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Safety-Seeking Behaviors / Safety Behaviors

Safety-seeking behaviors are behaviors that are carried out (either overtly or covertly) in specific situations in order to prevent feared outcomes (Salkovskis, 1991). Many safety-seeking behaviors are helpful and adaptive when the concern is real and the behavior can genuinely reduce the danger, such as checking the temperature of the water before getting in the bath or looking both ways before crossing the road. However, when safety-seeking behaviors concern perceived threats rather than actual dangers they are either unnecessary or can serve to exacerbate and maintain the anxiety.
The identification of safety-seeking behaviors has helped to explain the paradoxical observation that people with anxiety disorders have repeated experiences indicating that their fear is not warranted, yet fail to learn from their experiences (Harvey, Watkins, Mansell, & Shafran, 2004; Clark, 1999). Salkovskis (1991) states:
“In order to account for the failure of anxious patients to take advantage of naturally occurring disconfirmations, the cognitive hypothesis postulates a functional and internally logical link between cognition and behaviour … That is, a person panicking because he believes that a catastrophe is imminent will do anything he believes he can do to prevent the catastrophe. The person afraid of fainting sits, the person afraid of having a heart attack refrains from exercising, and so on. By doing so, the patient not only experiences immediate relief, but also unwittingly ‘protects’ his or her belief of the potential for disaster associated with particular sensations. Each panic attack, rather than being experienced as a disconfirmation, becomes another example of nearly being overtaken by disaster; ‘I have been close to fainting so many times: I have to be careful, or one of these times I won’t be able to catch it.’ This means that the apparent failure of panic patients to take advantage of natural disconfirmations may be because the non-occurrence of feared catastrophes, when associated with safety seeking behaviour, does not constitute an actual disconfirmation, and may sometimes be perceived as confirmation of a ‘near miss.’ ”
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Fight Or Flight Response

The fight or flight response is an automatic physiological reaction to an event that is perceived as stressful or frightening. The perception of threa ... https://www.psychologytools.com/resource/fight-or-flight-response

Assertive Communication

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Window Of Tolerance

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Embracing Uncertainty

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Activity Menu

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Obsessive Compulsive Disorder (OCD) Formulation

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Intolerance Of Uncertainty

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Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Second Edition): Client Workbook

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Second Edition) comes in two volumes. This page is for the Client Workbook. ... https://www.psychologytools.com/resource/unified-protocol-for-transdiagnostic-treatment-of-emotional-disorders-second-edition-client-workbook

Social Anxiety Formulation

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PTSD Formulation

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Behavioral Experiment

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Behavioral Experiment (Portrait Format)

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Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Second Edition): Therapist Guide

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Second Edition) comes in two volumes. This page is for the Therapist Guide. ... https://www.psychologytools.com/resource/unified-protocol-for-transdiagnostic-treatment-of-emotional-disorders-second-edition-therapist-guide

Health Anxiety Formulation

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Fear Ladder

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Panic Formulation

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Understanding Generalized Anxiety And Worry

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Habituation

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Understanding Obsessive Compulsive Disorder (OCD)

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Exposure Session Record

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What Is Worry?

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CBT Appraisal Model

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Understanding Social Anxiety

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Behavioral Activation Activity Planning Diary

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Treating Your OCD With Exposure And Response (Ritual) Prevention (Second Edition): Workbook

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Mastery Of Your Anxiety And Worry (Second Edition): Workbook

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Activity Planning

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Exposure Practice Form

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Autonomic Nervous System

The autonomic nervous system (ANS) automatically regulates the function of body systems outside of voluntary control. The Autonomic Nervous System han ... https://www.psychologytools.com/resource/autonomic-nervous-system

ABC Model

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Interoceptive Exposure

Misappraisals of body sensations trigger emotional and physiological reactions of fear and heightened arousal. These feelings motivate behavioral resp ... https://www.psychologytools.com/resource/interoceptive-exposure

Understanding Health Anxiety

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OCD Hierarchy

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Mastery Of Your Anxiety And Panic (Fifth Edition): Workbook

Mastery Of Your Anxiety And Panic comes in two volumes. This page is for the Workbook. Click on the following link to access the accompanying Therapis ... https://www.psychologytools.com/resource/mastery-of-your-anxiety-and-panic-workbook

Managing Social Anxiety (Third Edition): Workbook

Managing Social Anxiety – A Cognitive-Behavioral Therapy Approach comes in two volumes. This page is for the Workbook. Click on the following link t ... https://www.psychologytools.com/resource/managing-social-anxiety-workbook

Exposure And Response (Ritual) Prevention For Obsessive Compulsive Disorder (Second Edition): Therapist Guide

Exposure and Response (Ritual) Prevention for Obsessive-Compulsive Disorder comes in two volumes. This page is for the Therapist Guide. Click on the f ... https://www.psychologytools.com/resource/exposure-and-response-ritual-prevention-for-obsessive-compulsive-disorder-therapist-guide

Exposures For Fear Of Uncertainty

Fear of uncertainty is commonly associated with many psychological difficulties, including generalized anxiety disorder (GAD), obsessive compulsive di ... https://www.psychologytools.com/resource/exposures-for-fear-of-uncertainty

Understanding Post-Traumatic Stress Disorder (PTSD)

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-post-traumatic-stress-disorder-ptsd

Attention Training Experiment

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What Keeps Social Anxiety Going?

The "What Keeps It Going?" series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, t ... https://www.psychologytools.com/resource/what-keeps-social-anxiety-going

Checking Certainty And Doubt

Psychologists have discovered interesting relationships between Checking, Certainty, And Doubt. This information handout contains an exercise helpful ... https://www.psychologytools.com/resource/checking-certainty-and-doubt

Reciprocal CBT Formulation

CBT therapists often describe finding it difficult to apply CBT skills when clients bring relational problems to therapy. Familiar methods of visu ... https://www.psychologytools.com/resource/reciprocal-cbt-formulation

Safety Behaviors

Safety behaviors are actions carried out with the intention of preventing a feared catastrophe. In the short-term they often give a sense of relief, b ... https://www.psychologytools.com/resource/safety-behaviors

Mastery Of Your Anxiety And Worry (Second Edition): Therapist Guide

Mastery Of Your Anxiety And Worry comes in two volumes. This page is for the Therapist Guide. Click on the following link to access the accompanying W ... https://www.psychologytools.com/resource/mastery-of-your-anxiety-and-worry-therapist-guide

Fight or Flight (CYP)

The Fight Or Flight (CYP) information handout has been specifically designed for younger children and includes carefully simplified language. The prof ... https://www.psychologytools.com/resource/fight-or-flight-cyp

Uncertainty Beliefs – Experiment Record

Situations which are uncertain, novel, or ambiguous trigger a state of uncertainty. Evidence indicates that individuals who are dispositionally high i ... https://www.psychologytools.com/resource/uncertainty-beliefs-experiment-record

Self-Monitoring Record (Universal)

Developing self-monitoring skills teaches clients to systematically observe and record specific targets such as their own thoughts, body feelings, emo ... https://www.psychologytools.com/resource/self-monitoring-record-universal

Audio Collection: Psychology Tools For Overcoming PTSD

The Psychology Tools for Overcoming PTSD Audio Collection is designed for anyone with post-traumatic stress disorder (PTSD). This skills development p ... https://www.psychologytools.com/resource/psychology-tools-for-overcoming-ptsd-audio-collection

Mastery Of Your Anxiety And Panic (Fifth Edition): Therapist Guide

Mastery Of Your Anxiety And Panic comes in two volumes. This page is for the Therapist Guide. Click on the following link to access the accompanying C ... https://www.psychologytools.com/resource/mastery-of-your-anxiety-and-panic-therapist-guide

Understanding Panic

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-panic

Your Stone Age Brain

Your Stone Age Brain is an information handout which describes the freeze-flight-fight response: a set of evolutionary adaptations that increase the c ... https://www.psychologytools.com/resource/your-stone-age-brain

Reclaiming Your Life From A Traumatic Experience (Second Edition): Workbook

Prolonged Exposure Therapy For PTSD comes in two volumes. This page is for the Client Workbook. Click on the following link to access the accompanying ... https://www.psychologytools.com/resource/reclaiming-your-life-from-a-traumatic-experience-workbook

Overcoming Your Eating Disorder: Workbook

Overcoming Eating Disorders comes in two volumes. This page is for the Client Workbook. Click on the following link to access the accompanying Therapi ... https://www.psychologytools.com/resource/overcoming-your-eating-disorder-workbook

Cognitive Behavioral Model Of Post Traumatic Stress Disorder (PTSD: Ehlers & Clark, 2000)

Anke Ehlers' & David Clark's Cognitive Behavioral Model Of Post-Traumatic Stress Disorder (PTSD) is an influential account of the condition. The ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-post-traumatic-stress-disorder-ptsd-ehlers-clark-2000

Avoidance Hierarchy (Archived)

NOTE: An improved version of this resource is available here: Fear Ladder. Older versions of a resource may be archived in the event that they are ava ... https://www.psychologytools.com/resource/avoidance-hierarchy

Pacing For Pain And Fatigue

Pacing is an evidence-based approach to increasing activity and fitness, and in reducing overall pain and fatigue. It is designed to prevent 'boom and ... https://www.psychologytools.com/resource/pacing-for-pain-and-fatigue

Exposures For Fear Of Vomiting

Fear of vomiting is a chronic and distressing difficulty that is associated with significant impairment. Exposure is an effective treatment for addres ... https://www.psychologytools.com/resource/exposures-for-fear-of-vomiting

Cognitive Behavioral Treatment of Childhood OCD: It's Only a False Alarm: Workbook

Cognitive Behavioral Treatment Of Childhood OCD: It’s Only A False Alarm comes in two volumes. This page is for the Workbook. Click on the following ... https://www.psychologytools.com/resource/cognitive-behavioral-treatment-of-childhood-ocd-its-only-a-false-alarm-workbook

What Keeps Panic Going?

The "What Keeps It Going?" series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, t ... https://www.psychologytools.com/resource/what-keeps-panic-going

Managing Social Anxiety (Third Edition): Therapist Guide

Managing Social Anxiety – A Cognitive-Behavioral Therapy Approach comes in two volumes. This page is for the Therapist Guide. Click on the following ... https://www.psychologytools.com/resource/managing-social-anxiety-therapist-guide

Maximizing The Effectiveness Of Exposure Therapy

Despite its position as the leading treatment technique for anxiety disorders, not all clients respond to exposure therapy and some individuals relaps ... https://www.psychologytools.com/resource/maximizing-the-effectiveness-of-exposure-therapy

Cognitive Behavioral Treatment Of Childhood OCD: It's Only A False Alarm: Therapist Guide

Cognitive Behavioral Treatment Of Childhood OCD: It’s Only A False Alarm comes in two volumes. This page is for the Therapist Guide. Click on the fo ... https://www.psychologytools.com/resource/cognitive-behavioral-treatment-of-childhood-ocd-its-only-a-false-alarm-therapist-guide

Facing Your Fears And Phobias

The Facing Your Fears And Phobias guide is written for clients who struggle with fears or phobias. It provides comprehensive information about what fe ... https://www.psychologytools.com/resource/facing-your-fears-and-phobias

Prolonged Exposure Therapy For PTSD (Second Edition): Therapist Guide

Prolonged Exposure Therapy For PTSD comes in two volumes. This page is for the Therapist Guide. Click on the following link to access the accompanying ... https://www.psychologytools.com/resource/prolonged-exposure-therapy-for-ptsd-therapist-guide

Exposures For Fear Of Body Sensations

Fearful responses to physical sensations are common in several disorders. Interoceptive exposure (or ‘symptom induction’) is an effective treatmen ... https://www.psychologytools.com/resource/exposures-for-fear-of-body-sensations

Overcoming Eating Disorders (Second Edition): Therapist Guide

Overcoming Eating Disorders comes in two volumes. This page is for the Therapist Guide. Click on the following link to access the Client Workbook.&nbs ... https://www.psychologytools.com/resource/overcoming-eating-disorders-therapist-guide

Cognitive Behavioral Model Of Health Anxiety (Salkovskis, Warwick, Deale, 2003)

Health anxiety is characterized by a preoccupation with having or acquiring a serious illness, and a high level of anxiety about health. People with h ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-health-anxiety-salkovskis-warwick-deale-2003

Exposures For Fear Of Death

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What Keeps Fears And Phobias Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-fears-and-phobias-going

What Are Safety Behaviors?

Safety-seeking behaviors (‘safety behaviors’) are actions that people take in response to a real – or perceived – threat. When a threat is rea ... https://www.psychologytools.com/resource/what-are-safety-behaviors

Process Focused Case Formulation

The Process-Focused Case Formulation encourages clinicians to make hypotheses regarding mechanisms or processes which they believe may be maintainin ... https://www.psychologytools.com/resource/process-focused-case-formulation

Exposures For Fear Of Illness

Fear of illness is a common and persistent fear that can result in significant functional impairment. Exposure is an effective treatment for health-re ... https://www.psychologytools.com/resource/exposures-for-fear-of-illness

Critical Care And PTSD

The Critical Care And PTSD information handout is designed to help clients to learn about the properties of critical care that can increase the likeli ... https://www.psychologytools.com/resource/critical-care-and-ptsd

Panic Attack Record

Self-monitoring of thoughts, feelings, and symptoms is an essential skill for clients engaged in cognitive behavioral therapy (CBT). The Panic Attack ... https://www.psychologytools.com/resource/panic-attack-record

Panic - Self-Monitoring Record

Developing self-monitoring skills teaches clients to systematically observe and record specific targets such as their own thoughts, body feelings, emo ... https://www.psychologytools.com/resource/panic-self-monitoring-record

Am I Experiencing Post-Traumatic Stress Disorder (PTSD)?

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Exposures For Fear Of Appearing Anxious

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Cognitive Behavioral Model Of Body Dysmorphic Disorder (BDD: Veale, 2004)

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Understanding Fears And Phobias

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Am I Experiencing Generalized Anxiety Disorder (GAD)?

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Facing Your Fears (CYP)

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Understanding Psychosis

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Am I Experiencing Social Anxiety?

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Understanding Depersonalization And Derealization

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Am I Experiencing Depression?

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Am I Experiencing Health Anxiety?

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Cognitive Behavioral Model Of Fear Of Body Sensations

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Cognitive Behavioral Model Of Social Phobia (Clark, Wells, 1995)

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Activity Selection

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Cognitive Behavioral Model Of Panic (Clark, 1986)

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Exposures For Fear Of Flying

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Starvation Syndrome – The Effects of Semi-Starvation

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Critical Illness Intensive Care And Post-Traumatic Stress Disorder (PTSD)

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Transdiagnostic Processes

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Exposures For Fear Of Losing Control Of Your Mind

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Identifying The Meaning Of Body Sensations

Some anxiety disorders (including panic and health anxiety), are concerned with body sensations and symptoms. The Identifying The Meaning Of Body Sens ... https://www.psychologytools.com/resource/identifying-the-meaning-of-body-sensations

What Keeps Psychosis Going?

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Exposures For Fear Of Breathlessness

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Am I Experiencing Panic Attacks?

Panic attacks are discrete episodes of intense fear or apprehension. They are accompanied by the rapid and concurrent onset of characteristic symptoms ... https://www.psychologytools.com/resource/am-i-experiencing-panic-attacks

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Recommended Reading

  • Helbig‐Lang, S., & Petermann, F. (2010). Tolerate or eliminate? A systematic review on the effects of safety behavior across anxiety disorders. Clinical Psychology: Science and Practice, 17(3), 218-233.
  • Rachman, S., Radomsky, A. S., & Shafran, R. (2008). Safety behaviour: A reconsideration. Behaviour Research and Therapy, 46(2), 163-173 archive.org
  • Salkovskis, P. M. (1991). The importance of behaviour in the maintenance of anxiety and panic: a cognitive account. Behavioural and Cognitive Psychotherapy, 19, 6-19
  • Salkovskis, P. M., Clark, D. M., Hackmann, A., Wells, A., Gelder, M. G. (1999). An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia. Behaviour Research and Therapy, 37, 559-574 archive.org
  • Thwaites, R., Freeston, M. H. (2005). Safety-seeking behaviours: Fact or function? How can we clinically differentiate between safety-seeking behaviours and adaptive coping strategies across anxiety disorders? Behavioural and Cognitive Psychotherapy, 33, 177-188

What Are Safety Behaviors?

Blakey et al. (2019) review safety behaviors from an inhibitory learning standpoint and argue that safety behaviors interfere with safety learning in three ways:

  • they could prevent the violation of expectancies by attenuating the discrepancy between what the patient predicts will occur during an exposure task (i.e., catastrophe) and what actually occurs (i.e., no catastrophe);
  • safety behaviors might obstruct the generalization of safety-based associations by restricting safety learning to specific contexts;
  • they could impede the development of distress tolerance by obstructing patients from learning that they can persist in challenging tasks despite elevate levels of distress.

Although safety behaviors are labeled ‘behaviors’ they can also be internal processes or cognitive strategies, such as using distraction during an episode of panic, or rehearsing what you are going to say in social phobia. Helbig-Lang and Petermann (2010) give a two-dimensional account of the function and strategy of safety behaviors:

Function
Preventive Restorative
Strategy Behavioral Situational avoidance

Relying on safety signals

Subtle avoidance

Compulsive behavior carried out to prevent an increase in anxiety

Escape

Use of safety signals

Compulsive behavior carried out to decrease anxiety

Reassurance seeking

Cognitive Preparation Distraction/​focusing

Neutralizing

Thought suppression

Disorders That May Be Maintained by Safety-Seeking Behaviors

Harvey et al. (2004) propose that safety-seeking behavior is present in:

  • panic disorder with or without agoraphobia
  • specific phobia
  • social phobia
  • post-traumatic stress disorder (PTSD)
  • obsessive compulsive disorder (OCD)
  • body dysmorphic disorder
  • eating disorders
  • insomnia
  • psychosis

Helpful Questions for Assessing Safety-Seeking Behaviors

Some helpful questions for assessing safety-seeking behaviors include:

  • How do you respond when you feel threatened?
  • In situations where you feel anxious but can’t or don’t escape, what do you do to cope?
  • What are the short-term effects of coping in that way?
  • What would happen if you stopped using that safety behavior?

Treatment Approaches That Target Safety-Seeking Behaviors

The traditional approach to the treatment of anxiety is to expose the patient to the feared situation or stimulus with encouragement to drop the use of safety-seeking behaviors. Recent research has questioned whether the judicious use of safety behaviors might make exposure tasks more acceptable to patients, and might facilitate approach behaviors. Current evidence is mixed, with the authors of a 2019 trial concluding:

“… therapists may not need to be concerned if their patient is unwilling to immediately eliminate their safety behavior(s) as long as the patient explicitly tests their fear-based negative expectancies through direct and sustained confrontation with feared situations/​stimuli and also understands they should eliminate their use of safety behaviors as soon as they are willing” (Blakey et al., 2019).

References

  • Blakey, S. M., Abramowitz, J. S., Buchholz, J. L., Jessup, S. C., Jacoby, R. J., Reuman, L., & Pentel, K. Z. (2019). A randomized controlled trial of the judicious use of safety behaviors during exposure therapy. Behaviour Research and Therapy, 112, 28–35.
  • Clark, D. M. (1999). Anxiety disorders: Why they persist and how to treat them. Behaviour Research and Therapy37(1), S5.
  • Harvey, A. G., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. New York: Oxford University Press.
  • Helbig-Lang, S., & Petermann, F. (2010). Tolerate or eliminate? A systematic review on the effects of safety behavior across anxiety disorders. Clinical Psychology: Science and Practice, 17(3), 218–233.
  • Salkovskis, P. M. (1991). The importance of behaviourin the maintenance of anxiety and panic: A cognitive account. Behavioural and Cognitive Psychotherapy, 19(1), 6–19.