Guest Blog; Peter Klein CBT Therapist
Peter Klein is a BABCP-accredited CBT therapist working in Richmond and online, mainly with CBT for anxiety and OCD
Why reassurance never settles it
If you have ever asked the same question twice, you already know the shape of this. You ask whether the lump is harmless, whether the door was locked, if you said the wrong thing. Someone answers. You feel better. Then the doubt comes back, a little louder than before, and you ask again. That is reassurance-seeking, and it is one of the commonest things I see in the clients who come to me with anxiety. It is also one of the most understandable. The answer genuinely helps, for a few minutes. The trouble is what those few minutes teach you.
Why the relief does not last
Anxiety is not usually a problem with answers. It is a problem with certainty. What you are after, on the tenth asking, is not information. It is the feeling of being sure, and nobody else can hand you that feeling. So every answer does 2 things at once. It drops your anxiety for a minute, and it confirms that the doubt was worth asking about. Next time round the question arrives with more weight behind it, not less. Checking grows. A question asked once becomes a question asked 20 times in a day, and the person answering moves from your partner to a friend to a search engine to a doctor. I have had clients work through 3 people in an afternoon with the same question, worded slightly differently each time. Clients describe it as a question that keeps reopening. What they notice most is the exhaustion, and the sense of having done all this before.
Where it fits, and where it does not
Reassurance-seeking is a normal human response. Ruling out a real medical problem is sensible. Asking a friend how they handled something similar is sensible. A mild version of the pattern is not a problem at all. It becomes a problem when it turns into the main way you manage anxiety: when asking feels compulsory, when the relief lasts a shorter and shorter time, and when the people around you begin to look tired of it. You will see it in generalised anxiety and in health anxiety, and it is one of the most common compulsions in OCD, where it is often the last one to be noticed because it looks like ordinary conversation. It can be entirely mental, too. Replaying a conversation, checking a memory, going back over a decision. All of it does the same job as asking out loud. One distinction is worth holding on to. Asking for certainty is not the same as asking for help, and the pattern to watch is repetition, along with the sense of never quite concluding anything.
What helps instead
The treatment for this is exposure and response prevention, and the awkward part is that it means not doing the thing that has been helping. Given how unpleasant that is, it is worth knowing why it works. The aim is not to leave anxiety alone for ever. It is to let the anxiety be there without the question being answered. When you sit with the doubt rather than resolving it, you learn something the reassurance could never teach you: that you can carry the not knowing. That is the part that travels with you. It is done gradually, over a course of treatment rather than in one go. In my own practice a course for this runs between 8 and 20 sessions of about 50 minutes, weekly at the start, and the first weeks go on understanding the pattern before anything is withdrawn. A few things that help: • Agree the terms with the people around you. Tell them what you are working on and ask them not to answer. Not coldly, just consistently. • Start with the smaller doubts. Build the experience before you take on the worst one. • Put a delay in before you ask, then stretch it. 2 minutes becomes 10, then 30. • Write the question down instead of asking it, and come back to the page later rather than to the person. • Notice the difference between asking for help and asking for certainty. That last one matters most. Asking a friend how they coped with something similar is support. Asking them, for the fifth time, whether they are sure nothing is wrong, is the compulsion.
Reassurance in health anxiety
Health anxiety has its own version of this, and it is the one that costs the most time and money. The checking takes the form of scanning your own body, searching symptoms at 2 in the morning, asking a partner to look at something, and going back to the doctor. A clear result works better than anything else in the short term. It can settle the fear for a week. Then a new sensation turns up and the whole sequence starts again, with the last clear result counting for nothing. That is not because the person is unreasonable about evidence. It is because evidence was never quite what was being asked for. If certainty is the goal, no test reaches it. There is always one more test, one more opinion, one more search at midnight. So the work is the same as it is anywhere else. The checking has to come down, and the anxiety has to be met without it. That is harder when the fear is about your own body, which is why it is done with a therapist, and at a pace you agree to.
What the middle of it feels like
Two or three weeks in, most people report that the anxiety is worse rather than better. That is expected, and it is the point at which people stop. Nothing has gone wrong. You have stopped handing the uncertainty to somebody else, so for a while you are carrying all of it yourself, and that is heavier before it is lighter. What changes first is the time. The question takes up less of the day well before it takes up less of your attention. Clients often notice they have got through a morning without asking, and that the morning was fine.
When to get help
If the checking takes up a significant part of your day, if the relief no longer lasts, or if the people around you are worn down by it, that is reason enough to work on it with a therapist. CBT and ERP are well evidenced for this, and both are as effective online as they are in a room. A last thought. Progress here is not the absence of doubt. It is doing what matters to you while the doubt is there. Clients tell me the moment it changed was not when the worry stopped, but when they stopped needing it to.
Peter Klein runs kleincbt.com, a CBT practice in Richmond and online for anxiety and OCD.