Panel Discussion 13 - Safety Behaviors vs Safety Signals in Exposure Therapy: Are Safety Behaviors Always Contraindicated?

Safety behaviors (SBs)—actions intended to prevent, escape, or lessen feared outcomes—are commonly targeted for elimination during exposure because they may reduce expectancy violation and promote misattribution (“I was safe because I did X”). Yet empirical findings are mixed. A systematic review recommended identifying and abandoning SBs across anxiety disorders (Helbig Lang & Petermann, 2010), whereas a later meta analytic review found no consistent evidence that permitting versus prohibiting safety seeking behaviors reliably alters post treatment fear (Meulders et al., 2016). Analogue trials in claustrophobic and contamination fears reported substantial improvement with exposure whether or not selected SBs were permitted (Deacon et al., 2010; Rachman et al., 2011; Sy et al., 2011; van den Hout et al., 2011). Parallel basic science work suggests that “safety signals” (SSs)—conditioned inhibitory cues indicating threat omission—may not necessarily interfere with extinction learning, underscoring the need to distinguish SBs from SSs and to clarify mechanisms (Restrepo Castro et al., 2017).
The panelists will discuss and debate whether SBs should be routinely eliminated versus strategically used and then faded to enhance engagement and retention. The panelists will also provide conceptual clarity by differentiating SBs from SSs and reviewing translational implications from fear extinction paradigms. The discussion will culminate in a pragmatic decision framework (function, timing, dose, and client beliefs/attributions) and identify priorities for research and clinician training.
Audience takeaways: (1) a shared vocabulary for SBs vs SSs; (2) a balanced evidence synthesis; and (3) practical guidance for when to fade, permit, or prescribe safety related strategies within exposure.