Journal of Anxiety Disorders 25 (2011) 911–917 Contents lists available at ScienceDirect Journal of Anxiety Disorders Assessing excessive reassurance seeking in the anxiety disorders Neil A. Rector a,b,∗ , Katy Kamkar b,c , Stephanie E. Cassin a,b , Lindsay E. Ayearst d , Judith M. Laposa b,c a Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada b University of Toronto, Ontario, Canada c Centre for Addiction and Mental Health, Toronto, Ontario, Canada d York University, Toronto, Ontario, Canada a r t i c l e i n f o Article history: Received 15 November 2010 Received in revised form 9 May 2011 Accepted 9 May 2011 Keywords: Reassurance seeking Safety behaviors Anxiety Anxiety disorders Measurement CBT a b s t r a c t Reassurance seeking has long been hypothesized to be a key factor in the maintenance of anxiety within contemporary cognitive-behavioral approaches to the conceptualization and treatment of anxiety dis- orders. However, empirical studies have lagged due to the absence of a reliable and valid measure of reassurance seeking. The present study sought to develop and examine the psychometric properties of a theoretically derived measure of reassurance seeking in treatment-seeking participants with DSM-IV-TR (American Psychiatric Association, 2000) social phobia (n = 116), generalized anxiety disorder (n = 75), panic disorder with or without agoraphobia (n = 50), and obsessive compulsive disorder (n = 42). Partic- ipants (N = 283) completed the Reassurance Seeking Scale (RSS), Depression Anxiety Stress Scale, Beck Anxiety Inventory, and Beck Depression Inventory-II. An exploratory factor analysis resulted in a coher- ent three factor solution reflecting the need to seek excessive reassurance regarding: (1) uncertainty about decisions, (2) attachment and the security of relationships, and (3) perceived general threat and anxiety. The RSS was found to possess good internal consistency and was moderately correlated with measures of anxiety, stress, and depression. The psychometric properties of the RSS appear promising for the promotion of programmatic research on reassurance seeking and its treatment in the anxiety disorders. © 2011 Elsevier Ltd. All rights reserved. 1. Introduction Excessive reassurance seeking (ERS) has long been described as an important mechanism in managing psychological distress. Reassurance seeking has been shown to immediately reduce anx- iety, but this temporary reduction in anxiety is typically followed by a paradoxical increase in anxiety and an urge to seek additional reassurance, leading to increased frequency of reassurance seeking over time (Abramowitz, Schwartz, & Whiteside, 2002; Salkovskis & Warwick, 1986). Excessive reassurance seeking also appears to interfere with habituation to anxiety and contributes to the main- tenance of threat and an underestimation of the person’s ability to cope on their own with anxiety (Lohr, Olatunji, & Sawchuk, 2007; Parrish & Radomsky, 2010). Several definitions of ERS have been proposed, ranging from generic behavioral definitions such as “direct verbal requests for the repetitive provision of old informa- tion” (Salkovskis, 1985), to definitions that include the motivational factors thought to underlie ERS in specific psychological disorders. ∗ Corresponding author at: Sunnybrook Research Institute, Department of Psy- chiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, Ontario, M4N 3M5, Canada. Tel.: +1 416 480 6100x2233; fax: +1 416 480 5345. E-mail address: Neil.Rector@sunnybrook.ca (N.A. Rector). Salkovskis (1985) described ERS in the context of obsessive com- pulsive disorder (OCD) as an attempt to “put things right” and avert the possibility of being blamed by self or others for some- thing that one may be responsible for by diffusing responsibility for adverse events. Rachman (2002) notes that despite appear- ing as requests for information, requests for reassurance are most typically attempts to find safety from harm. Thus, requests for reassurance might temporarily reduce psychological distress by reducing the perceived threat and/or increasing perceived coping resources by diffusing responsibility for adverse events so that one does not have to cope with the threat alone. Reassurance sought by individuals with OCD has been concep- tualized as a compulsive checking behavior (Parrish & Radomsky, 2010; Rachman, 2002) and a form of neutralization behav- ior (Salkovskis, 1985). Reassurance seeking, neutralization, and compulsive checking share common features, and all can be con- ceptualized as attempts to reduce the probability of an adverse event, the effects of the event, or one’s responsibility for the event (Rachman, 2002; Salkovskis, 1996). For example, individuals with OCD might ask for reassurance that they will not become con- taminated or spread contaminants to others after coming into contact with bodily fluids or dirty substances. They might also ask others to ensure that doors are locked and appliances are turned off in order to prevent harm to self or others, or as a way 0887-6185/$ – see front matter © 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.janxdis.2011.05.003