Safety Behaviour Enhances the Acceptability of Exposure

Abstract

Compulsive washing and contamination fears are among the most common symptoms of obsessive-compulsive disorder (OCD). Research suggests that exposure and response prevention (ERP) is effective for OCD. However, ERP is prone to dropouts and refusals, and a substantial proportion of clients therefore do not receive the care they need. A proposed solution involves the judicious use of safety behaviour to enhance the acceptability of exposure-based interventions. The current study aimed to test this proposed solution. Participants were 70 undergraduate students who completed two exposure exercises for contamination fear, one with safety behaviour and one without. Participants then rated the acceptability of the two exercises. Exposure with safety behaviour (ESB) was rated as significantly more acceptable than ERP. Furthermore, subjective fear ratings were lower and behavioural approach to a series of contaminants was greater in the ESB condition. Results demonstrated the acceptability-enhancing potential of safety behaviour in exposure, and are discussed in terms of both theoretical and practical aspects of safety behaviour, exposure, and evidence-based interventions for anxiety disorders.

What do you really need? Self- and partner-reported intervention preferences within cognitive behavioural therapy for reassurance seeking behaviour

“…As with other research into the acceptability of CBT interventions for OCD and anxiety, this study's findings support the notion that a cognitive framework and focus on approach-supporting behaviour increases the perceived ability to adhere to an intervention's requirements (e.g. Levy and Radomsky, 2014;Milosevic and Radomsky, 2013;Rachman et al, 2008;Senn and Radomsky, 2015;Sighvatsson and Salkovskis, 2013). Given that the case studies of reducing accommodation suggest that negative reactions may be a barrier to treatment adherence, identifying alternatives that allow the intervention to become more acceptable, such as guiding significant others to provide adaptive support, is an important step towards ensuring that those who would benefit from the intervention are willing to complete it.…”

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

“…Overall, prior mental health treatment and anxiety (but not depressive) symptoms were associated with lower acceptability and anticipated adherence ratings. Consistent with Rachman and colleagues (2008) and recent experimental research (Levy & Radomsky, 2014), the findings from this study support the notion that safety behavior enhances the acceptability of CBT for anxiety disorders. Coupled with recent literature on the efficacy of exposure with safety behavior Hood et al, 2010;Milosevic & Radomsky, 2008, 2013aRachman et al, 2011;van den Hout et al, 2011), overall it appears that safety behavior may not interfere with exposure and may actually promote treatment engagement and success.…”

“…In fact, there could be situations in which the presence of a safety aid may actually assist in obtaining threatrelevant information. Indeed, previous research has shown that safety behavior enhances behavioral approach to anxiety-provoking stimuli during exposure (Hood et al, 2010;Levy & Radomsky, 2014;Milosevic & Radomsky, 2008, 2013a. By contrast, extinction-based CBT emphasizes complete engagement with feared stimuli to promote habituation, and the presence of safety aids (even when used judiciously) may be perceived as interfering with this process.…”

“…However, acceptability was assessed using a single-item prompt with unknown psychometric properties. In another study, Levy and Radomsky (2014) compared the acceptability of exposure for contamination fear with and without safety behavior and found higher acceptability ratings for the safety behavior condition. Finally, Milosevic and Radomsky (2013a) examined the acceptability of vignette-based descriptions of CBT for anxiety disorders as a function of safety behavior (judicious or discouraged) and treatment rationale (cognitive [i.e., exposure provides disconfirmatory information] or extinction [i.e., exposure promotes fear habituation]).…”

Exploring the impact of safety behaviour use on cognitive, psychophysiological, emotional and behavioural responses during a speech task

“…permitting SBs as needed, and gradually diminishing these behaviours over time) may reduce anxiety during exposure, increase treatment acceptability, and thus decrease attrition rates (e.g. Levy and Radomsky, 2014;van den Hout et al, 2011).…”