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. Author manuscript; available in PMC: 2022 Jan 1.
Published in final edited form as: J Clin Child Adolesc Psychol. 2019 May 3;50(1):88–96. doi: 10.1080/15374416.2019.1604234

Determinants of Excessive Reassurance-Seeking: Adolescents’ Internalized Distress, Friendship Conflict, and Behavioral Inhibition as Prospective Predictors

Matthew G Clayton 1, Matteo Giletta 2, Charlotte A Boettiger 1, Mitchell J Prinstein 1
PMCID: PMC6825879  NIHMSID: NIHMS1527057  PMID: 31050555

Abstract

Substantial research suggests that excessive reassurance-seeking behavior is associated with exacerbations in depressive symptoms and later interpersonal rejection, yet remarkably few studies have examined predictors of this maladaptive social behavior. This study proposed and examined a diathesis stress model suggesting that beyond the effects of prior internalized distress, a combination of poor inhibitory control and dyadic friendship conflict may be especially relevant predictors of adolescents’ excessive reassurance-seeking behavior. Longitudinal associations were examined in a sample of 865 adolescents (54.5% female; 22.2% African-American; 23.1% Latinx) who completed self-reported measures of depressive rumination/intrusive thoughts, depressive symptoms, loneliness, friendship conflict, and a performance-based measure of inhibitory control at baseline, as well as a measure of excessive reassurance-seeking at baseline and two years later. Results initially revealed a prospective effect of depressive rumination/intrusive thoughts on later excessive reassurance-seeking, consistent with prior work. Final results yielded only a significant interaction effect, revealing that higher levels of friendship conflict coupled with low levels of inhibitory control were associated longitudinally with higher levels of excessive reassurance-seeking. Findings suggest that inhibitory control may moderate the association between adolescents’ interpersonal conflict and their excessive reassurance-seeking.

Keywords: reassurance-seeking, inhibitory control, friendships, adolescence, depression

Interpersonal theories of depression suggest that some individuals exhibit maladaptive behaviors that both contribute to, and may be a consequence of their depressive symptoms (Coyne, 1976; Hammen, 1991). Perhaps most commonly studied among these behaviors is excessive reassurance-seeking, defined as a tendency for individuals to continually seek feedback regarding their self-worth and relationship quality from others, despite receiving continual reassurance (Coyne 1976; Joiner & Metalsky, 1995). Individuals’ engagement in excessive reassurance-seeking is associated with increases in depressive symptoms (e.g., Abela, Zuroff, Ho, Adams, & Hankin, 2006), and also in deteriorations of relationship quality among those from whom reassurance is sought (Joiner & Metalsky, 1995; Prinstein, Borelli, Cheah, Simon, & Aikins, 2005; Starr & Davila, 2008). Data also suggest that high levels of excessive reassurance-seeking are associated with greater depression contagion within close relationships (Davila, 2001). Unfortunately, relatively little is known regarding developmental antecedents of excessive reassurance-seeking (Starr & Davila, 2008), despite the important implications for preventive interventions that may be yielded from this avenue of inquiry (Joiner, Katy, & Lew, 1999).

Extant work suggests that markers of impending depression, such as internalizing correlates (e.g., low self-esteem, anxiety, loneliness, rumination/intrusive thoughts), negative life events, and maladaptive interpersonal schemata may represent possible precursors of excessive reassurance-seeking (Evraire & Dezois, 2011; Weinstock & Whisman, 2007). For instance, in a sample of undergraduate students, Joiner, Katz, and Lew (1999) revealed that excessive reassurance-seeking was predicted by negative life events three weeks prior, and this association was partially mediated by individuals’ experiences of depressive and anxiety symptoms. Evraire and Dozois (2014) revealed that maladaptive adult attachment styles and abandonment core beliefs/schemata predicted young adults’ excessive reassurance-seeking. In a study of young adolescents, Prinstein and colleagues revealed that negative interpersonal experiences (e.g., peer rejection, low friendship quality) were associated with increases in excessive reassurance-seeking eleven months later, particularly among girls and those experiencing higher levels of depressive symptoms (Prinstein et al., 2005). This study extended these ideas to the examination of a sample in middle adolescents. It was hypothesized that individuals who feel lonely, engage in depressive rumination/intrusive thoughts, endorse depressive symptoms, or have experienced conflict in close friendships may have a heightened need for reassurance; in other words, these individuals may be especially inclined to crave affirmation and validation regarding their self-worth and relationship stability.

Yet, internalizing correlates and life events that prompt an elevated affective need for reassurance may reflect only one of two classes of predictors for excessive reassurance-seeking. Note that research suggests that individuals who engage in this aversive social behavior continue to do so even after close friends ask them to stop (Joiner, Metalsky, Katz, & Beach, 1999). This inability to stop a deleterious behavior may reflect difficulties with inhibitory control in the face of interpersonal stress (Anestis, Selby, & Joiner, 2007). Although more typically discussed in the context of externalizing symptom development, recent work has elucidated a possible role of inhibitory control in the risk for internalizing distress. For instance, poor executive functions and effortful control, which both include inhibitory control, have been implicated in the development of depression (Eisenberg, Spinrad, Eggum, 2010; Luciana, 2016), and also may moderate the association between peer stress and depressive symptoms (Agoston & Rudolph, 2016). In this study, it was hypothesized that within the context of close friend conflict, low inhibitory control also may be associated prospectively with excessive reassurance-seeking. In sum, while elevated internalized distress might reflect a need for reassurance, we hypothesized that difficulties with inhibitory control would explain additional variance in predicting who may engage in reassurance-seeking behavior over time among those experiencing interpersonal conflict.

Notably, this interplay between negative interpersonal experiences and individuals’ own lack of inhibitory control may be especially pertinent in adolescence. Adolescence is associated with marked increases in depression symptom prevalence (Hankin, Abramson, & Siler, 2001) and increases in interpersonal stress (Rudolph, 2002). Moreover, research in developmental social neuroscience suggests that adolescence may be a period associated with heightened sensitivity to social cues, increased attention to potential social punishment, and immature cognitive control processes (Somerville, 2013; Steinberg, 2008), suggesting that the conjoint effects of negative interpersonal experiences and low inhibitory control may especially relevant for predicting the development of this maladaptive behavior.

Thus, this study examined two hypotheses in a sample of adolescents. First, as in past research, it was expected that higher levels of adolescents’ internalizing distress, assessed in this study with measures of loneliness, depressive rumination/intrusive thoughts, and depressive symptoms, would be associated longitudinally with increases in excessive reassurance-seeking. Second, a diathesis-stress hypothesis was examined, suggesting that beyond the prospective effects of internalizing distress, best friend conflict would also longitudinally predict excessive reassurance-seeking especially among adolescents with poor inhibitory control. This study benefited from the measurement of a developmentally-salient interpersonal experience (i.e., conflict within a “best” dyadic friendship), a performance-based measure of inhibitory control (i.e., a Go–NoGo task), and the measurement of excessive reassurance-seeking over a two year longitudinal interval.

Methods

Participants

This study included 865 participants (54.5% identified as female) in grades 9 and 10. All participants were between the ages of 14 to 17 (Mage = 15.12 years; SD = 0.78). The sample included 47.1% White/Caucasian participants, 22.2% African-American, 23.1% Latinx, 1.0% Asian-American, and 6.6% mixed-race or other. Census tract data for each participant’s street address revealed household income estimates within the lower-middle class (M = $40,759.59; SD = $15,491.39) (www.census.gov). All students attended public high schools in a rural county in the southeastern US (67% free or reduced-price lunch). All study procedures were approved by the research institution’s human subjects committee.

Procedure

Data to examine hypotheses were available at two time points within a multi-wave study on adolescent social experiences and psychological adjustment. Participants were originally recruited in the seventh and eighth grades via parental consent and participant assent. All students enrolled in middle school within a single southeastern US county were recruited for participation (n = 1,463), with the exception of adolescents in special education classrooms. Across all three middle schools, consent forms were returned by 90% of families (n = 1,205), with 74% of parents giving consent for their adolescent’s participation (n = 900) and all but 35 were assessed at baseline (n = 865; 59% of the total student population).

Data for analyses in this study were available at the third annual time point (referred to herein as Time 1), when a behavioral measure of inhibitory control was added to the study protocol. At this time point in the study, complete data were available from 776 participants (86% of the original sample). Attrition included 54 participants who had moved away from the area and were unable to be located, 29 had withdrawn from school, 19 students were absent, 16 declined participation, 5 were homeschooled, and one had deceased. A total of 653 of these participants (84% retained; 73% of the original sample) completed testing two years later (referred to herein as Time 2). Attrition between these time points was due to moving (n = 75), school withdrawal (n = 22), study withdrawal (n = 22), homeschooling (n = 3) and absenteeism (n = 1). Attrition analyses revealed no significant differences on any variables in this study among students with complete data and those with missing data at Times 1 or 2 in this study. Additionally, Little’s MCAR test revealed a nonsignificant coefficient, χ2 (284) = 261.07, p = . 832. Data thus were imputed using an expectation maximization procedure, allowing all analyses to include the full sample of adolescents who participated at least once in the study (n = 865). Analyses reported below were re-conducted using only available data, yielding no differences in the pattern of significant results.

Measures

Measures of loneliness, depressive rumination/intrusive thoughts, depressive symptoms, friendship conflict, and inhibitory control were administered at Time 1; excessive reassurance-seeking was measured at both time points. Socioeconomic status was computed for all participants after their original recruitment for the study.

Socioeconomic status.

Using the home addresses of each participant, SES was calculated using median household income reports from US census tract data. According to census data, the mean SES was comparable to the average household income of the families within the school district.

Excessive reassurance-seeking.

Adolescents completed the 10-item Revised Excessive Reassurance-Seeking Scale (Nesi & Prinstein, 2015) which was developed to address several developmental concerns (see Starr & Davila, 2008) regarding the use of the original four item Reassurance-Seeking Scale (RSS; Joiner & Metalsky, 1995) embedded within the Depressive Relationships Inventory (DIRI). The revised scale contains six additional items to address more adolescent-appropriate contexts (e.g. “I often ask people if they think my clothes look okay”) and further domains of reassurance-seeking outside of general liking, such as gossip (e.g. “I often ask people what other people say about me”). All items were answered using a five-point Likert scale (1 for Not at all true to 5 for Extremely true). Reliability for the Revised Excessive Reassurance-Seeking Scale is supported by high internal consistency as a unifactorial scale in prior research (α = .90; Nesi & Prinstein, 2015). In the current sample, internal consistency also was high (αs = .90 and .93 at Times 1 and 2, respectively).

Loneliness.

Loneliness was assessed using an adaptation of the Loneliness and Social Dissatisfaction Questionnaire (LSDQ; Cassidy & Asher, 1992) with two items developed by Ladd and Burgess (1999). The three items from the LSDQ (i.e., I felt alone; I felt left out of things; I was lonely) and two items from Ladd and Burgess (i.e., School was a lonely place for me; I was sad and alone) reflected a pure measure of subjective loneliness without objective items of social inclusion. Participants responded to each item using a five-point Likert-type scale (1 for Never to 5 for Very often). Internal consistency was excellent (α = .95).

Depressive rumination/intrusive thoughts.

Depressive rumination/intrusive thoughts were measured with the rumination (3 items; e.g., “When I have problems with a friend it’s really hard to stop thinking about what I did or said”) and intrusive thoughts (3 items; e.g., “I keep remembering what happened with my friend or can’t stop thinking about what might happen”) subscales of the Responses to Stress Questionnaire (RSQ; Compas, Connor, Osowiecki, & Welch, 1997; Connor-Smith, Compas, Wadsworth, Thomsen, & Saltzman, 2000). All items used a four-point Likert scale reflecting how frequently participants engaged in each response type (1 for Not at all to 4 for A lot).

In the original RSQ, both rumination and intrusive thoughts loaded together on the involuntary engagement domain, along with subscales measuring emotional arousal, physiologic arousal, and impulsive action (Connor-Smith et al., 2000). Only rumination and intrusive thoughts were examined in this study. Factor analyses revealed that these six items loaded onto a single factor, and internal consistency for these six items was stronger (alpha = .92) than for rumination (alpha = .85) or intrusive thoughts (alpha = .83) subscales computed separately1. Thus, a mean across all six items was computed to create a single composite score reflecting adolescents’ depressive rumination/intrusive thoughts in the context of friendship stress with higher scores reflecting more frequent engagement in rumination and intrusive thoughts.

Depressive Symptoms.

Depressive symptoms were measured using the Short Mood and Feelings Questionnaire (SMFQ; Angold et al. 1995) at Time 1. The questionnaire is an established measure to assess depressive symptoms in adolescent samples (e.g., Rothon et al. 2009) and has demonstrated good psychometric properties (Sharp et al. 2006). The SMFQ includes 13-itmes reflecting depressive affect, cognition, and behaviors over the past 2 weeks that that adolescents report are (0) not true, (1) sometimes true, or (2) true for them). Internal consistency in this sample was α = .95.

Friendship conflict.

The Network of Relationships Inventory (NRI; Furman, 1998) was used to measure conflict with their self-identified very best friend. The NRI conflict subscale is measured with three items (e.g., “How much do you and your best friend argue with each other?”) using a five-point Likert scale (1 for Little or None to 5 for The Most). Internal consistency was high (α = .85).

Inhibitory control.

Subjects completed a computerized Go–NoGo task (Altamirano et al., 2011) at Time 1, which provided an index of motor response inhibition. On each trial, a stimulus appeared on the screen for 700 milliseconds, followed by a blank screen for 300 milliseconds. The “Go” stimulus was “$70,” in white Arial font at the center of a black screen, and the “NoGo” stimulus was an identically formatted and positioned “$100.” Subjects were instructed to respond as quickly as possible to every Go stimulus with a button press, and to withhold responding to each NoGo stimulus. Subjects completed 2 runs of 80 trials each, with 15% NoGo trials, presented in pseudorandom order. Response accuracy and reaction time were recorded for each trial. Our primary task performance dependent measure was the number of false alarms, defined as executing a button press in response to a NoGo stimulus (Mscore = 0.89, SD = 0.09).

Data Analytic Plan

Descriptive statistics examined gender differences and bivariate associations among primary study variables. Hypotheses were examined using a hierarchical multiple regression analysis with excessive reassurance-seeking at Time 2 as a dependent variable. After controlling for Time 1 excessive reassurance-seeking on an initial step and socio-demographic variables on a second step (i.e., socioeconomic status, gender, minority status), the effects of internalizing distress were entered on Step 3, including loneliness, depressive rumination/intrusive thoughts, and depressive symptoms as simultaneous predictors. By examining the main effects of poor inhibitory control and friendship conflict (on Step 4) and their interaction (on Step 5, see Table 2), it was possible to examine the diathesis-stress hypothesis as an incremental, prospective predictor of excessive reassurance-seeking, after controlling for the effects of internalizing distress.

Table 2.

Longitudinal Prediction of Time 2 Excessive Reassurance Seeking by Excessive Reassurance-Seeking, Sociodemographics, Internalizing Distress, Inhibitory Control, and Friendship Conflict (self-reported)

Time 2 Excessive Reassurance-Seeking
Step Statistics Final Statistics
Predictors ΔR2 b (se b) β b (se b) β
Step 1 .24***
 Time 1 ERS .50 (.03) .49*** .45 (.03) .44***
Step 2, Sociodemographics .00
 Gender −.02 (.04) −.01 −.03 (.04) −.03
 Socioeconomic Status −.00 (.00) −.01 −.00 (.00) −.01
 Minority Status .02 (.04) .01 .01 (.04) .01
Step 3, Internalizing Distress .01*
 Loneliness −.00 (.03) −.01 .02 (.03) .03
 Depressive Rumination/Intrusive Thoughts .07 (.03) .09** .05 (.03) .07
 Depressive Symptoms .03 (.06) .024 −.00 (.06) −.00
Step 4, Main Effects .02***
 Inhibitory Control −.64 (.23) −.09** −.59 (.23) −.08**
 Friendship Conflict .08 (.02) .10*** .08 (.02) .11 ***
Step 5, Two Way Interaction .01*
 Inhibition Control x Friendship Conflict −.65 (.27) −.07*
Total R2 .27*
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*

p ≤ .05;

**

p ≤ .01;

***

p ≤ .001;

ERS = Excessive Reassurance-Seeking.

Results

Preliminary Analyses

Means and standard deviations for all primary variables are presented in Table 1. T-tests examining gender differences demonstrated higher levels of loneliness, depressive rumination/intrusive thoughts, depressive symptoms, excessive reassurance-seeking and greater inhibitory control for girls compared to boys at Time 1. Conversely, at Time 1, t-tests revealed greater reported levels of friendship conflict for boys as compared to girls.

Table 1.

Descriptives and Bivariate Associations Among Primary Study Variables

Time 1 Time 2
Excessive
Reassurance-
Seeking		 Loneliness Depressive
Rumination/
Intrusive Thoughts		 Depressive
Symptoms		 Friendship
Conflict		 Inhibitory
Control		 Excessive
Reassurance-
Seeking
Time 1
 Loneliness .37** -
 Depressive Rumination/Intrusive Thoughts .37** .48** -
 Depressive Symptoms .39** .79** .51** -
 Friendship Conflict .19** .06 .15** .12** -
 Inhibitory Control −.01 .07* −.00 .00 -.01
Time 2
 Excessive Reassurance-Seeking .45** .19** .24** .20** .18** −.07
Mean (Standard Deviation) 1.46(.62) 2.28(1.24) 1.96(.83) .49(.54) 1.88(.81) .89(.09) 1.48(.69)
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*

p ≤ .05;

**

p ≤ .01

Bivariate associations among all study variables were examined with Pearson correlations, as shown in Table 1. Excessive reassurance-seeking was associated significantly with loneliness, depressive rumination/intrusive thoughts, depressive symptoms and friendship conflict at both time points. Loneliness was significantly associated with depressive rumination/intrusive thoughts and depressive symptoms at both time points, but not with friendship conflict.

Longitudinal Associations Among Internalized Distress, Friendship Conflict, Inhibitory Control, and Excessive Reassurance-Seeking

Results from a hierarchical multiple regression are presented in Table 2. No significant findings emerged for gender, socioeconomic status, or racial/ethnic minority status as prospective predictors of excessive reassurance-seeking over time. Consistent with prior research, findings on Step 3 revealed that after controlling for these covariates, internalizing distress was significantly associated with excessive reassurance-seeking over time, with higher levels of depressive rumination/intrusive thoughts associated with higher levels of excessive reassurance-seeking over time.

Results on Step 4, revealed significant main effects suggesting that both low levels of inhibitory control and high levels of friendship conflict were associated with higher levels of excessive reassurance-seeking over time. However, these results were qualified by a significant interaction effect (see Step 5), consistent with the diathesis-stress hypothesis.

Post hoc probing was conducted to examine the nature of moderating effects in accordance with procedures outlined by Holmbeck (2002) and Preacher, Curran, and Bauer (2006). Specifically, following computation of a reduced model to safeguard suppressor effects (i.e., removing Step 2 (demographics), and Step 3 (loneliness, depressive rumination/intrusive thoughts, and depressive symptoms) from the model), and the creation of centered variables for the main and interactive effects of inhibitory control and friendship conflict, simple slopes were calculated at low and high levels of inhibitory control. Findings from Preacher and colleagues’ (2006) online post hoc probing utility revealed that under conditions of low (i.e., 1 SD below the mean) levels of inhibitory control, the prospective association between Time 1 friendship conflict and Time 2 excessive reassurance-seeking was statistically significant (slope estimate = 0.13, p = .001). However, under conditions of high inhibitory control (i.e., 1 SD above the mean), the prospective association between Time 1 friendship conflict and Time 2 excessive reassurance-seeking, after controlling for prior levels of excessive reassurance-seeking, was no longer significant (slope estimate = 0.04, p = .345). This interaction of inhibitory control and friendship conflict is further illustrated in Figure 1.

Figure 1.

Figure 1.

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Post Hoc Probing of Two-Way Interaction Between Time 1 Inhibitory Control and Friendship Conflict Prospectively Predicting Excessive Reassurance-Seeking at Time 2

Discussion

Substantial research has revealed that excessive reassurance-seeking predicts increases in depressive symptoms and in social rejection, contributing to an interpersonal framework for understanding depression onset and maintenance (Davila, 2001). Yet remarkably little work has examined possible determinants of excessive reassurance-seeking. This study thus addressed a critical gap in the literature, offering directions for future research by examining a unique set of prospective predictors as possible antecedents of excessive reassurance-seeking in a sample of youth at the developmental transition associated with dramatic increases in depression prevalence (Hankin et al., 1998).

An initial goal of this study was to replicate and extend prior work on predictors of excessive reassurance-seeking. Extant findings, predominantly among adults, have suggested that antecedents may include internalizing distress (e.g., lowered self-esteem, depressive symptoms; Joiner, Katz, & Lew, 1999) or markers of interpersonal uncertainty (e.g., anxiety, anxious attachment style; Evraire & Dozois, 2014). In a large sample of adolescents, results from this study similarly revealed that greater levels of depressive rumination/intrusive thoughts, but not loneliness or depressive symptoms, were associated longitudinally with increases in excessive reassurance-seeking behavior. Consistent with interpersonal theories (Coyne, 1976; Joiner & Metalsky, 2001), findings suggest that individuals with ruminative/intrusive thoughts may be more likely to seek reassurance from others, which prior research suggests may perhaps unwittingly contributing to a cycle of negative affect and aversive interpersonal behavior that accelerates a downward spiral of adolescent depression and interpersonal distress (Prinstein et al., 2005). Indeed, findings from this study suggested that a more ruminative/intrusive coping style may be more relevant than subjective experiences of loneliness or depressive symptoms, perhaps suggesting that cognitive processing of internalized distress may be especially important for the development of excessive reassurance-seeking. Findings from this study highlight the need for greater attention to social experiences, subjective distress, and cognitive styles that are relevant in adolescence, revealing new directions for early prevention of the social behaviors that may increase risk for depression among vulnerable youth. Studies examining an even wider array of internalizing correlates and cognitive schemata as determinants of adolescents’ excessive reassurance-seeking also are needed as so little research has been conducted to understand developmental precursors of this aversive and depressogenic social behavior.

This study also offered a novel framework to understand the development of excessive reassurance-seeking by examining a diathesis-stress framework. Consistent with hypotheses, findings revealed that after accounting for the effects of depressive rumination/intrusive thoughts, excessive reassurance-seeking was further predicted by the conjoint effects of interpersonal conflict with a very best friend and poor inhibitory control. It would appear that reassurance-seeking behaviors might be associated with an interaction between adolescents’ predispositions (i.e., inhibitory control) and their environmental experiences (i.e., interpersonal distress). Findings offer several important implications for future work.

First, results regarding the relevance of conflict within youth’s best friendships as a longitudinal predictor of excessive reassurance-seeking support the importance of children’s peer relationships as a critical context for the development of psychopathology and associated risk factors (Parker & Asher, 1987; Prinstein & Giletta, 2016). The adolescent transition is associated not only with increases in depression prevalence, but also marked changes in the frequency, sophistication, and intensity of adolescents’ peer relationships (Rudolph, 2009). Findings suggest that difficulties with the tasks associated with this developmental transition – namely, the establishment of a close dyadic friendship characterized by low conflict – is associated with increased risk for a powerful predictor of future psychopathology. An important direction for future research will be to examine whether these findings are specific to the peer context, or whether conflict within other important interpersonal relationships, such as those with parents, romantic partners, or teachers, may also promote the development of excessive reassurance-seeking behaviors.

Second, note that findings revealed the role of friendship conflict as a predictor of excessive reassurance-seeking was qualified by a significant interaction with youths’ inhibitory control, as measured by a performance-based measure. Specifically, friendship conflict was associated longitudinally with excessive reassurance-seeking only among adolescents exhibiting lower levels of inhibitory control. This offers a potential extension to theories on interpersonal models of depression, suggesting that those most likely to engage in aversive social behavior may not only be perceiving relationship disturbances, but also have limited capacity to inhibit potentially damaging behavioral impulses. Note that among youth, poor inhibitory control most frequently has been cited as a putative risk factor for a range of externalizing symptoms and health risk behaviors (Luciana, 2016). Findings from this study suggest that tendencies towards poor impulse control also may have potential implications for the developmental of internalizing disorders, through its role on the promotion of interpersonal risk factors for depression. Important questions for future work include the study of inhibitory control as a predictor of a range of youth internalizing disorders (Van Beveren, Mezulis, Wante, & Braet, 2016), potentially mediated by ill-advised social behaviors, such as excessive reassurance-seeking, negative feedback-seeking, or co-rumination (Rose, 2002; Borelli & Prinstein, 2006). Future work also may benefit from the study of the multifinality of inhibitory control as a possible predictor of a range of clinical outcomes, or perhaps as an indicator of broader emotion dysregulation skills that may promote general risk for psychopathology or comorbid presentations of internalizing and externalizing symptoms (Caspi et al., 2014; Fernandez, Jazaieri, & Gross, 2016).

Third, findings regarding the combined longitudinal effects of friendship conflict and low inhibitory control in the development of excessive reassurance-seeking offer implications for conceptualizations of depression-related social behaviors more broadly. Not merely the product of negative affect, excessive reassurance-seeking, and perhaps other social behaviors that promote depressive symptoms, may reflect the desire to satisfy a difficult-to-control urge to reduce negative affect and relationship uncertainty. In other words, excessive reassurance-seeking may be an active, albeit ill-advised, form of coping that marks a malleable strength among those most actively seeking reassurance (Coyne, 1976). This conceptualization of reassurance-seeking contrasts with depiction of depression-prone youth as withdrawn, lethargic, or lacking social initiative, and instead suggests that at least some children are actively, yet impulsively, attempting to address perceptions of friendship difficulties to remedy their social distress. Note that findings revealed no significant prospective association between depressive rumination/intrusive thoughts and excessive reassurance-seeking once an interaction between inhibitory control and friendship conflict was included in the model. Interventions that capitalize on these youths’ tendency to perceive relationship discord and desire to quickly ameliorate their own distress may be particularly effective, perhaps by teaching more adaptive relationship negotiation skills or by helping vulnerable youth simply observe and accept their distress mindfully (Greco & Hayes, 2008; Mufson, Weissman, & Moreau, 1999).

Future research would benefit by addressing several of the limitations of this study. First, although this research was bolstered by the use of a multi-year longitudinal design, revealing factors that may help explain long term risks for excessive reassurance-seeking over a critical developmental transition, it is unknown whether the processes under examination may also occur within shorter time intervals – perhaps even within the minutes or hours following negative affect and social conflict. The examination of shorter longitudinal time frames, or momentary assessments, are needed to reveal microprocesses that may also be relevant for understanding the development and immediate reinforcement of excessive reassurance-seeking behavior. Second, it is worth noting that this study offered rare data by examining prospective predictors of excessive reassurance-seeking in a sample of youth, focusing specifically on middle adolescence when depressive symptoms are especially likely to emerge. However, it is unknown whether the most salient risk factors for excessive reassurance-seeking emerge during this period, or perhaps at an earlier stage of development when relationship schemata are first developed. Third, note that in this study, friendship conflict was measured using a self-reported instrument. Research examining conflict as reported by youths’ relationship partners may reveal that it is one’s perception of interpersonal conflict more than actual social discord that is most relevant for understanding the development of excessive reassurance-seeking. Importantly, excessive reassurance-seeking behaviors were assessed broadly as a general measure of the behavior across all peer relationships. Future studies would benefit by assessing excessive reassurance-seeking behaviors in separate contexts, such as with a best friend, a romantic partner, or certain peer groups. In a similar vein, friendship conflict was assessed purely in the context of a best friend, where future work could also survey peer conflict across various domains. Last, caution always is needed regarding the generality of findings to populations of youth not adequately represented in this study. Although this study included a large, rural, and especially diverse sample of youth, supplemental analyses of these data did not reveal gender or racial/ethnic differences in the patterns of findings. More power may be needed to adequately test possible cultural moderators in future work, and replication of findings reported in this manuscript surely is needed.

Overall, this study supported the notion that excessive reassurance-seeking may be predicted not only by internalized distress, but also by a combination of perceived friendship conflict and poor inhibitory control skills. Results offer new directions for the conceptualization of excessive reassurance-seeking as a reflection of poor inhibitory control, perhaps when coping with relationship uncertainty. These findings should be followed by additional developmentally-based work designed to understand why some are more likely than others to engage in this aversive and risky social behavior.

Acknowledgements:

This study was funded by NIH grant 1R01 HD055342 awarded to the last author.

Footnotes

1

Analyses below were conducted to examine rumination or intrusive thoughts separately as prospective predictors of adolescents’ excessive reassurance-seeking. Results revealed near-identical patterns of findings for each subscale when examined separately

Contributor Information

Matthew G. Clayton, Email: mcg12@live.unc.edu.

Matteo Giletta, Email: m.giletta@uvt.nl.

Charlotte A. Boettiger, Email: cab@unc.edu.

Mitchell J. Prinstein, Email: mitch.prinstein@unc.edu.

References

  1. Agoston AM, & Rudolph KD (2016). Interactive contributions of cumulative peer stress and executive function deficits to depression in early adolescence. The Journal of Early Adolescence, 36(8), 1070–1094. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Altamirano LJ, Fields HL, D’Esposito M, & Boettiger CA (2011). Interaction between family history of alcoholism and locus of control in the opioid regulation of impulsive responding under the influence of alcohol. Alcoholism: Clinical and Experimental Research, 35(11), 1905–1914. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Anestis MD, Selby EA, & Joiner TE (2007). The role of urgency in maladaptive behaviors. Behaviour Research and Therapy, 45(12), 3018–3029. [DOI] [PubMed] [Google Scholar]
  4. Angold A, Costello EJ, Messer SC, & Pickles A (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5(4), 237–249. [Google Scholar]
  5. Borelli JL, & Prinstein MJ (2006). Reciprocal, longitudinal associations among adolescents’ negative feedback-seeking, depressive symptoms, and peer relations. Journal of Abnormal Child Psychology, 34(2), 154–164. [DOI] [PubMed] [Google Scholar]
  6. Cassidy J, & Asher SR (1992). Loneliness and peer relations in young children. Child Development, 63(2), 350–365. [DOI] [PubMed] [Google Scholar]
  7. Connor-Smith JK, Compas BE, Wadsworth ME, Thomsen AH, & Saltzman H (2000). Responses to stress in adolescence: Measurement of coping and involuntary stress responses. Journal of Consulting and Clinical Psychology, 68(6), 976–992. [PubMed] [Google Scholar]
  8. Coyne JC (1976). Toward an interactional description of depression. Psychiatry, 39, 28–40. [DOI] [PubMed] [Google Scholar]
  9. Davila J (2001). Refining the association between excessive reassurance seeking and depressive symptoms: The role of related interpersonal constructs. Journal of Social & Clinical Psychology, 20, 538–559. [Google Scholar]
  10. Evraire LE, & Dozois DJ (2011). An integrative model of excessive reassurance seeking and negative feedback seeking in the development and maintenance of depression. Clinical Psychology Review, 31(8), 1291–1303. [DOI] [PubMed] [Google Scholar]
  11. Evraire LE, & Dozois DJ (2014). If it be love indeed tell me how much: Early core beliefs associated with excessive reassurance seeking in depression. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, 46(1), 1. [Google Scholar]
  12. Furman W (1996). The measurement of friendship perceptions: Conceptual and methodological issues. The company they keep: Friendship in childhood and adolescence, 41–65. [Google Scholar]
  13. Hammen C (1991). Generation of stress in the course of unipolar depression. Journal of Abnormal Psychology, 100, 555–561. [DOI] [PubMed] [Google Scholar]
  14. Hankin BL (2006). Adolescent depression: description, causes, and interventions. Epilepsy & Behavior, 8(1), 102–114. [DOI] [PubMed] [Google Scholar]
  15. Hankin BL, Abramson LY, & Siler M (2001). A prospective test of the hopelessness theory of depression in adolescence. Cognitive Therapy and Research, 25, 607–632. [Google Scholar]
  16. Hankin BL, Abramson LY, Moffitt TE, Silva PA, McGee R, & Angell KE (1998). Development of depression from preadolescence to young adulthood: emerging gender differences in a 10-year longitudinal study. Journal of Abnormal Psychology, 107(1), 128. [DOI] [PubMed] [Google Scholar]
  17. Joiner TE Jr. (1999). A test of interpersonal theory of depression in youth psychiatric inpatients. Journal of Abnormal Child Psychology, 27, 77–85. [DOI] [PubMed] [Google Scholar]
  18. Joiner TE Jr., Katz J, & Lew A (1999). Harbingers of depressotypic reassurance seeking: Negative life events, increased anxiety, and decreased self-esteem. Personality and Social Psychology Bulletin, 25, 630–637. [Google Scholar]
  19. Joiner TE, & Metalsky GI (1995). A prospective test of an integrative interpersonal theory of depression: a naturalistic study of college roommates. Journal of Personality and Social Psychology, 69, 778–788. [DOI] [PubMed] [Google Scholar]
  20. Joiner TE, & Metalsky GI (2001). Excessive reassurance seeking: delineating a risk factor involved in the development of depressive symptoms. Psychological Science, 12, 371–378. [DOI] [PubMed] [Google Scholar]
  21. Joiner TE, Metalsky GI, Katz J, & Beach SR (1999). Depression and excessive reassurance-seeking. Psychological Inquiry, 10(3), 269–278. [Google Scholar]
  22. Ladd GW, & Burgess KB (1999). Charting the relationship trajectories of aggressive, withdrawn, and aggressive/withdrawn children during early grade school. Child Development, 70(4), 910–929. [DOI] [PubMed] [Google Scholar]
  23. Luciana M (2016). Executive function in adolescence: A commentary on regulatory control and depression in adolescents: Findings from neuroimaging and neuropsychological research. Journal of Clinical Child & Adolescent Psychology, 45(1), 84–89. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Nesi J, & Prinstein MJ (2015). Using social media for social comparison and feedback-seeking: gender and popularity moderate associations with depressive symptoms. Journal of Abnormal Child Psychology, 43(8), 1427–1438. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Prinstein MJ, Borelli JL, Cheah CS, Simon VA, & Aikins JW (2005). Adolescent girls’ interpersonal vulnerability to depressive symptoms: a longitudinal examination of reassurance-seeking and peer relationships. Journal of Abnormal Psychology, 114(4), 676. [DOI] [PubMed] [Google Scholar]
  26. Prinstein MJ & Giletta M (2016). Peer relations and developmental psychopathology. In Cicchetti D, (Ed.), Developmental Psychopathology, Third Edition (Volume 1, pp. 527–579). Hoboken, NJ: Wiley. [Google Scholar]
  27. Rose AJ (2002). Co–rumination in the friendships of girls and boys. Child Development, 73(6), 1830–1843. [DOI] [PubMed] [Google Scholar]
  28. Rothon C, Head J, Clark C, Klineberg E, Cattell V, & Stansfeld S (2009). The impact of psychological distress on the educational achievement of adolescents at the end of compulsory education. Social Psychiatry and Psychiatric Epidemiology, 44(5), 421–427. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Rudolph KD (2002). Gender differences in emotional responses to interpersonal stress during adolescence. Journal of Adolescent Health, 30S, 3–13. [DOI] [PubMed] [Google Scholar]
  30. Sharp C, Goodyer IM, & Croudace TJ (2006). The Short Mood and Feelings Questionnaire (SMFQ): a unidimensional item response theory and categorical data factor analysis of self-report ratings from a community sample of 7-through 11-year-old children. Journal of Abnormal Child Psychology, 34(3), 365–377. [DOI] [PubMed] [Google Scholar]
  31. Somerville LH (2013). The teenage brain: Sensitivity to social evaluation. Current Directions in Psychological Science, 22(2), 121–127. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Starr LR, & Davila J (2008). Excessive reassurance seeking, depression, and interpersonal rejection: a meta-analytic review. Journal of Abnormal Psychology, 117, 762–775. [DOI] [PubMed] [Google Scholar]
  33. Steinberg L (2008). A social neuroscience perspective on adolescent risk-taking. Developmental Review, 28(1), 78–106. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Van Beveren ML, Mezulis A, Wante L, & Braet C (2016). Joint contributions of negative emotionality, positive emotionality, and effortful control on depressive symptoms in youth. Journal of Clinical Child & Adolescent Psychology, 1–12. [DOI] [PubMed] [Google Scholar]
  35. Weinstock LM, & Whisman MA (2007). Rumination and excessive reassurance-seeking in depression: A cognitive–interpersonal integration. Cognitive Therapy and Research, 31(3), 333–342. [Google Scholar]

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