The role of reassurance and accommodation in the maintenance of anxiety disorders

Anxiety disorders are prevalent across the life span, constitute a significant economic, social and emotional burden, and tend to cluster in families. The overall prevalence of anxiety disorders in children and adolescents (from 2 to 21 years) is around 10% and in adults is similar, ranging from 8 5o 15% in primary care. Anxiety frequently first develops during childhood and contemporary models suggest that the clustering of anxiety disorders within families is due to a combination of genetic and environmental factors. Families provide both the genetics and a significant part of the environment.
The aim of this proposal is to focus on a key environmental factor – family accommodation. Family accommodation to anxiety has been proposed to be a common maintenance factor across a range of anxiety disorders. Family accommodation is positively associated with distress and theoretically is believed to inhibit recovery from anxiety. A specific kind of family accommodation, reassurance seeking and reassurance giving, has been specifically implicated in the aetiology of health anxiety, generalised anxiety disorder, obsessive compulsive disorder and social anxiety. As a result, psychological treatment (Cognitive Behaviour Therapy) typically seeks to eliminate reassurance seeking and reassurance giving within families. However, there is virtually no evidence that, in practice, reassurance seeking inhibits recovery or increases distress in patients or their family members. In addition, theoretical models from other areas of psychology suggest that providing reassurance to children and family members promotes positive psychological development, confidence and self esteem. Previous and on-going laboratory based research at UEA shows that reassurance giving by mothers increased children’s OCD-like behaviours but was not associated with increased anxiety or distress in mothers or their children.
The aim of this proposal is examine the role of reassurance seeking in anxiety disorders. The proposal has a number of phases and will involve a range of research methods and techniques including diagnostic interviewing, observational and experimental studies, and qualitative interviewing. The PhD student will work within a clinical research team and receive regular research supervision as well as appropriate clinical support. The studentship would be appropriate for a student with a strong background in developmental and abnormal psychology, a good understanding of research methods and skills in data management and analysis, excellent interpersonal skills and the ability to work as part of a team.
The student will join the research team and work alongside research associates and clinical studies officers in the NHS. Participants (adults and children) and family members will be recruited from those currently referred to primary and secondary mental health services and who are already routinely receiving diagnostic assessments. Two approaches to recruitment will be taken – top down and bottom up. The top down approach will recruit adults who have an anxiety disorder and who have one or more dependent children, through the Increasing Access to Psychological Therapies service in Norfolk. The bottom up approach will recruit children and adolescents with anxiety disorders, and their parent(s) through the Child and Adolescent Mental Health service in Norfolk.