مقاله انگلیسی رایگان در مورد مبارزه همگانی با اختلال وسواس فکری-جبری – الزویر 2025

Abstract

Excessive reassurance-seeking in OCD has been linked to the maintenance of OCD, functioning as a type of checking ritual. Current treatments recommend the imposition of the extinction of seeking and providing reassurance; however, this is not well tolerated. Although it has been suggested that the provision of support may provide a more helpful alternative, there is no empirical evidence for this. In the present study, 36 participants with OCD engaged with two personalised semi-idiographic scenarios in which they imagined seeking and receiving reassurance and seeking and receiving emotional support in counterbalanced order. The primary outcome measure was anticipated urge to seek reassurance, which was found to significantly decrease in the imagined support condition relative to the imagined reassurance condition regardless of order of presentation. Emotional support was perceived as significantly more acceptable when compared to imagining reassurance in terms of higher ratings of perceived helpfulness in managing emotions, feelings of calmness and closeness, and the sense that they were fighting OCD together. These findings provide preliminary evidence for the value of encouraging the seeking and giving of emotional support as an alternative to reassurance. Implications for clinical work and further research are discussed.

Introduction

Obsessive-compulsive disorder (OCD) is a common and pervasive mental health disorder characterised by the presence of severe and disabling obsessions and compulsions, (American Psychological Association, 2023). Thought to have a lifetime prevalence of around 2% (Cervin, 2023). OCD is associated with increased autoimmune disorders (de la Cruz et al., 2022), long-term socioeconomic difficulties (Pérez-Vigil et al., 2018), significantly impaired quality of life (Eisen et al., 2006; Macy et al., 2013), and significant strains on peer and family relationships (Grover & Dutt, 2011; Walseth et al., 2017).

Cognitive theories of OCD focus on the threat of harm to self and/or others, and an inflated sense of responsibility for such harm, as the precipitating factors and motivators of the responses that maintain OCD (Rachman, 2002; Salkovskis, 1985; Salkovskis & Warwick, 1985; Smith et al., 2022). Compulsive behaviours motivated by responsibility beliefs are considered key maintaining responses, functioning as safety-seeking behaviours (SSB) intended to achieve certainty that harm or responsibility for it is eliminated (Salkovskis, 1991). Like most SSBs, however, checking has the effect of preventing disconfirmation and maintaining pre-occupation (Osborne & Williams, 2013). For example, with each instance of checking the memory of previous checks is tarnished (Radomsky et al., 2006). As such, the level of certainty of safety tends to decrease, and checking is perpetuated (Rachman, 2002; Tolin et al., 2002). Recent work thus suggests that excessive reassurance-seeking (ERS) is a special type of checking. Defined as the “verbal and/or non-verbal interaction with someone who you perceive has access to potentially threat relieving information, with the intention of increasing your perceived sense of certainty from harm” (Halldorsson & Salkovskis, 2023), in practice, this often looks like requests or comments (verbal or non-verbal) that search for certainty that their feared outcome is untrue (e.g., “did I do that properly?“, “am I a bad person?” etc.) with responses provided that attempt to provide this certainty (e.g., “Yes you did”, “No you aren’t a bad person”. Unlike most other forms of checking, this interaction has the additional function of transferring responsibility onto others (Rachman, 2002; Salkovskis, 1999).

Conclusion

The present study highlights the anticipated advantages of seeking and receiving emotional support as opposed to reassurance. People with OCD imagined support as not only more effective in the long-term, but also as more acceptable when compared to reassurance. Future research may benefit from assessing these outcomes in caregivers of those with OCD also, in addition to in-vivo experiments that can investigate the effectiveness and acceptability of reassurance in practice.