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Summary Case 6 safety behaviours and mental imagery treatments
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case 6 from the course anxiety disorders. The course is part of the second year of the bachelor health sciences. I got an 8 for the exam myself
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Case 6 Safety Behaviours and Mental Imagery Treatments1. Helbig-Lang. Tolerate or eliminate? A systematic review on the effects of safety behaviors
across anxiety disorders.
- Safety behavior can emerge to both external (situations, persons, activities) as well as internal
(thoughts, emotions, memories) cues, and it is usually employed to reduce the experience of
unpleasant feelings or the risk of feared outcomes
- clinicians have frequent difficulties in distinguishing safety behavior and justifiable coping or
habits
- the present article focuses on (a) providing a clear definition of safety behaviour and its
differentiation from adaptive behaviors, and (b) reviewing the empirical evidence on the
effects of safety behavior in regard to maintenance and treatment of anxiety disorders.
- Rachman suggested that the presence of safety cues or safety signals in feared situations might
be responsible for the maintenance of agoraphobic anxiety, when situations are not avoided.
- Salkovskis introduced safetyseeking behavior in panic disorder, adding a new perspective on
how anxiety might be maintained despite disconfirming evidence. three categories:
o avoidance of situations
o escape from a situation once anxiety symptoms arise
o subtle avoidance behaviors carried out during panic attacks in order to prevent a
feared catastrophe
- Barlow divided emotional avoidance into categories of subtle behavioral avoidance, cognitive
avoidance, and use of safety signals. In general, he described safety behaviors as a variety of
emotion regulation strategies that cut across disorders.
- Summary
o (a) Anxiety-related behaviors can be both adaptive as well as inadequate strategies of
coping with emerging anxiety.
o (b) In case of real threat, anxiety-driven behaviors are most often adaptive as they
serve the survival of the individual.
o (c) Safety behaviors are dysfunctional emotion regulation strategies. They can be
differentiated from adaptive coping depending both on the situation in which they
occur (actual threat versus overrated or no real threat) as well as their function
(preventing feared outcomes that are unlikely to happen versus habitual behavior or
behavior unrelated to the occurrence of anxiety).
- 2 categories
o Preventive safety behaviors: are performed to prevent future distressing emotional
responses or increases in anxiety. Preventive strategies include situational avoidance,
relying on safety signals (e.g., leaving home only when accompanied, relying on
mobile phone) or subtle avoidance behaviors, such as avoiding exciting activities or
stimulating substances, avoiding eye contact, or avoiding touching things that might
be contaminated as well as worrying, or excessive preparation. Another term that
might be used to describe those behaviors is emotional (or experiental) avoidance
o Restorative safety behaviors: are performed to impede the emotional experience in a
feared situation. they most often aim at either reducing bodily symptoms related to
anxiety or the perceived likeliness of feared consequences (e.g., dying, embarrassing
oneself, bringing harm to oneself or others). Restorative behaviors include escaping
from situations or activities, attempts to control or suppress emotional responses,
reassurance seeking (e.g., calling someone to calm down,), as well as neutralizing
behaviors, such as washing when feeling contaminated.
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, o
- different effects of safety behavior:
o (a) safety behaviors might directly amplify (versterken) fear and anxiety: These
attentional shifts hamper (belemmeren) the processing of information that might
disconfirm anxiety and thereby contribute to the persistence of anxiety. Some safety
behaviors might even directly interfere with habituation processes
o (b) safety behaviors might reduce the experience of anxiety in situations but facilitate
its recurrence and persistence over time: the use of safety behavior leads to a
misattribution of perceived safety and control in a feared situation: The person
believes that by using safety behavior, anxiety can be controlled, and the likelihood of
a feared outcome can be decreased (it did not happen because I had my safety
behaviour)
o (c) safety behaviors might contribute to the development of clinical anxiety: Threat
overestimation might stimulate the use of inappropriate safety behaviour that, in turn,
contributes to the development of pathological fears and anxiety
- Safety Behaviors in the Etiology of Clinical Anxiety: safety behaviors might lead to threat
overestimation instead of being a consequence of it, although it has to be noted that it was not
clear whether increases in contamination fear were due to implementing safety behavior, or to
an increased awareness of potential contaminants. safety behaviors indeed contribute to the
onset of clinical anxiety, perhaps by inducing an attentional bias toward threat.
- Safety Behaviors in the Maintenance of Clinical Anxiety.: Attempts to control symptoms are
actually associated with increase in anxiety and increases in avoidance tendencies; however,
the individuals are usually unaware of these effects. The behavior is reinforced by irrational
beliefs that symptoms need to be and can be controlled.
o at least some safety behaviors might function as adaptive coping in social situations
and that it might be difficult to differentiate between adaptive and dysfunctional
strategies. However, the same behavior might also create different effects because it
serves different functions: preparation, for example, is clearly an adaptive behavior
before giving a talk; but excessive preparation is counterproductive.
o safety behaviour in OCD aimed at suppressing or neutralizing intrusive thoughts
immediately decreases distress when the thought occurs, but it increases distress due
to intrusive thoughts over time.
o In social phobia availability of safety signals, hence, impeded an increase in fear
during the situation.
o both distraction from the feared stimulus as well as focusing on safety signals lead to
an immediate decrease of fear because the attention is drawn away from the feared
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