Safety Behaviors in Adults With Social Anxiety: Review and Future Directions
Section snippets
Methods
Relevant studies for this systematic review were identified using PsycINFO (accessed via the EBSCOhost platform) and Google Scholar, as well as a backwards literature search that consisted of scanning references cited in identified articles to evaluate if these references might be relevant to our search criteria. Our search terms included, “safety behavior” and “anxiety,” as well as specific anxiety disorder terminology (e.g., “social anxiety disorder,” “social phobia”) when appropriate.
Defining and Measuring Safety Behaviors
Safety behaviors have long been defined as attempts to prevent or avoid feared outcomes that are viewed by the anxious individual as threatening or catastrophic (e.g., Salkovskis, 1991). For socially anxious individuals, the feared outcome typically involves social rejection, negative evaluation, or unbearable feelings of anxiety in social situations. Safety behavior use is strongly and positively related to these fears in social anxiety (Moscovitch et al., 2013, Okajima et al., 2009),
Safety Behaviors in Social Interactions
Cognitive-behavioral models of SAD assert that individuals with social anxiety employ safety behaviors to avoid feared social consequences without escaping the social situation completely (Clark, 2001, Heimberg et al., 2014, Hofmann, 2007). In fact, several studies indicate that individuals with high levels of social anxiety engage in more safety behaviors than individuals with low levels of social anxiety when participating in social interactions (e.g., McManus et al., 2008, Stangier et al.,
Safety Behaviors and Self-Imagery
Research on safety behaviors has expanded to incorporate the roles of attentional focus and self-imagery in social interactions. Self-imagery refers to the constructed (and often negative) self-impression that socially anxious individuals use to inform themselves on how others may view them in social situations. Research has suggested that self-imagery is critical in maintaining distorted cognitions and attentional biases in SAD. Spurr and Stopa (2003) manipulated perspective-taking in
Safety Behaviors and Post-Event Processing
After participating in a social situation, individuals with social anxiety engage in a maladaptive cognitive process that highlights the negative aspects of their performance, known as post-event processing (PEP). PEP often involves a detailed recounting of the social event, with a focus on negative self-appraisal and recounting of past social failures (Brozovich and Heimberg, 2008, Clark and Wells, 1995). Importantly, PEP is distinguishable from more adaptive forms of cognitive processing
Safety Behaviors and Treatment for SAD
Wells and colleagues’ (1995) study was the first to examine the role of safety behaviors in the treatment of social anxiety. Over the past 20 years, their results have been replicated in several studies. In a study involving intensive group CBT for SAD (Morgan & Raffle, 1999), half of the 30 participants received treatment as usual and the other half received psychoeducation about safety behaviors and were instructed to drop safety behaviors during exposure tasks. Participants in both
Conclusions
Research on the role of safety behaviors in the development, maintenance, and treatment of SAD has expanded in breadth and depth since the first published examination of safety behaviors in SAD (Wells et al., 1995). Safety behaviors were originally defined as actions perceived by an individual as necessary to prevent the occurrence of a feared outcome (e.g., Salkovskis, 1991). However, this broad definition requires further specification. Not all behaviors enacted in anxiety-provoking social
Conflict of Interest Statement
The authors have no conflicts of interest to report, nor was there any external funding for the preparation of this manuscript.
References (70)
- et al.
Interpersonal consequences of the pursuit of safety
Behaviour Research and Therapy
(1998) - et al.
An analysis of post-event processing in social anxiety disorder
Clinical Psychology Review
(2008) - et al.
A self- report measure of subtle avoidance and safety behaviors relevant to social anxiety: Development and psychometric properties
Journal of Anxiety Disorders
(2009) - et al.
Does the judicious use of safety behaviors improve the efficacy and acceptability of exposure therapy for claustrophobic fear?
Journal of Behavior Therapy and Experimental Psychiatry
(2010) - et al.
The effects of safety behavior directed towards a safety cue on perceptions of threat
Behavior Therapy
(2015) - et al.
Videotaped experiments to drop safety behaviors and self-focused attention for patients with social anxiety disorder: Do they change subjective and objective evaluations of anxiety and performance?
Journal of Behavior Therapy and Experimental Psychiatry
(2009) - et al.
Behavior as information: “If I avoid, then there must be a danger”
Journal of Behavior Therapy and Experimental Psychiatry
(2012) - et al.
The relations between social anxiety and social intelligence: A latent variable analysis
Journal of Anxiety Disorders
(2011) - et al.
A cognitive-behavioral model of social anxiety disorder
- et al.
The role of safety behaviors in exposure-based treatment for panic disorder and agoraphobia: Associations to symptom severity, treatment course, and outcome
Journal of Anxiety Disorders
(2014)
Change processes in residential cognitive and interpersonal psychotherapy for social phobia: A process-outcome study
Behavior Therapy
Effects of safety behaviors on fear reduction during exposure
Behaviour Research and Therapy
Predicting post-event processing in social anxiety disorder following two prototypical social situations: State variables and dispositional determinants
Behaviour Research and Therapy
The effect of the decreased safety behaviors on anxiety and negative thoughts in social phobics
Journal of Anxiety Disorders
Safety aid use and social anxiety symptoms: The mediating role of perceived control
Psychiatry Research
A prospective examination of predictors of post-event processing following videotaped exposures in group cognitive behavioural therapy for individuals with social phobia
Journal of Anxiety Disorders
Safety behaviours preserve threat beliefs: Protection from extinction of human fear conditioning by an avoidance response
Behaviour Research And Therapy
Are worry, rumination, and post-event processing one and the same? Development of the Repetitive Thinking Questionnaire
Journal of Anxiety Disorders
A demonstration of the efficacy of two of the components of cognitive therapy for social phobia
Journal of Anxiety Disorders
Why social anxiety persists: An experimental investigation of the role of safety behaviours as a maintaining factor
Journal of Behavior Therapy and Experimental Psychiatry
Safety behaviour does not necessarily interfere with exposure therapy
Behaviour Research and Therapy
General in-situation safety behaviors are uniquely associated with post-event processing
Journal of Behavior Therapy and Experimental Psychiatry
Intensive cognitive-behavioral group treatment (CBGT) of social phobia: A randomized controlled study
Journal of Anxiety Disorders
Self-portrayal concerns and their relation to safety behaviors and negative affect in social anxiety disorder
Behaviour Research and Therapy
Anxiety-control strategies: Is there room for neutralization in successful exposure treatment?
Clinical Psychological Review
Differential effects of safety behaviour subtypes in social anxiety disorder
Behaviour Research and Therapy
Post-event processing in social anxiety
Behaviour Research and Therapy
Safety behaviour: A reconsideration
Behaviour Research and Therapy
Reducing contamination by exposure plus safety behaviour
Journal of Behavior Therapy and Experimental Psychiatry
A cognitive-behavioral model of anxiety in social phobia
Behaviour Research and Therapy
A false sense of security: Safety behaviors erode objective speech performance in individuals with social anxiety disorder
Behavior Therapy
An experimental investigation of the role of safety-seeking behaviors in the maintenance of panic disorder with agoraphobia
Behaviour Research and Therapy
Randomized controlled trial of false safety behavior elimination therapy: A unified cognitive behavioral treatment for anxiety psychopathology
Behavior Therapy
The observer perspective: Effects on social anxiety and performance
Behaviour Research and Therapy
What determines observer-rated social performance in individuals with social anxiety disorder?
Journal of Anxiety Disorders
Cited by (90)
Nonverbal synchrony in diagnostic interviews of individuals with social anxiety disorder
2024, Journal of Anxiety DisordersPride in social anxiety disorder
2023, Journal of Anxiety Disorders