Excessive reassurance seeking (ERS) is believed to play an important role in maintaining mental health problems, in particular anxiety disorders such as obsessive-compulsive disorder and health anxiety. Despite this, therapists commonly give into patients’ requests for reassurance in clinical settings and are generally unsure how to handle the issue both in therapy itself and concerning advice to the patient’s loved ones. In order to increase our understanding of therapists’ perception of ERS and how interventions for ERS are managed, we examined therapists’ perception and understanding of ERS, including its function, which emotional problems therapists associate it with, and what treatment interventions they consider important for managing ERS. Qualified therapists (n=197) were benchmarked against international expert consensus (n=20) drawn from leading clinical researchers. There was evidence that clinical experience right up to the expert level may result in less reassurance giving within treatment settings. Still, there were enough inconsistencies between the experts and other clinicians to suggest that ERS remains poorly understood and is not consistently dealt with clinically. Results are discussed in terms of how current treatment interventions may be limited for treating ERS, highlighting the need to consider new approaches for dealing with this complicated interpersonal behaviour.

Background: Repeated checking in OCD can be understood from a cognitive perspective as the motivated need to achieve certainty about the outcome of a potentially 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 with the proposal that the use of “just right feelings” to terminate checking are related to EER.

Impaired action processing may be a key feature of the obsessive-compulsive checking phenomenon, although the mechanism underlying the impairment remains to be explored. We examined the ability to parse a continuous flow of movements and perceptual changes into meaningful segments of action — a key component of action processing — in checking proneness. Participants (N = 65) completed a measure of obsessive-compulsive symptoms and, while viewing four videotaped movies, were requested to detect the transitions between significant action steps. The main result indicated that Checking — but not the other obsessive-compulsive dimensions — was negatively related, with the size of meaningful units identified. These findings suggest that checking proneness may be specifically connected with difficulties in processing actions on the basis of abstract features such as goal-related information. This could explain why people with checking symptoms find it more difficult to determine whether an intended goal has actually been achieved.

Researchers have suggested that distrust in one's memory is both a cause and a consequence of repeated checking. We investigated whether reduced clarity and confidence occurs to an equal degree with repeated object use and repeated checking. In addition, whether decreased memory confidence persists after a delay in checking or use was examined. Participants (N = 113) either repeatedly checked or repeatedly used a virtual stove or a light bulb stimulus (the control stimulus). Significant declines in memory accuracy, confidence, vividness and detail were observed for the experimental compared to the control stimulus. No significant differences in these effects between the checking and exposure conditions were found. A significant increase in state anxiety across pre-, mid- and post-test was found for both conditions. These findings provide further support for the notion that repeated checking can be self-perpetuating due to its impact on memory processes. The findings also suggest that checking is not necessary for these effects to occur as repeated use without checking also results in significant declines in memory accuracy, confidence, vividness and detail. Theoretical and clinical implications are discussed.

There is equivocal evidence whether or not patients with obsessive–compulsive disorder (OCD) share an attentional bias for concern-related material and if so, whether this reflects hypervigilance towards or problems to disengage from disorder-related material. In a recent study, we failed to detect an attentional bias in OCD patients using an emotional variant of the inhibition of return (IOR) paradigm containing OCD-relevant and neutral words. We reinvestigated the research question with a more stringent design that addressed potential moderators. A new IOR paradigm was set up using visual stimuli. Forty-two OCD patients and 31 healthy controls were presented with neutral (e.g., cup), anxiety-relevant (e.g., shark), checking-relevant (e.g., broken door), and washing-relevant (e.g., dirty toilet) cue pictures at one of two possible locations. Following a short or long interval sensitive to automatic versus controlled processes, a simple target stimulus appeared at either the cued or the uncued location. OCD patients responded significantly slower to targets that were preceded by an OCD-relevant cue. Results lend support to the claim that OCD patients share a processing abnormality for concern-related visual material. (JINS, 2009, 15, 365–371.)

According to the cognitive model, an inflated sense of responsibility is an important cognitive mediator both in the development and maintenance of obsessive-compulsive disorder (OCD). Empirical findings assign differential roles to responsibility in different kinds of obsessive-compulsive (OC) symptoms. However, findings that suggested a different function for responsibility revealed the need for an operational definition of responsibility and its multi-factorial structure. Few studies have examined the role of responsibility in OC symptoms in adolescents. The present study therefore aimed to explore responsibility concerns and to evaluate the relationship between responsibility dimensions and obsessive-compulsive symptom subgroups in two samples of adolescents and university students in a developing non-Western country. The findings suggested that the Responsibility Attitude Scale had a bifactorial structure, responsibility being based on self-dangerousness and prevention. Adolescents reported more responsibility in prevention and self-dangerousness than university students. The results appear to contribute to the symptom differentiation of OC behaviour by highlighting the importance of both dimensions of responsibility for checking symptoms, responsibility based on danger prevention for cleaning and, finally, responsibility based on self-dangerousness for obsessive thinking. Replication with clinical samples and different methodologies are encouraged.

The present study aimed to test the hypothesis that women with high shape concern would differ in their use of mirrors from women with low levels of shape concern. The “Mirror Questionnaire” was completed by 150 women, half of whom had high levels of shape concern. The findings support the notion that women with high shape concern differ from those with low concern in their use of mirrors, and argue for further investigation of the role of mirror cognitions and behaviours in the maintenance of body image disturbance.