Amy Goetz and her colleagues recently published a new paper in Clinical Psychology Review. Goetz, A.R., Davine, T.P., Siwiec, S.G., & Lee, H.J. (in press). The functional value of preventive and restorative safety behaviors: A systematic review of the literature. Clinical Psychology Review Safety behaviors are unnecessary actions used to prevent, escape from, or reduce the severity of a perceived threat. Most cognitive-behavioral theorists posit that the use of safety behaviors during exposure is maladaptive because they interfere with fear reduction. However, there is growing evidence suggesting that the use of safety behaviors can facilitate exposure. Overall, the findings are mixed as to whether safety behaviors should be made available during exposure-based interventions. The aim of the review paper was to evaluate whether safety behaviors should be made accessible during exposure, and whether, under certain circumstances, they facilitate or hinder important exposure outcomes. Goetz and her colleagues examined two functional types of safety behaviors, preventive and restorative. A thorough review of the safety behavior literature from the last three decades was conducted. The evidence suggests (restorative) safety behaviors that allow for full confrontation with a core threat do not interfere with meaningful indicators of successful exposure, whereas (preventive) safety behaviors that hinder engagement with the stimulus or experience weaken exposure outcomes.
Given that clients often terminate exposure therapy for a number of reasons (e.g., fear or apprehension about the difficulty and intensity of the treatment), attempts to enhance the palatability of exposure-based treatment (without sacrificing intervention potency) are important. Thus, examination of the benign and/or facilitative role of safety behaviors as an adjunct to traditional exposure therapy is a promising research avenue.