A clinician named Hallam in 1974 identified reassurance seeking as a common compulsion in pediatric ocd. He described inpatient treatment of a 15 yr old female with OCD who sought reassurance regarding her social status, appearance, and whether others were gossiping about her. At first, unit staff were trained to respond to her questions by saying "I can't answer that" or "that question is a ritual". However, her ocd persisted in seeking reassurance. After realizing that the clinical approach wasn't working, the treatment team tried a new strategy-not responding to the questions at all. Instead, they turned their head/body away from met momentarily, and then redirected the conversation onto another topic. Hallam stated that this protocol dramatically reduced the number of questions she asked. Success!!! - Only, there's a catch. He didn't actually collect any data. So, fast forward to 1988, a doctor named Greta Francis has an 11yr old male client with OCD. He fears a variety of illness and death. Multiple times a day he asks his parents questions like "will I throw up today?" "will I die today?" "am I going blind?" or "do I have a tumor?". Francis decided to implement the treatment Hallam wrote about... But to collect data while doing it. - She designed a multiphase experiment. First, she and the boy's parents broke the day into four blocks (wake up to leaving for school, arriving home from school to 3pm, 3pm to end of dinner, end of dinner to bedtime). She asked them to count the number of blocks each day that he sought reassurance. - Next came baseline data collection. For 8 days the parents provided reassurance as usual. - This was followed my the first extinction phase- 8days where parents turned away briefly and then redirected the conversation. As you can see in the graph, he sought more reassurance than usual at first (an extinction burst) but the the questions tapered down to zero. During the extinction bursts, the parents observed the boy being highly irritable and "needy" - Then, the parents returned to giving reassurance for a few days. The child's number of questions spiked higher than during the baseline phase. - After that, the extinction phase was reintroduced. Parents ignored the questions and changed the conversation topic. After roughly ten days of fluctuating amounts of reassurance seeking, the boy finally completely eliminated that compulsion for the final ten days that his parents logged his behaviors. - One month later, the therapist suggested they track his behaviors for a few days as a "follow up". He had maintained his gains. 0 reassurance question asked! - Nowadays, clinicians still train loved ones to not provide reassurance. The best practice has evolved. Experts recommend starting with empathy by acknowledging the person with OCD's distress, then encouraging them or prompting them to use a therapy skill. If the person with OCD is actively engaging in treatment, it's possible to agree on a token system. The person with OCD starts each day or week with a preset number if reassurance tokens. Each time they ask for reassurance, they spend a token, which buys the a single sentence of reassurance. Once all the tokens are spent, that's it, no more reassurance for the time period. some families even agree that unused tokens can be cashed in or accumulated for rewards. Over time, the number of tokens the person with OCD starts with is decreased gradually. - Most of the time when I do science posts, I look for recent articles. I don't want to share out of date information. Nevertheless, there is value in looking back at articles from decades ago, because they paved the way for all the advancements we benefit from today. I wonder where the OCD research and treatment field will be at in 2050... Maybe some of the cutting edge science of the present will look crude to people reading it thirty years from now.... - Well, now that I've bombarded you with information, its time for you to share your thoughts. Here's a couple questions to get you started: how has someone helped you reduce or eliminate a compulsion? Have you ever experienced an extinction burst? What do you hope research will have discovered in 2050?