Alternative hypotheses

Compare mechanisms

Compare function, sequence, patient language, and treatment leverage. The aim is not to choose a label—it is to identify which hypothesis best explains this person’s pattern.

Ask this

Which pattern better explains the sequence, protective function, and consequences: reassurance seeking or avoidance?

Reassurance seeking

Reassurance seeking can soothe briefly but may maintain uncertainty intolerance, anxiety, dependency cycles, and interpersonal strain.

InterpersonalAttachmentCognition+1

Avoidance

Avoidance reduces distress in the short term but commonly maintains anxiety, trauma responses, functional impairment, and interpersonal narrowing.

BehaviourCognitionTrauma+1

Definition

ARepeatedly seeking certainty, safety, approval, or relational confirmation to reduce distress or doubt.

BA pattern of keeping away from internal experiences, situations, people, or tasks that trigger distress or perceived threat.

Core process

ADistress or doubt triggers interpersonal checking, which gives short-term relief while preventing internal tolerance of uncertainty.

BThreat appraisal activates escape, safety behaviour, suppression, or disengagement, which prevents corrective learning and narrows coping options.

Look for

ARepeated checking questions · Frequent messages

BMissed appointments · Safety behaviours

Patient language

A“Are you sure?”

B“I just avoid it”

Maintaining cycle

ADoubt -> reassurance -> relief -> doubt returns stronger -> reassurance escalates

BThreat cue -> anxiety -> avoidance -> relief -> threat belief remains untested

Treatment leverage

AShift from certainty seeking toward tolerating uncertainty and using internal anchors.

BTarget the relief-maintenance loop and build tolerable approach behaviours.

Check before using

AThe person is asking for ordinary information, care coordination, or reasonable clarification.

BWithdrawal is mainly due to low energy, cognitive impairment, environmental barriers, or lack of opportunity.

Formulation language

Reassurance seeking temporarily reduces doubt, but because the relief fades it can maintain dependence on external certainty.

Open full guide

Formulation language

Avoidance appears to reduce distress briefly, but it also prevents corrective experience and maintains the threat appraisal.

Open full guide

Browse the map Use both hypotheses

Alternative hypotheses

Compare mechanisms

Compare function, sequence, patient language, and treatment leverage. The aim is not to choose a label—it is to identify which hypothesis best explains this person’s pattern.

Ask this

Which pattern better explains the sequence, protective function, and consequences: reassurance seeking or avoidance?

Reassurance seeking

Reassurance seeking can soothe briefly but may maintain uncertainty intolerance, anxiety, dependency cycles, and interpersonal strain.

InterpersonalAttachmentCognition+1

Avoidance

Avoidance reduces distress in the short term but commonly maintains anxiety, trauma responses, functional impairment, and interpersonal narrowing.

BehaviourCognitionTrauma+1

Definition

ARepeatedly seeking certainty, safety, approval, or relational confirmation to reduce distress or doubt.

BA pattern of keeping away from internal experiences, situations, people, or tasks that trigger distress or perceived threat.

Core process

ADistress or doubt triggers interpersonal checking, which gives short-term relief while preventing internal tolerance of uncertainty.

BThreat appraisal activates escape, safety behaviour, suppression, or disengagement, which prevents corrective learning and narrows coping options.

Look for

ARepeated checking questions · Frequent messages

BMissed appointments · Safety behaviours

Patient language

A“Are you sure?”

B“I just avoid it”

Maintaining cycle

ADoubt -> reassurance -> relief -> doubt returns stronger -> reassurance escalates

BThreat cue -> anxiety -> avoidance -> relief -> threat belief remains untested

Treatment leverage

AShift from certainty seeking toward tolerating uncertainty and using internal anchors.

BTarget the relief-maintenance loop and build tolerable approach behaviours.

Check before using

AThe person is asking for ordinary information, care coordination, or reasonable clarification.

BWithdrawal is mainly due to low energy, cognitive impairment, environmental barriers, or lack of opportunity.

Formulation language

Reassurance seeking temporarily reduces doubt, but because the relief fades it can maintain dependence on external certainty.

Open full guide

Formulation language

Avoidance appears to reduce distress briefly, but it also prevents corrective experience and maintains the threat appraisal.

Open full guide

Browse the map Use both hypotheses