#195 Why is it so hard to deal with uncertainty in hoarding disorder? With Dr Jan Eppingstall

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Why is it so hard to deal with uncertainty, and what does that have to do with hoarding? This week I’m joined by Dr Jan Eppingstall to unpack how our brains handle ambiguity, why fear of making mistakes can keep us stuck, and how intolerance of uncertainty feeds into hoarding behaviours. We break down practical ways to build up your tolerance for not knowing and share some strategies that might actually make a difference.

• Uncertainty and Its Challenges
• Definition and context of uncertainty
• Evolutionary reasons for discomfort with uncertainty (Selfish Brain Theory)
• Contrast between historical resource scarcity and modern abundance
• Our minds’ outdated ways of managing uncertainty
• Cognitive Closure
• What is cognitive closure?
• Difference between cognitive closure (psychological need for definite answers) and “closure” in pop culture (emotional resolution)
• How it relates to need for certainty in present/future, not just past events
• The creation of cognitive closure measurement scales by researchers
• Factors influencing need for cognitive closure:
• Personality traits: Conscientiousness, neuroticism (now called emotionality), openness to experience, extroversion
• Trauma history and its effects on the nervous system
• Neurodivergence (with emphasis on autism and “sticky thinking”)
• Combination of personality, trauma, and neurodivergence
• Intolerance of Uncertainty
• Psychological definition of intolerance of uncertainty
• Negative cognitive bias: How it affects perception and response
• Manifestations in people experiencing uncertainty as distress
• Its direct relevance to hoarding behaviours
• The Link Between Hoarding Disorder and Intolerance of Uncertainty
• Research findings: intolerance of uncertainty as a predictor of hoarding symptom severity
• Usefulness in early intervention strategies
• intolerance of uncertainty as a transdiagnostic factor (across anxiety, some depression, and other mental health conditions)
• How heightened anxiety sensitivity in hoarding perpetuates avoidance
• Experiential avoidance in hoarding (saving and acquiring behaviours)
• Connection between maladaptive behaviours and intolerance of uncertainty
• Fear of Making Mistakes and Perfectionism
• Common fears of mistakes in hoarding (disposing, acquiring, putting things away)
• Perfectionism’s role (fear of failure, not wasting)
• All-or-nothing thinking and rigid decision-making rules
• Paralysing effect of avoidance due to fear of mistakes
• Not making a decision as a potential mistake itself
• Interaction and reinforcement between perfectionism and intolerance of uncertainty
• Comorbidity and Severity
• Research on multiple diagnoses: More than half of psychiatric patients have more than one diagnosis
• Diagnostic challenges and overlapping criteria
• How comorbidity compounds issues: More symptoms and more complexity
• Higher intolerance of uncertainty linked with more severe hoarding, especially when other conditions are present
• Impact on treatment difficulty
• intolerance of uncertainty’s Impact on Acquiring and Discarding Behaviours
• How acquiring reduces fear of missing out and future needs
• Difficulty discarding as protection against future regret
• Shame around mistake-making
• Common inner questions: Future use, responsibility, relationships
• More complexity leading to more avoidance
• Nuances in intolerance of uncertainty and Hoarding
• Study on sub-factors of uncertainty:
• Factor 1: Negative self-referential implications (linked to hoarding severity)
• Factor 2: Perception of uncertainty as unfair (not linked)
• Internal vs. external perspectives on uncertainty
• Relevance of anxiety-driven self-criticism
• Changing Relationship to Uncertainty: Curiosity and Reframing
• Rilke’s quote on “loving the questions”
• Transforming approach from fear to curiosity
• Curiosity as a therapeutic tool
• Creativity in imagining alternatives and solutions
• Relevance of loss aversion and cognitive biases
• Modern Life and Uncertainty Intolerance
• Research linking increased use of technology (inst