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

Come to a Dehoarding Accountability Zoom Session: http://www.overcomecompulsivehoarding.co.uk/ticketSubscribe to the podcast: https://www.overcomecompulsivehoarding.co.uk/subscribePodcast show notes, links and transcript: http://www.overcomecompulsivehoarding.co.uk/ 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 ChallengesDefinition and context of uncertaintyEvolutionary reasons for discomfort with uncertainty (Selfish Brain Theory)Contrast between historical resource scarcity and modern abundanceOur minds’ outdated ways of managing uncertaintyCognitive ClosureWhat is cognitive closure?Difference between cognitive closure (psychological need for definite answers) and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 eventsThe creation of cognitive closure measurement scales by researchersFactors influencing need for cognitive closure:Personality traits: Conscientiousness, neuroticism (now called emotionality), openness to experience, extroversionTrauma history and its effects on the nervous systemNeurodivergence (with emphasis on autism and “sticky thinking”)Combination of personality, trauma, and neurodivergenceIntolerance of UncertaintyPsychological definition of intolerance of uncertaintyNegative cognitive bias: How it affects perception and responseManifestations in people experiencing uncertainty as distressIts direct relevance to hoarding behavioursThe Link Between Hoarding Disorder and Intolerance of UncertaintyResearch findings: intolerance of uncertainty as a predictor of hoarding symptom severityUsefulness in early intervention strategiesintolerance of uncertainty as a transdiagnostic factor (across anxiety, some depression, and other mental health conditions)How heightened anxiety sensitivity in hoarding perpetuates avoidanceExperiential avoidance in hoarding (saving and acquiring behaviours)Connection between maladaptive behaviours and intolerance of uncertaintyFear of Making Mistakes and PerfectionismCommon 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 rulesParalysing effect of avoidance due to fear of mistakesNot making a decision as a potential mistake itselfInteraction and reinforcement between perfectionism and intolerance of uncertaintyComorbidity and SeverityResearch on multiple diagnoses: More than half of psychiatric patients have more than one diagnosisDiagnostic challenges and overlapping criteriaHow comorbidity compounds issues: More symptoms and more complexityHigher intolerance of uncertainty linked with more severe hoarding, especially when other conditions are presentImpact on treatment difficultyintolerance of uncertainty’s Impact on Acquiring and Discarding BehavioursHow acquiring reduces fear of missing out and future needsDifficulty discarding as protection against future regretShame around mistake-makingCommon inner questions: Future use, responsibility, relationshipsMore complexity leading to more avoidanceNuances in intolerance of uncertainty and HoardingStudy 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 uncertaintyRelevance of anxiety-driven self-criticismChanging Relationship to Uncertainty: Curiosity and ReframingRilke’s quote on “loving the questions”Transforming approach from fear to curiosityCuriosity as a therapeutic toolCreativity in imagining alternatives and solutionsRelevance of loss aversion and cognitive biasesModern Life and Uncertainty IntoleranceResearch linking increased use of technology (instant answers) to rising intolerance of uncertaintySmartphone/information overload and decreased tolerance “muscle”Relevance to hoarding (desire for backups, information saving)Example: IMDb, screenshots, saving digital infoTreatment StrategiesCognitive Behavioural Therapy (CBT) effects on intolerance of uncertainty in anxietyAcceptance and Commitment Therapy (ACT) and exposure-based methods: Pros and consImportance of a therapist experienced in error-related distress and uncertaintyKey skills: Observing distress, sitting with uncomfortable feelings, gradual exposureSelf-help approaches:Reframing mistakes as learningPracticing self-compassionValues-based decision-makingSystematic exposure to small errorsGradually breaking rigid rules (e.g., waste, tidiness)Recognising individual differences and ...