Clarifying a Construct: An Integrative Functional Model of Reassurance-Seeking Behaviors

Is everything really okay?: Using ecological momentary assessment to evaluate daily co-fluctuations in anxiety and reassurance seeking

OBJECTIVE

Reassurance seeking, a behavior prominent in anxiety disorders and depression, is associated with poorer quality of interpersonal relationships and acts as a mechanism of stress generation. However, little research has elucidated momentary associations between state anxiety and reassurance seeking behaviors.

METHOD

In a sample of 104 university-affiliated young adults, we sought to replicate cross-sectional associations of reassurance seeking with trait anxiety (Aim 1) and intolerance of uncertainty (Aim 2). We then used ecological momentary assessment (EMA) to evaluate concurrent fluctuations in daily anxiety and reassurance seeking across 14 consecutive days (Aim 3). Hierarchical multi-level models for intensive longitudinal data were used to evaluate the relationship between state anxiety and daily reassurance seeking.

RESULTS

In baseline analyses, trait anxiety and intolerance of uncertainty were significantly associated with greater trait reassurance seeking, controlling for depression. Analyses of the EMA data showed that daily reassurance seeking behaviors fluctuated concurrently with daily anxiety during the 14 days, while controlling for trait anxiety and depression.

CONCLUSION

Given evidence of concurrent fluctuations between state anxiety and reassurance seeking, the behavior should be considered as a potential target in treatment for anxiety disorders.

Gender differences in the relation between interpersonal stress and momentary shape and weight concerns in youth with overweight/obesity

The purpose of this study was to examine relations between interpersonal stress and momentary shape and weight concerns among pre-adolescent and early adolescent boys and girls with overweight/obesity, using ecological momentary assessment (EMA). We also aimed to determine whether interpersonal stress was differentially related to shape/weight concerns in boys versus girls. Forty youth, ages 8-14 years (53% female), with overweight or obesity reported their state-level shape/weight concerns and negative affect and their recent interpersonal stress (i.e., stress experienced since the last EMA assessment) multiple times a day, for two weeks. Results indicated that interpersonal stress predicted shape/weight concerns in girls but was not related to shape/weight concerns in boys. At the between-person level, higher overall feelings of loneliness and social rejection and a higher overall desire for more friends predicted higher average levels of shape/weight concerns. At the within-person level, higher momentary ratings of loneliness, social rejection, and desire for more friends predicted lower shape/weight concerns. These data suggest that the tendency to experience interpersonal stress may be more detrimental to body satisfaction for girls with overweight/obesity than for boys with overweight/obesity. Interventions that focus on reducing interpersonal stress may be effective in ameliorating shape/weight concerns in girls with overweight/obesity.

Adolescent girls' stress responses as prospective predictors of self-injurious thoughts and behaviors: A person-centered, multilevel study

Adolescent risk for self-injurious thoughts and behaviors (STBs) involves disturbance across multiple systems (e.g., affective valence, arousal regulatory, cognitive and social processes). However, research integrating information across these systems is lacking. Utilizing a multiple-levels-of-analysis approach, this person-centered study identified psychobiological stress response profiles and linked them to cognitive processes, interpersonal behaviors, and STBs. At baseline, adolescent girls (N = 241, Mage = 14.68 years, Range = 12-17) at risk for STBs completed the Trier Social Stress Test (TSST), questionnaires, and STB interviews. Positive affect (PA), negative affect (NA), and salivary cortisol (SC) were assessed before and after the TSST. STBs were assessed again during 3, 6, and 9 month follow-up interviews. Multitrajectory modeling of girls' PA, NA, and SC revealed four profiles, which were compared on cognitive and behavioral correlates as well as STB outcomes. Relative to normative, girls in the affective distress, hyperresponsive, and hyporesponsive subgroups were more likely to report negative cognitive style (all three groups) and excessive reassurance seeking (hyporesponsive only) at baseline, as well as nonsuicidal self-injury (all three groups) and suicidal ideation and attempt (hyporesponsive only) at follow-up. Girls' close friendship characteristics moderated several profile-STB links. A synthesis of the findings is presented alongside implications for person-centered tailoring of intervention efforts.