How Do I Say This? An Experimental Comparison of the Effects of Partner Feedback Styles on Reassurance Seeking Behaviour

  • Rachael L. Neal
  • Adam S. RadomskyEmail author
Original Article


Interventions for reassurance seeking (RS) in obsessive–compulsive disorder typically include reducing accommodation by asking partners to not provide reassurance, which may decrease RS but increase distress and be perceived as unhelpful. Alternatively, having partners provide support to encourage coping may be effective and associated with greater perceived helpfulness and lower negative affect. This experiment tested hypotheses that compared with no reassurance, supportive feedback would be associated with higher ratings of intervention helpfulness, fewer requests for reassurance, and lower ratings of RS urges and negative affect. Participants completed a threat-inducing kitchen task while observed by a partner, and afterwards sought reassurance to make a decision about safety. Partners’ feedback was manipulated such that half (n = 51) provided typical accommodation reduction-focused feedback and half (n = 51) provided support-focused feedback. Results suggest that individuals who received support-focused feedback versus accommodation reduction-focused feedback rated their partner’s feedback as significantly more helpful (d = 1.22). There was also a small-to-moderate effect size and trend suggesting that support was associated with less RS (d = 0.33). Overall, support provision may be associated with less RS behaviour and greater perceived helpfulness, and holds promise as an alternative intervention technique to strict accommodation reduction for problematic RS.


Reassurance seeking Obsessive–compulsive disorder (OCD) Cognitive-behaviour therapy (CBT) Accommodation Feedback Support 



The authors would like to thank Kristina Bucci, Sereena Pigeon, and Alex Varsaneux for their assistance with data collection.


This study was supported by a Canadian Institutes of Health Research Operating Grant (MOP 102552) awarded to the second author.

Compliance with Ethical Standards

Conflict of interest

Rachael L. Neal and Adam S. Radomsky declare that they have no conflict of interest.

Ethical Approval

The present study was in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in this study.

Research Involving Animal Rights

This article does not contain any studies with animals performed by any of the authors.


  1. Abramowitz, J. S. (2009). Getting over OCD: A 10-step workbook for taking back your life. New York: Guilford Press.Google Scholar
  2. Abramowitz, J. S., Baucom, D. H., Boeding, S., Wheaton, M. G., Pukay-Martin, N. D., Fabricant, L. E., … Fischer, M. S. (2013). Treating obsessive-compulsive disorder in intimate relationships: A pilot study of couple-based cognitive-behavior therapy. Behavior Therapy, 44, 395–407. Scholar
  3. Abramowitz, J. S., Fabricant, L. E., Taylor, S., Deacon, B. J., McKay, D., & Storch, E. A. (2014). The relevance of analogue studies for understanding obsessions and compulsions. Clinical Psychology Review, 34, 206–217. Scholar
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). Arlington: American Psychiatric Pub.Google Scholar
  5. Baucom, D. H., Whisman, M. A., & Paprocki, C. (2012). Couple-based interventions for psychopathology. Journal of Family Therapy, 34, 250–270. Scholar
  6. Beesdo-Baum, K., Jenjahn, E., Höfler, M., Lueken, U., Becker, E. S., & Hoyer, J. (2012). Avoidance, safety behavior, and reassurance seeking in generalized anxiety disorder. Depression and Anxiety, 29, 948–957. Scholar
  7. Belus, J. M., Baucom, D. H., & Abramowitz, J. S. (2014). The effect of a couple-based treatment for OCD on intimate partners. Journal of Behavior Therapy and Experimental Psychiatry, 45, 484–488. Scholar
  8. Bucarelli, B., & Purdon, C. (2016). Stove checking behaviour in people with OCD vs. anxious controls. Journal of Behavior Therapy and Experimental Psychiatry, 53, 17–24. Scholar
  9. Caporino, N. E., & Karver, M. S. (2012). The acceptability of treatments for depression to a community sample of adolescent girls. Journal of Adolescence, 35, 1237–1245. Scholar
  10. Clark, D. A. (2004). Cognitive-behavioral therapy for OCD. New York: Guilford Press.Google Scholar
  11. Clark, D. A., & Rhyno, S. (2005). Unwanted intrusive thoughts in nonclinical individuals: Implications for clinical disorders. In D. A. Clark (Ed.), Intrusive thoughts in clinical disorders: Theory, research, and treatment (pp. 1–29). New York: Guilford Press.Google Scholar
  12. Coyne, J. C. (1976). Toward an interactional description of depression. Psychiatry, 39, 28–40. Scholar
  13. Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46, 5–27. Scholar
  14. Eddy, K. T., Dutra, L., Bradley, R., & Westen, D. (2004). A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder. Clinical Psychology Review, 24, 1011–1030. Scholar
  15. Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., … Simpson, H. B. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 162, 151–161. Scholar
  16. Francis, G. (1988). Childhood obsessive-compulsive disorder: Extinction of compulsive reassurance-seeking. Journal of Anxiety Disorders, 2, 361–366. Scholar
  17. Freeston, M. H., Léger, E., & Ladouceur, R. (2001). Cognitive therapy of obsessive thoughts. Cognitive and Behavioral Practice, 8, 61–78. Scholar
  18. Gibbs, N. A. (1996). Nonclinical populations in research on obsessive-compulsive disorder: A critical review. Clinical Psychology Review, 16, 729–773. Scholar
  19. Gillihan, S. J., Williams, M. T., Malcoun, E., Yadin, E., & Foa, E. B. (2012). Common pitfalls in exposure and response prevention (EX/RP) for OCD. Journal of Obsessive–Compulsive and Related Disorders, 1, 251–257. Scholar
  20. Hallam, R. S. (1974). Extinction of ruminations: A case study. Behavior Therapy, 5, 565–568. Scholar
  21. Halldorsson, B., & Salkovskis, P. M. (2017a). Treatment of obsessive compulsive disorder and excessive reassurance seeking in an older adult: A single case quasi-experimental design. Behavioural and Cognitive Psychotherapy, 45, 616–628. Scholar
  22. Halldorsson, B., & Salkovskis, P. M. (2017b). Why do people with OCD and health anxiety seek reassurance excessively? An investigation of differences and similarities in function. Cognitive Therapy and Research, 41, 619–631. Scholar
  23. Halldorsson, B., Salkovskis, P. M., Kobori, O., & Pagdin, R. (2016). I do not know what else to do: Caregivers’ perspective on reassurance seeking in OCD. Journal of Obsessive–Compulsive and Related Disorders, 8, 21–30. Scholar
  24. Heerey, E. A., & Kring, A. M. (2007). Interpersonal consequences of social anxiety. Journal of Abnormal Psychology, 116, 125–134. Scholar
  25. Kline, R. B. (2009). Becoming a behavioral science researcher: A guide to producing research that matters. New York: Guilford Press.Google Scholar
  26. Kobori, O., Salkovskis, P., Pagdin, R., Read, J., & Halldorsson, B. (2017). Carer’s perception of and reaction to reassurance seeking in obsessive compulsive disorder. The Cognitive Behaviour Therapist, 10, 1–17. Scholar
  27. Kobori, O., & Salkovskis, P. M. (2013). Patterns of reassurance seeking and reassurance-related behaviours in OCD and anxiety disorders. Behavioural and Cognitive Psychotherapy, 41, 1–23. Scholar
  28. Lebowitz, E. R., Panza, K. E., Su, J., & Bloch, M. H. (2012). Family accommodation in obsessive-compulsive disorder. Expert Review of Neurotherapeutics, 12, 229–238. Scholar
  29. Leonhart, M. W., & Radomsky, A. S. (2017). Responsibility causes reassurance seeking, too: An experimental investigation. Journal of Obsessive-Compulsive and Related Disorders. (Advance online publication).Google Scholar
  30. Levy, H. C., & Radomsky, A. S. (2014). Safety behaviour enhances the acceptability of exposure. Cognitive Behaviour Therapy, 43, 83–92. Scholar
  31. Levy, H. C., & Radomsky, A. S. (2016). It’s the who not the when: An investigation of safety behavior fading in exposure to contamination. Journal of Anxiety Disorders, 39, 21–29. Scholar
  32. Levy, H. C., Senn, J. M., & Radomsky, A. S. (2014). Further support for the acceptability enhancing roles of safety behavior and a cognitive rationale in cognitive-behavior therapy for anxiety disorders. Journal of Cognitive Psychotherapy, 28, 303–316. Scholar
  33. Marinchak, J. (2013). Treating a mother’s accommodation behaviors of her adult son’s OCD: The case of “Brianne” and” Charlie”. Pragmatic Case Studies in Psychotherapy, 9, 1–57. Scholar
  34. Milosevic, I., Levy, H. C., Alcolado, G. M., & Radomsky, A. S. (2015). The treatment acceptability/adherence scale: Moving beyond the assessment of treatment effectiveness. Cognitive Behaviour Therapy, 44, 456–469. Scholar
  35. Neal, R. L., & Radomsky, A. S. (2015). An experimental investigation of contamination-related reassurance seeking: Familiar versus unfamiliar others. Journal of Behavior Therapy and Experimental Psychiatry, 49, 188–194. Scholar
  36. Neal, R. L., & Radomsky, A. S. (2018). What do you really need? Self- and partner-reported intervention preferences within cognitive-behavioural therapy for reassurance seeking behaviour. Manuscript submitted for publication.Google Scholar
  37. Nutt, D., & Malizia, A. (2006). Anxiety and OCD–the chicken or the egg? Journal of Psychopharmacology, 20, 729–731. Scholar
  38. Olatunji, B. O., Davis, M. L., Powers, M. B., & Smits, J. A. (2013). Cognitive-behavioral therapy for obsessive-compulsive disorder: A meta-analysis of treatment outcome and moderators. Journal of Psychiatric Research, 47, 33–41. Scholar
  39. Öst, L. G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993–2014. Clinical Psychology Review, 40, 156–169. Scholar
  40. Parrish, C. L., & Radomsky, A. S. (2006). An experimental investigation of responsibility and reassurance: Relationships with compulsive checking. International Journal of Behavioral Consultation and Therapy, 2, 174–191. Scholar
  41. Parrish, C. L., & Radomsky, A. S. (2010). Why do people seek reassurance and check repeatedly? An investigation of factors involved in compulsive behavior in OCD and depression. Journal of Anxiety Disorders, 24, 211–222. Scholar
  42. Parrish, C. L., Radomsky, A. S., & Dugas, M. J. (2008). Anxiety-control strategies: Is there room for neutralization in successful exposure treatment? Clinical Psychology Review, 28, 1400–1412. Scholar
  43. Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35, 793–802. Scholar
  44. Rachman, S. (1998). A cognitive theory of obsessions: Elaborations. Behaviour Research and Therapy, 36, 385–401. Scholar
  45. Rachman, S. (2002). A cognitive theory of compulsive checking. Behaviour Research and Therapy, 40, 625–639. Scholar
  46. Rachman, S. (2012). Health anxiety disorders: A cognitive construal. Behaviour Research and Therapy, 50, 502–512. Scholar
  47. Rachman, S., Radomsky, A. S., & Shafran, R. (2008). Safety behaviour: A reconsideration. Behaviour Research and Therapy, 46, 163–173. Scholar
  48. Radomsky, A. S., Neal, R. L., Parrish, C. L., Lavoie, S., & Schell, S. E. (2018). The Covert and Overt Reassurance Seeking Inventory: Development, validation, and psychometric analyses. Manuscript submitted for publication.Google Scholar
  49. Rector, N. A., Kamkar, K., Cassin, S. E., Ayearst, L. E., & Laposa, J. M. (2011). Assessing excessive reassurance seeking in the anxiety disorders. Journal of Anxiety Disorders, 25, 911–917. Scholar
  50. Renshaw, K. D., Steketee, G., & Chambless, D. L. (2005). Involving family members in the treatment of OCD. Cognitive Behaviour Therapy, 34, 164–175. Scholar
  51. Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571–583. Scholar
  52. Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37, S29–S52. Scholar
  53. Salkovskis, P. M., & Kobori, O. (2015). Reassuringly calm? Self-reported patterns of responses to reassurance seeking in obsessive compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 49, 203–208. Scholar
  54. Salkovskis, P. M., & Warwick, H. M. (1986). Morbid preoccupations, health anxiety and reassurance: A cognitive-behavioural approach to hypochondriasis. Behaviour Research and Therapy, 24, 597–602. Scholar
  55. Senn, J. M., & Radomsky, A. S. (2015). Measuring beliefs about distraction: Might the function of distraction matter more than distraction itself? Cognitive Therapy and Research, 39, 826–840. Scholar
  56. Shafran, R., Watkins, E., & Charman, T. (1996). Guilt in obsessive-compulsive disorder. Journal of Anxiety Disorders, 10(96), 509–516. Scholar
  57. Shapiro, L. J., & Stewart, S. E. (2011). Pathological guilt: A persistent yet overlooked treatment factor in obsessive-compulsive disorder. Annals of Clinical Psychiatry, 23, 63–70.Google Scholar
  58. Simpson, H. B., Huppert, J. D., Petkova, E., Foa, E. B., & Liebowitz, M. R. (2006). Response versus remission in obsessive-compulsive disorder. The Journal of Clinical Psychiatry, 67, 269–276. Scholar
  59. Starcevic, V., Berle, D., Brakoulias, V., Sammut, P., Moses, K., Milicevic, D., & Hannan, A. (2012). Interpersonal reassurance seeking in obsessive–compulsive disorder and its relationship with checking compulsions. Psychiatry Research, 200, 560–567. Scholar
  60. Thompson-Hollonds, J., Abramovitch, A., Tompson, M. C., & Barlow, D. H. (2015). A randomized clinical trial of a brief family intervention to reduce accommodation in obsessive-compulsive disorder: A preliminary study. Behavior Therapy, 46, 218–229. Scholar
  61. Tolin, D. F. (2001). Case study: Bibliotherapy and extinction treatment of obsessive-compulsive disorder in a 5-year-old boy. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 1111–1114. Scholar
  62. van Oppen, P., & Arntz, A. (1994). Cognitive therapy of obsessive-compulsive disorder. Behaviour Research and Therapy, 32, 79–87. Scholar
  63. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063–1070. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychologyConcordia UniversityMontrealCanada

Personalised recommendations