, 365 days a year
  • Shout: 85258 — text SHOUT, free, day or night
  • SANEline: 0300 304 7000 — 4pm–10pm, every day

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