Tolerate or Eliminate? A Systematic Review on the Effects of Safety Behavior Across Anxiety Disorders

Cognitive-behavioral models emphasize maintaining effects of safety behavior in anxiety disorders. Experimental evidence for deleterious effects of those behaviors is less consistent, leading to a controversy about their therapeutic use. The systematic integration of findings is hampered by the variety of concepts used to describe safety behavior, and methodological differences in empirical studies. This article provides a definition and classification of safety behavior in contrast to adaptive coping strategies. Existing evidence regarding contributions of safety behavior to onset and maintenance of anxiety disorders as well as effects of safety behavior on therapeutic outcome is reviewed. In contrast to previous justifications of safety behavior use, a rigorous procedure of identifying safety behavior and abandoning it throughout therapy is suggested.