Excessive reassurance-seeking, interpersonal rejection, rejection sensitivity and depressive symptoms: an intervention focusing on mediating mechanisms

Abstract: The current study sought to experimentally test an established interpersonal theory of depression and a new cognitive-behavioral theory of depression. Coyne’s interpersonal theory suggests that dysphoric individuals engage in excessive reassurance-seeking to assuage fears of being abandoned (Coyne, 1976), which then elicits interpersonal rejection, further exacerbating depressive symptoms (Joiner et. al., 1992). A new cognitive-behavioral theory postulates that excessive reassurance-seeking temporarily reduces rejection sensitivity (anxious expectations of rejection) in depressed individuals (Schmidt, et. al., 1999), but in the long-run reinforces rejection sensitivity, which exacerbates depressive symptoms (Ayduk et. al., 2001). The current study tested these models by experimentally manipulating excessive reassurance-seeking within the context of employing a psychosocial intervention with individuals experiencing depressive symptoms. Eighty-three participants were randomly assigned to one of three conditions: 1) ERS-Fading (N=33), 2) Expressive Writing (N=34), or 3) Wait-list (N=16). Participants in the ERS-Fading (ERS) condition were asked to reduce their reassurance-seeking and to talk about their rejection sensitivity. To control for expectations for improvement and non-specific treatment factors, participants in the Expressive Writing (EW) intervention were asked to write about their rejection sensitivity, but were not told to reduce their reassurance-seeking. The wait-list was included to control for the effect of time. Treatment outcome was evaluated for depressive symptoms and quality of life. Five treatment mediators were evaluated: excessive reassurance-seeking, interpersonal rejection, rejection sensitivity, health quality, and sleep quality. Results revealed significant decreases in depressive symptoms for both treatment conditions in comparison to wait-list control. No differences were detected between the two treatment groups on any outcome variables, except that ERS-fading participants demonstrated greater response and clinically significant change rates than EW participants. Both treatment groups demonstrated similar expectations for improvement and all three groups demonstrated significant decreases in excessive reassurance-seeking, with the ERS-fading and the Expressive Writing conditions demonstrating equally robust decreases that differed significantly from smaller decreases reported by the Wait-list control. Mediation analyses revealed that decreases in excessive reassurance-seeking mediated the effects of treatment on depressive symptoms in both treatment conditions. Implications of these findings are discussed.