Greg's best friend is getting married. As the best man, Greg is about to give a speech in front a large room full of people. But Greg experiences significant social anxiety, and this is his worst nightmare. As he stands there, preparing to give his speech, he worries about a multitude of things. Although it is hot, he keeps his jacket on because he worries that everyone will see the sweat under his arms. Worried that everyone will see his hands shaking, he grips his notes tightly to control them. Because he worries that his jokes won't be funny, he speaks quickly and quietly. Because he's worried that people will be giving him judgmental looks, he stares down at his notes and refuses to make eye contact with anybody.

Safety Behaviors: Not Really Safe

Greg is engaging in something called safety behaviors. Also sometimes called safety aids, these are cognitive or behavioral strategies that people use to try to temporarily decrease their anxiety.1 You can think of using safety behaviors to mentally "check out" from an experience, such as closing your eyes during a horror movie. While mentally checking out certainly decreases anxiety in the moment, it decreases anxiety only temporarily. Studies indicate that safety behaviors increase anxiety in the long run because they enable individuals to avoid fully experiencing an anxiety-provoking situation, which prevents them from learning that they can effectively engage with the situation.2, 3

For example, in Greg's case, by looking only at his notes and reading quietly, Greg avoids the full experience of giving a speech to an audience, which decreases his anxiety in that moment. But because he is essentially reading a piece of paper to himself in front of other people, rather than of giving a speech, he deprives himself of the chance to learn that he has the ability to give a speech. As a result, Greg continues to experience anxiety when faced with giving a speech again.

And by reading quietly and quickly, Greg prevents the audience from hearing his speech well, resulting in little laughter at his jokes. Greg may look back on this experience and think, "nobody thinks my jokes are funny," which leaves him feeling even more anxiety about giving speeches. He may also look back on the event and think, "I can only give speeches if I speak very quickly and quietly," which he continues to do in future speeches. Though anxiety-reducing at the time, this is how safety behaviors create a cycle that generates emotional reliance on the behavior and increases anxiety over time.

Treatment Target: Safety Behaviors

Because safety behaviors perpetuate a cycle of anxiety, it should come as no surprise that studies indicate that treatments that target safety behaviors are more effective or potent than those that do not.1,3 In response to such findings, researchers developed the False Safety Behavior Elimination Therapy (F-SET), a new group therapy treatment protocol that primarily focuses on the reduction of safety behaviors.4

Studies of the F-SET indicated that the treatment was effective for treating a wide range of anxiety disorders, including social anxiety, panic disorder, and generalized anxiety disorder (GAD). To examine the effect of F-SET in an individual therapy setting, researchers recently adapted F-SET for individual therapy, using a sample of 28 individuals with either social anxiety disorder, generalized anxiety disorder, or panic disorder.5 The results indicated that, compared to a wait list control group, those receiving F-SET experienced significant decreases in both depression and anxiety. The findings also indicated that the change in avoidance strategies primarily drove the change in anxiety symptoms.

Although the study had a small sample size, the findings provide evidence for targeting safety behaviors as an effective way to treat a variety of anxiety disorders. Additionally, they highlight the important role that engaging in safety behaviors play in maintaining symptoms of anxiety.

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Sources

1. 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, 153–161.

2. Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: exposure to corrective information. Psychological Bulletin, 99, 20–35.

3. Salkovskis, P. M., Clark, D. M., Hackmann, A., Wells, A., & Gelder, M. G. (1999). An experimental investigation of the role of safety-seeking behaviors in the maintenance of panic disorder with agoraphobia. Behaviour Research and Therapy, 37, 559–574.

4. Schmidt, N. B., Buckner, J. D., Pusser, A., Woolaway-Bickel, K., & Preston, J. L. (2012). Randomized control trial of False Safety Behavior Elimination Therapy (F-SET): A unified cognitive behavioral treatment for anxiety psychopathology. Behavior Therapy, 43, 518–532.

5. Riccardi, C. J., Korte, K. J., & Schmidt, N. B. (2017). False safety behavior elimination therapy: A randomized study of a brief individual transdiagnostic treatment for anxiety disorders. Journal of Anxiety Disorders, 46, 35–45.

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