Further Support for the Acceptability-Enhancing Roles of Safety Behavior and a Cognitive Rationale in Cognitive Behavioral Therapy for Anxiety Disorders

Abstract

It has been proposed that the judicious use of safety behavior may enhance the acceptability of cognitive behavioral therapy (CBT). Indeed, Milosevic and Radomsky (2013a) found that descriptions of CBT incorporating safety behavior were more acceptable than those that discouraged safety behavior. This study aimed to replicate and extend this work. Participants were 688 undergraduates who rated the acceptability of descriptions of CBT varying in safety behavior (judicious or discouraged) and rationale (cognitive or extinction). Consistent with Milosevic and Radomsky, CBT with safety behavior was significantly more acceptable than traditional CBT. Cognitively based CBT was preferred over extinction-based CBT. The effects of prior treatment and general distress were also examined. Overall, previous treatment and greater anxiety were associated with significantly lower acceptability ratings. Results support the acceptability-enhancing role of safety behavior in CBT and are discussed in terms of cognitive-behavioral theory and treatment of anxiety and related disorders.

Too little, too much, or just right? Does the amount of distraction make a difference during contamination-related exposure?

“…Similar treatment acceptability research has been conducted in the area of safety behaviour, but has typically investigated the use of overt safety aids (e.g., wearing gloves or protective gear) rather than looking at distraction, a more covert form of safety behaviour. In the safety behaviour literature, treatment vignettes incorporating the use of safety aids have been rated as more acceptable than those that discourage the use of safety behaviour (Levy, Senn, & Radomsky, 2014;Milosevic & Radomsky, 2013a), and the same pattern was observed in an experimental study with an unselected student sample . Of note, experimental studies have also been conducted to assess the impact of safety behaviour use on exposure outcome, some of which have found that safety behaviour use does not necessarily M A N U S C R I P T…”

“…To our knowledge, the acceptability of treatment with or without the use of distraction has yet to be investigated; however, distraction is often construed as a type of covert safety behaviour, and recent work has begun to focus on the potential acceptability-enhancing role of the use of safety behaviour in treatment. Specifically, preliminary studies have established that the use of safety behaviour may increase treatment acceptability, both experimentally in a student sample , and via treatment vignettes rated by both student (Levy, Senn, & Radomsky, 2014;Milosevic & Radomsky, 2013a) and clinical (Milosevic & Radomsky, 2013a) samples. Therefore, we also assessed treatment acceptability following an exposure session with or without distraction (Experiment 2), and hypothesized that treatment acceptability would be rated highest in conditions using moderate and high levels of distraction.…”

From the laboratory to the clinic (and back again): How experiments have informed cognitive–behavior therapy for obsessive–compulsive disorder

“…Although ERP is still widely used to treat compulsive checking and is currently listed as a first-line treatment for OCD (National Institute for Health & Clinical Excellence, 2005), the abovementioned experimental findings transformed the way that checking is targeted in CBT, primarily through the development of novel cognitive strategies (e.g., Rachman, 2003), that might even be more acceptable (e.g., Levy, Senn, & Radomsky, 2014; Shafran, Radomsky, Coughtrey, & Rachman, 2013; but see Ong, Clyde, Bluett, Levin, & Twohig, 2016). For instance, therapists can target inflated responsibility using behavioral experiments that stem from such experimental designs.…”

Disconfirming contamination-related threat beliefs by exposure plus safety behavior

“…They argued that there is no evidence that all SBs necessarily prevent disconfirmatory experiences, and that the incorporation of SB in exposure could facilitate treatment and may reduce drop-out and refusal. Recent research suggests that adding SB to exposure can indeed enhance treatment acceptability Levy, Senn, & Radomsky, 2014;Milosevic & Radomsky, 2013a), although other studies did not find differences in acceptability between exposure with SB (E þ SB) and without SB (E þ RP; see, for example, Deacon, Sy, Lickel, & Nelson, 2010;Milosevic & Radomsky, 2013b). Additionally, although several studies have shown unfavorable effects E þ SB compared to E þ RP (e.g., McManus, Sacadura, & Clark, 2008;Salkovskis, Clark, Hackmann, Wells, & Gelder, 1999), other studies suggest that SB is not always detrimental to the beneficial effects of exposure.…”