Safety behaviors (anxiety)

Safety behaviors are maladaptive coping behaviors that occur in order to reduce fear in a situation that contains little to no actual threat. However, the use of safety behaviors results in prolonged anxiety and fear of the nonthreatening situations.

History

The concept of safety behaviors was first related to a mental disorder when a “safety perspective” was used to explain how anxiety was maintained in agoraphobia in 1984. Safety behaviors were later defined and connected to panic disorder in 1991. These safety behaviors were divided into three categories: avoidance of situations, escape, and subtle avoidance. The concept was later expanded to include other disorders such as social phobia, obsessive compulsive disorder, and posttraumatic stress disorder. Currently, there are three possible theories about the use of safety behaviors.

1. Safety behaviors directly amplify fear and anxiety.
   • This theory was taken from the models describing panic disorder and social phobia (Rachman, 1984).
   • An example of a safety behavior amplifying anxiety occurs when people with social phobia withdraw themselves from social situations by quietly speaking, reducing body movement, and preventing eye contact with other people. These behaviors are meant to reduce the chances of receiving criticism from other people. Instead, these chances increase because other people view the person with social anxiety as an aloof and unwelcoming person (Kim, E. J., 2005; Wells et al., 1995).
2. Safety behaviors reduce anxiety in feared situations but exacerbate anxiety over time.
   • This theory was taken from learning theories and attributional processes (Salkovskis, 1991).
3. Safety behaviors directly develop clinical anxiety.
   • This theory was also taken from learning theories (Lohr, Olatunji, & Sawchuk, 2007; Salkovskis et al., 1996).
   • People participate in safety behaviors to reduce the chances of a threatening situation from occurring. Since the threatening situations are usually unlikely to happen, people then attribute the lack of threatening situations to the use of safety behaviors (Wells et al.; Salkovskis). Therefore, people will not be motivated to figure out that these threatening situations will most likely not occur or are not severe because they just need to use safety behaviors to prevent the situations from happening at all (Kim, E. J., 2005).

Classification

Safety behaviors can be grouped into two major categories: preventative and restorative safety behaviors.

Preventative safety behaviors

These behaviors are also known as emotional avoidance behaviors [see Helbig-Lang for citations]. These behaviors are aimed to reduce fear or anxiety in future situations. Examples include:

• Completely avoiding situations in which the threat might occur
• Relying on safety signals such as the support of loved ones
• Subtle avoidance behaviors such as avoiding physical contact
• Compulsive behaviors such as checking doors before leaving
• Preparations for potentially encountering these situations

Restorative safety behaviors

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

• Escaping the situation
• Using safety signals, such as taking anti-anxiety medication[cite to anxiolytic page]
• Subtle avoidance behaviors such as breathing techniques
• Compulsive behaviors such as repeatedly washing hands
• Seeking reassurance from loved ones or professionals to ensure that the fears are unwarranted
• Distracting attention from the threat or focusing attention on reducing the threat
• Neutralizing the threat by praying or counting
• Suppressing anxiety-provoking thoughts

Associated conditions

Social anxiety

Generally, people use social behaviors to either seek approval from others or avoid disapproval from others. People without social anxiety tend to use behaviors that are aimed to gain approval from others, while people with social anxiety prefer to use behaviors that help avoid disapproval from others (Arkin, 1981, Arkin et al., 1986 and Schlenker & Leary, 1982). In social anxiety, people use safety behaviors to reduce the chances of being seen negatively by other people. People with social anxiety therefore attempt to draw less attention to themselves by avoiding eye contact, focusing on saying the correct words, and doing other self-controlling behaviors (Kim, E. J., 2005). Exposure therapy alone is mildly effective in treating social anxiety. When people who undergo exposure therapy are also told to stop themselves from using safety behaviors during therapy, the beneficial effects increase (Wells et al., 1995). These effects are strongest 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 (Kim, E. J., 2005). This process is used in cognitive behavioral therapy combined with exposure therapy.

Objections to Treatment

Many psychologists support the removal of safety behaviors during therapy [citations needed]. Several psychologists believe that safety behaviors could be used to augment therapy [citations needed]. Rachman (1984) conducted an experiment that showed the effectiveness in safety signals in therapy. Rachman et al. (2008) conducted another experiment that showed how safety behaviors could be used to help patients respond with greater efficacy to exposure therapy.

See also

• Coping (psychology)