Safety-Seeking Behaviors / 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:

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 Therapy, 37(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.