Incorporating the Judicious Use of Safety Behavior Into Exposure-Based Treatments for Anxiety Disorders: A Study of Treatment Acceptability

This analog study investigated treatment acceptability and preference as a function of safety behavior use (judicious vs. discouraged) and treatment rationale (cognitive vs. extinction). Thirty-two clinically anxious participants and 437 undergraduate students provided ratings of acceptability and adherence, as well as preference ranks for four written vignettes describing a course of cognitive-behavioral therapy (CBT) for fear or anxiety. Treatment descriptions promoting judicious safety behavior use received significantly higher acceptability and adherence ratings compared to those discouraging its use. Descriptions that presented a cognitively based rationale, compared to an extinction-based rationale, were also rated as both significantly more acceptable and easier to adhere to. The highest preference rank was for treatment that included judicious safety behavior use, conveyed via a cognitive rationale. A similar pattern of results was observed in both participant groups. These findings suggest that the judicious incorporation of safety behavior into CBT has the potential to reduce treatment refusal and dropout. Results are discussed in terms of their implications for cognitive-behavioral and exposure-based treatments.