3 Treatment Modalities to Tackle Reassurance Seeking Compulsions in OCD

By Amanda Petrik-Gardner, LCPC, LPC, LIMHP, author of The Compulsive Reassurance Seeking Workbook

Reassurance seeking compulsions come in many sneaky shapes and sizes. From simply asking others if our obsession is true, to making confessions and watching for a reaction, to excessive googling for answers. Most individuals who have been diagnosed with obsessive compulsive disorder (OCD) have engaged in a reassurance seeking compulsion at some point or another. Ultimately, our goal is to eliminate compulsions, and fortunately, we have several treatment options to assist us toward recovery.

Exposure and Response Prevention (ERP)

ERP tackles reassurance seeking compulsions through the response prevention component of treatment. After experiencing distress from an obsession, there is an urge to engage in a compulsion in order to make the anxiety go away, to make the obsession go away, or to prevent a feared consequence. ERP encourages you to resist that urge. However, simply resisting that urge may be difficult, so different strategies can be implemented to reduce compulsions gradually until they can be eliminated.

One example of a response prevention strategy to delay reassurance seeking compulsions is delaying. Next time you have the urge to ask for compulsive reassurance, can you delay it? Start off in small increments. Try five minutes. If that seems doable, continue to increase the amount of time. Can you wait ten minutes? Maybe go an hour. This allows your body to recognize that you can tolerate the distress you are experiencing, and do not have to submit to the urge immediately. Eventually, the urge may even dissipate.

Acceptance and Commitment Therapy (ACT)

ACT aims to increase psychological flexibility by allowing internal experiences to exist (such as thoughts and feelings), creating distance from these experiences, staying present in the moment, connecting back to our values, in addition to other processes. Reassurance seeking compulsions can be reduced by connecting back to the here-and-now, and making sure our behaviors align with our values.

Take a moment to do an inventory of your values. What is most important to you, what do you want to achieve, what qualities and characteristics do you find admirable in yourself and others? Are your reassurance seeking compulsions bringing you closer to these values or further away from them? You may value your relationship with your significant other yet your reassurance seeking compulsions are straining your relationship. Or you may value your time with friends, yet the constant reassurance seeking texts are creating frustration and conflict. Use this information to bring awareness to your actions and commit back to a values-based lifestyle.

Inference-Based Cognitive Behavioral Therapy (I-CBT)

I-CBT is a cognitive treatment for OCD which resolves the faulty reasoning process behind our doubts leading to inferential confusion (when we mistake imagination for reality). Thus, if we no longer reason our way into obsessional doubts, compulsions do not occur, including reassurance seeking compulsions.

So, how does one get pulled into their obsessional doubt to begin with? Well, OCD does have a convincing argument; if it did not, we wouldn’t give our obsession the time of day. Our OCD says things like “Well it is possible. And it has happened to other people. I have read stories about this sort of thing.” OCD might throw in rules like “We should be careful” or “We should never do any harm.” OCD will throw in facts and arbitrary information you cannot debate like “Germs are everywhere and they are invisible.” And if you have ever had a similar experience to your obsession, OCD is definitely going to include that, like “Well, there was that one time you almost hit a pedestrian,” or “You did forget to turn off your stove one time in the past.” All of a sudden, OCD has a very convincing story that has pulled you in.

I-CBT explores the story and faulty reasoning process that pulled us in so quickly, that led us to feel compelled to engage in compulsions. As we shine a light on OCD’s tricks and recognize that we do not engage in this type of obsessional reasoning process in non-OCD situations (we use a normal reasoning process elsewhere), OCD’s story loses its hold over us.

Amanda Petrik-Gardner, LCPC, is an obsessive-compulsive disorder (OCD) and body-focused repetitive behavior (BFRB) specialist, licensed in multiple states. She is a member of the International OCD Foundation, TLC Foundation for BFRBs, and the Anxiety and Depression Association of America. Amanda is on the board for OCD Kansas, a state affiliate of the International OCD Foundation, and is author of An OCD Exposure Coloring Book.