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 language | English |
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Pages (from-to) | 144-156 |
Number of pages | 13 |
Journal | Clinical Psychology Review |
Volume | 45 |
DOIs | |
Publication status | Published - 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