Safety behaviors (also known as safety-seeking behaviors) are coping behaviors used to reduce anxiety and fear when the user feels threatened. An example of a safety behavior in social anxiety is to think of excuses to escape a potentially uncomfortable situation.Cuming, S., Rapee, R. M., Kemp, N., Abbott, M. J., Peters, L., & Gaston, J. E. (2009). A self-report measure of subtle avoidance and safety behaviors relevant to social anxiety: Development and psychometric properties. Journal of Anxiety Disorders, 23(7), 879–883. doi:10.1016/j.janxdis.2009.05.002 These safety behaviors, although useful for reducing anxiety in the short term, might become maladaptive over the long term by prolonging anxiety and fear of nonthreatening situations.Rachman, S. (1984). Agoraphobia—A safety-signal perspective. Behaviour Research and Therapy, 22(1), 59–70. doi:10.1016/0005-7967(84)90033-0 This problem is commonly experienced in anxiety disorders.Helbig-Lang, S., & Petermann, F. (2010). Tolerate or eliminate? A systematic review on the effects of safety behavior across anxiety disorders. Clinical Psychology: Science and Practice, 17(3), 218–233. doi:10.1111/j.1468-2850.2010.01213.x Treatments such as exposure and response prevention focus on eliminating safety behaviors due to the detrimental role safety behaviors have in mental disorders.Wells, A., Clark, D.M., Salkovskis, P., Ludgate, J., Hackmann, A., & Gelder, M. (1995). Social phobia: The role of in-situation safety behaviors in maintaining anxiety and negative beliefs. Behavior Therapy, 26(1), 153–161. doi:10.1016/S0005-7894(05)80088-7van den Hout, M., & Kindt, M. (2004). Obsessive–compulsive disorder and the paradoxical effects of perseverative behaviour on experienced uncertainty. Journal of Behavior Therapy and Experimental Psychiatry, 35(2), 165–181. doi:10.1016/j.jbtep.2004.04.007 There is a disputed claim that safety behaviors can be beneficial to use during the early stages of treatment.Rachman, S., Radomsky, A. S., & Shafran, R. (2008). Safety behaviour: A reconsideration. Behaviour Research and Therapy, 46, 143–173. doi:10.1016/j.brat.2007.11.008
History The concept of safety behaviors was first related to a mental disorder in 1984 when the “safety perspective” hypothesis was proposed to explain how agoraphobia is maintained over time. The “safety perspective” hypothesis states that people with agoraphobia act in ways they believe will increase or maintain their level of safety. In 1991, the use of safety behaviors was observed in people with panic disorders. Later studies observed the use of safety behaviors in people with other disorders such as social phobia, obsessive compulsive disorder,Salkovskis, P. M. (1999). Understanding and treating obsessive—compulsive disorder. Behaviour Research and Therapy, 37, S29-S52. doi:10.1016/S0005-7967(99)00049-2 and posttraumatic stress disorder.Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345. doi:10.1016/S0005-7967(99)00123-0
Theories about effects Safety behaviors directly amplify fear and anxiety. The use of safety behaviors promotes the monitoring of anxiety symptoms. For example, people with panic disorders tend to monitor themselves for symptoms of anxiety and respond to these symptoms with avoidant behaviors.Ehlers, A., & Breuer, P. (1992). Increased cardiac awareness in panic disorder. Journal of Abnormal Psychology, 101(3), 371–382. doi:10.1037/0021-843X.101.3.371 This over analysis of physical sensations results in detection of symptoms that may not lead to panic attacks but are perceived as panic-inducing symptoms. People with social phobia withdraw themselves from social situations by quietly speaking, reducing body movement, and preventing eye contact with other people.Kim, E. J. (2005). The effect of the decreased safety behaviors on anxiety and negative thoughts in social phobics. Journal of Anxiety Disorders, 19(1), 69–86. doi:10.1016/j.janxdis.2003.11.002 These behaviors are meant to reduce the chances of receiving criticism from other people. Instead, safety behaviors result in more criticism because people with social phobia are seen as aloof and unwelcoming people.
Safety behaviors reduce anxiety in feared situations but retain anxiety in the long term. When a person uses safety behaviors to reduce anxiety and fear in a threatening situation, the anxiety and fear may subside. The user will then believe that the safety behaviors caused the emotional decrease and continue to use safety behaviors in future situations. However, the decrease in anxiety and fear may be due to other factors such as time. The decrease in anxiety and fear may also be due to the situation itself. Situations that seem severely threatening, such as giving a presentation, are not actually very harmful. By avoiding the situation through the use of safety behaviors, the user is unable to realize that the situation is harmless, allowing the cycle of anxiety and behavior to continue.
Classification Safety behaviors can be grouped into two major categories: preventive and restorative safety behaviors.Rachman, S., & Hodgson, R. (1980). Obsessions and compulsions. Englewood Cliffs, NJ: Prentice Hall.
Preventative These behaviors are also known as "emotional avoidance behaviors".Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioural disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152–1168. doi:10.1037/0022-006X.64.6.1152Salters-Pedneault, K., Tull, M. T., & Roemer, E. (2004). The role of avoidance of emotional material in the anxiety disorders. Applied and Preventive Psychology, 11, 95–114. doi:10.1016/j.appsy.2004.09.001 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 inviting companions to social events for support Subtle avoidance behaviors such as avoiding physical contact Compulsive behaviors such as checking doors before leaving Preparations for potentially encountering these situations
Restorative These behaviors are aimed to reduce fear or anxiety in a currently threatening situation. Examples include: Escaping the situation Using safety signals such as looking at cell phones to reduce social anxiety 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 Agoraphobia
People may increase their risk for agoraphobia when they use safety behaviors to avoid potentially dangerous environments even though the danger may not be as severe as perceived.Salkovskis, P.M., Clark, D.M., Hackman, A., Wells, A., & Gelder, M.G. (1999). An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia. Behaviour Research and Therapy, 37, 559–574. doi:10.1016/S0005-7967(98)00153-3 A common safety behavior is when a person with agoraphobia attempts to entirely avoid a crowded place such as a mall or a public bus.Mayo Clinic Staff. Agoraphobia. Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/agoraphobia/basics/definition/con-20029996 If the affected person does end up in a crowded area, then the person may tense his or her legs to prevent collapsing in the area. The affected person may also attempt to escape these crowded situations. People with agoraphobia then attribute the lack of feared symptoms to the safety behaviors instead of to the lack of danger itself. This incorrect attribution may lead to persisting fears and symptoms.
Generalized anxiety disorder
People with generalized anxiety disorder (GAD) view the world as a highly threatening environment.Woody, S., & Rachman, S. (1994). Generalized anxiety disorder (GAD) as an unsuccessful search for safety. Clinical Psychology Review, 14, 743–753. doi:10.1016/0272-7358(94)90040-X These people continuously search for safety and use safety behaviors. A common safety behavior used by GAD sufferers is seeking reassurance from a loved one to reduce the excessive worry. The affected person may also attempt to avoid all possible risks of danger and protect others from that danger. However, these behaviors are unlikely to significantly reduce anxiety because the affected person often has multiple fears that are not clearly defined.
Insomnia
People with insomnia tend to excessively worry about getting enough sleep and the consequences of not getting enough sleep.Harvey, A. G. (2002). A cognitive model of insomnia. Behaviour Research and Therapy, 40(8), 869–893. doi:10.1016/S0005-7967(01)00061-4 These people use safety behaviors in an attempt to reduce their excessive anxiety. However, the use of safety behaviors serves to increase anxiety and reduce the chances that the affected person will disconfirm these anxiety-provoking thoughts. A common safety behavior used by affected people is attempting to control the anxiety-provoking thoughts by distracting themselves with other thoughts. The affected person may also cancel appointments and decide not to work because the person believes that he or she will not function properly. The affected person may take naps to compensate for the lack of sleep.
Obsessive-compulsive disorder
People with obsessive-compulsive disorder (OCD) use safety behaviors to reduce their anxiety when obsessions arise.Deacon, B., & Maack, D. J. (2008). The effects of safety behaviors on the fear of contamination: An experimental investigation. Behaviour Research and Therapy, 46(4), 537–547. doi:10.1016/j.brat.2008.01.010 Common safety behaviors include washing hands more times than needed and avoiding potential contaminants by not shaking hands. However, when people with OCD use safety behaviors to reduce the chance of contamination, their awareness of potential contamination increases. This heightened awareness then leads to an increased fear of being contaminated.
Checking rituals, such as checking several times to determine if all of the doors to a house are locked, are also common safety behaviors.Salkovskis, P.M., Wroe, A.L., Gledhill, A., Morrison, N., Forrester, E., Richards, C., Reynolds, M., & Thorpe, S. (2000). Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder. Behaviour Research and Therapy, 38, 347–372. doi:10.1016/S0005-7967(99)00071-6 People with OCD often believe that if they do not perform their checking rituals, others will be in danger. Consequentially, people with OCD often perceive themselves as more responsible for the wellbeing of others than people without the disorder. Therefore, people with OCD use safety behaviors when they believe that other people will be in danger if these behaviors are not used. Continuous checking reduces the certainty and vividness of memories related to checking. Exposure and response prevention therapy is effective in treating OCD.
Posttraumatic stress disorder