DEFINING REASSURANCE SEEKING BEHAVIOUR

Reassurance seeking is defined as any explicit, implicit, verbal, or nonverbal behaviour where one seeks assurance from another individual, even if it has already been provided (Gillett & Mazza, 2018).

REASSURANCE SEEKING BEHAVIOUR AS PART OF NORMAL DEVELOPMENT

It is natural to seek some reassurance when confronted with uncertainty, lack of predictability and structure. Reassurance can come in the way of external reassurance or internal reassurance. External reassurance involves relying on others for feedback to calm a doubt, allay a worry, solidify a plan of action, or guide a decision. Internal reassurance involves relying on oneself by going inside and drawing comfort from one’s own resources (Landes, 2018). Everyone uses a combination of external and internal reassurance skills to handle situations effectively.

EXCESSIVE REASSURANCE SEEKING BEHAVIOUR OF CONCERN

For some children they seek external reassurances so many times that it becomes excessive.

It is important to note that ERS behaviour exists for a variety of reasons, and is particularly prominent in people with anxiety disorder, Obsessive-compulsive disorder, Hypochondriasis (excessively worrying about having a serious illness) and depression.

IMPACT OF EXCESSIVE REASSURANCE SEEKING BEHAVIOUR

When a child begins to persistently exhibit ERS behaviour, the climate of the context (e.g. childcare, early childhood, primary and secondary school, disability support and youth services) can change dramatically. A considerable amount of time and energy can be spent on the child showing the ERS behaviour, which can have a deleterious effect on the quality of the learning experience for all the children. Research consistently shows that managing behaviour is linked to staff experiencing high levels of stress, burnout and job dissatisfaction.

Example 1:

Jenny initially asked her teacher at the beginning of the day, ‘Is Mum going to pick me up at 3pm?’ When her teacher would say ‘Yes,’ Jenny would ask, ‘How do you know?’ When her teacher would answer the question, Jenny would appear to calm down; however, over time, the need for external reassurance worsened until Jenny was asking these questions several times throughout the day. The degree of her questioning also increased to a series of questions like, ‘Is Mum going to pick me up at 3pm? How do you know? What if there’s a traffic jam? What will happen if Mum gets here at 3:30pm? Will you leave if my mum isn’t here?’ It seemed as if the more questions the teacher answered, the more questions Jenny had. Jenny now asks these questions constantly, and the teacher can almost see that Jenny isn’t listening to the answers but thinking of the next question.

The example highlights how the need for external reassurance can become a never-ending cycle. Providing the external reassurance only relieves the child’s fear, worry and unease momentarily, but as soon as the external reassurance ends, the anxiety returns. This happens because when the child feels anxious (e.g. What if mum doesn’t come to pick me up?), they seek safety through reassurance, which makes them feel better. This bolsters their belief that if they hadn’t sought reassurance from an adult immediately, their anxiety may have increased, and the feared consequence may have happened. Thus, the ERS behaviour is reinforced, which can snowball into the child requiring more and more reassurance over time.

Hence, ERS affects everyone involved and the child who is seeking reassurance requires necessary help to learn positive ways of behaving and managing their emotions.

POSITIVE BEHAVIOUR SUPPORT AND EXCESSIVE REASSURANCE SEEKING BEHAVIOUR

Positive Behaviour Support (PBS) focuses on evidence-based strategies and person-centred supports that address the needs of the individual and the underlying causes of behaviours of concern, to enhance the quality of life for both the individual and those that support them.

PBS recognises that there is no single cause for ERS behaviour. It is a complex behaviour that is a product of the interaction between multiple factors contributing to its development and persistence.

ERS behaviour is like the tip of the iceberg so it is essential to look beneath the surface to work out the why before we can address the problem.

There are three main setting-related factors which impact the child and their behaviour:

  • environment
  • activity, and
  • interaction

These factors place different demands on the child and when any of these demands outweigh the child’s skills to cope with them, the child engages in ERS behaviour. ERS may be the only way the child has learnt how to respond to these demands and get their message across.

EXAMPLE 2:

Rani needs to make a choice of what she would like to buy from the ice-cream van. She keeps asking her mum ‘Should I get the vanilla ice-cream? What if I don’t like the vanilla ice-cream? Do you think I should get the chocolate ice-cream instead? What if I get the chocolate ice-cream and it doesn’t taste like the chocolate ice-cream I like? I don’t know which one to get can you please decide?’ The reason she is seeking external reassurance is because she is having difficulty coping with the discomfort caused by having to make a choice and feeling uncertain about what is the best decision. Rani is relying on others to guide her decision.

The example highlights that ERS behaviour is not without purpose. It is never too late to address ERS behaviour, even if it has been occurring for a while.

Developing a comprehensive and individualised PBS plan to address the ERS behaviour involves three stages: Assess-Manage-Prevent.

  • ASSESS: How to identify the reasons that contribute to the ERS behaviour,
  • MANAGE: How to respond when ERS behaviour occurs, and
  • PREVENT: How to minimise or eliminate the occurrence of ERS behaviour.

ASSESS STAGE

Assess Stage Aims

The Assess stage helps to identity:

  • Activities during which the ERS behaviour occurs,
  • Environments in which the ERS behaviour occurs, and
  • People dealing with the ERS behaviour.

Assess Stage Checklist:

  • Child’s profile – Gather information about the child to create a comprehensive picture of the child, their abilities and needs.
  • Behaviour data collection forms – Record measurable details (e.g. frequency, intensity, duration) about the child’s ERS behaviour.
  • Functional Behaviour Analysis (FBA)- Systematically reflect on an incident by analysing the antecedents (what preceded the ERS behaviour), describing the ERS behaviour, consequences (what happened after the ERS behaviour).
  • Hypothesis – Determine the purpose (function) that the ERS behaviour served.

MANAGE STAGE

Manage Stage Aims

The Manage Stage outlines how to effectively respond to the behaviours that occur before the ERS and after. Appropriate responses can help to safely defuse, redirect, and de-escalate the situation in the least disruptive manner.

Manage Stage Checklist:

  • Escalation stages – Help those supporting the child to recognise the number of stages the child exhibits as their emotion rises (i.e. mild escalation, moderate escalation, extreme escalation, and recovery stage).
  • Escalation profile– Help those supporting the child to recognise what non-verbal and/or verbal behaviours are exhibited in the different escalation stages, where the ERS behaviour occurs in the escalation and how long it can last.
  • De-escalation plan – Help those supporting the child with guidelines on how to immediately respond when the behaviour occurs, safely defuse, and de-escalate the situation in the least disruptive manner.

PREVENT STAGE

Prevent Stage Aims

This stage aims to minimise the occurrence of the ERS by minimising or avoiding the triggers that cause it and teach the child alternative behaviours.

Prevent Stage plan

The plan details strategies to minimise or avoid the triggers that contribute to the ERS behaviours by providing the child with:

  • Supportive environments – Tailoring environment related aspects to minimise or avoid triggers that contribute to the occurrence of ERS behaviour.
  • Supportive activities – Tailoring activity related aspects to minimise or avoid triggers that contribute to the occurrence of ERS behaviour.
  • Supportive interactions – Tailoring interaction aspects to minimise or avoid triggers that contribute to the occurrence of ERS behaviour, and
  • Teaching the child – Teaching the student positive ways of communicating their messages and managing their emotions and behaviours.

E FOR EXCESSIVE REASSURANCE SEEKING: POSITIVE BEHAVIOUR SUPPORT GUIDE

Use the practical tools (checklists, forms, and strategies) in E for Excessive Reassurance Seeking: Positive Behaviour Support guide to develop comprehensive PBS plans that can be used to support children of all ages consistently in all settings.

This invaluable guide is useful for parents, caregivers, educators in childcare, early childhood, primary and secondary schools, disability, mental health, allied health, and supervisory professionals.

References

  • Gillett, D.A., & Mazza, S.J. (2018). Clarifying a Construct: An Integrative Functional Model of Reassurance-Seeking Behaviors. Journal of Rational-Emotive & Cognitive-Behaviour Therapy, 36, 362–377.
  • Landes, L. (2018). Child Anxiety and Reassurance Seeking. Retrieved April 2020, from https://www.helpinganxiouskids.com/blog-1/anxiety-the-reassurance-junkie