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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Our minds’ outdated ways of managing uncertainty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 (instant answers) to rising intolerance of uncertainty
Smartphone/information overload and decreased tolerance “muscle”
Relevance to hoarding (desire for backups, information saving)
Example: IMDb, screenshots, saving digital info
Treatment Strategies
Cognitive Behavioural Therapy (CBT) effects on intolerance of uncertainty in anxiety
Acceptance and Commitment Therapy (ACT) and exposure-based methods: Pros and cons
Importance of a therapist experienced in error-related distress and uncertainty
Key skills: Observing distress, sitting with uncomfortable feelings, gradual exposure
Self-help approaches:
Reframing mistakes as learning
Practicing self-compassion
Values-based decision-making
Systematic exposure to small errors
Gradually breaking rigid rules (e.g., waste, tidiness)
Recognising individual differences and seeking appropriate support
Embracing Mistakes and Humanity
Learning from therapist/client anecdotes
Cultural expectations around perfectionism vs. real human messiness
How mistakes can be positive or even entertaining
Letting go of the need for perfection
The Four Cs for Managing Uncertainty
From Elizabeth Weingarten: Curiosity, Conversation, Community, Commitment
How to foster each:
Curiosity: Approach with questions and exploration
Conversation: Discuss uncertainties with trusted people
Community: Build social support
Commitment: Dedication to exploring questions and knowing when to let go

Links

Hillman, S. R. HOARDING DISORDER AND Intolerance of Uncertainty, Anxiety Sensitivity and Distress Tolerance in Hoarding Disorder Compared to OCD and Healthy Controls - Shemariah R. Hillman; Claire L. Lomax; Nadeen Khaleel; Theresa R. Smith; James D. Gregory
Baldwin, P. A Multimethod Examination of Vulnerability in Hoarding, UNSW Sydney, 2016. https://doi.org/10.26190/UNSWORKS/19156
Castriotta, N.; Dozier, M. E.; Taylor, C. T.; Mayes, T.; Ayers, C. R. Intolerance of Uncertainty in Hoarding Disorder. Journal of Obsessive-Compulsive and Related Disorders 2019, 21, 97–101. https://doi.org/10.1016/j.jocrd.2018.11.005
Exploring Humanity’s Relationship to Uncertainty with Elizabeth Weingarten 
Podcast ep 49: Sitting with discomfort: distress tolerance and hoarding – How unconscious distress avoidance might be worsening your problems
Podcast ep 190: What if we forgive ourselves, but now we know better, we do better? Choosing compassion over shame in hoarding disorder
Podcast ep 182: What are “towards and away moves” and what on earth do they have to do with hoarding recovery? With Dr Jan Eppingstall
Podcast ep 127: Overcoming overspending with Paige Pritchard, Money Coach
Come to a Dehoarding Accountability Zoom session: Accountability Booking Form
Dr Jan Eppingstall at Stuffology
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Dr Jan Eppingstall on Pinterest
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