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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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Problem

Therapy tool

Language

Avoidance Hierarchy

Avoidance and safety-seeking behavior serves to maintain anxiety, and exposure to the fear stimuli/situation is an effective treatment for anxiety. Th ... https://www.psychologytools.com/resource/avoidance-hierarchy/

Exercise

Behavioral Experiment

Behavioral experiments are planned experiential activities to test the validity of a belief. They are one of the most powerful techniques available to ... https://www.psychologytools.com/resource/behavioral-experiment/

Worksheet

Behavioral Experiment (Portrait Format)

Behavioral experiments allow individuals to test the validity of their beliefs and assumptions. They are a core experiential technique for therapeutic ... https://www.psychologytools.com/resource/behavioral-experiment-portrait-format/

Worksheet

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/

Exercise

Cognitive Behavioral Model Of Anorexia Nervosa (2003)

Anorexia nervosa is an eating disorder characterized by restriction of energy intake and intense fear of gaining weight. For women, the lifetime preva ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-anorexia-nervosa-2003/

Information Handout

Cognitive Behavioral Model Of Body Dysmorphic Disorder (BDD) (2004)

Individuals with body dysmorphic disorder (BDD) experience distress associated with their body image. The Cognitive Behavioral Model Of Body Dysmorphi ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-body-dysmorphic-disorder-bdd-2004/

Information Handout

Cognitive Behavioral Model Of Fear Of Bodily Sensations (2018)

Fear of bodily sensations is present in a number of conditions, most notably panic disorder. The Cognitive Behavioral Model Of Fear Of Bodily Sensatio ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-fear-of-bodily-sensations-2018/

Information Handout

Cognitive Behavioral Model Of Health Anxiety (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-2003/

Information Handout

Cognitive Behavioral Model Of Health Anxiety (2018)

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-2018/

Information Handout

Cognitive Behavioral Model Of Low Self-Esteem (1997)

Low self-esteem is characterized as a negative sense of the self and co-occurs with many other mental health problems. Although not formally represent ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-low-self-esteem-1997/

Information Handout

Cognitive Behavioral Model Of Obsessive Compulsive Disorder (1998)

The essential insight of the cognitive behavioral model of obsessive compulsive disorder (OCD) is that it is the client’s interpretation of the intr ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-obsessive-compulsive-disorder-1998/

Worksheet

Cognitive Behavioral Model Of Panic (1986)

The Cognitive Behavioral Model Of Panic identifies catastrophic misinterpretation of body sensations as a criticial maintenance factor which serves to ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-panic-1986/

Information Handout

Cognitive Behavioral Model Of Persistent Postural-Perceptual Dizziness (PPPD) (2017)

Persistent postural-perceptual dizziness (PPPD) is a form of dizziness which is thought to be maintained by psychological factors. ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-persistent-postural-perceptual-dizziness-pppd-2017/

Information Handout

Cognitive Behavioral Model Of Tinnitus (2014)

The Cognitive Behavioral Model Of Tinnitus identifies cognitive, behavioral, and perceptual changes which operate to maintain tinnitus perception and ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-tinnitus-2014/

Information Handout

Embracing Uncertainty

Intolerance of uncertainty (IU) was first described in individuals suffering from Generalized Anxiety Disorder (GAD). Many behaviors associated with G ... https://www.psychologytools.com/resource/embracing-uncertainty/

Exercise

Emotions Motivate Actions

Many clients find it helpful to recognize the range of actions that are motivated by different emotional states. This worksheet encourages clients to ... https://www.psychologytools.com/resource/emotions-motivate-actions/

Information Handout

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/

Information Handout

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/

Exercise

Interpersonal Beliefs And Styles

Interpersonal issues and relationship problems form an important part of what clients bring to therapy: they might present as clients’ current conce ... https://www.psychologytools.com/resource/interpersonal-beliefs-and-styles/

Worksheet

Intolerance Of Uncertainty

Uncertainty is a normal part of life – we can never be 100% sure about what will happen next. Many people feel good about uncertainty and live lives ... https://www.psychologytools.com/resource/intolerance-of-uncertainty/

Information Handout

Maintenance Of Obsessive Compulsive Disorder (OCD)

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/maintenance-of-obsessive-compulsive-disorder-ocd/

Worksheet

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/

Information Handout

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/

Exercise

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/

Worksheet

Reciprocal CBT Formulation

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

Worksheet

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/

Information Handout

Safety Behaviors Example

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-example/

Information Handout

Transdiagnostic Processes

A ‘transdiagnostic process’ is the label given to a mechanism which is present across disorders and which is either a risk or maintaining factor f ... https://www.psychologytools.com/resource/transdiagnostic-processes/

Information Handout

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/

Information Handout

Recommended Reading

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.