Taak 3 How to improve exposure therapy: what about a cognitive
approach and safety behaviors?
Learning goals
1. Wat zijn de basisprincipes van de cognitieve theorie?
2. Kijk naar de link tussen information processing theory en de cognitive theory
3. Attentional bias, interpretation bias, memory bias
4. Link tussen cognitive biases en anxiety disorders (vooral het volhouden van
anxiety)
5. Applicatie van voorgaande informatie op deel A van de taak (gaat wss vanzelf in
nabespreking)
6. Wat zijn safety behaviors?
7. Wat zijn de belangrijkste targets waar je bij behandeling rekening mee moet
houden?
8. Wat is de relatie tussen attention/interpretation en anxiety?
9. Advies aan Saskia
Bron: Helbig-Lang & Petermann
Safety behavior
● Common to all anxiety disorders
○ Assumed to play an essential role for the onset and maintenance of clinical
anxiety
● Can emerge to 2 types of thoughts
○ External
■ Situations, persons, activities
○ Internal
■ Thoughts, emotions, memories
● Employed to reduce the experience of unpleasant feelings or the risk of feared outcomes
● Also frequently linked to a marked functional impairment and might serve as an indicator
of disorder severity
● What has to be regarded as safety behavior → still dissatisfactory!
Defining safety behavior
● Early models of anxiety
○ Escape and avoidance already assumed to maintain anxiety by serving as a
contingent reinforcement for learned associations between situational cues and
inadequate anxiety responses
● Today
○ Identifying and defining safety behavior is still challenging for both clinical
practice and research
● Anxiety-related behaviors can be both adaptive as well as inadequate strategies of
coping with emerging anxiety.
, ● In case of real threat, anxiety-driven behaviors are most often adaptive as they serve the
survival of the individual.
● 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).
● Restorative (= herstellend) safety behaviors
○ To impede (= belemmeren) the emotional experience in a feared situation
■ Aiming to reduce bodily symptoms related to anxiety or the perceived
likeliness of feared consequences
Conceptualization of safety behavior
● First introduced to explain why pathological anxiety is maintained in despite the repeated
experience that feared consequences do not occur
● Different effects of safety behavior
○ Might directly amplify fear and anxiety
○ Might reduce the experience of anxiety in situations but facilitate its recurrence
and persistence over time
○ Might contribute to the development of clinical anxiety
Effects of safety behavior on anxiety symptoms
● Different studies (table 2)
● Neutralizing led to more discomfort and stronger urges to neutralize in the subsequent
trials
● Suppression was related to higher anxiety during the challenge; less willingness to
participate in a second trial
approach and safety behaviors?
Learning goals
1. Wat zijn de basisprincipes van de cognitieve theorie?
2. Kijk naar de link tussen information processing theory en de cognitive theory
3. Attentional bias, interpretation bias, memory bias
4. Link tussen cognitive biases en anxiety disorders (vooral het volhouden van
anxiety)
5. Applicatie van voorgaande informatie op deel A van de taak (gaat wss vanzelf in
nabespreking)
6. Wat zijn safety behaviors?
7. Wat zijn de belangrijkste targets waar je bij behandeling rekening mee moet
houden?
8. Wat is de relatie tussen attention/interpretation en anxiety?
9. Advies aan Saskia
Bron: Helbig-Lang & Petermann
Safety behavior
● Common to all anxiety disorders
○ Assumed to play an essential role for the onset and maintenance of clinical
anxiety
● Can emerge to 2 types of thoughts
○ External
■ Situations, persons, activities
○ Internal
■ Thoughts, emotions, memories
● Employed to reduce the experience of unpleasant feelings or the risk of feared outcomes
● Also frequently linked to a marked functional impairment and might serve as an indicator
of disorder severity
● What has to be regarded as safety behavior → still dissatisfactory!
Defining safety behavior
● Early models of anxiety
○ Escape and avoidance already assumed to maintain anxiety by serving as a
contingent reinforcement for learned associations between situational cues and
inadequate anxiety responses
● Today
○ Identifying and defining safety behavior is still challenging for both clinical
practice and research
● Anxiety-related behaviors can be both adaptive as well as inadequate strategies of
coping with emerging anxiety.
, ● In case of real threat, anxiety-driven behaviors are most often adaptive as they serve the
survival of the individual.
● 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).
● Restorative (= herstellend) safety behaviors
○ To impede (= belemmeren) the emotional experience in a feared situation
■ Aiming to reduce bodily symptoms related to anxiety or the perceived
likeliness of feared consequences
Conceptualization of safety behavior
● First introduced to explain why pathological anxiety is maintained in despite the repeated
experience that feared consequences do not occur
● Different effects of safety behavior
○ Might directly amplify fear and anxiety
○ Might reduce the experience of anxiety in situations but facilitate its recurrence
and persistence over time
○ Might contribute to the development of clinical anxiety
Effects of safety behavior on anxiety symptoms
● Different studies (table 2)
● Neutralizing led to more discomfort and stronger urges to neutralize in the subsequent
trials
● Suppression was related to higher anxiety during the challenge; less willingness to
participate in a second trial
