Tolerate or eliminate? A systematic review on the effects of safety behavior across anxiety disorders.

Abstract

Cognitive-behavioral models emphasize maintaining effects of safety behavior in anxiety disorders. Experimental evidence for deleterious effects of those behaviors is less consistent, leading to a controversy about their therapeutic use. The systematic integration of findings is hampered by the variety of concepts used to describe safety behavior, and methodological differences in empirical studies. This article provides a definition and classification of safety behavior in contrast to adaptive coping strategies. Existing evidence regarding contributions of safety behavior to onset and maintenance of anxiety disorders as well as effects of safety behavior on therapeutic outcome is reviewed. In contrast to previous justifications of safety behavior use, a rigorous procedure of identifying safety behavior and abandoning it throughout therapy is suggested.

Covert neutralization in the treatment of OCD with overt compulsions

“…Our findings are consistent with recent studies which indicate that safety behavior does not necessarily impede disconfirmatory experiences and that judicious use of safety behavior may in fact make exposure more tolerable (Rachman, Radomsky, & Shafran, 2008). Other authors, however, have argued that the positive aspects of safety behavior may reflect a mistaking of safety behavior for positive coping strategies (Helbig-Lang & Petermann, 2010;Thwaites & Freeston, 2005). In fact, with some safety behavior, individuals may feel comfortable moving forward and gaining further insight into the process at a safe pace.…”

“…Although some ERP therapists routinely assess and address both overt and covert (i.e., neutralization) rituals in treatment (Helbig-Lang & Petermann, 2010), subtle covert neutralization is often overlooked and thus not explicitly targeted. When covert neutralization is not targeted during treatment, patients might retain these rituals, or switch to them as they learn to suppress overt compulsions such as washing, checking, and ordering.…”

An evidence-based causal model of panic disorder

“…Specifically, the level of panic sensations experiences is reduced when participants can control the amount of CO 2 concentration (Meuret, Ritz, Wilhelm, & Roth, 2005). Additionally, the literature on safety signals (Helbig-Lang & Peterman, 2010) suggests that once medication acquires the association with panic control, the mere presence of medication availability decreases a perceived risk of experiencing panic attacks.…”

Excessive reassurance seeking and anxiety pathology: Tests of incremental associations and directionality

“…Individuals with panic disorder may carry safety aids such as a cell phone, water, or medication, or check for exits and restrooms (Rachman, 1984). There is evidence to suggest that safety behaviors are important maintaining factors in anxiety disorders (Helbig-Lang & Petermann, 2010). They may act to prevent threat disconfirmation through misattribution of safety to the safety behavior itself rather than the harmless nature of the stimulus or situation.…”