Excessive Reassurance Seeking and Cognitive Confidence in Obsessive-Compulsive Disorder

Abstract

Repeatedly questioning others about perceived threats, or excessive reassurance seeking (ERS), occurs across various psychiatric disorders, including obsessive-compulsive disorder (OCD; Parrish 2009). Three ERS domains have been consistently identified: ERS in response to general, decision-related, and social threats. We sought to examine whether (1) specific ERS domains are common in OCD, (2) ERS correlates with OCD symptom severity, (3) ERS levels impact the likelihood of having primary checking compulsions, and (4) ERS correlates with cognitive confidence. Participants were OCD patients (n = 35) and non-psychiatric controls (n = 34) who completed diagnostic and/or self-report measures. OCD patients reported significantly greater ERS than controls across all domains. ERS correlated positively with symptom severity. High decision-related ERS was found to increase the likelihood of checking as a primary symptom. Decision-related ERS correlated negatively with decision-making confidence and overall cognitive confidence. These findings greatly enhance our understanding of ERS in OCD. Implications for psychological interventions are discussed.

This is a preview of subscription content, log in to check access.

Notes

  1. 1.

    The results were re-run with patients with comorbid major depressive episodes and patients with generalized anxiety disorder removed. In both cases, results remained significant.

References

  1. Abramowitz, J. S., Franklin, M. E., & Cahill, S. P. (2003). Approaches to common obstacles in the exposure-based treatment of obsessive-compulsive disorder. Cogn Behav Pract, 10(1), 14–22.

    Article  Google Scholar 

  2. Alcolado, G. M., & Radomsky, A. S. (2016). A novel cognitive intervention for compulsive checking: targeting maladaptive beliefs about memory. Journal of Behavior Therapy and Experimental Psychiatry, 53, 75–83.

    Article  PubMed  Google Scholar 

  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  4. Banca, P., Vestergaard, M. D., Rankov, V., Baek, K., Mitchell, S., Lapa, T., et al. (2015). Evidence accumulation in obsessive-compulsive disorder: the role of uncertainty and monetary reward on perceptual decision-making thresholds. Neuropsychopharmacology, 40(5), 1192–1202.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Beck, A. T., & Steer, R. A. (1993). Beck anxiety inventory manual. San Antonio: The Psychological Corporation.

    Google 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(11), 948–957.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. First, M. B., Spitzer, R. L., & Gibbon, M. (1996). Structured clinical interview for DSM-IV axis I disorders, clinical version (SCID-CV). Washington, DC: American Psychiatric Press, Inc..

    Google Scholar 

  9. First, M. B., Williams, J. B. W., Karg, R. S., & Spitzer, R. L. (2014). Structured clinical interview for DSM-5 disorders–research version (SCID-5-RV). Arlington: American Psychiatric Association.

    Google Scholar 

  10. Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P. M. (2002). The obsessive–compulsive inventory: development and validation of a short version. Psychological Assessment, 14, 485–496.

    Article  PubMed  Google Scholar 

  11. Frost, R. O., & Shows, D. L. (1993). The nature and measurement of compulsive indecisiveness. Behaviour Research and Therapy, 31(7), 683–692.

    Article  PubMed  Google Scholar 

  12. Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., et al. (1989). The Yale-Brown obsessive compulsive scale: I. Development, use, and reliability. Archives of General Psychiatry, 46(11), 1006–1011.

    Article  PubMed  Google Scholar 

  13. Hermans, D., Engelen, U., Grouwels, L., Joos, E., Lemmens, J., & Pieters, G. (2008). Cognitive confidence in obsessive-compulsive disorder: distrusting perception, attention and memory. Behaviour Research and Therapy, 46(1), 98–113.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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), 1–1),23.

    Article  PubMed  Google Scholar 

  16. Lobbestael, J., Leurgaris, M., & Arntz, A. (2011). Inter-rater reliability of the Structured Clinical Interview for DSM-IV Axis 1 disorders (SCID 1) and Axis II disorders (SCID II). Clinical Psychology Psychotherapy, 18(1), 75–79.

    Article  PubMed  Google Scholar 

  17. Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales (2nd ed.). Sydney: Psychology Foundation.

    Google Scholar 

  18. Nedeljkovic, M., & Kyrios, M. (2007). Confidence in memory and other cognitive processes in obsessive–compulsive disorder. Behaviour Research and Therapy, 45(12), 2899–2914.

    Article  PubMed  Google Scholar 

  19. Nedeljkovic, M., Moulding, R., Kyrios, M., & Doron, G. (2009). The relationship of cognitive confidence to OCD symptoms. Journal of Anxiety Disorders, 23(4), 463–468.

    Article  PubMed  Google Scholar 

  20. Nie, N. H., Bent, D. H., & Hull, C. H. (1970). SPSS: statistical package for the social sciences. New York: McGraw-Hill.

    Google Scholar 

  21. Parrish, C. L. (2009). An investigation of excessive reassurance seeking in OCD. (Doctoral Dissertation). Department of Psychology, Concordia University. Retrieved from http://ezproxy.nottingham.ac.uk/login??url, http://search.proquest.com/docview/607047743?accountid=8018\n, http://sfx.nottingham.ac.uk/sfx_local/?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&genre=dissertations+&+theses&sid=ProQ:ProQuest.

  22. 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.

    Article  PubMed  Google Scholar 

  23. Pietrefesa, A. S., & Coles, M. E. (2008). Moving beyond an exclusive focus on harm avoidance in obsessive compulsive disorder: considering the role of incompleteness. Behavior Therapy, 39(3), 224–231.

    Article  PubMed  Google Scholar 

  24. Rachman, S. (2002). A cognitive theory of compulsive checking. Behaviour Research and Therapy, 40(6), 625–639.

    Article  PubMed  Google Scholar 

  25. Radomsky, A. S., & Alcolado, G. M. (2010). Don’t even think about checking: mental checking causes memory distrust. Journal of Behavior Therapy and Experimental Psychiatry, 41(4), 345–351.

    Article  PubMed  Google Scholar 

  26. Radomsky, A. S., Dugas, M. J., Alcolado, G. M., & Lavoie, S. L. (2014). When more is less: doubt, repetition, memory, metamemory, and compulsive checking in OCD. Behaviour Research and Therapy, 59, 30–39.

    Article  PubMed  Google Scholar 

  27. Rasmussen, S. A., & Eisen, J. L. (1990). Epidemiology of obsessive-compulsive disorder. Journal of Clinical Psychiatry, 51(2), 10–13.

    PubMed  Google Scholar 

  28. 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(7), 911–917.

    Article  PubMed  Google Scholar 

  29. Rector, N. A., Katz, D., Quilty, L. C., Laposa, J. M., Collimore, K., & Kay, T. (2018). Reassurance seeking in the anxiety disorders: Psychometric validation and treatment sensitivity. Manuscript in preparation.

  30. Salkovskis, P. M., & Warwick, H. M. (1986). Morbid preoccupations, health anxiety and reassurance: a cognitive-behavioural approach to hypochondriasis. Behaviour Research and Therapy, 24(5), 597–602.

    Article  PubMed  Google Scholar 

  31. Sheehan, D. V. (2014). The Mini-International Neuropsychiatric Interview, Version 7.0 for DSM-5 (M.I.N.I. 7.0). Medical Outcomes Systems Inc.

  32. Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Janavs, J., Weiller, E., Keskiner, A., et al. (1997). The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. European Psychiatry, 12(5), 232–241.

    Article  Google Scholar 

  33. Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(Suppl 20), 22–33.

    PubMed  Google Scholar 

  34. Shin, N. Y., Lee, T. Y., Kim, E., & Kwon, J. S. (2013). Cognitive functioning in obsessive-compulsive disorder: a meta-analysis. Psychological Medicine, 44(6), 1121–1130.

  35. 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.

    Article  PubMed  Google Scholar 

  36. Woody, S. R., Steketee, G., & Chambless, D. L. (1995). Reliability and validity of the Yale-Brown obsessive-compulsive scale. Behaviour Research and Therapy, 33(5), 597–605.

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to E. Orr.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Orr, E., McCabe, R.E., McKinnon, M.C. et al. Excessive Reassurance Seeking and Cognitive Confidence in Obsessive-Compulsive Disorder. J Cogn Ther 11, 17–30 (2018). https://doi.org/10.1007/s41811-018-0008-y

Download citation

Keywords

  • Excessive reassurance seeking
  • Obsessive-compulsive disorder
  • Cognitive confidence
  • Decision-making confidence