Hostname: page-component-cb9f654ff-hqlzj Total loading time: 0 Render date: 2025-07-31T08:55:22.379Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment of Obsessive Compulsive Disorder and Excessive Reassurance Seeking in an Older Adult: A Single Case Quasi-Experimental Design

Published online by Cambridge University Press:  08 June 2017

Brynjar Halldorsson  and
Paul M. Salkovskis
Brynjar Halldorsson*
Affiliation:
Department of Psychology, University of Bath, UK
Paul M. Salkovskis
Affiliation:
Department of Psychology, University of Bath, UK
*
Correspondence to Brynjar Halldorsson, School of Psychology and Clinical Language Sciences, University of Reading, Reading RG6 6AL, UK. E-mail: b.halldorsson@reading.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

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.

Keywords

Reassurance seekingOCDsingle case experimental designCBT

Information

Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 45 , Issue 6 , November 2017 , pp. 616 - 628
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Abramowitz, J. S., Franklin, M. E. and Cahill, S. P. (2003). Approaches to common obstacles in the exposure-based treatment of obsessive-compulsive disorder. Cognitive and Behavioral Practice, 10, 14–22. doi: https://doi.org/10.1016/S1077-7229(03)80004-4 CrossRefGoogle Scholar
Barlow, D. H., Nock, M. K. and Hersen, M. (2008). Single Case Experimental Designs: Strategies for Studying Behavior Change. Boston: Pearson.Google Scholar
First, M. B., Spitzer, R. L., Gibbon, M. and Williams, J. B. W. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders. Washington, DC: American Psychiatric Press, Inc.Google Scholar
Foa, E. B., Kozak, M. J., Salkovskis, P. M., Coles, M. E. and Amir, N. (1998). The validation of a new obsessive–compulsive disorder scale: The Obsessive-Compulsive Inventory. Psychological Assessment, 10, 206–214.CrossRefGoogle Scholar
Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Fraklin, M. E. et. al. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 162, 151–161.Google Scholar
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, 1006–1011.CrossRefGoogle ScholarPubMed
Halldorsson, B. (2015). ‘Please help me’: excessive reassurance seeking as an interpersonal process in obsessive compulsive disorder and health anxiety. PhD thesis, University of Bath.Google Scholar
Halldorsson, B. and Salkovskis, P. M. (2017). Why do people with OCD and health anxiety seek reassurance excessively? An investigation of differences and similarities in function. Cognitive Therapy and Research, 1–13. doi: 10.1007/s10608-016-9826-5 Google Scholar
Halldorsson, B., Salkovskis, P. M., Kobori, O. and Pagdin, R. (2016). I do not know what else to do: caregivers’ perspective on reassurance seeking in OCD. Journal of Obsessive-Compulsive and Related Disorders, 8, 21–30.Google Scholar
Houghton, S., Saxon, D., Bradburn, M., Ricketts, T. and Hardy, G. (2010). The effectiveness of routinely delivered cognitive behavioural therapy for obsessive-compulsive disorder: a benchmarking study. British Journal of Clinical Psychology, 49, 473–489.Google Scholar
Kobori, O. and Salkovskis, P. M. (2013). Patterns of reassurance seeking and reassurance-related behaviours in OCD and anxiety disorders. Behavioural and Cognitive Psychotherapy, 41, 1–23. doi: 10.1017/S1352465812000665 Google Scholar
Kobori, O., Salkovskis, P. M., Read, J., Lounes, N. and Wong, V. (2012). A qualitative study of the investigation of reassurance seeking in obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders, 1, 25–32.Google Scholar
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.Google Scholar
Marks, I. M. (2005). Living with Fear: Understanding and Coping with Anxiety (2nd edn). Glasgow: McGraw-Hill.Google Scholar
Mundt, J. C., Marks, I. M., Shear, M. K. and Greist, J. M. (2002). The Work and Social Adjustment Scale: a simple measure of impairment in functioning. The British Journal of Psychiatry, 180, 461–464. doi: 10.1192/bjp.180.5.461 Google Scholar
Ong, C. W., Clyde, J. W., Bluett, E. J., Levin, M. E. and Twohig, M. P. (2016). Dropout rates in exposure with response prevention for obsessive-compulsive disorder: What do the data really say? Journal of Anxiety Disorders, 40, 8–17. doi: https://doi.org/10.1016/j.janxdis.2016.03.006 CrossRefGoogle ScholarPubMed
Parrish, C. L. and 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, 211–222.Google Scholar
Parrish, C. L. and Radomsky, A. S. (2011). An experimental investigation of factors involved in excessive reassurance seeking: the effects of perceived threat, responsibility and ambiguity on compulsive urges and anxiety. Journal of Experimental Psychopathology, 2, 44–62.CrossRefGoogle Scholar
Peris, T. S., Bergman, R. L., Langley, A., Chang, S., McCracken, J. T. and Piacentini, J. (2008). Correlates of accommodation of pediatric obsessive-compulsive disorder: parent, child, and family characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1173–1181. doi: https://doi.org/10.1097/CHI.0b013e3181825a91 Google Scholar
Rachman, S. (1976). Obsessional-compulsive checking. Behaviour Research and Therapy, 14, 269–277. doi: https://doi.org/10.1016/0005-7967(76)90002-4 Google Scholar
Rachman, S. (2002). A cognitive theory of compulsive checking. Behaviour Research and Therapy, 40, 625–639.CrossRefGoogle ScholarPubMed
Rachman, S. and Hodgson, R. (1980). Obsessions and Compulsions. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
Salkovskis, P. M. (1985). Obsessional-compulsive problems: a cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571–583.Google Scholar
Salkovskis, P. M. (1991). The importance of behavior in the naintenance of anxiety and panic – a cognitive account. Behavioural Psychotherapy, 19, 6–19.Google Scholar
Salkovskis, P. M. (1996a). Avoidance behaviour is motivated by threat beliefs: a possible resolution of the cognitive-behaviour debate. In Salkovskis, P. M. (ed), Trends in Cognitive and Behavioural Therapies (pp. 25–41). Oxford: John Wiley and Sons.Google Scholar
Salkovskis, P. M. (1996b). The cognitive approach to anxiety: threat beliefs, safety-seeking behavior, and the special case of health anxiety and obsessions. In Salkovskis, P. M. (ed), Frontiers of Cognitive Therapy (pp. 48–74). New York: Guilford Press.Google Scholar
Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37 (suppl 1), S29–52.CrossRefGoogle ScholarPubMed
Salkovskis, P. M. and Kobori, O. (2015). Reassuringly calm? Self-reported patterns of responses to reassurance seeking in obsessive compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 49, 203–208. doi: 10.1016/j.jbtep.2015.09.002 Google Scholar
Salkovskis, P. M. and Warwick, H. M. (1986). Morbid preoccupations, health anxiety and reassurance: a cognitive-behavioural approach to hypochondriasis. Behaviour Research and Therapy, 24, 597–602.CrossRefGoogle ScholarPubMed
Salkovskis, P. M., Wroe, A. L., Gledhill, A., Morrison, N., Forrester, E., Richards, C. et al. (2000). Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder. Behaviour Research and Therapy, 38, 347–372.Google Scholar
Shafran, R., Radomsky, A. S., Coughtrey, A. E. and Rachman, S. (2013). Advances in the cognitive behavioural treatment of obsessive compulsive disorder. Cognitive Behaviour Therapy, 42, 265–274. doi:10.1080/16506073.2013.773061 Google Scholar
Shafran, R., Ralph, J. and Tallis, F. (1995). Obsessive-compulsive symptoms and the family. Bulletin of the Menninger Clinic, 59, 472–479.Google Scholar
Spitzer, R. L., Kroenke, K., Williams, J. B. and Lowe, B. (2006). A brief measure for assessing generalized anxiety disorders: the GAD-7. Archives of Internal Medicine, 166, 1092–1097.Google Scholar
Stewart, S. E., Beresin, C., Haddah, S., Stack, D., Farna, J. and Jenike, M. (2008). Predictors of family accommodation in obsessive-compulsive disorder. Annals of Clinical Psychiatry, 20, 65–70. doi: 10.1080/10401230802017043 Google Scholar
Storch, E. A., Geffken, G. R., Merlo, L. J., Jacob, M. L., Murphy, T. K., Goodman, W. K. et al. (2007). Family accommodation in pediatric obsessive-compulsive disorder. Journal of Clinical Child and Adolescent Psychology, 36, 207–216. doi: 10.1080/15374410701277929 Google Scholar
Supplementary material: File

Halldorsson and Salkovskis supplementary material

Halldorsson and Salkovskis supplementary material 1

Download Halldorsson and Salkovskis supplementary material(File)
File 115.2 KB
Supplementary material: PDF

Halldorsson and Salkovskis supplementary material

Halldorsson and Salkovskis supplementary material 2

Download Halldorsson and Salkovskis supplementary material(PDF)
PDF 298 KB
Supplementary material: PDF

Halldorsson and Salkovskis supplementary material

Halldorsson and Salkovskis supplementary material 3

Download Halldorsson and Salkovskis supplementary material(PDF)
PDF 500.6 KB
Submit a response

Comments

No Comments have been published for this article.