Therapists’ beliefs about excessive reassurance seeking and helping manage it: does experience play a role?

Journal article

Excessive reassurance seeking (ERS) is prevalent in obsessive-compulsive disorder (OCD) and causes caregiver distress whilst maintaining obsessions. ERS has been conceptualised as “compulsive checking by proxy” whereby checks are obtained through reassurance from family members. At present, there is little empirical evidence confirming similarities between the mechanisms of ERS and compulsive checking. Further, difficulties faced by caregivers in resisting reassurance are incompletely understood, and there is scope to refine how clinicians address family reassurance withdrawal during cognitive-behavioural therapy (CBT). This thesis comprised two streams that aimed to further our understanding of the mechanisms of ERS in OCD (Chapters 2-4) and identify and address caregiver characteristics presenting barriers to reducing reassurance (Chapters 5 and 6). In Chapter 2, I compared the outcomes of receiving reassurance or checking and confirmed reassurance facilitates responsibility transferral and leads to uncertainty and threat re-evaluation, similar to checking. In Chapter 3, I explored whether poor memory confidence could contribute to both ERS and checking maintenance, and found evidence that ERS is more likely maintained by difficulties judging reassurance certainty. I continued to explore memory confidence as a possible catalyst of ERS in Chapter 4 using a novel laboratory-based protocol and failed to find evidence that this factor underlies reassurance seeking, suggesting a further difference between checking and ERS. In Chapter 5, I turned to examining caregiver characteristics, and identified that positive accommodation beliefs and difficulties prioritising longer-term outcomes over immediate gain predicted difficulties withholding reassurance on a behavioural task. From this, I developed a single-session web-based caregiver accommodation intervention, which I tested for acceptability and feasibility in Chapter 6 with promising preliminary outcomes. My findings suggest that a “checking by proxy” theory of ERS may overlook key differences in the motivators and maintaining factors of checking and reassurance seeking. Identified barriers to reassurance withdrawal in caregivers, including accommodation beliefs and difficulties prioritising long-term gains, may be amenable to change through a web-based intervention adjunct to CBT. This thesis contributes to a theoretical model of ERS in OCD and demonstrates the importance of increasing the accessibility of psychoeducation and skills training for caregivers of individuals with OCD

Authors: Halldorsson, B; Salkovskis, PM

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Cambridge University Press
• Journal: The Cognitive Behaviour Therapist
• Volume: 16
• Pages: e25
• Article number: e25
• Publication date: 2023-09-13
• DOI: 10.1017/s1754470x23000144
• EISSN: 1754-470X
• ISSN: 1754-470X
• Language: English
• Keywords: Social psychology; Psychiatry; Psychotherapist; Anxiety; Clinical psychology; Perception; Psychological intervention; Intervention (counseling); Interpersonal communication; Psychology