Abstract:

Safety behaviors are actions used to prevent or minimize a feared consequence. They are considered one of the primary mechanisms of maintaining anxiety disorders and may interfere with exposure therapy. Here, we review recent studies on safety behaviors in anxiety and their effects.

A large body of research demonstrates that safety behaviors are closely associated with both the level of anxiety and relevant cognitive bias, such as probability bias, cost bias, and post-event processing. In other words, individuals who use more safety behaviors will experience higher level of anxiety, have greater post-event processing, and overestimate the likelihood and costs of negative outcomes. The misattribution of safety hypothesis, biased attentional resources hypothesis, and behavior as information hypothesis explain the mechanisms of how safety behaviors impact anxiety. To start with, by the lens of misattribution of safety hypothesis, anxious individuals attribute safe outcomes to their safety behaviors rather than recognizing their feared outcomes are irrational or to tolerable. Comparing to misattribution of safety hypothesis, biased attentional resources hypothesis postulates that anxious individuals allocate attention to the execution of safety behaviors, as a result, their attentional resources are directed away from disconfirmatory information. Additionally, behavior as information hypothesis posits that response information may influence stimulus evaluation, and anxious individuals tend to infer danger on the basis of safety behaviors.

Some research reveals that the utilization of safety behaviors can interfere with the efficacy of exposure therapy. In contrast to these results, some literature suggests that safety behaviors may not necessarily undermine the efficacy of CBT. There are three reasons for the inconsistent results. First, the conflicting results may result from the conceptualization of safety behaviors. The definition of safety behaviors emphasizes the underlying behavioral intention and its idiosyncratic character. Thus it is unsure to what extent previous studies employed the same definition. Secondly, Another reason for different findings might be that the measurements of treatment outcomes are carried out mostly during or immediately after the treatments. Thirdly, the reason that may explain the inconsistency is that there may be individual differences in the motivation of safety behaviors. In terms of the acceptability ofnj CBT, some researchers suggest that the judicious use of safety behaviors may make treatment less aversive and reduce refusal and drop-out. However, there is no sufficient practical research to support this viewpoint. Furthermore, when researchers talk about the effects of safety behaviors on anxiety treatment, some important factors, such as the classification of safety behaviors, the treatment process, and the type of anxiety disorder, may interfere with the relationship between safety behaviors and exposure therapy.

The current study puts forward some valuable directions for future studies. First, in order to draw more consistent conclusions, safety behaviors should be defined more clearly and measured more accurately. Secondly, due to some limitations in cross sectional studies and previous experimental studies, study designs need to be improved in the future. Researchers should conduct multiwave longitudinal study and control sample bias as well as important extraneous variables. Thirdly, the third wave of behavioural psychotherapies should be used for reference to explain the relationship between safety behaviors and anxiety. Traditional CBT focuses on modifying the content of cognitive bias. In contrast, the third wave of behavioural psychotherapies focuse more on the persons' relationship to thought and emotion than on their content. From this perspective, theorists can make a new explanation concerning the impacts of safety behaviors on anxiey. Fourthly, It is necessary to investigate not only the negative but also positive effects of these behaviors on anxiety treatment. Finally, more attention should be paid to the development of treaments focusing on safety behaviors. When designing more targeted treatments, clinical practitioners should put much emphasis on how to recognize and eliminate the false safety behaviors.

Key words: safety behaviours, anxiety disorder, exposure therapy