Yes, intolerance of uncertainty is a factor in health anxiety and pain anxiety. The clinical implications include the need for treatment to involve learning to manage everyday levels of uncertainty about health and pain. Ways to do this include exposure techniques, cognitive restructuring, and acceptance-based techniques (which overlap to a large extent with the other two).

I speak from experience having a patient whose anxiety and stress have psychosomatic effects (headaches, irritable bowel syndrome, gastroesophageal reflux disease [GERD] and diffuse back pains).

The problem in this case is how much of the pain is caused by anxiety and how much is caused by stress. This is quite complicated from my point of view, seeing as stress generally determines anxiety. As such, there is only a small number of patients with anxiety and without stress.

As for treatment: (no matter "ratio" of anxiety to stress):

- symptom related treatment to reduce the suffering and eliminate the possibility of added stress or impairment (e.g. back pains as an impairment/excuse to go to social events which would deepen the avoidance issue)

- psychiatric treatment for the anxiety (and depression that may coexist)

- I see the two previous treatments as a solution for the problem in the present, but not as a cure.

Psychotherapy would be the best treatment for actually curing the patient. As for the form of psychotherapy, it depends on other psychiatric comorbidities and the scale of the problem. If the patient only presents with a high intolerance for uncertainty, and is otherwise (physically) healthy i think cognitive-behavioral therapy would represent the best way. In other cases, personalized medicine has a big role because it is important to choose the best (and shortest) form of psychotherapy.

On another note, i only read the abstract of the attached paper and I do not see the exact correlation with the subject discussed. Can you please explain?

Uncertainty and avoidance sound like fear based feelings/behaviours. Any sort of psychotherapy that explored that would be beneficial, but I would opt for ones that tap creatively into unconscious factors, not ones that try to encourage more control, since controlling behaviour is possibly what ends up looking like anxiety and avoidance in the first place! I have not read your paper, but for my money, the seat of these sorts of negative feelings is the body....psychic pain turned into body pain.

Absolutely. If one looks at pain and anxiety from a chemical and neurotransmitter perspective there is an overlap specifically heart, stomach, and muscle pain. The body and mind is no doubt connected, and just as it is impossible for me as a clinician to objectively measure anxiety so it is with pain. A patient that is less tolerant of uncertainty is particulary vunerable to anxiety related pain because they often will see themselves as a victim of circumstance, unable to have control or influence in their life. With this comes more depression which may cause a more disengagement from life and decreased mobility which can cause an increase in pain (stiffness, inability to have a bowel movement, etc.) High intolerance of uncertainity will certainly cause more anxiety. On the severe end of the spectrum anxiety mimics heart attack symptoms. I would wager that uncertainty intolerance is related to higher depression and anxiety scores AND higher pain scores.

Trauma therapy, CBT, and DBT actually target the ability of a client to tap into their resilience. They teach mindfulness skills which leads to an increase subjective control. These techniques also rely on psycho-eduation which would generally decrease a sense of uncertainty. Sucessful uses of these therapies increase resilience, aid in grounding, and increase the internal locus of control.

Thank you for your thoughtful answers. I was wondering along the lines of interpreting ambiguous body sensations. For example, if a person is developing, or is at risk of developing complex regional pain syndrome, where the sensations in the affected limb are altered but not yet full-blown CRPS, could intolerance for uncertainty drive both the psychological and the physiological changes we see? For example, if a person has reduced two point discrimination because of temporary changes in input, could this "fuzzy" sensation be interpreted catastrophically in part because of intolerance for ambiguity?

In terms of treatment, after reading your replies, I suppose I would be persuaded to try ACT, with a large dollop of mindfulness to allow increased tolerance to uncertainty, with a good deal of exposure to ambiguous stimuli particularly in the context of valued activities. Id be interested in your thoughts about this approach.

We have some data the show that uncertainty affected fibromyalgia patients exclusively (compared with healthy volunteers and yoga practitioners) to modify their experienced pain. The article just appeared in the October issue of International Journal of Yoga Therapy.

As Ellis said (REBT), "Musturbation" is a major factor behind anxiety. If the person feel that my future should or "must" be certain in the case of pain, then uncertainty will definitely play a big role.

Somatisation is always linked to problems of containing ambivalences and inner conflicts, most often "negative" affects such as aggression or sadness. I work with psychodynamic therapy which focuses on affect clarification, symbolisation and interpersonal conflicts. Additionally, those patients profit of creative and body therapy approaches. We also have good experiences with mentalisation-based work such as reflecting team in front of the patient and, additionally, MBSR.

There are many examples of people storing memories that later cause pain, ask any psychotherapist of any modality. But working out precisely what the memories are and how they operate in each individual over the lifespan is very complex. I am wary of anyone who claims 100% success rates in areas such as this. Reflecting further on the original question, I would suggest that HIGH tolerance for uncertainty and concommitant anxiety or fear might initially CONTRIBUTE to the ways in which a traumatic memory is stored. Initial resilience, and avoidance of dwelling on problems, which can be seen as positive at the time (upbeat/undaunted/ strong) as time passes, might well exacerbate a later inability to cope. If we are too strong, too controlled, too upbeat for too long, the psyche eventually gets tired and the body typically expresses the mind's distress, even if the mind still prefers to avoid this fact.

The plural of anecdotes is not evidence!

Like others, I'm extremely wary of claims of "nearly 100%" success rates. I'm not comfortable with chronic pain being equated with psychosomatic illnesses either, it sounds just a little too much like the dualist notion of body separate from mind. Pain's complex, and yes people can be helped by psychological approaches, but this doesn't mean (a) that the pain was psychological in origin or (b) that it was imaginary or (c) that because it can't be imaged it "must" be psychological.

Chronic pain is not a single entity or homogenous, it's a good generic term to describe pain that persists, but one long-term pain is not the same as another. Some people have pain arising from nociception (like osteoarthritic pain or rheumatoid arthritis pain), some from central mechanisms (like fibromyalgia or phantom limb pain), and some from both (like post-spinal cord injury pain). And even within these groupings, some people will have different genetic and familial vulnerabilities, coping strategies, socio-cultural and economic backgrounds, opportunities - all of these have an effect on the individual's experience of pain, and on their disability.

I'm sorry, but L. Ron Hubbard is not a plausible researcher, and dianetics has not been rigorously tested using methodologies designed to eliminate bias. When Scientology allows itself to be fully open to scrutiny by independent investigators, and the evidence published in peer-reviewed literature I might change my mind, but until then I don't think so.

There's nothing 'imaginary' about psychosomatic pain, it's all too painful for that! And even if something IS 'imaginary', the imagination is a very real, very powerful force that contributes to us being human beings.

'Origin': I am not sure it is possible or even desireable to try and decide what the origins of something always are....it is what is happening now and what we can do with it that counts, which may or may not include wondering about past events.

It would be nice to know the molecular cellular disorders associated with uncertainity aversion - which seems universal in animal brains.  Not "risk"a version.

Listened to a useful NIH lecture on micro and millisecond arrhythmias in neurotransmitters as basis for mental and behavior disorders..