Reassurance seeking behaviour: An engine of anxiety/OCD sufferers

If someone asked me what are a few words that may summarise the needs and actions of anxiety and obsessive-compulsive disorder (OCD) clients, I would say - control, reassurance behaviours, and beliefs that things may happen to them.

That might be through magical events or through simply thinking about bad things. (In this case, magical events are assumed life events that may take place if a client does not carry out some action. For example, some people may believe that if they think something bad in a church or mosque, their mother or father will get ill).

Let me explain further. The sense of  ‘lack of control’ may be exacerbated by feelings of stress, panic attacks, intrusive thoughts or feelings of some kind of impending catastrophe that some people may feel. The feelings and experiences that they have create a sense of things being done to them, rather than them being able to manage them. Over time, a sense of lack of control reduces their confidence, and self-esteem and worse still, makes them feel that they are somehow incapable or lesser than other people. In other words, they are somehow deficient and this has an ongoing impact on their self-esteem and confidence. It is a vicious cycle and the lower the self-esteem, the less a person’s ability to manage anxiety, phobias or OCD obsessions or compulsions.

The reality is that such individuals are not deficient and working with them to a point where they can understand the events, thoughts or perceptions that formed the root of their anxiety, phobias, OCD or panic is a start. It is an important foundational start.

However, this is only the start of a journey for therapists. Through this working journey with clients, reassurance-seeking behaviours may show themselves in various ways in therapy. For example, clients may subtly ask for reassurance on matters that are causing them anxiety, such as whether they may have a heart attack or whether they will harm someone. Any reassurance from therapists may simply fuel and entrench such thinking and so therapists need to be in a position where they can get clients to test out or expose themselves to activities that test out these thoughts. This is essential and it is also key that therapists look for any reassurance behaviours that may creep in over time as exposure work is carried out by clients.

It is also appropriate that stress management techniques are discussed with clients. This work is not easy for clients and they will need to find ways to manage their stress, whether that be through walking, running, swimming or doing anything that reduces their stress levels. Stress is integrally linked to higher levels of anxiety, obsessions and compulsions and panic attacks. Additionally, untreated anxiety can grow branches of phobias that can start to limit the lives of anxiety sufferers. So stress management is another part of the strategy of therapeutic services that need to be employed by therapists.

Lastly, I want to come onto the issue of ‘magical events’. These are catastrophic life events that may happen if a client suffering from OCD, for example, does not address them through energy-sapping compulsive behaviours. Some people that I have worked with talk about their need to repeatedly keep away from cracks in pavements, steer clear from graveyards or even ensure that they do not write down odd numbers, just in case, it leads to harm against someone they love. In other words, such individuals believe that they can control the outcome of something bad happening through their actions. It is therefore what we call, a form of magical thinking.

As I said, this usually involves some kind of compulsive set of rituals that will be undertaken until the individual feels better and they are satisfied that they have done enough to ensure that the harmful event does not happen.

Part of the treatment strategy must therefore assess whether clients have magical thoughts and if so, it is important for therapists to devise a plan where clients don’t carry out the compulsions, whilst therapists assess ways that clients can manage the uncertainty which fuels their anxiety, obsessions and compulsions.

This is multi-layered work that needs empathy, compassion and consistent communications with clients. The results though can be life-changing and set sufferers on a path to a quality of life that many probably thought was never achievable.