Reducing so-called “safety behaviors” might not always lead to reduced anxiety, especially in non-clinical situations, according to new research published in the journal Cognitive Behaviour Therapy. The findings highlight the need for a more nuanced approach in understanding and managing anxiety in various situations.
Safety behaviors refer to actions and mental processes that people engage in to avoid feared outcomes. These behaviors can take various forms, such as seeking reassurance or repeatedly washing hands.
While safety behaviors can be essential in the presence of a genuine threat, they can also become problematic when there’s no actual danger. Previous research has linked the excessive use of safety behaviors to elevated levels of anxiety.
The researchers were motivated by the idea that if safety behaviors could be curtailed or prevented altogether, it might reduce the risk of developing anxiety disorders. Past studies primarily focused on reducing safety behaviors within a treatment context.
These studies found that decreasing safety behaviors could lead to better treatment outcomes for various anxiety disorders. So, the researchers aimed to explore whether a prevention intervention could be equally effective, potentially reducing the prevalence of anxiety disorders.
“My lab’s interest in safety behaviors stems directly from our collaboration with Dr. Jason Goodson at the Salt Lake City VA,” explained study author Gerald Haeffel, an associate professor of psychology at University of Notre Dame. “Dr. Goodson has been studying these behaviors for over a decade, and has made them a focus of his treatment for PTSD in U.S. veterans. Research shows that reductions in these behaviors are related to treatment efficacy. Thus, we wanted to determine if we could prevent their use before they become problematic.”
The study involved 131 college students, with an average age of 19, recruited from a private university in the Midwest. Participants were randomly assigned to one of two groups: the safety behavior reduction workbook condition or the active control condition.
The safety behavior reduction workbook spanned four weeks and featured daily activities that took approximately 10 minutes each day. It aimed to educate participants about safety behaviors, their potential to increase anxiety, and the various categories of these behaviors. Participants also learned strategies to reduce and eliminate safety behaviors, which were tailored to their specific safety concerns.
On the other hand, the active control group engaged in a workbook aimed at enhancing academic skills, with topics including study habits, time management, and note-taking.
To assess the effectiveness of the intervention, participants completed questionnaires measuring safety behavior usage and anxious symptoms both before and after the intervention. The researchers also tracked the fidelity (or engagement level) of participants in completing the workbook activities.
The study’s findings did not align with the researchers’ initial hypotheses. Contrary to expectations, participants in the safety behavior workbook condition did not report using fewer safety behaviors after the intervention compared to those in the active control condition. Additionally, there was no significant difference in the levels of anxious symptoms between the two groups post-intervention.
“We were very surprised that both of our hypotheses were wrong,” Haeffel told PsyPost. “Participants in the safety behavior workbook condition did not use fewer safety behaviors and did not have lower levels of anxiety post-intervention than participants in the active control condition. This suggests that safety behaviors are difficult to change using online interventions, even for those who may really need it.”
However, when the researchers delved deeper into the data, some intriguing patterns emerged. Participants who completed all activities in the safety behavior workbook did, in fact, report using significantly fewer safety behaviors compared to those in the active control condition. This suggests that the effectiveness of the safety behavior workbook may be dose-dependent – high engagement is needed for positive results.
Yet, perhaps the most unexpected discovery was related to the relationship between safety behavior reduction and anxious symptoms. Participants in the active control condition who reduced their safety behaviors reported a subsequent reduction in anxious symptoms, which aligns with conventional wisdom.
However, in the safety behavior workbook condition, participants who reduced their safety behaviors did not experience a corresponding decrease in anxious symptoms. This raises questions about the potential unintended consequences of promoting safety behavior reduction in non-clinical samples.
“Our exploratory analyses revealed interesting finding — participants in the safety behavior workbook condition who decreased their use of safety behaviors reported similar post-intervention anxiety levels to those who reported no change or increased safety behavior use,” Haeffel explained. “In contrast, those in the control condition who decreased their safety behavior use reported significantly less anxiety than those reporting no change or an increase in safety behaviors.”
“These results suggest that encouraging non-clinical samples to focus on, and reduce, safety behavior may actually maintain anxiety (at least initially). In other words, forcing people who do not suffer from clinically significant anxiety to change their safety behavior use may backfire. It will be important for future work to determine when it is appropriate and useful to reduce safety behaviors.”
While this study provided valuable insights, it had its limitations. For one, the participants were college students, which means the findings may not generalize to more diverse populations or individuals with more severe anxiety symptoms. Additionally, the study was conducted during the COVID-19 pandemic, which introduced new concerns and behaviors related to safety and anxiety.
To address these limitations, future research could explore the impact of safety behavior interventions on different demographic groups and use more comprehensive measures of anxiety symptoms.
“The take home message is that unless you are suffering from clinically significant anxiety, there is no evidence that you should try to reduce safety behaviors (at least by yourself or without the help of a therapist),” Haeffel said. “Our prevention workbook was not effective, and it may even be detrimental to reduce safety behaviors unnecessarily.”
The study, “Reducing safety behaviors to prevent anxious symptoms: a pre-registered prevention intervention study“, was authored by Ellen L. Gorman, Jason T. Goodson, and Gerald J. Haeffel.
