Treatment of Obsessive Compulsive Disorder and excessive reassurance seeking in an older adult: a single case quasi-experimental design

Background: Cognitive behavioural interventions for excessive reassurance seeking (ERS) typically focus on encouraging individuals to refrain from seeking any reassurance and in some cases banning caregivers (e.g. family members) from providing it. However, this blanket consideration that reassurance is a bad thing that should simply be stopped may not always be appropriate or helpful. Cognitive behavioural treatment (CBT) targeting ERS by helping the sufferer to shift from seeking reassurance to seeking support may be a promising treatment intervention. Aims: This study aims to examine the targeted treatment of ERS in an older adult who has been suffering from severe obsessive compulsive disorder (OCD) for seven decades. Method: Using a single case quasi-experimental design (ABCD), the frequency of reassurance seeking, urges to seek reassurance, OCD beliefs and anxiety were measured daily for almost a year in addition to standard symptom measures. Results: At the end of treatment, visual inspection showed that reassurance seeking was no longer considered excessive and OCD severity fell from the severe to non-clinical range across the treatment sessions. All treatment gains were maintained at follow-up. Conclusions: This study illustrates how CBT can be successfully applied to treat long-standing OCD and ERS in an older adult. Engendering support as an alternative to reassurance seeking in CBT may be a particularly promising intervention for ERS.Aims: This study aims to examine the targeted treatment of ERS in an older adult who has been suffering from severe Obsessive Compulsive Disorder (OCD) for seven decades Method: Using a single case quasi-experimental design (ABCD), the frequency of reassurance seeking, urges to seek reassurance, OCD beliefs and anxiety were measured daily for almost a year in addition to standard symptom measures. Results: At the end of treatment, visual inspection showed that reassurance seeking was no longer considered excessive and OCD severity fell from the severe to non-clinical range across the treatment sessions. All treatment gains were maintained at follow-up. Conclusions: This study illustrates how CBT can be successfully applied to treat long standing OCD and ERS in an older adult. Engendering support as an alternative to reassurance seeking in CBT may be a particularly promising intervention for ERS

Why do people with OCD and health anxiety seek reassurance excessively? An investigation of differences and similarities in function

Excessive reassurance seeking (ERS) is commonly reported in patients who have OCD or health anxiety. Despite its prevalence and associated risk of ongoing difficulties, little is known about the function of ERS. It has been conceptualised as a type of compulsive checking behaviour, but could also be seen as being a supportive maneuver. This study offers a new approach towards defining ERS and support seeking (SS), and similarities between these two constructs in a sample of OCD and health anxious patients. A semi-structured interview was employed. Participants reflected on the nature and goals of their reassurance and support seeking—its impact on themselves and other people. Twenty interviews were conducted, transcribed and analysed in accordance to framework thematic analysis. Six overarching themes were identified in terms of ERS and five for SS. Results revealed limited diagnosis specificity of ERS. Strikingly, participants with health anxiety did not report seeking support

I do not know what else to do: caregivers’ perspective on reassurance seeking in OCD

Excessive Reassurance Seeking (ERS) is an under-researched and poorly understood behavior that resembles the compulsive behaviors that are typically seen in OCD. ERS can be complex, persistent, extensive, debilitating and may dominate people’s interactions. In addition to resembling compulsive checking in OCD it may also have the effect of transferring responsibility to others. Caregivers are frequently asked to take part in a range of rituals as part of the OCD sufferer’s problem, often seeing it as a way of supporting the sufferer. We are still in the early stages of understanding the factors that elicit and maintain these responses in caregivers. The present investigation considered the interpersonal components of ERS by applying an in-depth analysis using qualitative methods in the context of an interview of caregivers who provide reassurance to OCD sufferers. Ten interviews were conducted and analysed using thematic analysis. Seven overarching themes were identified as important in the experience of being asked for and providing reassurance. These concern factors such as how people seek reassurance, how they process it, why other people give it and so on. A particularly pervasive theme was caregivers’ experience of frustration in the face of ERS. Clinical implications of the findings are discussed

Reassurance and its alternatives : Overview and cognitive behavioural conceptualisation

Funding Information: Excessive Reassurance Seeking (ERS) is an under-researched and poorly understood behaviour that maps onto the compulsive behaviours that are typically seen in obsessional problems. ERS can be complex, persistent, extensive, debilitating and may dominate the interactions of those involved. In this paper we review how ERS has been defined in the literature and put forward a new definition for this construct based on a cognitive behavioural theory. We also highlight the important role ERS may play in maintaining different anxiety problems and explore new ways of managing this behaviour clinically by helping patients to shift from seeking reassurance to seeking support.Peer reviewe

Acknowledging religion in cognitive behavioural therapy: the effect on alliance, treatment expectations and credibility in a video-vignette study

Objectives: Developing mental health services which are accessible and acceptable to those from minority backgrounds continues to be a priority. In the United Kingdom, individuals who identify with a religion are underrepresented in Talking Therapies services as compared to those with no religion. This necessitates an understanding of how therapy is perceived. This online study explored the impact of explicitly acknowledging religion on anticipated alliance, treatment credibility and expectations of therapy in a non-clinical sample of British Muslims. Methods: A video-vignette experimental design was used in which participants who self-reported as either high or low in religiosity were randomly allocated to receiving information about cognitive behavioural therapy either with or without an explicit mention of religion as a value in the therapeutic process. Results: One hundred twenty-nine British Muslim adults aged 18–70+ years from various ethnic backgrounds participated in the study. Between-subjects ANOVAs showed that scores on the perceived credibility of therapy and treatment expectations were significantly higher when religion was explicitly mentioned by the ‘therapist’, but that acknowledging religion did not impact upon anticipated alliance. Conclusions: These findings suggest that mentioning religion as a value to be considered in therapy has some positive impacts upon how therapy is perceived by British Muslims. Although video vignettes do not provide insight into the complexity of actual therapeutic encounters, acknowledging religion in mental health services more broadly remains an important consideration for improving equity of access and may bear relevance to other minoritized groups

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

Publisher Copyright: © The Author(s), 2023. Published by Cambridge University Press on behalf of British Association for Behavioural and Cognitive Psychotherapies.Excessive reassurance seeking (ERS) is believed to play an important role in maintaining mental health problems, in particular anxiety disorders such as obsessive-compulsive disorder and health anxiety. Despite this, therapists commonly give into patients' requests for reassurance in clinical settings and are generally unsure how to handle the issue both in therapy itself and concerning advice to the patient's loved ones. In order to increase our understanding of therapists' perception of ERS and how interventions for ERS are managed, we examined therapists' perception and understanding of ERS, including its function, which emotional problems therapists associate it with, and what treatment interventions they consider important for managing ERS. Qualified therapists (n=197) were benchmarked against international expert consensus (n=20) drawn from leading clinical researchers. There was evidence that clinical experience right up to the expert level may result in less reassurance giving within treatment settings. Still, there were enough inconsistencies between the experts and other clinicians to suggest that ERS remains poorly understood and is not consistently dealt with clinically. Results are discussed in terms of how current treatment interventions may be limited for treating ERS, highlighting the need to consider new approaches for dealing with this complicated interpersonal behaviour. Key learning aims (1) To describe the role of excessive reassurance seeking in checking behaviour, including its negative personal and interpersonal consequences. (2) To learn that therapists commonly report finding it difficult to manage reassurance seeking. (3) To learn that therapists' beliefs about excessive reassurance seeking may play a key role in helping us understand how to tackle this complicated behaviour. (4) To consider what therapeutic interventions may be appropriate and helpful for treating excessive reassurance seeking.Peer reviewe

Hoarding among older people: An evaluative review

AbstractWhile there is considerable evidence that the factors involved in hoarding typically begin to manifest early in life (mostly in adolescence), the majority of those sampled in research studies are in their later years. As so much of our understanding of the psychological factors involved in hoarding is derived from those who are older and more chronically affected, the core hoarding psychopathology may have been masked, overlaid or even disregarded in previous research and in our approaches to clinical intervention. That is, factors relating primarily to chronicity of the problem and feelings of demoralization, hopelessness, loss and the extent of the damage caused to the person's life may swamp the processes which led to and maintain the problem. The present review examines the extent to which this is so and considers theoretical and clinical implications. The literature relevant to hoarding in later life was reviewed evaluatively in relation to a number of questions placing hoarding in a lifespan developmental context. Many studies relied on purely descriptive methodologies, meaning that typical case presentations and case histories are well documented, with less attention paid to underlying causal and maintaining mechanisms. Efforts to identify and control for factors relating to age or problem chronicity were minimal. A key future direction is the identification of younger samples of people who hoard in order to identify more clearly the processes which drive acquisition and retention of excessive amounts of material.</jats:p

El enfoque cognitivo-comportamental para la ansiedad por la salud ("Hipocondría")

El presente artículo describe las líneas generales del enfoque cognitivo aplicado a la ansiedad por la salud (hipocondría). En este trastorno, la ansiedad se operativiza mediante 4 factores cognitivos clave: la probabilidad percibida de tener una enfemiedad; su "coste'; la percepción de la propia capacidad para afrontarla; y la percepción de cuánto ayudarán otros factores externos. Se plantea un modelo de mantenimiento de la ansiedad por la salud en el que varios factores como el arousal fisiológico, la malinterpretación de los síntomas, la atención selectiva a y el sesgo confirmatorío de la información relacionada con la enfermedad, y la conducta de comprobación, estarían manteniendo la ansiedad mediante el aumento de los síntomas y de la preocupación. A partir del modelo cognitivo-comportamental se exponen las líneas principales del tratamiento, cuya meta es que el paciente alcance la comprensión de cómo funciona su problema. Para ello se plantean explicaciones alternativas, se discute la evidencia a favor y en contra, y se llevan a cabo experimentos conductuales. Un aspecto que se destaca es el papel que juega, en el mantenimiento e incremento de la ansiedad, el hecho de tranquilizar a los pacientes. Por último se revisan los datos disponibles hasta la fecha acerca de la eficacia de este enfoque de tratamiento, y se sugieren líneas futuras de Investigación

Cognitive Behaviour Therapy for Health Anxiety:A systematic review and meta-analysis

Background: Health anxiety (HA), or hypochondriasis, is a psychological problem characterized by a preoccupation with the belief that one is physically unwell. A 2007 Cochrane review (Thomson and Page, 2007) found cognitive behavioural therapy (CBT) to be an effective intervention for individuals with HA. Similar findings were reported in a recent meta-analysis (Olatunji et al., 2014), which did not employ a systematic search strategy. The current review aimed to investigate the efficacy of CBT for HA, and to update the existing reviews. Method: A systematic search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance, including randomized controlled trials that compared CBT with a control condition for people with HA. Five hundred and sixty-seven studies were found in the original search, of which 14 were included in the meta-analysis. Results: Meta-analysis was conducted on 21 comparisons and a large effect size for CBT compared with a control condition was found at post therapy d = 1.01 (95% confidence interval 0.77–1.25), as well as at 6- and 12-month follow-up. Conclusions: This systematic review and meta-analysis provides support for the hypothesis that CBT is an effective intervention for HA when compared with a variety of control conditions, e.g. treatment-as-usual, waiting list, medication, and other psychological therapies

Social phobia: the role of in-situation safety behaviours in maintaining anxiety and negative beliefs

One of the puzzles surrounding social phobia is that patients with this problem are often exposed to phobic situations without showing a marked reduction in their fears. It is possible that individuals with social phobia engage in behaviors in the feared situation that are mtended to avert feared catastrophes but that also prevent disconfirmation of their fears. This hypothesis was tested in a single case series of eight socially phobic patients. All patients received one session of exposure alone and one session of exposure plus decrease in &quot;safety &quot; behaviors in a counterbalanced within-subject design. Exposure plus decreased safety behaviors was significantly better than exposure alone in reducmg within-situation anxiety and belief m the feared catastrophe. Other factors that may moderate exposure effects are also discussed. Exposure is an effective treatment for social phobia. However, the improvements obtained with exposure alone are relatively modest (Butler, Cullington, Munby, Amies, &amp; Gelder, 1984; Mattick &amp; Peters, 1988), and in everyday life individuals with social phobia are repeatedly exposed to social situations without marked reductions in anxiety. From a cognitive perspective, these observation