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

The Termination of Checking and the Role of Just Right Feelings:A Study of Obsessional Checkers Compared with Anxious and Non-clinical Controls

Background: Repeated checking in OCD can be understood from a cognitiveperspective as the motivated need to achieve certainty about the outcome of apotentially risky action, leading to the application of Elevated Evidence Requirements (EER) and overuse of subjective criteria. Method: Twenty-four obsessional checkers, 22 anxious controls, and 26 non-clinical controls were interviewed about and rated recent episodes where they felt (a) they needed to check and (b) checked mainly out of habit (i.e. not obsessionally). Results: Both subjective and objective criteria were rated as significantly more important in obsessional checkers than in controls; obsessional checkers also used more criteria overall for the termination of the check, and rated more criteria as “extremely important” than the control groups. The termination of the check was rated as more effortful for obsessional checkers than for the comparison groups. Analysis of the interview data was consistent with the ratings. Feelings of “rightness” were associated with the termination of a check for obsessional checkers but not for controls. Conclusion: Results were consistent withthe proposal that the use of “just right feelings” to terminate checking are related to EER

Still cognitive after all these years? Perspectives for a cognitive behavioural theory of obsessions and where we are 30 years later - a commentary

Background: Obsessive-Compulsive Disorder (OCD) was historically regarded as untreatable. In 1965 OCD was seen as an intractable and deteriorating condition, with little hope of improvement. It was not understood, but generally regarded as a kind of “pre-psychotic” state, with sufferers permanently at risk of being tipped over that edge. Treatment was confined to long term hospitalisation and psychosurgery, although neither of these held any hope of recovery. Fifty years on, OCD is not only understood as being a result of a range of otherwise normal processes but is also regarded as entirely treatable, with complete recovery being a real possibility. This has come about through the development and evolution of first behavioural then cognitive-behavioural approaches to its understanding and treatment. Objective: In 1993, Clark and Purdon, wrote an important and stimulating paper in Australian Psychologist in which they explored emerging cognitive theory, particularly that set out by Salkovskis (1985). The current paper aims to examine the contribution of the Clark and Purdon paper to the field. We aim to review this in the context of both the status of the field when it was written and subsequent developments. Method & Results: This evaluation is used to consider the current status of cognitive and cognitive behavioural theories. Since 1993 there have been a number of key developments in the field. In our view, these include work that has focused on formulation and development of a shared alternative explanation, the use of safety seeking behaviours, identification of Elevated Evidence Requirements, reassurance seeking and mental contamination. All of which will be reviewed in turn. Conclusion: It is concluded that the Clark and Purdon paper, although incorrect in several key aspects, made an important contribution to the development of a field which continues to evolve in a vibrant and challenging way

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

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

Screening for post-traumatic stress symptoms in looked after children

Purpose: Many children who are looked after by the state have experienced adverse and traumatic life circumstances prior to being removed from their biological parents. Previous research has highlighted that many of them experience barriers to accessing psychological therapies. The purpose of this paper is to investigate the feasibility of assessing post-traumatic stress disorder (PTSD)-like symptoms using a screening tool, and through this to determine the prevalence of PTSD-like symptoms in looked after children presenting with emotional and/or behavioural problems.   Design/methodology/approach: The Child Revised Impact of Events Scale (CRIES-8) was identified as a suitable screening tool for PTSD-like symptoms. This measure was piloted for three months, and the prevalence of PTSD-like symptoms amongst respondents ( n=27) was recorded.   Findings: Prevalence of PTSD-like symptoms was found to be high 75 per cent amongst respondents. The psychometric properties of the CRIES-8 were similar to those found in a previous study assessing PTSD following a single-incident trauma. Health care professionals reported finding the CRIES-8 to be a clinically useful measure.   Originality/value: Prevalence of PTSD-like symptoms may be high amongst looked after children, and the CRIES-8 appears to have good psychometric properties when used with this population. It is likely that this highly treatable condition is under-detected: thus, recommendations are made for clinical practice and further research

Understanding the link between feelings of mental defeat, self-efficacy and the experience of chronic pain

© 2018, © The British Pain Society 2018. Objectives: ‘Mental defeat’ (MD) has been identified among people with chronic pain as a type of self-processing related to social role and rank. Research has linked it to anxiety, pain interference and functional disability. The relationship between MD and other cognitive constructs, such as hopelessness and depression, remains poorly understood. This study considers the association between MD, pain symptomatology and self-efficacy in the context of other cognitive factors. Methods: In total, 59 participants completed a questionnaire pack assessing anxiety, depression, hopelessness, pain catastrophising and MD in order to examine the relationship with pain symptomatology and self-efficacy. Results: Linear multiple regression analyses showed that anxiety was most strongly associated with pain symptomatology, accounting for 26% of the variance, while catastrophising showed the strongest association with sensory pain and MD the strongest association with affective pain. Finally, MD was found to be strongly associated with pain-related self-efficacy, accounting for 47% of the variance. Conclusion: This research has demonstrated the potential importance of assessing MD in chronic pain patients, suggesting that targeting these cognitions during interventions and therapy could be valuable. Furthermore, the study indicates that MD differs from related cognitive constructs involved in pain, such as depression, hopelessness and catastrophising

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