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Build a hierarchy of situations involving uncertainty, ranked by distress, to guide graded exposure to tolerating not knowing.
If intolerance of uncertainty drives your worry, deliberately practising tolerating uncertainty is key. List situations where you would need to sit with uncertainty (e.g. not checking, not asking for reassurance, making a decision without being sure), rate the distress, and work up from the bottom.
Use alongside the tolerating uncertainty practice record when a graded approach to uncertainty exposure is indicated. Particularly useful for clients who find the prospect of tolerating uncertainty overwhelming without a structured, stepped approach.
Collaboratively build the hierarchy by brainstorming situations involving uncertainty and rating each for distress. Explain that starting with manageable situations builds confidence and skill before tackling more challenging ones.
For clients with comorbid avoidance, include both active uncertainty exposures (doing something without guaranteed outcomes) and passive exposures (resisting the urge to check or seek reassurance). Adjust the step size based on the client's progress.
Avoid constructing the hierarchy prematurely before the client has bought into the rationale for uncertainty exposure. A hierarchy built without genuine collaboration is unlikely to be followed between sessions.
The hierarchy should include a mix of situational and cognitive exposures. Encourage the client to note what they predicted would happen versus what actually happened at each level, as this mismatch data is powerful for belief updating.
Suitable for clients working with uncertainty, exposure hierarchy, gad, dugas, cbt, intolerance of uncertainty. This tool can be used as a standalone worksheet or as part of a structured homework plan.
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Identify and challenge negative beliefs about worry — the beliefs that worry is uncontrollable or dangerous.
Track Attention Training Technique (ATT) practice sessions with focus ratings and observations.
Practise noticing and tolerating everyday uncertainty to build your tolerance muscle.
A formulation based on Wells' metacognitive model of GAD — mapping the role of positive and negative beliefs about worry in maintaining the worry cycle.