Different cognitive behavioural processes underpinning reassurance seeking in depression and obsessive-compulsive disorder

Emma Smith, Neil Carrigan, Paul M. Salkovskis

Research output: Contribution to journalArticlepeer-review

3 Citations (SciVal)

Abstract

Background and objectives: It has been suggested that reassurance seeking may play an important role in the development and maintenance of common mental health problems such as OCD and depression. We considered the extent of reassurance seeking in depression and OCD relative to a healthy comparison group and tested the hypothesis that reassurance seeking is primarily motivated by threat in those suffering from OCD and by interpersonal concerns in those suffering from depression. Methods: The frequency and intensity of reassurance seeking and the motivation for seeking reassurance was measured using the reassurance seeking questionnaire in 28 people with OCD, 18 people with depression and 29 healthy controls. Results: The OCD group sought reassurance more and at a higher intensity than both the depression group and healthy controls. For the OCD group, reassurance seeking was found to be linked to threat concern motivation. The depression group were not motivated by threat or interpersonal concerns. Limitations: The OCD group did not significantly differ from the depression group on the measure of depression, most likely due to secondary depression in the OCD group. Conclusions: For people suffering from OCD, reassurance is motivated by threat concern. For the depression group, levels of reassurance seeking were not substantially increased relative to controls, and the motivation to seek reassurance is less clear but interpersonal concern may not be a distinct motivational factor.

Original languageEnglish
Article number101774
JournalJournal of Behavior Therapy and Experimental Psychiatry
Volume77
Early online date9 Sept 2022
DOIs
Publication statusPublished - 31 Dec 2022

Bibliographical note

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Funding

According to Coynes (1976b) ' interpersonal theory of depression, ERS is involved in the maintenance of the problem and depressed individuals seek reassurance regarding their value to others in an effort to increase relationship security. Reassurance is then scrutinized for its sincerity and consequently more reassurance is sought as the person doubts the reassurance and assumes people have given reassurance out of a sense of pity or because they feel an obligation to (Coyne, 1976a). Such behaviour can irritate others which then makes it likely that it will increase social rejection and thus confirm their depressive cognitions around being unlovable and unworthy (Coyne, 1976a). According to this theory, reassurance seeking impacts on depression because it elicits rejection from others (Coyne, 1976a). Subsequent research is consistent with this by showing that students who were depressed were more likely to seek reassurance and it is the combination of depression and reassurance seeking that leads to rejection from others. Furthermore, a meta-analysis found that higher levels of ERS are associated with a greater number of depressive symptoms (Starr & Davila, 2008) which supports Coyne, (1976a) interpersonal theory of depression.Coyne (1976a) proposed that depressed individuals are particularly likely to seek reassurance regarding their value to others and do so because they seek relationship security. This position is supported by a review of interpersonal processes in depression (Hames, Hagner, & Joiner; 2013) which found that ERS is a behavioural characteristic of adults with depression. In the present study the depression group did not seek reassurance more than the healthy control group and interpersonal reasons were not found to motivate reassurance seeking. Furthermore, people with depression were not found to seek reassurance more frequently or intensely when compared with the OCD and healthy control group. This finding is inconsistent with research which suggests that reassurance seeking is excessively and persistently sought by people with depression about whether they are loveable and worthy (Joiner, Alfano, & Metalsky, 1992; Joiner & Metalsky, 1995). This evidence has come exclusively from non-clinical (college-student) samples, whilst the theory is grounded in clinical observation. In relation to the results from this study, it is possible that whilst depressed patients are not seeking more reassurance than healthy controls, they are more concerned about its interpersonal effects. Therefore, it might be that depressed patients are sensitive to the interpersonal effects of depression. This could mean that depressed patients are more interpersonally sensitive regarding any interactions where they are asking others to meet their needs; that is, a generalised interpersonal sensitivity. This supports research which found that people with depression have high levels of interpersonal sensitivity (Boyce & Parker, 1989; Wilhelm, Boyce, & Brownhill, 2004).

Keywords

  • Depression
  • Interpersonal motivation
  • Obsessive-Compulsive disorder
  • Reassurance seeking
  • Reassurance seeking questionnaire
  • Threat motivation

ASJC Scopus subject areas

  • Experimental and Cognitive Psychology
  • Clinical Psychology
  • Arts and Humanities (miscellaneous)
  • Psychiatry and Mental health

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