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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Activity Planning

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Activity Selection

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Avoidance Hierarchy (Archived)

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Behavioral Activation Activity Planning Diary

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

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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 Persistent Postural-Perceptual Dizziness (PPPD: Whalley, Cane, 2017)

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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)

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Cognitive Behavioral Model Of The Relapse Process (Marlatt & Gordon, 1985)

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

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Embracing Uncertainty

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Exercises

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

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Treatments That Work®

Exposure Practice Form

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Exercises

Exposure Session Record

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Worksheets

Exposures For Fear Of Appearing Anxious

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Exposures For Fear Of Body Sensations

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Exposures For Fear Of Breathlessness

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Exposures For Fear Of Death

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Exposures For Fear Of Flying

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Exposures For Fear Of Heights

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Exposures For Fear Of Illness

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Exposures For Fear Of Losing Control Of Your Mind

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Exposures For Fear Of Uncertainty

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Exposures For Fear Of Vomiting

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Exposures For Trauma

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Information handouts

Facing Your Fears (CYP)

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Facing Your Fears And Phobias

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Fear Ladder

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Worksheets

Fight or Flight (CYP)

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Fight Or Flight Response

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Habituation

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Health Anxiety Formulation

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Identifying The Meaning Of Body Sensations

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Interoceptive Exposure

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Exercises

Intolerance Of Uncertainty

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Managing Social Anxiety: Therapist Guide

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Managing Social Anxiety: Workbook

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Mastery Of Your Anxiety And Panic: Therapist Guide

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Mastery Of Your Anxiety And Panic: Workbook

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Mastery Of Your Anxiety And Worry: Therapist Guide

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Mastery Of Your Anxiety And Worry: Workbook

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Guides

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OCD Hierarchy

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Panic Attack Record

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Panic Formulation

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Reciprocal CBT Formulation

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Safety Behaviors

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Safety Behaviors Example

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Worksheets

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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

References