The use of safety-seeking behavior in exposure-based treatments for fear and anxiety: Benefit or burden? A meta-analytic review

Ann Meulders*, Tom Van Daele, Stéphanie Volders, Johan W S Vlaeyen

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

There is a longstanding debate whether allowing safety-seeking behaviors (SSBs) during cognitive-behavioral treatment hampers or facilitates the reduction of fear. In this meta-analysis, we evaluate the impact of SSBs on exposure-based fear reduction interventions. After filtering 409 journal articles, 23 studies were included for systematic review of which 20studies were coded for meta-analysis. For each study, the Standardized Mean Difference (SMD or Hedges' g) of self-reported fear was calculated at post-intervention. Two comparisons were distinguished: I) exposure without safety-seeking behavior (SSB-) versus baseline behavior (BL), and II) exposure with safety-seeking behavior (SSB+) versus BL. The results showed that average effect sizes were in favor of SSB-, (I: SMD=0.31, 95% CI [-0.04, 0.66]), and in favor of BL, (II: SMD=-0.13, 95% CI [-0.37, 0.11]). Neither of the effect sizes were statistically significant (I: Z=1.75, p=.08; II: Z=1.07, p=.28). The current meta-analysis could not provide compelling evidence supporting either the removal or addition of SSB during exposure. More systematic and statistically empowered replications, using comparable research methods, in (non-)clinical settings are needed. Novel insights from fear conditioning research may also shed light on the role of SSB in fear reduction.

Original languageEnglish
Pages (from-to)144-156
Number of pages13
JournalClinical Psychology Review
Volume45
DOIs
Publication statusPublished - Apr 2016

Keywords

  • Safety-seeking behavior
  • Exposure
  • Fear
  • Anxiety
  • Meta-analysis
  • Review
  • MOVEMENT-RELATED PAIN
  • CHRONIC MUSCULOSKELETAL PAIN
  • RANDOMIZED CONTROLLED-TRIAL
  • SOCIAL ANXIETY
  • PANIC DISORDER
  • HEALTH ANXIETY
  • BACK-PAIN
  • THERAPY
  • EXTINCTION
  • PHOBIA

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