Reassurance: How it prevents recovery

Reassurance (noun): the action of removing someone’s doubts or fears; a statement or comment that removes someone’s doubts or fears.

What is reassurance?

You’re walking around and you see a kid riding a bike. The kid falls over, and someone who seems to be the mother runs over and scoops them up, saying things like, “It’s okay. You’re going to be okay. It’s just a scratch.”

Or maybe you’re sitting in a coffee shop when you hear someone at the next table telling their friends about a recent breakup, listing all the reasons life will never be good again. The friends swoop in and say, “You can’t think like that. You’re just in a lot of pain right now. It wasn’t even that great of a relationship anyways.”

These are examples of people giving reassurance to someone else. And they’re so recognizable because reassurance is an everyday part of social interaction: someone expresses a doubt or fear, and you help them feel better by negating that doubt or fear. This happens in infinitely many ways each day. In fact, it’s hard to imagine how one would get through life without reassurance when things get really tough.

Photo: Matthew Henry

Is it normal to want reassurance?

Everybody– from newborn infants to the oldest and wisest adults– feels a strong need to be reassured in situations that provoke fear, guilt, anxiety, stress, sadness, and so on. These tend to be unpleasant feelings, so we usually want to get rid of them. Reassurance often helps, at least in the short term, but it’s not always effective. Someone in grief, for example, is probably not going to hear They’re in a better place now and feel much better.

Barring a huge life change like illness or death, people also tend to learn other responses to stressful situations after some experience with them. After enough trips down the big slide at the park, most kids will stop asking whether or not it will be okay. By testing the world, we learn what is safe and what we should probably avoid. (Even this learning can be skewed by a bunch of factors, but let’s get into that another time.)

Reassurance, like most things we do, isn’t exactly good or bad. It’s certainly normal, and makes up a sizable portion of all the social interactions you’ll observe on a given day. For most people, especially adults, the need for reassurance is strong at times, but not persistently strong. And even when it is strong, it might seem plausible that there are other ways to proceed, besides temporarily getting rid of unpleasant feelings. But excessive reassurance seeking is associated with a number of mental health conditions, including depression, obsessive-compulsive disorder (OCD), and anxiety disorders.

Recovery from OCD requires habituation to the distress caused by uncertainty. And habituation cannot occur when reassurance keeps the person from getting exposure to uncertainty.

Photo: Korney Violin

What does reassurance have to do with OCD?

Because we keep talking about most people, there’s clearly a group that doesn’t mesh with some of the above statements. That would be people with OCD, health anxiety, and a few other psychiatric conditions. Let’s have a look at a 2017 paper written by Drs. Brynjar Halldorsson and Paul Salkovskis:

Excessive reassurance seeking (ERS) is particularly prominent in people who suffer from obsessive-compulsive disorder (OCD) and health anxiety… reassurance seeking functions in a similar way to compulsive checking in OCD with the added potential of transferring ‘responsibility’ for the feared harm to another person (Rachman 2002; Salkovskis 1985, 1999). However, it could also be seen as being a supportive maneuver, and is often considered in this way by sufferers and their loved ones.

 

They introduce the central complication of reassurance in OCD: on the one hand, reassurance seeking is a compulsive response to the distress caused by obsessions; on the other hand, it’s a very normal way to seek support from others. It’s what everyone else is doing, in other words. But the need for reassurance isn’t a passing thing for people with OCD.

It might help for a little bit, but the urge tends to return quickly. As a result, people with OCD tend to ask for reassurance more often, and with more urgency, than others. And they may feel unable to proceed without it. The distinguishing factor for people with OCD isn’t that they seek reassurance; it’s that their reassurance seeking behaviors get out of their control quickly.

Photo: Dean Hergert

Why do people with OCD seek reassurance?

Because researchers haven’t found a definite cause of OCD, attempts to explain this on a neurological level aren’t going to satisfy. From a psychological perspective, reassurance-seeking behaviors are another attempt by people with OCD to get rid of the uncertainty at the core of the condition. If you feel unsure about something, you might check it repeatedly- or you might try to get someone else to tell you that things will work out just fine.

When you ask for reassurance, you’re basically asking someone else to neutralize the distress of confronting uncertainty, by presenting a different way of viewing the situation. It feels like a big relief to have this distress taken away, but in the long term it guarantees that you won’t learn how to tolerate uncertainty (or even learn that you can tolerate it). You’ll be stuck in a loop of perceiving uncertainty, growing distressed, seeking reassurance. In this way, reassurance-seeking is both a compulsion (a repetitive behavior meant to minimize distress) and a form of avoidance.

Let’s use a metaphor that’s imperfect but hopefully instructive. There are two people next to each other lifting weights. They’re of equal strength, but only one is confident. The other is so full of doubt that– as the more confident one keeps trying, failing, adjusting, even succeeding– they keep calling a friend over to help. After a few months of this, the confident one has grown much stronger. But the less confident one has only become more and more convinced that they need help, and hasn’t become able to lift anything on their own.

Photo: Victor Freitas

Does reassurance keep people from getting better?

People with OCD seem particularly bothered by not having absolute certainty, at least in a few key areas depending on one’s specific symptoms. As countless research papers and personal stories tell us, recovery from OCD requires habituation to the distress caused by uncertainty. And habituation– the lessening of a physiological or emotional response after repeated exposure to a stimulus– cannot occur when reassurance keeps the person from getting that exposure to uncertainty.

Some research suggests that people get worse when they’re getting reassurance because the feared stimulus grows even more fearsome as others help them avoid it. At the very least, getting reassurance doesn’t help people get better. Like other compulsions, reassurance seeking works by negative reinforcement: because it gets rid of an unpleasant feeling, the behavior is strengthened. The result? We just want more and more reassurance.

The insatiable desire for reassurance, always increasing due to operant conditioning, combines with the impossibility of certainty to lock people into the endless quest of trying to make sure things will be alright. Unsurprisingly, this can result in all kinds of unfortunate situations where other people end up resenting the person who is constantly asking for reassurance. Because friends and family might pull away, it’s common for people to end up lonely just because they didn’t know how to avoid asking too much of loved ones.

Photo: Brannon Naito

What can we do instead of reassurance?

Remember that research paper that we discussed above? Later they bring up an interesting concept: reassurance-seeking versus support-seeking.

Here’s how they define reassurance-seeking:

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 of safety from harm.

And this is support-seeking:

Interpersonal behaviour, verbal or non-verbal, that is intended to get encouragement, confidence, or assistance to cope with feelings of distress.

 

The difference is subtle, which points to the confusion most of us face when trying to decide how to help someone. But remember the chain of events: uncertainty -> distress -> behavior. Reassurance-seeking is an attempt to get rid of the distress by getting rid of the uncertainty that underlies it. Support-seeking, however, is an attempt to have someone encourage you while you deal with the distress caused by your uncertainty. It means allowing the uncertainty and distress to exist while also acknowledging that it’s easier to succeed with the support of others.

Photo: Victor Freitas

If we think now of the person on the other end of these interactions, the one offering either reassurance or support, the distinction can be even more subtle. Because of this subtlety, it might require saying something as direct as, “It seems like you’re looking for reassurance, which I understand because you’re dealing with difficult feelings right now. But I know you can get through this, as you have so many times before, and I also know it’s important for you to get through these situations so you can learn to trust yourself and the world a little more. I’m here with you, but I can’t tell you whether or not things will be fine.”

It’s probably worth talking about this process when the person isn’t in the midst of anxiously spiraling or compulsively seeking reassurance. If they’re unconvinced that learning to tolerate uncertainty is going to help them feel a lot better long-term, try showing them this blog post or any resource about ERP and habituation to anxiety. If they already know all this, just tell them, “Because I want you to feel better in the long term, and not just have short-term relief at the expense of your recovery, I’m not going to offer you reassurance when it seems like you’re asking me to get rid of uncertainty for you. But I’ll be happy to spend time with you while you feel this distress.”

If you’ve tried to help the person understand why you’re not giving them reassurance and they decide to look for it somewhere else, that’s out of your control. But hopefully you’ll find that a genuine offer of your emotional support, combined with a calm and nonjudgmental explanation of why you don’t want to reassure them and prevent their recovery, will do the trick.


We’ll be posting again soon with further examples of reassurance-seeking behavior, and strategies for relying less on reassurance. Keep an eye out.
If you want to learn more about OCD, visit our website

Photo: Justin Luebke

Patrick Carey

Author Patrick Carey

I’m a writer working with nOCD to make mental health less confusing.

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