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Coyne’s (1976) interpersonal theory of depression proposes that individuals suffering from depressive symptoms tend to engage in excessive reassurance-seeking (ERS), defined as repetitively asking for assurances from close others about one’s lovability and worth. Research has shown that ERS is associated with negative evaluations from close others and lower partner-reported romantic relationship satisfaction, specifically (Starr & Davila, 2008). In a recent elaboration of Coyne’s theory, Evraire and Dozois (2011) proposed that ERS might only lead to rejection among individuals who possess core beliefs about the instability and unpredictability of relationships. The primary goal of the current study was to provide the first empirical test of this revised model. Furthermore, I sought to extend previous research in 2 important ways by: 1) employing both self-reported and behaviorally-assessed measures of ERS and 2) defining rejection in objective, behavioral terms. I recruited a sample of 118 women who attended an initial laboratory session with their male dating partners. The couple completed measures of ERS, depressive symptoms, anxious attachment (AA), rejection sensitivity (RS), and relationship satisfaction, and engaged in a laboratory task that was later coded for incidences of female ERS. AA and RS were combined to index core beliefs reflecting insecurity in relationships (i.e., “negative relationship cognitions”; NRC). Women completed a contextual interview to retrospectively assess historical romantic relationship rejection events. The women were re-contacted four months later to determine their relationship status. Consistent with hypotheses, behavioral ERS was significantly associated with concurrent male relationship dissatisfaction, but only among dysphoric women with high NRC. Surprisingly, ERS was only significantly associated with historical rejection in non-dysphoric women with low levels of NRC. In the prospective models, I found a main effect of self-reported ERS on partner-initiated rejection, but behavioral ERS was only associated with rejection among non-dysphoric women. My results were inconsistent with theory and previous research in models defining rejection behaviorally. Thus, I proposed revisions to existing interpersonal models to better capture the relationship between ERS and “real-world” rejection. My results underscore the importance of evaluating ERS in a particular relationship when predicting rejection outcomes in that specific relationship. / Thesis (Ph.D, Psychology) -- Queen's University, 2013-06-13 13:39:01.64

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.

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