Radically different
Background: Community college (CC) students face significant mental health concerns but are unlikely to receive treatment. Barriers to mental health service uptake among CC students have been delineated, but few studies have identified strategies to improve uptake. Text messaging has been used to address engagement barriers to mental health services among adolescents and adults, but little research has explored this strategy for CC students. Objective: The goal of this study was to partner with CC students to co-design and conduct pilot usability testing of a text messaging intervention to address barriers and increase uptake of a mental health screening and treatment program, called Screening and Treatment for Anxiety and Depression (STAND), offered to CC students. Methods: We conducted 2 parallel sets of 4 co-design focus groups with CC students who had varying levels of engagement with STAND. We used rapid qualitative analysis to extract key themes, create text message prototypes and refine them, and present updated prototypes to gather feedback across workshops. We also assessed six usability factors on a 5-point Likert scale: satisfaction, helpfulness, attractiveness, readability, comprehension, and likelihood of getting started with STAND after receiving texts. Results: Key themes emerged about perceptions of texting, barriers to STAND, a basic framework for the text message intervention, feedback about the format of messages, and feedback about the content of messages. Students expressed positive regard for text messaging and general agreement on key barriers to STAND. Students codeveloped a framework for the intervention, including (1) delivering introductory texts to engage students in the text messages, (2) providing a personalized approach for students to select barriers most salient for them, and (3) delivering tailored content designed by students to address each barrier. Across workshops, several themes emerged with regard to how messages should be formatted and delivered, including the following: use short messages; use not too many messages; use relevant language; use images, memes, and short videos; and make messages “human-like.” Themes related to the content of messages included the following: reminders that you are not alone, knowledge that STAND has worked for other students, expressing understanding of student context and stressors, and providing an option to speak to a team member. Mean ratings on usability factors ranged from 3.88 (SD 0.64) to 4.25 (SD 0.46). Conclusions: This study describes a process for co-designing a text messaging mental health engagement intervention with CC students that is grounded in a human-centered design approach. Further research is needed to rigorously test this intervention and make iterative refinements to improve response and effectiveness.
<img src="https://jmir-production.s3.us-east-2.amazonaws.com/thumbs/8205377cceae781ec5169b5fbc0a42cc" />
– by Jordan Karr, PhD
We all need reassurance once in a while. Receiving reassurance from a friend, loved one, or expert can reduce short-term distress, foster a sense of connection, and help us move forward in a productive way. On the other hand, excessive reassurance seeking can lead to a painful cycle of stress and doubt. For individuals with obsessive-compulsive disorder (OCD), reassurance is fleeting and is quickly followed by a resurgence of perceived threat and a compelling drive to seek additional reassurance.
As an OCD and anxiety specialist, I am no stranger to reassurance traps. I see them in the patient who repeatedly consults doctors but never fully trusts their answers; the partner who keeps asking, “Do you still love me?” while scrutinizing every response; and the teenager who needs her homework checked repeatedly but does not learn to tolerate uncertainty. While the content of excessive reassurance seeking may vary, its function remains the same, relieving anxiety momentarily while allowing obsessions to rebound more strongly in the long run. In each example, we see an individual desperately trying to protect something they hold dear while being misled by one of OCD’s most convincing lines: “What if this time the reassurance sticks?”
Psychologists have long argued that excessive reassurance seeking helps maintain OCD, anxiety, and depression (Abramowitz et al., 2002; Burns et al., 2006). What is new is the landscape. Today, reassurance is available instantly and endlessly through search engines, medical websites, social media, and artificial intelligence tools. Emerging research suggests that online reassurance seeking may be as prevalent as interpersonal reassurance seeking (Parsons & Alden, 2022). These digital reassurance traps present in a variety of forms, including:
Why do some individuals seek reassurance primarily from others in face-to-face contexts while others turn to the internet? Findings from one study suggest that individuals may be more likely to seek interpersonal reassurance when they desire emotional support, whereas online reassurance seeking is more likely when individuals feel ashamed or fear judgment from others (Parsons et al., 2025). In the same study, shame was reported more frequently among individuals with OCD. The perceived anonymity of the internet creates a compelling environment for seeking reassurance about our most distressing fears and the fears we feel ashamed to have.
Wait, hold on… shouldn’t having access to all the information on the internet be empowering? After all, there’s that famous saying, “Knowledge is Power.” Well I’m not sure what Francis Bacon would say if he could scroll on TikTok, but in the age of the internet, more information does not always mean more power or knowledge. In fact, information overload seems to trigger excessive reassurance seeking online (Yang & Luo, 2024). Once digital algorithms detect health-related concerns, users may be exposed to increasingly frequent and targeted content, further amplifying health anxiety and driving additional reassurance seeking online (Zhang et al., 2024).
Despite these challenges, evidence-based treatments offer hope. Exposure and response prevention (ERP), the gold-standard treatment for OCD, helps individuals tolerate uncertainty and break free from compulsive behaviors. ERP therapists are prepared to respond to clients who compulsively seek reassurance while taking care to avoid reinforcing a client’s anxiety and setting boundaries when appropriate. On the other hand, AI chatbots are available 24/7 and will continue to reassure users when it would be clear to a skilled therapist that more reassurance is harmful. Some helpful activities I have encouraged clients to try include:
Clinicians working with youth should also attend to parental accommodations that inadvertently facilitate online reassurance seeking. Supportive Parenting for Anxious Childhood Emotions (SPACE) is an evidence-based, parent-focused intervention that emphasizes increasing supportive statements while reducing unhelpful accommodations. Setting reasonable limits on smartphone use while responding with empathy and confidence can help youth build resilience and independence (i.e. “I know it’s tough to be away from your phone and I know you got this!”).
Finally, because shame plays a central role in digital reassurance traps, incorporating self-compassion practices may be beneficial. Compassion-focused exercises help individuals respond to their struggles with kindness rather than self-criticism, complementing ERP by fostering emotional resilience. I sometimes ask clients to imagine that a close friend or loved one is feeling ashamed because they are experiencing obsessions and are stuck in an OCD loop. Then, I invite them to write down how they would support this friend while paying special attention to how compassion feels in their body. By practicing compassion for others, we strengthen the same muscles in our brains that help us turn compassion inward.
If you are getting stuck in digital reassurance traps, you are not alone! Many of these technologies are brand new and we are learning how to integrate them into our lives in a healthy way. If you need help managing compulsive online habits, finding a therapist trained in ERP could be a useful step!
References
Abramowitz, J. S., Schwartz, S. A., & Whiteside, S. P. (2002). A contemporary conceptual model of hypochondriasis. Mayo Clinic Proceedings, 77(12), 1323–1330. https://doi.org/10.4065/77.12.1323
Burns, A. B., Brown, J. S., Plant, E. A., Sachs-Ericsson, N., & Joiner, T. E., Jr. (2006). On the specific depressotypic nature of excessive reassurance-seeking. Personality and Individual Differences, 40(1), 135–145. https://doi.org/10.1016/j.paid.2005.05.019
Parsons, C. A., & Alden, L. E. (2022). Online reassurance-seeking and relationships with obsessive-compulsive symptoms, shame, and fear of self. Journal of Obsessive-Compulsive and Related Disorders, 33, 100714. https://doi.org/10.1016/j.jocrd.2022.100714
Parsons, C. A., Kim, H. J., Singh, S., Lkhagva, T., Wang, J., & Alden, L. E. (2025). Covert or connected: Motivations for online and interpersonal reassurance-seeking in OCD. Journal of Anxiety Disorders, 115, 103057. https://doi.org/10.1016/j.janxdis.2025.103057
Yang, X., & Luo, X. (2024). Unpacking cyberchondria: The roles of online health information seeking, health information overload, and health misperceptions. Telematics and Informatics, 97, 102225.
Zhang, X., Zheng, H., Zeng, Y., Zou, J., & Zhao, L. (2024). Exploring how health-related advertising interference contributes to the development of cyberchondria: A stressor–strain–outcome approach. BMC Public Health, 24, 534.
Jordan Karr, PhD, is the owner of River Falls Therapy in Portland, OR. He is a licensed psychologist in Oregon and Virginia, and specializes in evidence-based therapies for OCD and anxiety disorders. Dr. Karr has experience working in outpatient, community-based, and school-based settings.
The post Digital Reassurance Seeking in OCD appeared first on International OCD Foundation.
This is today’s edition of The Download, our weekday newsletter that provides a daily dose of what’s going on in the world of technology.
Last weekend, several current and former advisers to President Donald Trump on AI publicly lobbed insults at the country’s leading AI companies. David Sacks branded Anthropic’s models “lobotomized” and “woke.” Emil Michael, a top Pentagon official, called OpenAI’s new head of strategic futures a “supreme village idiot.”
It began because no one can agree on what to do about Kimi, a free, open-source model that Chinese AI company Moonshot launched last week. It appears to rival the intelligence of models from OpenAI and Anthropic, which are very much not free.
Every time a new smart, free model from China gets released, US companies see less reason to fork out money for models from Anthropic or OpenAI. That’s creating economic and political problems for the president—and dividing the top AI strategists in his orbit.
Read the full story on why no one can agree what to do about Kimi.
—James O’Donnell
This article is from The Algorithm, our weekly AI newsletter. Sign up to receive it in your inbox every Monday.
The must-reads
I’ve combed the internet to find you today’s most fun/important/scary/fascinating stories about technology.
1 Anthropic’s record $1.5 billion copyright settlement has been approved
The plaintiffs said Anthropic used pirated works to train Claude. (Reuters $)
+ And won the largest known copyright payout in history. (Engadget)
+ Yet many authors and creators still don’t view it as a win. (TechCrunch)
+ But AI copyright anxiety could limit creativity. (MIT Technology Review)
2 The Trump administration is weighing a ban on Chinese AI models
The launch of Kimi K3 has revived calls for restrictions. (Axios)
+ But officials are divided on the proposals. (Fast Company)
+ China’s bet on open-source is paying off. (MIT Technology Review)
3 China is mulling tighter export controls on AI models and chips
It wants to stop the West from acquiring its tech and startups. (FT $)
+ Beijing has held talks with tech firms about potential restrictions. (Reuters $)
4 Trump’s AI safety head has resigned after just three months
Chris Fall had led CAISI, the federal AI Safety Institute, since April. (Axios)
+ No reason was given for his exit. (CNBC)
5 Google is working on a new chip to run Gemini models more efficiently
The chip, called “Frozen V2,” may be deployed in 2028. (Information $)
+ Alphabet stock popped on the report. (CNBC)
6 New Orleans police have explored arming drones with weapons
A draft drone manual paves the way for weaponised quadcopters. (404 Media)
+ Shoplifters could soon be chased by drones. (MIT Technology Review)
7 The EU has handed AliExpress a record fine over unsafe product sales
The €550 million fine is the largest-ever under the Digital Services Act. (BBC)
+ Alibaba has vowed to appeal the fine. (SCMP)
8 Election advice from AI chatbots is “inaccurate and unreliable”
That’s the conclusion from tests in Hungary earlier this year. (Guardian)
9 Red light therapy is showing promise for healing and healthy aging
Better skin and reduced vision loss are also on the cards. (Economist $)
10 Neill Blomkamp’s new horror clip is all AI-generated—and it sucks
The acclaimed director wants to make “a full feature in this format.” (Gizmodo)
Quote of the day
—Tech investor Chamath Palihapitiya slams plans to restrict Chinese AI models in a post on X.
One More Thing
Early on the morning of September 2, 2024, four people were shot and killed on a westbound train in Chicago. Police swiftly activated a digital dragnet—a surveillance network that connects thousands of cameras across the city—and arrested the suspect just 90 minutes later.
Law enforcement and security advocates say this vast monitoring system protects public safety and works well. But activists and many residents say it’s a surveillance panopticon that creates a chilling effect on behavior and violates guarantees of privacy and free speech.
Go inside the surveillance network that’s dividing Chicago.
—Rod McCullom
We can still have nice things
A place for comfort, fun, and distraction to brighten up your day. (Got any ideas? Drop me a line.)
+ NASA has shared a stunning timelapse video of the Psyche spacecraft’s view of Mars.
+ This comparison of American and European Urbanism shows good city design is a choice.
+ Musician Luca Stricagnoli recently performed a marvellous acoustic guitar medley of Prodigy songs.
+ Two Australian paddleboarders saved a stranded wallaby after it was swept out to sea—and caught the whole rescue on video.