The use of safety behaviours during in vivo exposure for anxiety

Anxiety disorder interventions usually require in vivo exposure without the use of safety behaviours. However, the literature has started to query whether safety behaviour use is harmful, and whether they might actually help to make therapy accessible for patients who usually refuse or drop-out of treatment.

This study attempted to improve methodology and give greater consideration to the differing underlying theories. It was hypothesised that that role of safety behaviours would be in line with cognitive theory (Salkovskis, 1991) and the inhibitory learning model (Craske et al., 2008).
Thirty-three participants with sub-clinical arachnophobia were recruited from student and community populations. N = 11 completed in vivo exposure without the use of safety behaviours (exposure), n = 11 with the use of safety behaviours (safety) and n = 11 were assigned to the no-exposure control group. Outcomes included two behavioural approach tests and two questionnaires.

Results showed that the exposure group outperformed the safety group at post-exposure and follow-up. It is suggested that the role of safety behaviours is more likely to be unpinned by cognitive theory and the inhibitory learning model (than by emotional processing theory). However, these findings need to be replicated with clinical populations and more research is needed on what appropriate and relevant outcomes look like in anxiety interventions.