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

Clinical Psychology: Science and Practice

Volumn 17, Issue 3, 2010, Pages 218-233

  Helbig Lang, Sylvia ^a   Petermann, Franz ^a  

^a UNIVERSITY OF BREMEN   (Germany)

Author keywords

Anxiety disorders; Avoidance; Safety behavior; Safety seeking behavior

Indexed keywords

EID: 77956628550     PISSN: 09695893     EISSN: 14682850     Source Type: Journal    
DOI: 10.1111/j.1468-2850.2010.01213.x     Document Type: Review

References (66)

1. Abramowitz J S, Moore E L. An experimental analysis of hypochondriasis. Behaviour Research and Therapy 2007, 45:413-424.
2. Abramowitz J S, Tolin D F, Street G P. Paradoxical effects of thought suppression: A meta-analysis of controlled studies. Clinical Psychology Review 2001, 21:683-703.
3. Antony M M, McCabe R E, Leeuw I, Sano N, Swinson R P. Effect of distraction and coping style on in vivo exposure for specific phobia of spiders. Behaviour Research and Therapy 2001, 39:1137-1150.
4. Barlow D H. Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. American Psychologist 2000, 55:1247-1263.
5. Barlow D H, Allen L B, Choate M L. Toward a unified treatment for emotional disorders. Behavior Therapy 2004, 35:205-230.
6. Campbell-Sills L, Barlow D H, Brown T A, Hofmann S G. Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders. Behaviour Research and Therapy 2006, 44:1251-1263.
7. Clark D M. A cognitive perspective on social phobia. International handbook of social anxiety: Concepts, research and interventions relating to the self and shyness 2001, Crozier W RAlden L E. Eds, New York, John Wiley & Sons
8. Craske M G, Street L, Barlow D H. Instructions to focus upon or distract from internal cues during exposure treatment of agoraphobic avoidance. Behaviour Research and Therapy 1989, 27:663-672.
9. Craske M G, Street L L, Jayaraman J, Barlow D H. Attention versus distraction during in vivo exposure: Snake and spider phobias. Journal of Anxiety Disorders 1991, 5:199-211.
10. Deacon B, Maack D J. The effects of safety behaviours on the fear of contamination: An experimental investigation. Behaviour Research and Therapy 2008, 46:537-547.
11. Desilva P, Rachman S. Does escape behaviour strengthen agoraphobic avoidance-A preliminary study. Behaviour Research and Therapy 1984, 22:87-91.
12. Ehlers A, Breuer P. Increased cardiac awareness in panic disorder. Journal of Abnormal Psychology 1992, 101:371-382.
13. Ehlers A, Clark D M. A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy 2000, 38:319-345.
14. Eifert G H, Heffner M. The effects of acceptance versus control contexts on avoidance of panic-related symptoms. Journal of Behaviour Therapy and Experimental Psychiatry 2003, 34:293-312.
15. Foa E B, Steketee G, Milby J B. Differential effects of exposure and response prevention in obsessive-compulsive washers. Journal of Consulting and Clinical Psychology 1980, 48:71-79.
16. Grayson J B, Foa E B, Steketee G. Habituation during exposure treatment: Distraction vs. attention-focusing. Behaviour Research and Therapy 1982, 20:323-328.
17. Haw J, Dickerson M. The effects of distraction on desensitization and reprocessing. Behaviour Research and Therapy 1998, 36:765-769.
18. Hayes S C, Wilson K G, Gifford E V, Follette V M, Strosahl K. Experiential avoidance and behavioural disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology 1996, 64:1152-1168.
19. Hedtke K A, Kendall P C, Tiwari S. Safety-seeking and coping behavior during exposure tasks with anxious youth. Journal of Clinical Child & Adolescent Psychology 2009, 38:1-15.
20. van den Hout M, Engelhard I M, de Boer C, du Bois A, Dek E. Perseverative and compulsive-like staring causes uncertainty about perception. Behaviour Research and Therapy 2008, 46:1300-1304.
21. van den Hout M, Engelhard I M, Smeets M, Dek E C P, Turksma K, Saric R. Uncertainty about perception and dissociation after compulsive-like staring: Time course of effects. Behaviour Research and Therapy 2009, 47:535-539.
22. van den Hout M, Kindt M, Weiland T, Peters M. Instructed neutralization, spontaneous neutralization and prevented neutralization after an obsession-like thought. Journal of Behaviour Therapy and Experimental Psychiatry 2002, 33:177-189.
23. van den Hout M, van Pol M, Peters M. On becoming neutral: Effects of experimental neutralizing reconsidered. Behaviour Research and Therapy 2001, 39:1439-1448.
24. Johnstone K A, Page A C. Attention to phobic stimuli during exposure: The effect of distraction on anxiety reduction, self-efficacy and perceived control. Behaviour Research and Therapy 2004, 42:249-275.
25. Kamphuis J H, Telch M J. Effects of distraction and guided threat appraisal on fear reduction during exposure-based treatments for specific fears. Behaviour Research and Therapy 2000, 38:1163-1181.
26. Kim E J. The effect of the decreased safety behaviours on anxiety and negative thoughts in social phobics. Journal of Anxiety Disorders 2005, 19:69-86.
27. Levitt J T, Brown T A, Orsillo S M, Barlow D H. The effects of acceptance versus suppression of emotion on subjective and psychophysiological response to carbon dioxide challenge in patients with panic disorder. Behavior Therapy 2005, 35:747-766.
28. Lohr J M, Olatunji B O, Sawchuk C N. A functional analysis of danger and safety signals in anxiety disorders. Clinical Psychology Review 2007, 27:114-126.
29. McManus F, Clark D M, Grey N, Wild J, Hirsch C, Fenell M. A demonstration of the efficacy of two of the components of cognitive therapy for social phobia. Journal of Anxiety Disorders 2009, 23:496-503.
30. McManus F, Sacadura C, Clark D M. Why social anxiety persists: An experimental investigation of the role of safety behaviours as a maintaining factor. Journal of Behaviour Therapy and Experimental Psychiatry 2008, 39:147-161.
31. Milosevic I, Radomsky A S. Safety behaviour does not necessarily interfere with exposure therapy. Behaviour Research and Therapy 2008, 46:1111-1118.
32. Mohlman J, Zinbarg R E. What kind of attention is necessary for fear reduction? An empirical test of the emotional processing model. Behavior Therapy 2000, 31:113-133.
33. Morgan H, Raffle C. Does reducing safety behaviours improve treatment response in patients with social phobia? Australian and New Zealand Journal of Psychiatry 1999, 33:503-510.
34. Mowrer O H. Learning theory and behavior 1960, New York, Wiley
35. Okajima I, Kanai Y, Chen J, Sakano Y. Effects of safety behaviours on the maintenance of anxiety and negative belief social anxiety disorder. International Journal of Social Psychiatry 2009, 55:71-81.
36. Oliver N S, Page A C. Fear reduction during in vivo exposure to blood-injection stimuli: Distraction vs. attentional focus. British Journal of Clinical Psychology 2003, 42:13-25.
37. Oliver N S, Page A C. Effects of internal and external distraction and focus during exposure to blood-injury-injection stimuli. Journal of Anxiety Disorders 2008, 22:283-291.
38. Parrish C L, Radomsky A S, Dugas M J. Anxiety-control strategies: Is there room for neutralization in successful exposure treatment? Clinical Psychology Review 2008, 28:1400-1412. http://dx.doi.org/10.1016/j.cpr.2008.07.007, doi:
39. Penfold K, Page A C. The effect of distraction on within-session anxiety reduction during brief in vivo exposure for mild blood-injection fears. Behavior Therapy 1999, 30:607-621.
40. Powers M B, Smits J A J, Telch M J. Disentangling the effects of safety-behaviour utilization and safety-behaviour availability during exposure-based treatment: A placebo-controlled trial. Journal of Consulting and Clinical Psychology 2004, 72:448-454.
41. Rachman S. Agoraphobia-A safety-signal perspective. Behaviour Research and Therapy 1984, 22:59-70.
42. Rachman S, Bichard S. The overprediction of fear. Clinical Psychology Review 1988, 8:303-312.
43. Rachman S, Craske M, Tallman K, Solyom C. Does escape behaviour strengthen agoraphobic avoidance-A replication. Behavior Therapy 1986, 17:366-384.
44. Rachman S, Hodgson R. Obsessions and compulsions 1980, Englewood Cliffs, NJ, Prentice Hall
45. Rachman S, Radomsky A S, Shafran R. Safety behaviour: A reconsideration. Behaviour Research and Therapy 2008, 46:143-173.
46. Radomsky A S, Gilchrist P T, Dussault D. Repeated checking really does cause memory distrust. Behaviour Research and Therapy 2006, 44:305-316.
47. Rayment P, Richards J. Fear of autonomic arousal and use of coping strategies as predictors of agoraphobic avoidance in panic disorder. Behaviour Change 1998, 15:228-236.
48. Rodriguez B I, Craske M G. Does distraction interfere with fear reduction during exposure-A test among animal-fearful subjects. Behaviour Therapy 1995, 26:337-349.
49. Salkovskis P M. The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural Psychotherapy 1991, 19:6-19.
50. Salkovskis P M. Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy 1999, 37:S29-S52.
51. Salkovskis P M, Clark D M, Gelder M G. Cognition-behaviour links in the persistence of panic. Behaviour Research and Therapy 1996, 34:453-458.
52. Salkovskis P M, Clark D M, Hackmann A, Wells, Gelder M G. An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia. Behaviour Research and Therapy 1999, 37:559-574.
53. Salkovskis P M, Hackmann A, Wells A, Gelder M G, Clark D M. Belief disconfirmation versus habituation approaches to situational exposure in panic disorder with agoraphobia: A pilot study. Behaviour Research and Therapy 2006, 45:877-885.
54. Salkovskis P M, Thorpe S J, Wahl K, Wroe A L, Forrester E. Neutralizing increases discomfort associated with obsessional thoughts: An experimental study with obsessional patients. Journal of Abnormal Psychology 2003, 112:709-715.
55. Salkovskis P M, Westbrook D, Davis J, Jeavons A, Gledhill A. Effects of neutralizing on intrusive thoughts: An experiment investigating the etiology of obsessive-compulsive disorder. Behaviour Research and Therapy 1997, 35:211-219.
56. Salters-Pedneault K, Tull M T, Roemer E. The role of avoidance of emotional material in the anxiety disorders. Applied and Preventive Psychology 2004, 11:95-114.
57. Sartory G, Master D, Rachman S. Safety-signal therapy in agoraphobics-A preliminary test. Behaviour Research and Therapy 1989, 27:205-209.
58. Schmid-Leuz B, Elsesser K, Lohrmann T, Johren P, Sartory G. Attention focusing versus distraction during exposure in dental phobia. Behaviour Research and Therapy 2007, 45:2691-2703.
59. Shear M K, Bjelland I, Beesdo K, Gloster A T, Wittchen H-U. Supplementary dimensional assessment in anxiety disorders. International Journal of Methods in Psychiatric Research 2007, 16:S52-S64.
60. Sloan T, Telch M J. The effects of safety-seeking behaviour and guided threat reappraisal on fear reduction during exposure: An experimental investigation. Behaviour Research and Therapy 2002, 40:235-251.
61. Spira A P, Zvolensky M J, Eifert G H, Feldner M T. Avoidance-oriented coping as a predictor of panic-related distress: A test using biological challenge. Journal of Anxiety Disorders 2004, 18:309-323.
62. Telch M J, Valentiner D, Bolte M. Proximity to safety and its effects on fear prediction bias. Behaviour Research and Therapy 1994, 32:747-751.
63. Telch M J, Valentiner D P, Ilai D, Young P R, Powers M B, Smits J A J. Fear activation and distraction during the emotional processing of claustrophobic fear. Journal of Behaviour Therapy and Experimental Psychiatry 2004, 35:219-232.
64. Thwaites R, Freeston M H. Safety-seeking behaviours: Fact or function? How can we clinically differentiate between safety behaviours and adaptive coping strategies across anxiety disorders? Behavioural and Cognitive Psychotherapy 2005, 33:177-188.
65. Wells A, Clark D M, Salkovskis P M, Ludgate J, Hackmann A, Gelder M G. Social phobia: The role of in-situation safety behaviours in maintaining anxiety and negative beliefs. Behavior Therapy 1995, 26:153-162.
66. Wolitzky K B, Telch M J. Augmenting in vivo exposure with fear antagonistic actions: A preliminary test. Behavior Therapy 2009, 40:57-71.