LIPS: Lectures in Psychological Science
Lecture 1: Living with uncertainty: Why the unknown hurts more than we think (Dr.
Volpato) - Challenges in decision-making and emotional responses
“You did a medical test. Results in 10 days.”
What happens in your mind before the results? Stress, bad sleep, thinking about it, imagining
worst possible scenario’s, anticipation, rumination…
Ambiguous symptoms
Ambiguous bodily sensations : Fatigue, shortness of breath,
palpidation, tiredness…
> the sensation itself is not alarming, but the uncertainty makes
it alarming
- Is this normal?
- Is my condition getting worse?
Uncertainty is a stressor itself, as long as the system cannot
give an answer it stays on alert about signals
> Cognitive/emotional and functional perspective
> Not knowing weather something will happen (uncertainty) can be more stressful
Ex. When you know you will receive a shock the stress will be lower than when you do not know
when the shock will come.
Generalized to the daily life: uncertainty about when the train will come, if the person we are
dating likes us…
How to define uncertainty?
Uncertainty is a natural part of life that impacts how we make decisions and experience discomfort.
Uncertainty is the inability to determine the meaning of illness-related events, occurring when the
decision maker is unable to assign definite value to objects or events, or is unable to predict
outcomes accurately ( Mishel, 1988).
Uncertainty as a psychological stressor
1. Increases salience: implies that more as one
outcome is possible
a. Salience: more attention towards the
bodily sensations bc of uncertainty
2. Brain generates diVerent competing
predictions about what might happen next,
these predictions will generate conflict
3. This is a challenge as it prevents the system
for selecting a stable response (brain cannot
close the loop)
4. Default response to uncertainty is fear,
vigilance, anxiety, stress…
5. Chronic exposure to this uncertainty (because of their personality traits, factors,
environment…) this increases the risk of developing disturbances and conditions
1
,Intolerance of Uncertainty (IU)
= the degree to which a person interprets or reacts in a
negative way to an uncertain situation
> dispositional incapacity: diVicult to tolerate/cope with
what this uncertainty does to your mind
=/= anxiety sensitivity, ambiguity tolerance… it can
overlaps but it is not the exact same
> intolerance is seen as a transdiagnostic aspect that
contributes to worry, avoidance, compulsive checking…
(diViculties when we are coping with illness)
Cognitive mechanisms
Uncertainty is not only something we can feel but also in the mind
> mind has mechanisms that make us deal with this feeling of discomfort
- Worry
- Catastrophizing
- Threat monitoring
These are often ineVective in the long term, the contribute to maintain anxiety
Ex. Person with pulmonary disease (COPD) who experiences breathlessness
Breathlessness can fluctuate and be influenced by certain factors (internal and external) -> the
meaning is often unclear as why sometimes it is worse
> there is uncertainty
- Worry: is a form of cognitive avoidance, it keeps a person in a specific analytical mode
(thinking, planning, preparing something…)
o Might make a person even more breathless (arousal)
o Ex. What if I end up in the hospital, what if this is the start of a worse period… ->
what- if chain that drifts to negative scenario’s
o Negative problem orientation
o It reduces the problem-solving ability and reduces confidence
- Catastrophizing: suspecting the worst-case scenario when information is incomplete
o Person focuses on a very negative possibility, positive and neutral possibilities
are seen as unrealistic
o Overestimation of the likelihood of the negative events
o Often exaggerate the intensity and severity of the outcome (they underestimate
their ability to cope)
- Threat monitoring = hypervigilance: treat uncertainty as a sign of danger (something
might be wrong)
o Constant monitoring and scanning for all the potential negative things that can
happen
o Ex. Noticing every single change in breathing, coughs… monitoring our breathing
o Naturally drives safety-seeking behaviors (ex. Search online for information,
overplan visits to doctor…)
Their goal is to reduce the level of uncertainty, but they often increase the level of arousal,
uncertainty and stress behavior over time -> also to the physiological level
Emotional Consequences of uncertainty
Amplifies negative aVect
- ↑ anxiety and fear (uncertainty felt as imminent threat)
- ↑ anger/irritability (uncertainty as an unfair obstacle: it blocks a person ability to reach
goals)
2
, - ↑ sadness/demoralisation(=discouragement) (“pessimistic certainty”: instead of
tolerating what you don’t know you assume the worst)
Dampens positive aVect
- ↓ excitement and joy even in potentially positive contexts
- ↓ reward anticipation (especially in depression) DiViculty “savoring” positive moments
Increases emotional dysregulation over time
- Self-regulatory fatigue → chronic stress, burnout
- More rumination and suppression (maladaptive behaviors)
- Greater vulnerability to avoidance and withdrawal
Behavioral consequences
It doesn’t remain internal but also is translated in behavior
- Avoidance: avoiding situations with uncertain outcomes (new experiences, decisions,
situations where outcomes cannot be controlled…)
- Safety behaviours: checking, reassurance-seeking, overplanning
• They teach the brain that it can only cope with this if they check
- Information seeking: excessive research (including digital checking)
• Research symptoms, side eVects…
• Paradox: more information of increases uncertainty because it exposes the
person to more scenarios
- Procrastination & perfectionism: delaying action to avoid uncertainty
• Acting means facing the unknown
- Control behaviours: over-functioning to prevent mistakes
• Taking over tasks for others, micromanaging, controlling…
• Teaches the brain that having complete control will reduce uncertainty
• Often people do not allow themselves to celebrate small achievements
These behaviours reduce distress short-term, but maintain anxiety long-term (transdiagnostic ->
they appear across di5erent conditions (OCD, PTSS…))
Psychological correlates
IU is linked to altered anticipation and salience processing ->
the startle reflex
- ↑ anterior insula & amygdala during uncertain
anticipation (fMRI) -> anticipation
o Limbic system that connects past experiences
with emotions (cognitive and emotion)
- ↓ prefrontal recruitment (dlPFC/vlPFC): weaker top–
down regulation
o Responsible for executive functions, planning, regulating…
Connection to seeking system in the brain that looks for meaning
ACC involvement: altered conflict monitoring
- Startle: often ↑ during unpredictable threat
- Corrugator: ↑ negative valence during anticipation (presents higher level of IU)
- SCR: less consistent in instructed uncertainty tasks
Many diVerent and mixed results
- Life uncertainty might not always be experienced as uncertainty in the lab (here the
situation is often still controlled and understood by the participant, which may reduce
uncertainty)
- Small diVerences in experimental designs (stimuli, number of condition, timing)
3
, Paper: Idea that the brain is fundamentally an anticipatory system
> Not only reacts to something that is happening now but is constantly trying to predict what
might happen in the future and prepare our body for what might happen
> In uncertainty we lose the ability to prepare our body, this becomes stressfull and activates
other mechanisms in the body -> fear (short term) and anxiety (long term)
Definition and Types
- Expected uncertainty (aleatory): predictable variability, variability that is known and
stable, the rules are clear
o ex. Gambling -> you know the outcome is uncertain but you also know that that
uncertainty is part of the game
- Unexpected uncertainty: sudden change / broken expectations
o Ex. Very bad unexpected news
- Epistemic uncertainty: lack of knowledge (potentially learnable) that can be reduced
with investigation and learning
- Perceptual uncertainty: ambiguous sensory input, not to the outcome but the
input/bodily sensation (diVicult to interpret)
- Volatility: rules change frequently over time
o Ex. Chronic illness where it can fluctuate from day to day
- Deep vs shallow uncertainty: probabilities unknown vs quantifiable risk
- Objective vs subjective uncertainty
o Objective: related to the future where the outcome is not determined yet (ex.
Result of a football match)
o Subjective: the outcome already exists but you don’t know yet
The example of GAD
Clearest application of the uncertainty intolerance
framework
Ex. Sara, 28yo, history of chronic worry, gets a message
of her boss ‘can we talk tomorrow?’
- Triggers a threat response -> mind generates a lot
of possible predictions
- Copes through strategy: worry loops, looking for
information (email to manager, ask family for
insurance, send mail to colleagues…) and
struggles to focus on her current tasks
- In her mind worry feels useful
Next day during meeting: there is a positive outcome, a
new possibility for Sara to grow in her work
- Now her brain has learned that worry has been eVective and protective
- Cycle is being inforced
Uncertainty in personality disorders
In PDs, uncertainty is often experienced as a threat to:
- Self-coherence (identity): the self is stable over time (my identity, my goals, values… are
stable, a unique coherent narritive)
• uncertainty becomes existential (in our daily life) ex. Not knowing what someone
feels may feel as deeply threatening
- Attachment security (relationships): chronic uncertainty in relationships (ex. Do they
care about me? Will this person stay?...)
4
Lecture 1: Living with uncertainty: Why the unknown hurts more than we think (Dr.
Volpato) - Challenges in decision-making and emotional responses
“You did a medical test. Results in 10 days.”
What happens in your mind before the results? Stress, bad sleep, thinking about it, imagining
worst possible scenario’s, anticipation, rumination…
Ambiguous symptoms
Ambiguous bodily sensations : Fatigue, shortness of breath,
palpidation, tiredness…
> the sensation itself is not alarming, but the uncertainty makes
it alarming
- Is this normal?
- Is my condition getting worse?
Uncertainty is a stressor itself, as long as the system cannot
give an answer it stays on alert about signals
> Cognitive/emotional and functional perspective
> Not knowing weather something will happen (uncertainty) can be more stressful
Ex. When you know you will receive a shock the stress will be lower than when you do not know
when the shock will come.
Generalized to the daily life: uncertainty about when the train will come, if the person we are
dating likes us…
How to define uncertainty?
Uncertainty is a natural part of life that impacts how we make decisions and experience discomfort.
Uncertainty is the inability to determine the meaning of illness-related events, occurring when the
decision maker is unable to assign definite value to objects or events, or is unable to predict
outcomes accurately ( Mishel, 1988).
Uncertainty as a psychological stressor
1. Increases salience: implies that more as one
outcome is possible
a. Salience: more attention towards the
bodily sensations bc of uncertainty
2. Brain generates diVerent competing
predictions about what might happen next,
these predictions will generate conflict
3. This is a challenge as it prevents the system
for selecting a stable response (brain cannot
close the loop)
4. Default response to uncertainty is fear,
vigilance, anxiety, stress…
5. Chronic exposure to this uncertainty (because of their personality traits, factors,
environment…) this increases the risk of developing disturbances and conditions
1
,Intolerance of Uncertainty (IU)
= the degree to which a person interprets or reacts in a
negative way to an uncertain situation
> dispositional incapacity: diVicult to tolerate/cope with
what this uncertainty does to your mind
=/= anxiety sensitivity, ambiguity tolerance… it can
overlaps but it is not the exact same
> intolerance is seen as a transdiagnostic aspect that
contributes to worry, avoidance, compulsive checking…
(diViculties when we are coping with illness)
Cognitive mechanisms
Uncertainty is not only something we can feel but also in the mind
> mind has mechanisms that make us deal with this feeling of discomfort
- Worry
- Catastrophizing
- Threat monitoring
These are often ineVective in the long term, the contribute to maintain anxiety
Ex. Person with pulmonary disease (COPD) who experiences breathlessness
Breathlessness can fluctuate and be influenced by certain factors (internal and external) -> the
meaning is often unclear as why sometimes it is worse
> there is uncertainty
- Worry: is a form of cognitive avoidance, it keeps a person in a specific analytical mode
(thinking, planning, preparing something…)
o Might make a person even more breathless (arousal)
o Ex. What if I end up in the hospital, what if this is the start of a worse period… ->
what- if chain that drifts to negative scenario’s
o Negative problem orientation
o It reduces the problem-solving ability and reduces confidence
- Catastrophizing: suspecting the worst-case scenario when information is incomplete
o Person focuses on a very negative possibility, positive and neutral possibilities
are seen as unrealistic
o Overestimation of the likelihood of the negative events
o Often exaggerate the intensity and severity of the outcome (they underestimate
their ability to cope)
- Threat monitoring = hypervigilance: treat uncertainty as a sign of danger (something
might be wrong)
o Constant monitoring and scanning for all the potential negative things that can
happen
o Ex. Noticing every single change in breathing, coughs… monitoring our breathing
o Naturally drives safety-seeking behaviors (ex. Search online for information,
overplan visits to doctor…)
Their goal is to reduce the level of uncertainty, but they often increase the level of arousal,
uncertainty and stress behavior over time -> also to the physiological level
Emotional Consequences of uncertainty
Amplifies negative aVect
- ↑ anxiety and fear (uncertainty felt as imminent threat)
- ↑ anger/irritability (uncertainty as an unfair obstacle: it blocks a person ability to reach
goals)
2
, - ↑ sadness/demoralisation(=discouragement) (“pessimistic certainty”: instead of
tolerating what you don’t know you assume the worst)
Dampens positive aVect
- ↓ excitement and joy even in potentially positive contexts
- ↓ reward anticipation (especially in depression) DiViculty “savoring” positive moments
Increases emotional dysregulation over time
- Self-regulatory fatigue → chronic stress, burnout
- More rumination and suppression (maladaptive behaviors)
- Greater vulnerability to avoidance and withdrawal
Behavioral consequences
It doesn’t remain internal but also is translated in behavior
- Avoidance: avoiding situations with uncertain outcomes (new experiences, decisions,
situations where outcomes cannot be controlled…)
- Safety behaviours: checking, reassurance-seeking, overplanning
• They teach the brain that it can only cope with this if they check
- Information seeking: excessive research (including digital checking)
• Research symptoms, side eVects…
• Paradox: more information of increases uncertainty because it exposes the
person to more scenarios
- Procrastination & perfectionism: delaying action to avoid uncertainty
• Acting means facing the unknown
- Control behaviours: over-functioning to prevent mistakes
• Taking over tasks for others, micromanaging, controlling…
• Teaches the brain that having complete control will reduce uncertainty
• Often people do not allow themselves to celebrate small achievements
These behaviours reduce distress short-term, but maintain anxiety long-term (transdiagnostic ->
they appear across di5erent conditions (OCD, PTSS…))
Psychological correlates
IU is linked to altered anticipation and salience processing ->
the startle reflex
- ↑ anterior insula & amygdala during uncertain
anticipation (fMRI) -> anticipation
o Limbic system that connects past experiences
with emotions (cognitive and emotion)
- ↓ prefrontal recruitment (dlPFC/vlPFC): weaker top–
down regulation
o Responsible for executive functions, planning, regulating…
Connection to seeking system in the brain that looks for meaning
ACC involvement: altered conflict monitoring
- Startle: often ↑ during unpredictable threat
- Corrugator: ↑ negative valence during anticipation (presents higher level of IU)
- SCR: less consistent in instructed uncertainty tasks
Many diVerent and mixed results
- Life uncertainty might not always be experienced as uncertainty in the lab (here the
situation is often still controlled and understood by the participant, which may reduce
uncertainty)
- Small diVerences in experimental designs (stimuli, number of condition, timing)
3
, Paper: Idea that the brain is fundamentally an anticipatory system
> Not only reacts to something that is happening now but is constantly trying to predict what
might happen in the future and prepare our body for what might happen
> In uncertainty we lose the ability to prepare our body, this becomes stressfull and activates
other mechanisms in the body -> fear (short term) and anxiety (long term)
Definition and Types
- Expected uncertainty (aleatory): predictable variability, variability that is known and
stable, the rules are clear
o ex. Gambling -> you know the outcome is uncertain but you also know that that
uncertainty is part of the game
- Unexpected uncertainty: sudden change / broken expectations
o Ex. Very bad unexpected news
- Epistemic uncertainty: lack of knowledge (potentially learnable) that can be reduced
with investigation and learning
- Perceptual uncertainty: ambiguous sensory input, not to the outcome but the
input/bodily sensation (diVicult to interpret)
- Volatility: rules change frequently over time
o Ex. Chronic illness where it can fluctuate from day to day
- Deep vs shallow uncertainty: probabilities unknown vs quantifiable risk
- Objective vs subjective uncertainty
o Objective: related to the future where the outcome is not determined yet (ex.
Result of a football match)
o Subjective: the outcome already exists but you don’t know yet
The example of GAD
Clearest application of the uncertainty intolerance
framework
Ex. Sara, 28yo, history of chronic worry, gets a message
of her boss ‘can we talk tomorrow?’
- Triggers a threat response -> mind generates a lot
of possible predictions
- Copes through strategy: worry loops, looking for
information (email to manager, ask family for
insurance, send mail to colleagues…) and
struggles to focus on her current tasks
- In her mind worry feels useful
Next day during meeting: there is a positive outcome, a
new possibility for Sara to grow in her work
- Now her brain has learned that worry has been eVective and protective
- Cycle is being inforced
Uncertainty in personality disorders
In PDs, uncertainty is often experienced as a threat to:
- Self-coherence (identity): the self is stable over time (my identity, my goals, values… are
stable, a unique coherent narritive)
• uncertainty becomes existential (in our daily life) ex. Not knowing what someone
feels may feel as deeply threatening
- Attachment security (relationships): chronic uncertainty in relationships (ex. Do they
care about me? Will this person stay?...)
4
