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Safety behaviors (anxiety)

January 13, 2023

Safety behaviors (also known as safety-seeking behaviors) are coping behaviors used to reduce anxiety and fear when the user feels threatened.[1] An example of a safety behavior in social anxiety is to think of excuses to escape a potentially uncomfortable situation.[2] These safety behaviors, although useful for reducing anxiety in the short term, might become maladaptive over the long term by prolonging anxiety and fear of nonthreatening situations.[1][3] This problem is commonly experienced in anxiety disorders.[4] Treatments such as exposure and response prevention focus on eliminating safety behaviors due to the detrimental role safety behaviors have in mental disorders.[5][6] There is a disputed claim that safety behaviors can be beneficial to use during the early stages of treatment.[7]

History

The concept of safety behaviors was first related to a mental disorder in 1984 when the “safety perspective” hypothesis was proposed to explain how agoraphobia is maintained over time.[3] The “safety perspective” hypothesis states that people with agoraphobia act in ways they believe will increase or maintain their level of safety.[3] In 1991, the use of safety behaviors was observed in people with panic disorders.[1] Later studies observed the use of safety behaviors in people with other disorders such as social phobia,[5] obsessive compulsive disorder,[8] and posttraumatic stress disorder.[9]

Theories about effects

Safety behaviors directly amplify fear and anxiety.[4]

  • The use of safety behaviors promotes the monitoring of anxiety symptoms. For example, people with panic disorders tend to monitor themselves for symptoms of anxiety and respond to these symptoms with avoidant behaviors.[10] This over analysis of physical sensations results in detection of symptoms that may not lead to panic attacks but are perceived as panic-inducing symptoms.[10]
  • People with social phobia withdraw themselves from social situations by quietly speaking, reducing body movement, and preventing eye contact with other people.[5][11] These behaviors are meant to reduce the chances of receiving criticism from other people.[5][11] Instead, safety behaviors result in more criticism because people with social phobia are seen as aloof and unwelcoming people.[5][11]

Safety behaviors reduce anxiety in feared situations but retain anxiety in the long term.[4]

  • When a person uses safety behaviors to reduce anxiety and fear in a threatening situation, the anxiety and fear may subside.[4] The user will then believe that the safety behaviors caused the emotional decrease and continue to use safety behaviors in future situations.[1] However, the decrease in anxiety and fear may be due to other factors such as time.[1]
  • The decrease in anxiety and fear may also be due to the situation itself.[1] Situations that seem severely threatening, such as giving a presentation, are not actually very harmful.[1] By avoiding the situation through the use of safety behaviors, the user is unable to realize that the situation is harmless, allowing the cycle of anxiety and behavior to continue.[1]

Classification

Safety behaviors can be grouped into two major categories: preventive and restorative safety behaviors.[12]

Preventative

These behaviors are also known as "emotional avoidance behaviors".[13][14] These behaviors are aimed to reduce fear or anxiety in future situations.[12] Examples include:

  • Completely avoiding situations in which the threat might occur[4]
  • Relying on safety signals such as inviting companions to social events for support[4]
  • Subtle avoidance behaviors such as avoiding physical contact[4]
  • Compulsive behaviors such as checking doors before leaving[4]
  • Preparations for potentially encountering these situations[4]

Restorative

These behaviors are aimed to reduce fear or anxiety in a currently threatening situation.[12] Examples include:

  • Escaping the situation[4]
  • Using safety signals such as looking at cell phones to reduce social anxiety[4]
  • Subtle avoidance behaviors such as breathing techniques[4]
  • Compulsive behaviors such as repeatedly washing hands[4]
  • Seeking reassurance from loved ones or professionals to ensure that the fears are unwarranted[4]
  • Distracting attention from the threat or focusing attention on reducing the threat[4]
  • Neutralizing the threat by praying or counting[4]
  • Suppressing anxiety-provoking thoughts[4]

Associated conditions

Agoraphobia

Main article: Agoraphobia

People may increase their risk for agoraphobia when they use safety behaviors to avoid potentially dangerous environments even though the danger may not be as severe as perceived.[15] A common safety behavior is when a person with agoraphobia attempts to entirely avoid a crowded place such as a mall or a public bus.[16] If the affected person does end up in a crowded area, then the person may tense his or her legs to prevent collapsing in the area.[15] The affected person may also attempt to escape these crowded situations.[15] People with agoraphobia then attribute the lack of feared symptoms to the safety behaviors instead of to the lack of danger itself.[15] This incorrect attribution may lead to persisting fears and symptoms.[15]

Generalized anxiety disorder

Main article: Generalized anxiety disorder

People with generalized anxiety disorder (GAD) view the world as a highly threatening environment.[17] These people continuously search for safety and use safety behaviors.[17] A common safety behavior used by GAD sufferers is seeking reassurance from a loved one to reduce the excessive worry.[17] The affected person may also attempt to avoid all possible risks of danger and protect others from that danger.[17] However, these behaviors are unlikely to significantly reduce anxiety because the affected person often has multiple fears that are not clearly defined.[17]

Insomnia

Main article: Insomnia

People with insomnia tend to excessively worry about getting enough sleep and the consequences of not getting enough sleep.[18] These people use safety behaviors in an attempt to reduce their excessive anxiety.[18] However, the use of safety behaviors serves to increase anxiety and reduce the chances that the affected person will disconfirm these anxiety-provoking thoughts.[18] A common safety behavior used by affected people is attempting to control the anxiety-provoking thoughts by distracting themselves with other thoughts.[18] The affected person may also cancel appointments and decide not to work because the person believes that he or she will not function properly.[18] The affected person may take naps to compensate for the lack of sleep.[18]

Obsessive-compulsive disorder

Main article: Obsessive-compulsive disorder

People with obsessive-compulsive disorder (OCD) use safety behaviors to reduce their anxiety when obsessions arise.[19] Common safety behaviors include washing hands more times than needed and avoiding potential contaminants by not shaking hands.[19] However, when people with OCD use safety behaviors to reduce the chance of contamination, their awareness of potential contamination increases.[19] This heightened awareness then leads to an increased fear of being contaminated.[19]

Checking rituals, such as checking several times to determine if all of the doors to a house are locked, are also common safety behaviors.[20] People with OCD often believe that if they do not perform their checking rituals, others will be in danger.[20] Consequentially, people with OCD often perceive themselves as more responsible for the wellbeing of others than people without the disorder.[20] Therefore, people with OCD use safety behaviors when they believe that other people will be in danger if these behaviors are not used.[20] Continuous checking reduces the certainty and vividness of memories related to checking.[6] Exposure and response prevention therapy is effective in treating OCD.[6]

Posttraumatic stress disorder

Main article: Posttraumatic stress disorder

People with posttraumatic stress disorder (PTSD) believe that their general safety has been compromised after a trauma has occurred.[21] These people use safety behaviors to restore their general sense of safety and to prevent the trauma from happening again.[21] A common safety behavior used by affected people is staying awake for long periods of time to make sure that potential intruders do not attempt to break into their homes.[21] The person may also attempt to avoid potential reminders of the trauma such as moving away from the place where the trauma occurred.[21] These behaviors may lead to persistent fears because the behaviors prevent the affected person from disconfirming the threatening beliefs.[21]

Schizophrenia

Main article: Schizophrenia

People with schizophrenia may have persecutory delusions.[22] These people use safety behaviors to prevent the potential threats that arise from their persecutory delusions.[23] Common safety behaviors include avoiding locations where perceived persecutors can be found and physically escaping from the perceived persecutors.[23] These behaviors may increase the amount of persecutory delusions the person experiences because the safety behaviors prevent the affected person from disconfirming the threatening beliefs.[23]

Social anxiety

Main article: Social anxiety disorder

Generally, people use social behaviors to either seek approval or avoid disapproval from others.[24] People without social anxiety tend to use behaviors that are designed to gain approval from others, while people with social anxiety prefer to use behaviors that help to avoid disapproval from others.[24][25][26]

Safety behaviors seem to reduce the chances of obtaining criticism by drawing less attention to the affected person.[11] Common safety behaviors include avoiding eye contact with other people, focusing on saying the proper words, and other self-controlling behaviors.[11]

Exposure therapy alone is mildly effective in treating social anxiety.[5] There are larger decreases in anxiety and fear when people are also told to stop themselves from using safety behaviors during therapy than when people are encouraged to use safety behaviors.[5] These decreases are largest when people are told to stop using safety behaviors and disconfirm the thoughts that the threatening situation will most likely not happen even if the safety behaviors are stopped.[11] This combination of techniques is used in exposure and response prevention therapy for social anxiety.[5]

Assessment measures

Several assessments have been developed to measure the amount of safety behaviors used by people with specific psychological conditions. Two examples of assessments developed to measure safety behaviors performed by people with social anxiety are the Social Behavior Questionnaire and the Subtle Avoidance Frequency Examination.[2][27] An assessment developed to measure safety behaviors performed by people with panic disorder is the Texas Safety Maneuver Scale.[28]

Social Behavior Questionnaire

The Social Behavior Questionnaire (SBQ) is an assessment of safety behaviors in social anxiety that was developed in 1994.[27] The frequency at which a behavior is performed is rated from “never” to “always.”[27] Examples of safety behaviors recorded in this assessment include “avoiding asking questions” and “controlling shaking.”[27] The SBQ has been shown to distinguish between people with strong from people with weak fears of being negatively evaluated by others.[29]

Subtle Avoidance Frequency Examination

The Subtle Avoidance Frequency Examination (SAFE) is an assessment of safety behaviors in social anxiety that was developed in 2009.[2] The frequency at which a behavior is performed and the total number of safety behaviors utilized is rated from “never” to “always.”[2] Examples of safety behaviors recorded in this assessment include “speaking softly” and “avoiding eye contact.”[2] This measure has been shown to distinguish between people with clinical levels of social anxiety and those without.[2][30] This assessment has also been shown to support other measures of social anxiety such as the Social Phobia Scale.[2][31]

Texas Safety Maneuver Scale

The Texas Safety Maneuver Scale (TSMS) is an assessment of safety behaviors in panic disorder that was developed in 1998.[28] The frequency at which each behavior is performed is measured on a five-point scale from “never” to “always.”[28] Examples of safety behaviors recorded in this assessment include “checking pulse” and “avoiding stressful encounters.”[28] This assessment has also been shown to correlate with agoraphobia measures such as the Fear Questionnaire.[28]

Objections to treatment

Some researchers have claimed that safety behaviors can be helpful in therapy but only when the behaviors are used during the early stages of treatment.[7] For example, exposure therapy will appear less threatening if patients are able to use safety behaviors during the treatment.[7] Patients will also feel more in control in the threatening situations if they are able to use their safety behaviors to reduce anxiety.[7] The studies testing this claim have shown mixed results.[4]

See also

References

  1. ^ a b c d e f g h Salkovskis, P. M. (1991). The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural Psychotherapy, 19(1), 6–19. doi:10.1017/S0141347300011472
  2. ^ a b c d e f g Cuming, S., Rapee, R. M., Kemp, N., Abbott, M. J., Peters, L., & Gaston, J. E. (2009). A self-report measure of subtle avoidance and safety behaviors relevant to social anxiety: Development and psychometric properties. Journal of Anxiety Disorders, 23(7), 879–883. doi:10.1016/j.janxdis.2009.05.002
  3. ^ a b c Rachman, S. (1984). Agoraphobia—A safety-signal perspective. Behaviour Research and Therapy, 22(1), 59–70. doi:10.1016/0005-7967(84)90033-0
  4. ^ a b c d e f g h i j k l m n o p q r Helbig-Lang, S., & Petermann, F. (2010). Tolerate or eliminate? A systematic review on the effects of safety behavior across anxiety disorders. Clinical Psychology: Science and Practice, 17(3), 218–233. doi:10.1111/j.1468-2850.2010.01213.x
  5. ^ a b c d e f g h Wells, A., Clark, D.M., Salkovskis, P., Ludgate, J., Hackmann, A., & Gelder, M. (1995). Social phobia: The role of in-situation safety behaviors in maintaining anxiety and negative beliefs. Behavior Therapy, 26(1), 153–161. doi:10.1016/S0005-7894(05)80088-7
  6. ^ a b c van den Hout, M., & Kindt, M. (2004). Obsessive–compulsive disorder and the paradoxical effects of perseverative behaviour on experienced uncertainty. Journal of Behavior Therapy and Experimental Psychiatry, 35(2), 165–181. doi:10.1016/j.jbtep.2004.04.007
  7. ^ a b c d Rachman, S., Radomsky, A. S., & Shafran, R. (2008). Safety behaviour: A reconsideration. Behaviour Research and Therapy, 46, 143–173. doi:10.1016/j.brat.2007.11.008
  8. ^ Salkovskis, P. M. (1999). Understanding and treating obsessive—compulsive disorder. Behaviour Research and Therapy, 37, S29-S52. doi:10.1016/S0005-7967(99)00049-2
  9. ^ Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345. doi:10.1016/S0005-7967(99)00123-0
  10. ^ a b Ehlers, A., & Breuer, P. (1992). Increased cardiac awareness in panic disorder. Journal of Abnormal Psychology, 101(3), 371–382. doi:10.1037/0021-843X.101.3.371
  11. ^ a b c d e f Kim, E. J. (2005). The effect of the decreased safety behaviors on anxiety and negative thoughts in social phobics. Journal of Anxiety Disorders, 19(1), 69–86. doi:10.1016/j.janxdis.2003.11.002
  12. ^ a b c Rachman, S., & Hodgson, R. (1980). Obsessions and compulsions. Englewood Cliffs, NJ: Prentice Hall.
  13. ^ Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioural disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152–1168. doi:10.1037/0022-006X.64.6.1152
  14. ^ Salters-Pedneault, K., Tull, M. T., & Roemer, E. (2004). The role of avoidance of emotional material in the anxiety disorders. Applied and Preventive Psychology, 11, 95–114. doi:10.1016/j.appsy.2004.09.001
  15. ^ a b c d e Salkovskis, P.M., Clark, D.M., Hackman, A., Wells, A., & Gelder, M.G. (1999). An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia. Behaviour Research and Therapy, 37, 559–574. doi:10.1016/S0005-7967(98)00153-3
  16. ^ Mayo Clinic Staff. Agoraphobia. Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/agoraphobia/basics/definition/con-20029996
  17. ^ a b c d e Woody, S., & Rachman, S. (1994). Generalized anxiety disorder (GAD) as an unsuccessful search for safety. Clinical Psychology Review, 14, 743–753. doi:10.1016/0272-7358(94)90040-X
  18. ^ a b c d e f Harvey, A. G. (2002). A cognitive model of insomnia. Behaviour Research and Therapy, 40(8), 869–893. doi:10.1016/S0005-7967(01)00061-4
  19. ^ a b c d Deacon, B., & Maack, D. J. (2008). The effects of safety behaviors on the fear of contamination: An experimental investigation. Behaviour Research and Therapy, 46(4), 537–547. doi:10.1016/j.brat.2008.01.010
  20. ^ a b c d Salkovskis, P.M., Wroe, A.L., Gledhill, A., Morrison, N., Forrester, E., Richards, C., Reynolds, M., & Thorpe, S. (2000). Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder. Behaviour Research and Therapy, 38, 347–372. doi:10.1016/S0005-7967(99)00071-6
  21. ^ a b c d e Dunmore, E., Clark, D. M., & Ehlers, A. (1999). Cognitive factors involved in the onset and maintenance of posttraumatic stress disorder (PTSD) after physical or sexual assault. Behaviour Research and Therapy, 37(9), 809–829. doi:10.1016/S0005-7967(98)00181-8
  22. ^ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.
  23. ^ a b c Freeman, D., Garety, P. A., Kuipers, E., Fowler, D., Bebbington, P. E., & Dunn, G. (2007). Acting on persecutory delusions: The importance of safety seeking. Behaviour Research and Therapy, 45(1), 89–99. doi:10.1016/j.brat.2006.01.014
  24. ^ a b Schlenker, B.R., & Leary, M.R. (1982). Social anxiety and self-presentation: A conceptualization and model. Psychological Bulletin, 92, 641–669. doi:10.1037/0033-2909.92.3.641
  25. ^ Arkin, R. M. (1981). Self-presentation styles. In J. T. Tedeschi (Eds.), Impression management theory and social psychological research (pp. 311–333). New York: Academic Press.
  26. ^ Arkin, R. M., Lake, E. A., & Baumgarder, A. H. (1986). Shyness and self-presentation. In W. H. Jones, J. M. Cheek, & S. R. Briggs (Eds.), Shyness: Perspectives on research and treatment (pp. 189–204). New York: Plenum Press.
  27. ^ a b c d Clark, D. M., Wells, A., Hackmann, A., Butler, G., & Fennell, M. J. U. (1994). Social behaviour questionnaire. Unpublished. Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford.
  28. ^ a b c d e Kamphuis, J. H., & Telch, M. J. (1998). Assessment of strategies to manage or avoid perceived threats among panic disorder patients: The Texas Safety Maneuver Scale (TSMS). Clinical Psychology & Psychotherapy, 5(3), 177–186.
  29. ^ Spurr, J. M., & Stopa, L. (2003). The observer perspective: Effects on social anxiety and performance. Behaviour Research and Therapy, 41(9), 1009–1028. doi:10.1016/S0005-7967(02)00177-8
  30. ^ Moscovitch, D. A., Rowa, K., Paulitzki, J. R., Ierullo, M. D., Chiang, B., Antony, M. M., & McCabe, R. E. (2013). Self-portrayal concerns and their relation to safety behaviors and negative affect in social anxiety disorder. Behaviour Research and Therapy, 51(8), 476–486. doi:10.1016/j.brat.2013.05.002
  31. ^ Rapee, R. M., Gaston, J. E., & Abbott, M. J. (2009). Testing the efficacy of theoretically derived improvements in the treatment of social phobia. Journal of Consulting and Clinical Psychology, 77(2), 317. doi:10.1037/a0014800

January 13, 2023
safety, behaviors, anxiety, safety, behaviors, also, known, safety, seeking, behaviors, coping, behaviors, used, reduce, anxiety, fear, when, user, feels, threatened, example, safety, behavior, social, anxiety, think, excuses, escape, potentially, uncomfortabl. Safety behaviors also known as safety seeking behaviors are coping behaviors used to reduce anxiety and fear when the user feels threatened 1 An example of a safety behavior in social anxiety is to think of excuses to escape a potentially uncomfortable situation 2 These safety behaviors although useful for reducing anxiety in the short term might become maladaptive over the long term by prolonging anxiety and fear of nonthreatening situations 1 3 This problem is commonly experienced in anxiety disorders 4 Treatments such as exposure and response prevention focus on eliminating safety behaviors due to the detrimental role safety behaviors have in mental disorders 5 6 There is a disputed claim that safety behaviors can be beneficial to use during the early stages of treatment 7 Contents 1 History 2 Theories about effects 3 Classification 3 1 Preventative 3 2 Restorative 4 Associated conditions 4 1 Agoraphobia 4 2 Generalized anxiety disorder 4 3 Insomnia 4 4 Obsessive compulsive disorder 4 5 Posttraumatic stress disorder 4 6 Schizophrenia 4 7 Social anxiety 5 Assessment measures 5 1 Social Behavior Questionnaire 5 2 Subtle Avoidance Frequency Examination 5 3 Texas Safety Maneuver Scale 6 Objections to treatment 7 See also 8 ReferencesHistory EditThe concept of safety behaviors was first related to a mental disorder in 1984 when the safety perspective hypothesis was proposed to explain how agoraphobia is maintained over time 3 The safety perspective hypothesis states that people with agoraphobia act in ways they believe will increase or maintain their level of safety 3 In 1991 the use of safety behaviors was observed in people with panic disorders 1 Later studies observed the use of safety behaviors in people with other disorders such as social phobia 5 obsessive compulsive disorder 8 and posttraumatic stress disorder 9 Theories about effects EditSafety behaviors directly amplify fear and anxiety 4 The use of safety behaviors promotes the monitoring of anxiety symptoms For example people with panic disorders tend to monitor themselves for symptoms of anxiety and respond to these symptoms with avoidant behaviors 10 This over analysis of physical sensations results in detection of symptoms that may not lead to panic attacks but are perceived as panic inducing symptoms 10 People with social phobia withdraw themselves from social situations by quietly speaking reducing body movement and preventing eye contact with other people 5 11 These behaviors are meant to reduce the chances of receiving criticism from other people 5 11 Instead safety behaviors result in more criticism because people with social phobia are seen as aloof and unwelcoming people 5 11 Safety behaviors reduce anxiety in feared situations but retain anxiety in the long term 4 When a person uses safety behaviors to reduce anxiety and fear in a threatening situation the anxiety and fear may subside 4 The user will then believe that the safety behaviors caused the emotional decrease and continue to use safety behaviors in future situations 1 However the decrease in anxiety and fear may be due to other factors such as time 1 The decrease in anxiety and fear may also be due to the situation itself 1 Situations that seem severely threatening such as giving a presentation are not actually very harmful 1 By avoiding the situation through the use of safety behaviors the user is unable to realize that the situation is harmless allowing the cycle of anxiety and behavior to continue 1 Classification EditSafety behaviors can be grouped into two major categories preventive and restorative safety behaviors 12 Preventative Edit These behaviors are also known as emotional avoidance behaviors 13 14 These behaviors are aimed to reduce fear or anxiety in future situations 12 Examples include Completely avoiding situations in which the threat might occur 4 Relying on safety signals such as inviting companions to social events for support 4 Subtle avoidance behaviors such as avoiding physical contact 4 Compulsive behaviors such as checking doors before leaving 4 Preparations for potentially encountering these situations 4 Restorative Edit These behaviors are aimed to reduce fear or anxiety in a currently threatening situation 12 Examples include Escaping the situation 4 Using safety signals such as looking at cell phones to reduce social anxiety 4 Subtle avoidance behaviors such as breathing techniques 4 Compulsive behaviors such as repeatedly washing hands 4 Seeking reassurance from loved ones or professionals to ensure that the fears are unwarranted 4 Distracting attention from the threat or focusing attention on reducing the threat 4 Neutralizing the threat by praying or counting 4 Suppressing anxiety provoking thoughts 4 Associated conditions EditAgoraphobia Edit Main article Agoraphobia People may increase their risk for agoraphobia when they use safety behaviors to avoid potentially dangerous environments even though the danger may not be as severe as perceived 15 A common safety behavior is when a person with agoraphobia attempts to entirely avoid a crowded place such as a mall or a public bus 16 If the affected person does end up in a crowded area then the person may tense his or her legs to prevent collapsing in the area 15 The affected person may also attempt to escape these crowded situations 15 People with agoraphobia then attribute the lack of feared symptoms to the safety behaviors instead of to the lack of danger itself 15 This incorrect attribution may lead to persisting fears and symptoms 15 Generalized anxiety disorder Edit Main article Generalized anxiety disorder People with generalized anxiety disorder GAD view the world as a highly threatening environment 17 These people continuously search for safety and use safety behaviors 17 A common safety behavior used by GAD sufferers is seeking reassurance from a loved one to reduce the excessive worry 17 The affected person may also attempt to avoid all possible risks of danger and protect others from that danger 17 However these behaviors are unlikely to significantly reduce anxiety because the affected person often has multiple fears that are not clearly defined 17 Insomnia Edit Main article Insomnia People with insomnia tend to excessively worry about getting enough sleep and the consequences of not getting enough sleep 18 These people use safety behaviors in an attempt to reduce their excessive anxiety 18 However the use of safety behaviors serves to increase anxiety and reduce the chances that the affected person will disconfirm these anxiety provoking thoughts 18 A common safety behavior used by affected people is attempting to control the anxiety provoking thoughts by distracting themselves with other thoughts 18 The affected person may also cancel appointments and decide not to work because the person believes that he or she will not function properly 18 The affected person may take naps to compensate for the lack of sleep 18 Obsessive compulsive disorder Edit Main article Obsessive compulsive disorder People with obsessive compulsive disorder OCD use safety behaviors to reduce their anxiety when obsessions arise 19 Common safety behaviors include washing hands more times than needed and avoiding potential contaminants by not shaking hands 19 However when people with OCD use safety behaviors to reduce the chance of contamination their awareness of potential contamination increases 19 This heightened awareness then leads to an increased fear of being contaminated 19 Checking rituals such as checking several times to determine if all of the doors to a house are locked are also common safety behaviors 20 People with OCD often believe that if they do not perform their checking rituals others will be in danger 20 Consequentially people with OCD often perceive themselves as more responsible for the wellbeing of others than people without the disorder 20 Therefore people with OCD use safety behaviors when they believe that other people will be in danger if these behaviors are not used 20 Continuous checking reduces the certainty and vividness of memories related to checking 6 Exposure and response prevention therapy is effective in treating OCD 6 Posttraumatic stress disorder Edit Main article Posttraumatic stress disorder People with posttraumatic stress disorder PTSD believe that their general safety has been compromised after a trauma has occurred 21 These people use safety behaviors to restore their general sense of safety and to prevent the trauma from happening again 21 A common safety behavior used by affected people is staying awake for long periods of time to make sure that potential intruders do not attempt to break into their homes 21 The person may also attempt to avoid potential reminders of the trauma such as moving away from the place where the trauma occurred 21 These behaviors may lead to persistent fears because the behaviors prevent the affected person from disconfirming the threatening beliefs 21 Schizophrenia Edit Main article Schizophrenia People with schizophrenia may have persecutory delusions 22 These people use safety behaviors to prevent the potential threats that arise from their persecutory delusions 23 Common safety behaviors include avoiding locations where perceived persecutors can be found and physically escaping from the perceived persecutors 23 These behaviors may increase the amount of persecutory delusions the person experiences because the safety behaviors prevent the affected person from disconfirming the threatening beliefs 23 Social anxiety Edit Main article Social anxiety disorder Generally people use social behaviors to either seek approval or avoid disapproval from others 24 People without social anxiety tend to use behaviors that are designed to gain approval from others while people with social anxiety prefer to use behaviors that help to avoid disapproval from others 24 25 26 Safety behaviors seem to reduce the chances of obtaining criticism by drawing less attention to the affected person 11 Common safety behaviors include avoiding eye contact with other people focusing on saying the proper words and other self controlling behaviors 11 Exposure therapy alone is mildly effective in treating social anxiety 5 There are larger decreases in anxiety and fear when people are also told to stop themselves from using safety behaviors during therapy than when people are encouraged to use safety behaviors 5 These decreases are largest when people are told to stop using safety behaviors and disconfirm the thoughts that the threatening situation will most likely not happen even if the safety behaviors are stopped 11 This combination of techniques is used in exposure and response prevention therapy for social anxiety 5 Assessment measures EditSeveral assessments have been developed to measure the amount of safety behaviors used by people with specific psychological conditions Two examples of assessments developed to measure safety behaviors performed by people with social anxiety are the Social Behavior Questionnaire and the Subtle Avoidance Frequency Examination 2 27 An assessment developed to measure safety behaviors performed by people with panic disorder is the Texas Safety Maneuver Scale 28 Social Behavior Questionnaire Edit The Social Behavior Questionnaire SBQ is an assessment of safety behaviors in social anxiety that was developed in 1994 27 The frequency at which a behavior is performed is rated from never to always 27 Examples of safety behaviors recorded in this assessment include avoiding asking questions and controlling shaking 27 The SBQ has been shown to distinguish between people with strong from people with weak fears of being negatively evaluated by others 29 Subtle Avoidance Frequency Examination Edit The Subtle Avoidance Frequency Examination SAFE is an assessment of safety behaviors in social anxiety that was developed in 2009 2 The frequency at which a behavior is performed and the total number of safety behaviors utilized is rated from never to always 2 Examples of safety behaviors recorded in this assessment include speaking softly and avoiding eye contact 2 This measure has been shown to distinguish between people with clinical levels of social anxiety and those without 2 30 This assessment has also been shown to support other measures of social anxiety such as the Social Phobia Scale 2 31 Texas Safety Maneuver Scale Edit The Texas Safety Maneuver Scale TSMS is an assessment of safety behaviors in panic disorder that was developed in 1998 28 The frequency at which each behavior is performed is measured on a five point scale from never to always 28 Examples of safety behaviors recorded in this assessment include checking pulse and avoiding stressful encounters 28 This assessment has also been shown to correlate with agoraphobia measures such as the Fear Questionnaire 28 Objections to treatment EditSome researchers have claimed that safety behaviors can be helpful in therapy but only when the behaviors are used during the early stages of treatment 7 For example exposure therapy will appear less threatening if patients are able to use safety behaviors during the treatment 7 Patients will also feel more in control in the threatening situations if they are able to use their safety behaviors to reduce anxiety 7 The studies testing this claim have shown mixed results 4 See also EditDenial Dissociation Escapism Risk compensation adjusting behavior depending on perceived level of safety or risk Security blanket Self medication Sensitization Stress managementReferences Edit a b c d e f g h Salkovskis P M 1991 The importance of behaviour in the maintenance of anxiety and panic A cognitive account Behavioural Psychotherapy 19 1 6 19 doi 10 1017 S0141347300011472 a b c d e f g Cuming S Rapee R M Kemp N Abbott M J Peters L amp Gaston J E 2009 A self report measure of subtle avoidance and safety behaviors relevant to social anxiety Development and psychometric properties Journal of Anxiety Disorders 23 7 879 883 doi 10 1016 j janxdis 2009 05 002 a b c Rachman S 1984 Agoraphobia A safety signal perspective Behaviour Research and Therapy 22 1 59 70 doi 10 1016 0005 7967 84 90033 0 a b c d e f g h i j k l m n o p q r Helbig Lang S amp Petermann F 2010 Tolerate or eliminate A systematic review on the effects of safety behavior across anxiety disorders Clinical Psychology Science and Practice 17 3 218 233 doi 10 1111 j 1468 2850 2010 01213 x a b c d e f g h Wells A Clark D M Salkovskis P Ludgate J Hackmann A amp Gelder M 1995 Social phobia The role of in situation safety behaviors in maintaining anxiety and negative beliefs Behavior Therapy 26 1 153 161 doi 10 1016 S0005 7894 05 80088 7 a b c van den Hout M amp Kindt M 2004 Obsessive compulsive disorder and the paradoxical effects of perseverative behaviour on experienced uncertainty Journal of Behavior Therapy and Experimental Psychiatry 35 2 165 181 doi 10 1016 j jbtep 2004 04 007 a b c d Rachman S Radomsky A S amp Shafran R 2008 Safety behaviour A reconsideration Behaviour Research and Therapy 46 143 173 doi 10 1016 j brat 2007 11 008 Salkovskis P M 1999 Understanding and treating obsessive compulsive disorder Behaviour Research and Therapy 37 S29 S52 doi 10 1016 S0005 7967 99 00049 2 Ehlers A amp Clark D M 2000 A cognitive model of posttraumatic stress disorder Behaviour Research and Therapy 38 4 319 345 doi 10 1016 S0005 7967 99 00123 0 a b Ehlers A amp Breuer P 1992 Increased cardiac awareness in panic disorder Journal of Abnormal Psychology 101 3 371 382 doi 10 1037 0021 843X 101 3 371 a b c d e f Kim E J 2005 The effect of the decreased safety behaviors on anxiety and negative thoughts in social phobics Journal of Anxiety Disorders 19 1 69 86 doi 10 1016 j janxdis 2003 11 002 a b c Rachman S amp Hodgson R 1980 Obsessions and compulsions Englewood Cliffs NJ Prentice Hall Hayes S C Wilson K G Gifford E V Follette V M amp Strosahl K 1996 Experiential avoidance and behavioural disorders A functional dimensional approach to diagnosis and treatment Journal of Consulting and Clinical Psychology 64 1152 1168 doi 10 1037 0022 006X 64 6 1152 Salters Pedneault K Tull M T amp Roemer E 2004 The role of avoidance of emotional material in the anxiety disorders Applied and Preventive Psychology 11 95 114 doi 10 1016 j appsy 2004 09 001 a b c d e Salkovskis P M Clark D M Hackman A Wells A amp Gelder M G 1999 An experimental investigation of the role of safety seeking behaviours in the maintenance of panic disorder with agoraphobia Behaviour Research and Therapy 37 559 574 doi 10 1016 S0005 7967 98 00153 3 Mayo Clinic Staff Agoraphobia Mayo Clinic Retrieved from http www mayoclinic org diseases conditions agoraphobia basics definition con 20029996 a b c d e Woody S amp Rachman S 1994 Generalized anxiety disorder GAD as an unsuccessful search for safety Clinical Psychology Review 14 743 753 doi 10 1016 0272 7358 94 90040 X a b c d e f Harvey A G 2002 A cognitive model of insomnia Behaviour Research and Therapy 40 8 869 893 doi 10 1016 S0005 7967 01 00061 4 a b c d Deacon B amp Maack D J 2008 The effects of safety behaviors on the fear of contamination An experimental investigation Behaviour Research and Therapy 46 4 537 547 doi 10 1016 j brat 2008 01 010 a b c d Salkovskis P M Wroe A L Gledhill A Morrison N Forrester E Richards C Reynolds M amp Thorpe S 2000 Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder Behaviour Research and Therapy 38 347 372 doi 10 1016 S0005 7967 99 00071 6 a b c d e Dunmore E Clark D M amp Ehlers A 1999 Cognitive factors involved in the onset and maintenance of posttraumatic stress disorder PTSD after physical or sexual assault Behaviour Research and Therapy 37 9 809 829 doi 10 1016 S0005 7967 98 00181 8 American Psychiatric Association 2013 Diagnostic and statistical manual of mental disorders 5th ed Washington DC a b c Freeman D Garety P A Kuipers E Fowler D Bebbington P E amp Dunn G 2007 Acting on persecutory delusions The importance of safety seeking Behaviour Research and Therapy 45 1 89 99 doi 10 1016 j brat 2006 01 014 a b Schlenker B R amp Leary M R 1982 Social anxiety and self presentation A conceptualization and model Psychological Bulletin 92 641 669 doi 10 1037 0033 2909 92 3 641 Arkin R M 1981 Self presentation styles In J T Tedeschi Eds Impression management theory and social psychological research pp 311 333 New York Academic Press Arkin R M Lake E A amp Baumgarder A H 1986 Shyness and self presentation In W H Jones J M Cheek amp S R Briggs Eds Shyness Perspectives on research and treatment pp 189 204 New York Plenum Press a b c d Clark D M Wells A Hackmann A Butler G amp Fennell M J U 1994 Social behaviour questionnaire Unpublished Department of Psychiatry University of Oxford Warneford Hospital Oxford a b c d e Kamphuis J H amp Telch M J 1998 Assessment of strategies to manage or avoid perceived threats among panic disorder patients The Texas Safety Maneuver Scale TSMS Clinical Psychology amp Psychotherapy 5 3 177 186 Spurr J M amp Stopa L 2003 The observer perspective Effects on social anxiety and performance Behaviour Research and Therapy 41 9 1009 1028 doi 10 1016 S0005 7967 02 00177 8 Moscovitch D A Rowa K Paulitzki J R Ierullo M D Chiang B Antony M M amp McCabe R E 2013 Self portrayal concerns and their relation to safety behaviors and negative affect in social anxiety disorder Behaviour Research and Therapy 51 8 476 486 doi 10 1016 j brat 2013 05 002 Rapee R M Gaston J E amp Abbott M J 2009 Testing the efficacy of theoretically derived improvements in the treatment of social phobia Journal of Consulting and Clinical Psychology 77 2 317 doi 10 1037 a0014800 Retrieved from https en wikipedia org w index php title Safety behaviors anxiety amp oldid 1047649451, wikipedia, wiki, book, books, library,

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