What do you really need? Self- and partner-reported intervention preferences within cognitive behavioural therapy for reassurance seeking behaviour

Abstract

Background:Reassurance seeking (RS) in obsessive compulsive disorder (OCD) is commonly addressed in cognitive behavioural therapy (CBT) using a technique called reducing accommodation. Reducing accommodation is a behaviourally based CBT intervention that may be effective; however, there is a lack of controlled research on its use and acceptability to clients/patients, and case studies suggest that it can be associated with negative emotional/behavioural consequences. Providing support to encourage coping with distress is a cognitively based CBT intervention that may be an effective alternative, but lacks evidence regarding its acceptability.Aims:This study aimed to determine whether support provision may be a more acceptable/endorsed CBT intervention for RS than a strict reducing accommodation approach.Method:Participants and familiar partners (N = 179) read vignette descriptions of accommodation reduction and support interventions, and responded to measures of perceived intervention acceptability/adhereability and endorsement, before completing a forced-choice preference task.Results:Overall, findings suggested that participants and partners gave significantly higher ratings for the support than the accommodation reduction intervention (partial η2 = .049 to .321). Participants and partners also both selected the support intervention more often than the traditional reducing accommodation intervention when given the choice.Conclusions:Support provision is perceived as an acceptable CBT intervention for RS by participants and their familiar partners. These results have implications for cognitive behavioural theory and practice related to RS.

Partner symptom accommodation in generalized anxiety disorder: a preliminary examination of correlates with symptoms and cognitive behavioural therapy outcome

“…Providing reassurance was the most highly endorsed accommodation behaviour, which is consistent with research showing it is highly sought by people with GAD (Rector et al, 2019;Woody and Rachman, 1994). It is likely that individuals with GAD seek reassurance from their partners with the aim of bolstering their feelings of safety and certainty regarding a particular outcome (Gústavsson et al, 2021;Halldorsson and Salkovskis, 2017;Neal and Radomsky, 2020). When reassurance is received, it temporarily alleviates distress by diminishing the perceived threat.…”

“…In addition, given the preliminary evidence that partner SA is associated with greater relationship satisfaction, a potential barrier to decreasing SA during treatment is increased relationship distress. As an alternative to eliminating SA behaviours, treatment could focus on changing the function of these behaviours from safety-seeking to supportive (Neal and Radomsky, 2019;Neal and Radomsky, 2020). In other words, instead of providing reassurance that a bad outcome will not transpire, the partner could provide encouragement to sit with the discomfort and engage in skills use (Neal and Radomsky, 2020).…”

“…As an alternative to eliminating SA behaviours, treatment could focus on changing the function of these behaviours from safety-seeking to supportive (Neal and Radomsky, 2019;Neal and Radomsky, 2020). In other words, instead of providing reassurance that a bad outcome will not transpire, the partner could provide encouragement to sit with the discomfort and engage in skills use (Neal and Radomsky, 2020). There is evidence in a non-clinical sample that providing adaptive support is an effective treatment intervention that is associated with a reduction in reassurance-seeking behaviours (Neal and Radomsky, 2019).…”

Understanding why people with OCD do what they do, and why other people get involved: supporting people with OCD and loved ones to move from safety-seeking behaviours to approach-supporting behaviours

“…Research suggests when people with OCD receive supportive feedback from their partner following an exposure task this can increase perceived helpfulness of the feedback given and reduce reassurance seeking behaviours compared with those whose partners were instructed to provide neutral or more generally supportive responses to reassurance seeking (Neal and Radomsky, 2019). Literature also suggests that people find this approach to treatment more acceptable than traditional CBT, which focused more on reducing accommodation to requests for reassurance (Neal and Radomsky, 2020). Dependent upon the individual's culture and beliefs, it may also be important to involve other individuals from the person's community, e.g.…”

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

“…The main conclusions from that study were that a cognitive behavioural therapy which focuses on helping people who engage in ERS to shift from seeking reassurance to seeking support might be beneficial (Halldorsson and Salkovskis, 2017b). Further support for this intervention comes from recent work by Neal and Radomsky (2019, 2020), which has shown that support provision is both effective (Neal and Radomsky, 2019) and acceptable for patients and their caregivers (Neal and Radomsky, 2020).…”