The Impact of Fading Restorative Safety Behaviors on Symptoms of Contamination Fear During a Single Session Exposure Intervention: an Experimental Investigation

Abstract

Safety behaviors are actions taken to prevent, escape from, or reduce the severity of a perceived threat. Cognitive-behavioral theorists posit that safety behaviors interfere with important exposure processes and should be removed from therapy. However, there is a growing accumulation of data suggesting that some safety behaviors may not be detrimental, and those that allow for full confrontation with a core threat, may not interfere with meaningful indicators of successful exposure. Therefore, it is important to examine parameters associated with restorative safety behaviors under conditions of use and then later removal. The current study examined the continuous (RSB) versus faded use (F-RSB) of restorative safety behaviors during a single session of exposure, as compared to exposure with no safety behaviors (NSB). Participants completed 15 trials of exposure, with or without safety behaviors as well as behavioral approach tasks at pretreatment, post-treatment, and two-week follow-up. Results showed that pre to post-treatment as well as pretreatment to follow-up, all three groups showed similar rates of reduction on clinical symptoms and rates of behavioral approach. Ratings obtained during repeated exposure trials indicated that participants in F-RSB and RSB had greater and more rapid reductions on relevant process measures, relative to NSB. Moreover, F-RSB resulted in greater reductions following safety behavior removal, indicating that safety behavior use and later withdrawal may be facilitative of continued improvement. Overall, no reliable drawbacks were associated with safety behaviors, and findings are in line with the benign and/or beneficial role of restorative safety behaviors in exposure protocols. The theoretical and clinical implications of these findings are discussed, and future directions in the investigation of safety behaviors are suggested.