Comprehensive summary of ALL literature concerning Task 6 (Safety behaviors and Mental Imagery Treatments), summarized per article. Written in English, with Dutch clarifications. All tasks of this course are also available as a bundle! GGZ2024 - Anxiety Disorders
Task 6 Safety Behaviors and Mental Imagery Treatments
Learning goals:
1. What are safety behaviors?
2. How do safety behaviors difer from oping me hanisms?
3. Preventve vs. restoratve?
4. Are safety behaviors useful for treatment?
5. What is EMDR? (Underlying me hanisms)
6. What is imagery res riptng? (underlying me hanism?, need to in orporate most aversive
s enes?, is it dangerous to fantasize revenge?)
Powers MB, Smits JA, & Telch MJ. (2004). Disentangling the efects oo saoety-behavior utliiaton and
saoety-behavior availability during exposure-based treatment: a placebo-controlled trial.
Effects of safety-behavior durrig epoosrre-basedu treateegt.
Introdu ton
Safety behaviors are (overt or overt) a tons designed to avert or ope with a per eived threat. The
most ommon lass of safety behaviors is avoiduagce.
Sitratiogal avoiduagce – e.g., avoiding rasins one’s hand in lass for fear of embarrassment.
Co gitive avoiduagce – mental distra ton (aaeidingner niet aan denken).
Other safety behavior are more subtle and AD-spe if . Some examples:
PD – ofen he king your pulse.
SAD – mental rehearsal of senten es.
GAD – repeatedly seek reassuran e from others, avoiding risks.
Safety-behavior rtiliiatiog (SBU) may play a prominent role in the maintenan e of anxiety disorders,
suggested by interfering (belemmeren) with threat dis onfrmaton through the misatributon of
safety to the use of safety behaviors rather than the inno uous nature of the stmulus or situaton.
Also other eviden e is found thate SBU has a interfering efe t on exposure therapy.
Studies on the dire t efe ts of safety-behavior availability (SBA) during exposure lead to the
queston whether detrimental (nadelige) efe ten van SBA were due to their a tual use or simply
their per eived availability.
Aim of this study – investgate the deleterious (schadelijke) efe ts of safety-seeking behaviors on
fear redu ton by disentangling (ontraoelen) the efe ts of per eived availability of threat relevant
safety behaviors during treatment versus their a tual use (het aanweiig iijn vs. het daadwerkelijk
gebruiken ervan).
The treatment onditons use (SBU)
vs. availability (SBA) of safety aids
were ompared with an exposure-no-
safety-aid onditon (pla ebo (PL) and
wait list (WL) ontrol onditons).
Another onditon group was
exposure-only (EO).
, Dis ussion
Consistently with previous resear h, making safety behaviors available to laustrophobi
individuals during in vivo exposure had a marked duisrrotive (verwoestend) effect og fear
redurctiog.
The fndings suggest that it is the oerceotiog of the availability of SBs as opposed to their a tual
use that exerts the disruptve efe ts on fear redu ton. This is supported by the fnding that level
of fear redu ton was unafe ted by part ipants’ a tual use of the safety behaviors made
available for them.
So, disruptve efe ts on fear redu ton per epton of availability of SBs, rather than a tual
use of SBs.
The data strongly suggest that in vivo exposure is both ef a ious and spe if in its treatment
efe ts. However, the data also suggests that making safety behaviors available to
laustrophobi s during in vivo exposure redu es its treatment ef a y to almost the ef a y of
the PL treatment. The study also found that safety aids do not need to be a tually used in order
to exert their detrimental efe ts.
Thwaites, R., & Freeston, M. H. (1999). Saoety-Seeking Behaviours: Fact or Functonn How an We
linically Diferentate Between Saoety Behaviours and Adaptve oping Strategies Across Anxiety
Disordersn
Whole lifestyles an be onstru ted around spe if fears. Some people need to perform ertain
spe if behaviours in order to prevent a atastrophe from happening. The role of su h behaviours
(safety behaviorrs or safety-seekig behaviorrs) are redu ing short- tme anxiety, but they prevent
long- term ognitve hange e.g., people ontnue to believe, that they may have a heart ata k
be ause they have prevented themselves from having the opportunity to dis onfrm their worst
fears.
Many urrent treatments on entrate on gradually dismantling safety behaviours and helping
patents design opportunites to test out their beliefs. This is in ontrast to earlier treatments,
whi h emphasized the tea hing of “appropriate” skills and strategies to patents to ontrol their
anxiety.
But how an we re ognize when a given behaviour is a safety behaviour and when it is an
adaptve oping strategy? it be omes important to distnguish between safety-seeking
behaviours (that would need to be gradually dropped) and adaptve oping strategies (that
would ontnue to help the individual with no long term ost).
o E.g., an inexperien ed publi speaker who experien es some anxiety might adaptvely
spend onsiderable tme preparing for a presentaton as a way of oping. In a so ially
phobi individual, the same behaviour ould fun ton as a safety-seeking behaviour.
Safety behaviours or safety-seeking behaviour
Safety behaviours are intended to avoid disaster and these response have the se ondary efe t of
preventng the dis onfrmaton that would otherwise take pla e.
o Defned with referen e to both their intended purpose and their onsequen es.
3 eaig tyoes of safety behaviorr (these ‘behaviours’ an also be internal pro esses or ognitve
strategies – using distra ton, rehearsing onversatons et .).
o Dire t avoidan e of situatons, es ape from situatons & subtle avoidan e within the
anxiety-provoking situaton.
Clini ally, it has long been observed that it is the “availability” of safety behaviours rather than
their “usage” that limits new learning and maintains threat beliefs (e.g., arrying anxiolyt
medi aton without using it). Patents link the la k of a feared atastrophe to the safety
behaviour.
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