Abstract
Reassurance seeking (RS) has emerged as an important transdiagnostic psychological construct. However, RS has been conceptualized inconsistently and applied to functionally disparate behaviors within research and practice. In order to clarify the construct, the presently proposed Integrative Functional Model of Reassurance Seeking (IFM-RS) operationalizes and categorizes RS behaviors according to their functions. The following three categories comprise the model: Avoidant (negatively reinforced) RS, Evocative (positively reinforced) RS, and Bifunctional (simultaneously reinforced) RS. To evidence the validity and utility of this model, a review of relevant research is presented. The IFM-RS is then applied in conceptualizing the deleterious effects of RS on mental health and relevant treatment implications are subsequently discussed. We contend that adoption of the IFM-RS and its terminology by clinicians and researchers would facilitate accurate communication about the construct, improve the validity and applicability of RS research, and guide clinicians to effectively identify and target RS behaviors in the context of psychopathology.
Similar content being viewed by others
References
Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. (2011). Exposure therapy for anxiety: Principles and practice. New York, NY: Guilford Press.
Abramowitz, J. S., & Moore, E. L. (2007). An experimental analysis of hypochondriasis. Behaviour Research and Therapy, 45(3), 413–424.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Barrett, P. M., Dadds, M. R., & Rapee, R. M. (1996). Family treatment of childhood anxiety: A controlled trial. Journal of Consulting and Clinical Psychology, 64(2), 333.
Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical aspects (Vol. 32). Philadelphia, PA: University of Pennsylvania Press.
Beck, A. T. (2002). Cognitive models of depression. In R. L. Leahy & E. T. Dowd (Eds.), Clinical advances in cognitive psychotherapy: Theory and application (pp. 29–61). New York, NY: Springer.
Beck, A. T. (2005). The current state of cognitive therapy: A 40-year retrospective. Archives of General Psychiatry, 62(9), 953–959.
Beck, A. T., & Alford, B. A. (2009). Depression: Causes and treatment (2nd ed.). Philadelphia, PA: University of Pennsylvania Press.
Beck, A. T., & Emory, G. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York, NY: Guilford Press.
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(11), 948–957.
Billieux, J., Maurage, P., Lopez-Fernandez, O., Kuss, D. J., & Griffiths, M. D. (2015). Can disordered mobile phone use be considered a behavioral addiction? An update on current evidence and a comprehensive model for future research. Current Addiction Reports, 2(2), 156–162.
Burns, A. B., Brown, J. S., Plant, E. A., Sachs-Ericsson, N., & Joiner, T. E. (2006). On the specific depressotypic nature of excessive reassurance-seeking. Personality and Individual Differences, 40(1), 135–145.
Bylsma, L. M., Morris, B. H., & Rottenberg, J. (2008). A meta-analysis of emotional reactivity in major depressive disorder. Clinical Psychology Review, 28(4), 676–691.
Clark, D. A. (2004). Cognitive-behavioral therapy for OCD. New York: Guilford.
Cougle, J. R., Fitch, K. E., Fincham, F. D., Riccardi, C. J., Keough, M. E., & Timpano, K. R. (2012). Excessive reassurance seeking and anxiety pathology: Tests of incremental associations and directionality. Journal of Anxiety Disorders, 26(1), 117–125.
Coyne, J. C. (1976). Depression and the response of others. Journal of Abnormal Psychology, 85(2), 186–193.
Elhai, J. D., Dvorak, R. D., Levine, J. C., & Hall, B. J. (2017). Problematic smartphone use: A conceptual overview and systematic review of relations with anxiety and depression psychopathology. Journal of Affective Disorders, 207, 251–259.
Evraire, L. E., & Dozois, D. J. (2011). An integrative model of excessive reassurance seeking and negative feedback seeking in the development and maintenance of depression. Clinical Psychology Review, 31(8), 1291–1303.
Grant, S. M., Judah, M. R., Mills, A. C., Lechner, W. V., Davidson, C. L., & Wingate, L. R. (2014). Rumination and excessive reassurance seeking: Mediators of the relationship between social anxiety and depression? Journal of Psychopathology and Behavioral Assessment, 36(3), 465–474.
Haeffel, G. J., Voelz, Z. R., & Joiner, T. E. (2007). Vulnerability to depressive symptoms: Clarifying the role of excessive reassurance seeking and perceived social support in an interpersonal model of depression. Cognition and Emotion, 21(3), 681–688.
Halldorsson, B., & Salkovskis, P. M. (2017). Why do people with OCD and health anxiety seek reassurance excessively? An investigation of differences and similarities in function. Cognitive Therapy and Research, 41(4), 619–631.
Heerey, E. A., & Kring, A. M. (2007). Interpersonal consequences of social anxiety. Journal of Abnormal Psychology, 116(1), 125–134.
Hopko, D. R., Lejuez, C. W., Ruggiero, K. J., & Eifert, G. H. (2003). Contemporary behavioral activation treatments for depression: Procedures, principles, and progress. Clinical Psychology Review, 23(5), 699–717.
Joiner, T. E., Alfano, M. S., & Metalsky, G. I. (1992). When depression breeds contempt: Reassurance seeking, self-esteem, and rejection of depressed college students by their roommates. Journal of Abnormal Psychology, 101(1), 165.
Joiner, T. E., Alfano, M. S., & Metalsky, G. I. (1993). Caught in the crossfire: Depression, self-consistency, self-enhancement, and the response of others. Journal of Social and Clinical Psychology, 12(2), 113–134.
Joiner, T. E., Katz, J., & Lew, A. (1999a). Harbingers of depressotypic reassurance seeking: Negative life events, increased anxiety, and decreased self-esteem. Personality and Social Psychology Bulletin, 25(5), 632–639.
Joiner, T. E., & Metalsky, G. I. (1995). A prospective test of an integrative interpersonal theory of depression: A naturalistic study of college roommates. Journal of Personality and Social Psychology, 69(4), 778.
Joiner, T. E., & Metalsky, G. I. (2001). Excessive reassurance seeking: Delineating a risk factor involved in the development of depressive symptoms. Psychological Science, 12(5), 371–378.
Joiner, T. E., Metalsky, G. I., Gencoz, F., & Gencoz, T. (2001). The relative specificity of excessive reassurance-seeking to depressive symptoms and diagnoses among clinical samples of adults and youth. Journal of Psychopathology and Behavioral Assessment, 23(1), 35–41.
Joiner, T. E., Metalsky, G. I., Katz, J., & Beach, S. R. H. (1999b). Depression and excessive reassurance-seeking. Psychological Inquiry, 10(3), 269–278.
Joiner, T. E., & Schmidt, N. B. (1998). Excessive reassurance-seeking predicts depressive but not anxious reactions to acute stress. Journal of Abnormal Psychology, 107(3), 533.
Katz, J., Beach, S. R., & Joiner, T. E. (1998). When does partner devaluation predict emotional distress? Prospective moderating effects of reassurance-seeking and self-esteem. Personal Relationships, 5(4), 409–421.
Khanna, M. S., & Kendall, P. C. (2009). Exploring the role of parent training in the treatment of childhood anxiety. Journal of Consulting and Clinical Psychology, 77(5), 981–986.
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), 1–23.
Kobori, O., Salkovskis, P. M., Read, J., Lounes, N., & Wong, V. (2012). A qualitative study of the investigation of reassurance seeking in obsessive–compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders, 1(1), 25–32.
Lewinsohn, P. M., Youngren, M. A., & Grosscup, S. J. (1979). Reinforcement and depression. In R. A. Depue (Ed.), Psychobiology of the depressive disorders: Implications for the effects of stress (pp. 291–316). New York, NY: Academic Press.
Lohr, J. M., Olatunji, B. O., & Sawchuk, C. N. (2007). A functional analysis of danger and safety signals in anxiety disorders. Clinical Psychology Review, 27(1), 114–126.
Lovas, D. A., & Barsky, A. J. (2010). Mindfulness-based cognitive therapy for hypochondriasis, or severe health anxiety: A pilot study. Journal of Anxiety Disorders, 24(8), 931–935.
McNeil, C., & Hembree-Kigin, T. L. (2010). Parent-child interaction therapy. New York, NY: Springer.
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(2), 211–222.
Potthoff, J. G., Holahan, C. J., & Joiner, T. E. (1995). Reassurance seeking, stress generation, and depressive symptoms: An integrative model. Journal of Personality and Social Psychology, 68(4), 664–670.
Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23(5), 571–583.
Starcevic, V., Berle, D., Brakoulias, V., Sammut, P., Moses, K., Milicevic, D., et al. (2012). Interpersonal reassurance seeking in obsessive-compulsive disorder and its relationship with checking compulsions. Psychiatry Research, 200(2), 560–567.
Starr, L. R., & Davila, J. (2008). Excessive reassurance seeking, depression, and interpersonal rejection: A meta-analytic review. Journal of Abnormal Psychology, 117(4), 762–775.
Teasdale, J. D., Segal, Z. V., & Williams, J. M. G. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behaviour Research and Therapy, 33, 25–39.
Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68(4), 615–623.
Wood, J. J., Piacentini, J. C., Southam-Gerow, M., Chu, B. C., & Sigman, M. (2006). Family cognitive behavioral therapy for child anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 45(3), 314–321.
Woody, S., & Rachman, S. (1994). Generalized anxiety disorder (GAD) as an unsuccessful search for safety. Clinical Psychology Review, 14(8), 743–753.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gillett, D.A., Mazza, S.J. Clarifying a Construct: An Integrative Functional Model of Reassurance-Seeking Behaviors. J Rat-Emo Cognitive-Behav Ther 36, 362–377 (2018). https://doi.org/10.1007/s10942-018-0291-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10942-018-0291-9