Worry and Uncertainty
What if the uncertainty is real, and the worry is still costing more than it gives?
A quick note on this page. CBT has well-developed ways of working with worry. For disabled people, many worries concern real, consequential uncertainty: care, health, benefits, equipment. This page sets out how to tell useful preparation from a loop that has stopped helping.
The short version
CBT can help when worry has become a loop that costs more than it gives. For disabled people, many worries concern real uncertainty about care, health, benefits or equipment. The work is to act where you can, plan for what might happen, review as things change, and let the loop go where it has stopped helping.
You might recognise this
Illustrative statements drawn together from common experiences. They are not quotes from individual people.
- “My worries aren’t hypothetical. My care package really is under review.”
- “I rehearse every possible way the assessment could go wrong.”
- “If I stop worrying, something will slip through.”
- “Planning ahead is how I survive. But I can’t switch it off.”
- “I was told to postpone my worry. The deadline wasn’t going to postpone itself.”
What CBT says about worry
CBT treats worry as a chain of “what if?” thoughts about the future. Some of it is useful: it prompts preparation. Much of it is not: it repeats without producing anything new, and keeps the body on alert.
Several CBT ideas help explain why worry persists:
- Intolerance of uncertainty. Michel Dugas, Robert Ladouceur and colleagues describe how some people find not knowing so hard to bear that they keep worrying in an attempt to feel certain.
- Beliefs about worry itself. Adrian Wells’s metacognitive approach points to beliefs such as “worrying keeps me prepared” and “my worry is uncontrollable”, which keep the cycle going.
- Worry as avoidance. Thomas Borkovec suggested that verbal worry can be a way of avoiding more vivid, distressing images and feelings.
Real uncertainty is not a distortion
For disabled people, many concerns are practical and consequential: changing care arrangements, uncertain health, benefits reviews, equipment that might fail, transport that might not turn up. These are not hypothetical in the way a phobic worry might be. Preparing for them can be sensible, and sometimes essential.
So the useful question is not “is this worry irrational?” but “is this thinking still producing anything useful?”
Four kinds of concern
Gillian Butler and Tony Hope’s “worry tree” separates worries you can act on from those you can’t. A disability-informed version adds a little more detail:
Sorting a concern
- A problem you can act on now. Make the call, send the email, ask for support.
- A future possibility that needs a contingency. Make a backup plan, write it down, and agree when to review it, for example when new information arrives.
- Uncertainty that cannot currently be resolved. No amount of thinking will produce an answer yet.
- Repetitive thinking that costs more than it gives. The same loop, with no new information.
A process to try
- Name the concern as specifically as you can.
- Identify any action available now.
- Decide who is responsible. Some of this may belong to a service, not to you.
- Make a realistic contingency, if one would help, record it somewhere, and set a point to review it.
- Notice when thinking has stopped producing new information.
- Choose how to bring your attention back to the present, in a way that works for you. This is about flexible attention, not forcing thoughts away; trying to suppress worry often makes it louder.
Preparing for a real difficulty can be sensible. Rehearsing every possible difficulty may use up the energy needed to live. And a plan may solve one problem while other uncertainty remains. That is normal, not a sign the plan has failed.
Worry time, adapted
A common CBT technique is “worry postponement”: setting aside a short, fixed time each day for worry, and gently deferring worries that arise outside it. It can help, but for disabled people it may need adapting:
- If a worry needs action before the scheduled time, act on it. Postponement is for loops, not for deadlines.
- Choose a time of day when energy and pain allow clear thinking.
- Use the time partly for practical planning, not only for worry.
- On flare days, the plan may simply be to notice the worry and leave it.
A moment in the session
An illustrative exchange, written for teaching. It is not a real session.
Where to slow down
- The worry is about safety, abuse or loss of essential care. That may need action and support, not worry management.
- The person is being asked to tolerate uncertainty that someone else could resolve, such as a service that hasn’t replied.
- Worry is being treated as the problem, when the situation is the problem.
For therapists
- Is this worry about a real, consequential uncertainty?
- Is there an action, or an advocate, that could reduce it?
- Am I asking the client to tolerate something a service should fix?
- Would I be worried in this position?
A different experience
Some disabled people find that their worry is clearly out of proportion, and want help to turn it down, regardless of the real issues in their lives. Recognising real uncertainty does not mean every worry is justified. Both can be true.
Evidence and status
- Sources checked in October 2026, using targeted searches rather than a systematic review. “We have not located” means our searches did not find it, not that it does not exist.
- Documented theory: intolerance of uncertainty (Dugas and Ladouceur), metacognitive beliefs about worry (Wells), worry as avoidance (Borkovec), and the worry tree (Butler and Hope).
- Research: CBT approaches to generalised anxiety and worry have a substantial evidence base.
- Our synthesis: the four-way sorting and the adaptations to worry postponement. We have not located studies of worry interventions designed for disabled people facing real practical uncertainty.
A question worth carrying: is this thinking still producing anything new, or has it already done its job?
Where this connects
Act where you can. Plan, and review when things change. Let the loop go where it has stopped helping.
Within the CBT section
- CBT Through a Disability Lens – the hub.
- When “Cognitive Distortions” Are Actually Reality – when a prediction is accurate.
- Assertiveness and Access Requests – turning a worry into a request.
Across the site
- Mine, Yours, Ours, System – whose job is it to fix this?
- What If the Base Is Never Stable? – living without secure foundations.
- Acceptance and Commitment Therapy – another way of relating to worry.
← Trauma and Medical Experiences · CBT section map · Next: Why CBT Can Fail Neurodivergent Clients →