by Michael D. Anestis, M.S.
There are many theories regarding why certain individuals are vulnerable to developing depression. In his interactional theory of depression, Coyne (1976) proposed that particular people interact with their environment in such a way as to increase the likelihood that they will experience a depressive episode. This theory focuses on interpersonal interactions and argues that individuals who are feeling mildly depressed tend to interact with peers in a manner that alienates others, causing the depressed individual to become isolated and experience increased depressive symptoms. This cycle continues indefinitely and leads to a clinically relevant deterioration of mood.
Joiner, Alfano, and Metalsky (1992) refined this theory, arguing that
excessive reassurance seeking is the key behavioral component of
Coyne's hypothesis. Excessive reassurance seeking is characterized by a tendency to seek positive feedback from peers, dismiss its legitimacy, then continue to seek more feedback until peers become alienated and ultimately reject the person seeking reassurance. As an example, an individual feeling upset about not gaining entry to a group may turn to a friend and ask her if she really cares about her or if she is just acting friendly out of obligation. The friend, of course, will assure her that she truly cares, but the depressed individual will dismiss this feedback, assuming that, in reality, such comments are simply socially required. This will make the depressed individual feel even worse, increasing her need for reassurance. Again, she will turn to her friend for comfort and, again, she will dismiss positive feedback as inauthentic. This pattern will continue until the friend becomes irritated and rejects the depressed individual, which in turn significantly increases the depressed individual's depressive symptoms. In the end, excessive reassurance seeking thus serves as a self-fulfilling prophesy in that the individual's belief that people do not care about her leads her to behave in such a way that she becomes socially isolated.
Excessive reassurance seeking is a fairly stable tendency. In other words, although the degree to which an individual engages in this behavior can fluctuate from time to time, generally speaking, individuals maintain a relatively consistent pattern with respect to how often they become stuck in this cycle. Because the behavior is fairly stable, it is considered a risk factor rather than a symptom of depression. Joiner and Metalsky (2001) supported this idea empirically by demonstrating that excessive reassurance seeking precedes depressive symptoms. Not surprisingly, excessive reassurance seeking has also been shown to predict interpersonal rejection (Joiner & Metalsky, 1995). Additionally, higher levels of reassurance seeking predict greater vulnerability to and severity of depressive symptomatology (Joiner, 2000).
The relationship between excessive reassurance seeking and depression has been expanded upon in a number of studies. In one study, such behaviors were shown to interact with negative life events to predict depression (Joiner & Metalsky, 2001; Katz, Beach, & Joiner, 1998). In other words, negative life events (e.g., getting fired, breaking up with a romantic partner) increase everyone's vulnerability to depression, but individuals who tend to excessively seek reassurance are at particular risk for depression when faced with a negative life event. Additionally, Joiner (1994) found that, amongst college students, individuals who excessively seek reassurance are more likely than those who do not to develop depression after interacting with a depressed roommate. In a more recent study, Burns, Brown, Plant, Sachs-Ericsson, and Joiner (2006) found that excessive reassurance seeking behaviors exhibit a fairly unique relationship with depression relative to other disorders and, as such, are a risk factor specifically for depression rather than mental illness in general.
The relationship between excessive reassurance seeking and depression is not confined to adults. Abela and colleagues (2005) found that, in children whose parents are affectively ill, this relationship is statistically significant. Additionally, excessive reassurance seeking has been shown to predict increased depressive symptoms in children following the onset of parental depressive episodes and the experience of negative life events (Abela et al., 2006). These findings are important for several reasons. First, they demonstrate that excessive reassurance seeking behaviors can begin at an early age, increasing vulnerability to childhood depression. Second, they demonstrate that such behaviors can increase the danger of previously established risk factors for depression (e.g. negative life events).
In response to the mounting evidence that excessive reassurance seeking exhibits a strong relationship with depression, Starr and Davila (2008) conducted a meta-analysis of thirty-eight studies to test the strength of the relationship. Meta-analysis is a statistical technique researchers use to determine, on average, how strong relationships are across many different studies, essentially serving as a study of studies. In this particular analysis, the authors found that the relationship between excessive reassurance seeking and depression is, in fact, moderately strong, although that strength is greater in studies that use questionnaires than in those that use interviews. The finding was thus supportive of a model that highlights excessive reassurance seeking as a risk factor for depression, but indicates that the research on this matter likely requires more sophisticated measurement techniques in order to ensure accurate findings.
Having established that excessive reassurance seeking exhibits a strong relationship with depression, researchers have recently begun examining which individuals are at risk for developing such behaviors in the first place. Weinstock and Whisman (2007) found that rumination mediates the relationship between excessive reassurance seeking and depression. In other words, the relationship between excessive reassurance seeking and depression is, at least in part, explained by the tendency of individuals who excessively seek reassurance to ruminate. Additionally, Anestis, Selby, and Joiner (2007) found that individuals with high levels of negative urgency - the tendency to act rashly in response to negative affect in an effort to immediately decrease negative emotions (Whiteside & Lynam, 2001) - tend to exhibit high levels of excessive reassurance seeking. These findings point to difficulties regulating emotions as a potential explanation as to why certain individuals tend to engage in this behavior. As such, the need to teach effective emotion regulation skills at an early age appears to be paramount so as to decrease the likelihood that individuals will alienate the social support system they need when they begin feeling symptoms of depression.
Ultimately, the findings mentioned in this article highlight the fact that, what seems like a fairly benign and understandable behavioral tendency can have a highly problematic impact upon mood. When individuals are feeling depressed, they tend to view their environment through a distorted lens that highlights any information potentially supportive of a negative view of themselves while dismissing information that runs counter to such conclusions. It is thus imperative that individuals who are feeling upset challenge their thoughts with evidence and resist the gut impulse to believe their negative cognitions. Failure to do so can result in behaviors like excessive reassurance seeking which, when done with enough regularity, can lead to the onset of depression.
Mike Anestis is a doctoral candidate in the clinical psychology department at Florida State University.
