Seeking Reassurance when HA strikes - Opinions

[Emmapony]

I know I am the worst for it!!!! But today I had a very interesting CBT session. I am probably not allowed to go into a lot of details but one very interesting topic that came up was about how seeking reassurance i.e. on health forums of even from family and friends just makes the worry grow and just cause the cycle to repeat.
I wonder how many people who suffer with HA think that this is correct. Does seeking re assurance just make the worry stick around for longer or does it actually help you feel better.
I often feel it is a short term solution and the worry will only plague me again in a few days!
Would be interested to hear others opinions on this! :bighug1:

[MyNameIsTerry]

I don't have HA but I do have GAD & OCD. OCD has reassurance as one of its possible compulsions. So, I'll try to explain how I see this from an OCD context as I believe there are similarities to HA. It should also be noted that some of the people who post in the HA section demonstrate known forms of OCD e.g. contamination as opposed to a Somatoform Disorder.

The first thing to understand is that compulsions can be based on self reassurance or mitigation of they can be based on the reassurance you are raising, the kind you receive from an external source or person.

Some examples of reassurance rituals are:

- confession compulsion which aims to get closure from the other person. This is a short lived form of reassurance and the obsession then starts the cycle off again about the same elements or different ones or both.

- the more standard form of reassurance seeking seen more in "Pure O" forms of OCD e.g. fear of having a more serious psychiatric disorder such as schizophrenia, contamination issues such as HIV (I've seen threads for battery acid on the OCD board), paedophilia OCD where the person seeks constant reassurance that they are not changing into a paedophile or could abuse their own babies/children (common to new parents), hamd based OCD where the person has a similiar need to be reassured they are not turning into a violent psychopath, etc.

- Self reassurance compulsions are the more classic view of OCD where you check locks, wash your hands, etc but extends into more complex issues and includes things like touching rituals, mitigation rituals that can also involve use of imagery, needing to walk on the cracks in the pavement, etc. Thats all reassurance and/or risk mitigation.

So, you can see that what is discussed on the HA board has some similiarities to the OCD guys hence why this board can be a bit jumbled at times. They are not the same though and Googling may have no impact on the OCD person, the same level of impact or a different one such as using Dr Google to actually reassure as opposed to cause fear. Google can also be a trigger due to what you find e.g. seeing a picture of a child in a bathing suit could easily cause panic to the paedophilia OCD person but they may be able to use the internet otherwise and this depends on their severity.

So, the issue of "don't Google" isn't quite as clear as people may think it is. But thats because of how the HA board has been structured and how people don't often understand the difference between things like OCD and other conditions. Some can even be GAD based hence again whether Googling is an issue depends on the persons individual circumstances.

In OCD, acting out compulsions/rituals is part of the anxiety cycle. While you do this, you can't resolve your anxiety because you are still allowing the obsession to drive you to act out the compulsion. This reinforces the disorder in your subconscious.

Anxiety at a subconscious level includes associations between feelings, thoughts, emotions, sensations and even memories as you have probably learnt in CBT early on. So, by acting on the obsession to act out the compulsion, you tell your subconscious that the pattern is "valid". Notice the use of the word "valid" and not correct.

You have to cut out the reaction to the obsession. Your subconscious looks for emotional reactions, the stronger the better, and uses them to validate its behaviour in producing the intrusive thoughts or obsessions. So, if you act in a non judgemental way, as taught in Mindfulness, your subconscious doesn't see an strong negative reaction anymore. In time this changes the associations as you get a new one between the obsession and no reaction so the anxiety fades out of the step that drives the compulsion. In time the anxiety goes and you can still end up with an obsession that no longer drives an anxiety based compulsion and seems to serve little use in your mind. Eventually this goes to as you retrain your subconscious to use a different set of associations thus the obsession stops.

In HA people seem to be chasing for an answer, often to an irrelevent question. This is often the case in OCD too. In OCD someone may be chasing tests for things like HIV or it could just be a search for what it causing their thoughts (which again could be seen in any disorder as it can just be an obsessional tendency).

The reassurance they get with do the same as in HA because it has the same temporary calming effect. With shorter compulsions such as checking or touching, it may not even do that and sometimes you feel worse immediately out of frustration to act out what you feel you have no control over in your body.

In the long term, whichever form it takes, it reinforces the disorder. This is why breaking the cycle or reducing it is important but not only this but stopping that negative reaction to the obsession and changing how you view your thoughts.

So, if I said to you 'I HAVE to touch this lightswitch or something bad could happen to my parents' (a real example of one of the many compulsions I had), would you tell me to touch it so I can get past it or would you tell me that if I do that I will only reinforce my need to keep doing it?

Is that so far away from what people tell each other on the HA board?

---------- Post added at 05:30 ---------- Previous post was at 05:24 ----------

I've put this in a seperate post as it likely broadens the issue outwards.

Is reassurance just a "safety behaviour?" These can be seen in every anxiety disorder such as carrying water with you to going out with a friend for support. They are helpful in the short term when you are more severe but in the long term you have to break these too otherwise they will keep reinforcing your view that you need them to protect you.

Safety-seeking behaviours are behaviors which are carried out (either overtly or covertly) and which are intended to prevent feared catastrophes. While in the short-term they act to reduce anxiety, they have the unintended consequence of maintaining anxiety in the long term by preventing disconfirmation of an unhelpful belief. Three main types of safety behavior have been identified:

Direct avoidance (overt, observable)
Escape (overt, observable)
Subtle avoidance (covert, often internal processes)
Although safety behaviors are labelled 'behaviors' they can also be internal processes or cognitive strategies, such as using distraction during an episode of panic, or rehearsing what you are going to say in social phobia.

Safety behaviors often seem to overlap with adaptive coping strategies. For example, distraction can be a safety behaviour, but it can also be a helpful strategy if we are in pain at the dentist. Avoidance can be a safety behaviour, but it can also be life-saving in a truly dangerous situation. The key point of differentiation is the intention of the action and whether it is, for example, designed to reduce anxiety (adaptive - anxiety is unpleasant) or to prevent a feared catastrophe (maladaptive - long-term benefit is more likely to come from challenging unhelpful belief).

Some useful examples:

DESCRIPTION
Safety-seeking behaviors are a response to a feared catastrophe. While safety behaviors can provide relief in the short term, they have the effect of reinforcing beliefs about threat, mean that beliefs don't get challenged, or lead to other unintended consequences. This worksheet gives an example from the Simpsons of the thought process underlying safety behaviors.

http://media.psychology.tools/worksheets/english_us/safety_behaviors_example_en-us.pdf?

DESCRIPTION
Safety-seeking behaviors are a response to a feared catastrophe (think 'fight or flight' - people naturally act to keep themselves safe). Unfortunately, while safety behaviors can provide relief in the short term, they have the effect of reinforcing beliefs about threat, mean that beliefs don't get challenged, or have other unintended consequences. This CBT worksheet provides a clear and comprehensive explanation of safety behaviors.

http://media.psychology.tools/worksheets/english_us/safety_behaviors_en-us.pdf?

Even worse that this is that these will impact on your core beliefs. They will create new ones or "associated cores" by attaching to a current negative one.

The second worksheet explains the difference between "safety behaviours" and "adaptive behaviours". The latter are the healthy aim.

[Fishmanpa]

In short, your therapist is spot on. Reassurance seeking is like crack to an addict. You know it's not good for you but you do it even when it flies in the face of all logic.

That's not to say we shouldn't seek it at all. Some amount of what I will call "normal" reassurance is welcome in life. Knowing you're safe and loved, are doing a good job at work etc. is normal IMO. Asking a group of strangers on a forum to reassure you after a medical professional has done so isn't, again IMO.

At best it's a quick fix that lasts only a short time. At worst it keeps you focused on the problem and prevents you from moving forward and does nothing to quell your fears. I call it "Yeah But" disease... "You're fine"... "yeah but......" Many times an individual will just move from fear to fear to fear and the cycle just continues.

I've seen many who have started therapy and drifted away from the boards and it proves what your therapist is saying.

Positive thoughts

[lyndau63]

I had CBT and was told that you shouldn't seek any type of reassurance, even going over things in you head to recall what has been done or said as this too is a type of reassurance. I find that very hard I must say.

[Liv7117]

I had a therapist appointment recently and my therapist encouraged me to google my symptoms claiming it would reassure me that I wasn't dying. I disagree with her thoughts on the subject as using google simply makes me more scared because my HA makes me think irrationally. I am not taking my therapists advice and have been avoiding reassurance. I think posting kind of makes me more anxious and find that ignoring my fears helps more. I've also started journaling which I find helpful. You might have noticed that I posted a thread and then deleted it, because I am trying to avoid seeking reassurance and trying to simply do things to distract me from my anxieties. Anyway, I basically think that posting here for reassurance may help someone in the short term, but in the long term it does not. It provides me with a brief moment of reassurance, only to be replaced with more fear. This is just my experience, I'm not saying it's the same for everyone.

---------- Post added at 19:00 ---------- Previous post was at 18:58 ----------


I had a therapist appointment recently and my therapist encouraged me to google my symptoms claiming it would reassure me that I wasn't dying. I disagree with her thoughts on the subject as using google simply makes me more scared because my HA makes me think irrationally. I am not taking my therapists advice and have been avoiding reassurance. I think posting kind of makes me more anxious and find that ignoring my fears helps more. I've also started journaling which I find helpful. You might have noticed that I posted a thread and then deleted it, because I am trying to avoid seeking reassurance and trying to simply do things to distract me from my anxieties. Anyway, I basically think that posting here for reassurance may help someone in the short term, but in the long term it does not. It provides me with a brief moment of reassurance, only to be replaced with more fear. This is just my experience, I'm not saying it's the same for everyone. I also agree that it is very difficult to stop seeking this reassurance

[MyNameIsTerry]

I had a therapist appointment recently and my therapist encouraged me to google my symptoms claiming it would reassure me that I wasn't dying. I disagree with her thoughts on the subject as using google simply makes me more scared because my HA makes me think irrationally. I am not taking my therapists advice and have been avoiding reassurance. I think posting kind of makes me more anxious and find that ignoring my fears helps more.

Its worth discussing with the therapist. There are reasons why Googling in therapy are used but not as a form of reassurance but as a Behavioural Experiment or as part or an exposure treatment.

It would hardly help you to Google for reassurance. Until you understand your thoughts and things like Cognitive Distortions enough to challenge them, Googling is only going to mean you focus on the scary stuff as opposed to using Google to look at everything that comes up and then coming to a conclusion that it is not anything scary. Otherwise its only like someone with OCD, like me, being told to act on my obsession by acting out my compulsion for reassurance, which is a reinforcement of my anxiety!

Its worth discussing what you do to ignore your fears. If by ignoring you do healthy things to take you away from the fears then its a positive thing (at some point being able to face them is still needed to know you can handle it) but I would be wary of trying to push thoughts away as that can reinforce the subconscious view that they are "valid". Not correct, just valid as a process.

---------- Post added at 04:31 ---------- Previous post was at 04:27 ----------


I had CBT and was told that you shouldn't seek any type of reassurance, even going over things in you head to recall what has been done or said as this too is a type of reassurance. I find that very hard I must say.

Going over things in your head in an OCD context would be "Mental Checking". So, its just another compulsion and one that is often seen in the Pure O forms.

I'm not sure how you can avoid going over things in your head completely though, we need to do that in normal life anyway. It sounds a bit odd considering in CBT you are trying to challenge negative thoughts and to do that, you need to use your cognitive ability to come up with the counter evidence. Maybe it means not obsessing over the negative elements in your head? Or maybe even to do it on paper, like in a CBT Thought Record which is aimed at something like this?