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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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94 of 94 resources

ABC Model

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Attention Training Experiment

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Audio Collection: Psychology Tools For Overcoming PTSD

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Avoidance Hierarchy (Archived)

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CFT Compassion Formulation

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Checking Certainty And Doubt

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Cognitive Behavioral Model Of Anorexia Nervosa (Fairburn, Cooper, Shafran, 2003)

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

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Cognitive Behavioral Model Of Depersonalization (Hunter, Phillips, Chalder, Sierra, David, 2003)

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Cognitive Behavioral Model Of Fear Of Body Sensations

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

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Cognitive Behavioral Model Of Insomnia (Harvey, 2002)

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Cognitive Behavioral Model Of Intolerance Of Uncertainty (Hebert, Dugas, 2019)

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Cognitive Behavioral Model Of Low Self-Esteem (Fennell, 1997)

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Cognitive Behavioral Model Of Obsessive Compulsive Disorder (OCD: Salkovskis, Forrester, Richards, 1998)

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Cognitive Behavioral Model Of Panic (Clark, 1986)

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Cognitive Behavioral Model Of Persistent Postural-Perceptual Dizziness (PPPD: Whalley, Cane, 2017)

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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

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

People suffering from social anxiety disorder (previously known as social phobia) experience persistent fear or anxiety concerning social or performan ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-social-phobia-clark-wells-1995

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Cognitive Behavioral Model Of Tinnitus (McKenna, Handscombe, Hoare, Hall, 2014)

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

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

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Critical Care And PTSD

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

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Embracing Uncertainty

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

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Exposure Practice Form

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Exposure Session Record

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Facing Your Fears (CYP)

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Exercises

Facing Your Fears And Phobias

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Guides

Fear Ladder

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Fight or Flight (CYP)

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Fight Or Flight Response

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Habituation

The Habituation information sheets are designed to help clinicians to explain the concept of habituation and its role in exposure therapy. The handout ... https://www.psychologytools.com/resource/habituation

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Health Anxiety Formulation

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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

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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

Exercises

Intolerance Of Uncertainty

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Managing Social Anxiety: 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

Treatments That Work®

Managing Social Anxiety: 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

Treatments That Work®

Mastery Of Your Anxiety And Panic: 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

Treatments That Work®

Mastery Of Your Anxiety And Panic: 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

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Mastery Of Your Anxiety And Worry: 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

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Mastery Of Your Anxiety And Worry: Workbook

Mastery Of Your Anxiety And Worry 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-worry-workbook

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Maximizing The Effectiveness Of Exposure Therapy

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Information handouts

Narrative Exposure Therapy (NET)

Narrative Exposure Therapy (NET) is an empirically validated treatment for survivors of multiple traumatic events who are suffering from post-traumati ... https://www.psychologytools.com/resource/narrative-exposure-therapy-net

Guides

Obsessive Compulsive Disorder (OCD) Formulation

An important treatment implication of the cognitive behavioral model of OCD is that clinicians can work at the level of the meaning of the intrusion. ... https://www.psychologytools.com/resource/obsessive-compulsive-disorder-ocd-formulation

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OCD Hierarchy

Part of traditional CBT treatment for OCD is exposure to situations which trigger obsessions (classically accompanied by the prevention of the associa ... https://www.psychologytools.com/resource/ocd-hierarchy

Exercises

Overcoming Eating Disorders: 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

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Overcoming Your Eating Disorder: Workbook

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Pacing For Pain And Fatigue

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Exercises

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

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Panic Attack Record Form

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

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Panic Formulation

The aim of a formulation is to help the client and therapist to come to a shared understanding of what a client is experiencing. The Panic Formulation ... https://www.psychologytools.com/resource/panic-formulation

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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

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Prolonged Exposure Therapy For PTSD: Therapist Guide

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PTSD Formulation

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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

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Reclaiming Your Life From A Traumatic Experience: Workbook

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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

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Safety Behaviors Example

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Self-Monitoring Record (Universal)

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Social Anxiety Formulation

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Starvation Syndrome – The Effects of Semi-Starvation

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Transdiagnostic Processes

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

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Uncertainty Beliefs – Experiment Record

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Understanding Depersonalization And Derealization

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Understanding Fears And Phobias

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Understanding Generalized Anxiety And Worry

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Understanding Health Anxiety

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Understanding Obsessive Compulsive Disorder (OCD)

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Understanding Panic

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Understanding Post-Traumatic Stress Disorder (PTSD)

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Understanding Psychosis

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Understanding Social Anxiety

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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

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What Is Worry?

Worrying is a form of thinking about the future, defined as thinking about future events in a way that leaves you feeling anxious or apprehensive. Cli ... https://www.psychologytools.com/resource/what-is-worry

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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

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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

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What Keeps Psychosis Going?

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What Keeps Social Anxiety Going?

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Window Of Tolerance

The window of tolerance concept was coined by Dan Siegel in his 1999 book The Developing Mind. Siegel proposes that everyone has a range of intensitie ... https://www.psychologytools.com/resource/window-of-tolerance

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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

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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
Strategy	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 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.

Safety-Seeking Behaviors / Safety Behaviors

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What Are Safety Behaviors?

Disorders That May Be Maintained by Safety-Seeking Behaviors

Helpful Questions for Assessing Safety-Seeking Behaviors

Treatment Approaches That Target Safety-Seeking Behaviors

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