Excessive Reassurance Seeking (ERS) is an under-researched and poorly understood behaviour that resembles the compulsive behaviours that are typically seen in obsessional problems. ERS can be complex, persistent, extensive, debilitating and may dominate the interactions of those involved. In addition to resembling compulsive checking in Obsessive-Compulsive Disorder (OCD) it may have the effect of transferring responsibility to another person. However, it could be seen as a type of support. Both ERS and support are defined and key questions about these concepts are considered in five studies which examine ERS from the perspectives of non-clinical samples, sufferers of anxiety problems, caregivers and therapists. Study 1 qualitatively examines interpersonal components of ERS in OCD and identified the experience of frustration in caregivers as being particularly pervasive. Study 2 examines the diagnosis specific/transdiagnostic elements of ERS in OCD and health anxiety contrasted with support using mixed methods. Results revealed some limited diagnosis specificity of ERS. Strikingly, people with health anxiety did not seek support; reassurance seeking may be their default response. Study 3 uses a larger sample to quantitatively evaluate therapists’ perception of ERS and its treatment, with results suggesting that there is considerable room for improvement. Study 4 examined therapeutic intervention for ERS in treatment refractory OCD using a single case experimental design; Cognitive Behavioural Treatment (CBT) that focuses on treating ERS had beneficial effects. Study 5 tackled the diagnosis specific/transdiagnostic issues in a questionnaire by considering ERS across different anxiety problems. ERS may represent a final common pathway of multiple processes; some processes appear transdiagnostic; others may indicate disorder specificity. Overall, findings reveal the complexity of ERS and its likely nature as a safety-seeking behaviour which requires attention in treatment. Engendering support as an alternative to reassurance in CBT may be particularly promising.

<p>The purpose of this thesis was to develop novel ways to study tinnitus, to investigate the course of tinnitus, and to study the effects of cognitive-behaviour therapy on tinnitus related distress. Data from 377 tinnitus patients were collected.</p><p>A group of 216 patients completed audiological measures and were assessed in a structured interview. The Klockhoff and Lindblom's grading system was used and its inter-rater reliability assessed in a subsample showing a high degree of correspondence. A discriminant analysis showed that a substantial proportion of patients could be correctly classified into grade II or III, by measures of pitch, minimal masking level of tinnitus, avoidance of situations because of tinnitus, and tolerance in relation to onset.</p><p>Using tests developed in cognitive psychology, it was found that tinnitus patients had impaired performance. There was no evidence for an attentional bias towards tinnitus related words using a computerized emotional Stroop task, but masking sounds of an "on-and-off" character were more disruptive than constant masking when patients performed the digit-symbol test. It is suggested that tinnitus distress may be increased by the 'changing-state' character of the tinnitus signal, or alternatively by intermittent masking sounds.</p><p>In a case-study a patient received an i.v. injection of lidocaine while Positron Emission Tomograpy was conducted. The brain activity associated with tinnitus included the left primary, secondary and integrative auditory brain areas, as well as right paralimbic areas related to negative feelings. The precuneus (Brodmann area 7) might be a brain area involved in the aversiveness associated with tinnitus.</p><p>Using a tinnitus questionnaire as the dependent measure it was found that tinnitus maskability at admission predicted distress at follow-up for an average of five years following admission. Some improvement in tinnitus occurred over time, but this was more evident in patients who had received a cognitive-behavioural treatment program.</p><p>The effect of an Internet based cognitive-behavioural self-help treatment program for tinnitus was investigated showing a high dropout rate, but with positive results in that the treated patients improved.</p>

The purpose of this thesis was to develop novel ways to study tinnitus, to investigate the course of tinnitus, and to study the effects of cognitive-behaviour therapy on tinnitus related distress. Data from 377 tinnitus patients were collected. A group of 216 patients completed audiological measures and were assessed in a structured interview. The Klockhoff and Lindblom's grading system was used and its inter-rater reliability assessed in a subsample showing a high degree of correspondence. A discriminant analysis showed that a substantial proportion of patients could be correctly classified into grade II or III, by measures of pitch, minimal masking level of tinnitus, avoidance of situations because of tinnitus, and tolerance in relation to onset. Using tests developed in cognitive psychology, it was found that tinnitus patients had impaired performance. There was no evidence for an attentional bias towards tinnitus related words using a computerized emotional Stroop task, but masking sounds of an "on-and-off" character were more disruptive than constant masking when patients performed the digit-symbol test. It is suggested that tinnitus distress may be increased by the 'changing-state' character of the tinnitus signal, or alternatively by intermittent masking sounds. In a case-study a patient received an i.v. injection of lidocaine while Positron Emission Tomograpy was conducted. The brain activity associated with tinnitus included the left primary, secondary and integrative auditory brain areas, as well as right paralimbic areas related to negative feelings. The precuneus (Brodmann area 7) might be a brain area involved in the aversiveness associated with tinnitus. Using a tinnitus questionnaire as the dependent measure it was found that tinnitus maskability at admission predicted distress at follow-up for an average of five years following admission. Some improvement in tinnitus occurred over time, but this was more evident in patients who had received a cognitive-behavioural treatment program. The effect of an Internet based cognitive-behavioural self-help treatment program for tinnitus was investigated showing a high dropout rate, but with positive results in that the treated patients improved.