Teddy pumped the sanitizer bottle for the second time in three minutes. “I know, I know, it doesn’t help when I haven’t touched anything else, but I want to be sure. You never know these days, right?” Freda waits to enter gatherings and meetings until everyone else has shown up- “It just helps me know I won’t run the risk of embarrassing myself.” Hassan skips driving over tall bridges. “Maybe it adds time to my commute, but I once heard of a bridge that collapsed, so you never can be too careful.”
Clinically, Safety Behaviors (aka “False Safety Behaviors”) are “unnecessary actions taken to prevent, escape from, or reduce the severity of a perceived threat” (APA PsycNet, 2020). Pursuing safety in a healthy context is valuable and will keep you alive- this is why work sites have a key motto: “Safety First.” However, notice the word “unnecessary” in the definition of a safety behavior.
If you feel fatigued, are a procrastinator, overwhelmed, anxious all the time, or just "stressed out," safety behaviors may be at play. When people start to have problems with my opening examples, they may still think that their behaviors aren't necessary to consider or aren't harmful in any way. I know! It's really tricky to differentiate at times, especially when many things we do, depending on context, can be helpful OR harmful. But imagine if there's 1,000 little examples in a day of double-checking, reassurance seeking, second-guessing- every extra second spent, movement taken, or second-guess made leads to extra stress, processing, and/or energy. When a person has a disorder like Generalized Anxiety, PTSD, Specific Phobia, Social Anxiety, and more (in OCD call them by a different term: compulsions), safety behaviors must be addressed for robust recovery.
We can categorize safety behaviors into several different types.
Any of the above might be healthy for any one person. It must be functionally assessed (what is the function of a behavior or thought?) to determine if it’s helpful or pathological (disordered). Using sanitizer after touching doors in a pandemic looks different than outside the pandemic. Checking in on your Amazon order status with an important order may help you plan your day. Having a baby monitor you look at for fun or in case of emergency can offer flexibility and safety. But for every positive example of these, there's an example that feeds fear: compulsive sanitizer use, online checking, or obsessive fear about a baby's health. You have the opportunity to evaluate your own head and heart (and may I suggest having some help with friends in the know, a therapist, a mentor).
Let's take Social Anxiety Disorder. Jenny learned to "cope" with her social fears starting in adolescence by just saying she was shy when around people. She would avoid gatherings where she had to interact with people she didn't know well, get her family to talk for her, and always carried her phone in case she needed to put in ear buds and look down. When she got to college she began to realize that events and activities she wanted to do felt really difficult. Making friends was a substantial challenge and led to shame and anger at herself and others. She couldn't place her finger on it, but felt embarrassed when talking with others and would often feel hot, her face became flush, and she would slip on her words. Her answer was to avoid and go back to her dorm to listen to music, quickly feeling better. She would later replay interactions in her mind and would run multiple mental scenarios before any social interaction. Jenny didn't realize that these were avoidance, distraction, and mental rumination/checking. They are safety behaviors, and they made her anxiety worse- much worse.
In therapy, your history will be gathered and rapport ideally built with your counselor. People who come to see me are so often relieved they're not alone, crazy, weird, or bad for struggling. How treatment goes depends on the person and their condition being treated, but transdiagnostically, when safety behaviors impair or limit a person, well want to do three key things:
Here's a personal example of how I've integrated this CBT work into my own life. I have the actual ability to speak and teach in public, write articles, and provide quality therapy. At any given time, I have had/do have various triggers to fear. For example, I gave a talk that was highly rated by all attendees (5 stars by 95%). One person literally stood up and started openly disagreeing during the talk over one quote (from an evidence based source) I had shared. I still don't know what the problem was, because it was ultimately inconsequential to the big picture, but something apparently 'hit a nerve.' Though I was still friendly with the person came redirected to talk afterwards (they didn't take me up on the offer), I unfortunately let this impact me for a bit, avoiding talks for about 9 months after, ruminating on what I did wrong and could have done better, and scanning groups of people in case my "heckler" was ever there again. I was living in fear and giving into safety behaviors.
I had always expected my nerves would calm down a bit after giving talks for 5-10 years. But unfortunately, I hadn't yet integrated CBT work in safety behaviors into my life, and so my stress remained stagnant, though I did engage in my goals (which involves public speaking). At the almost 15 year mark of giving talks, I now work on cutting out rumination at times I don't need to be thinking (going to bed, in the bathroom before a presentation, etc.), saying yes to any talk that's within my goals and expertise, and so forth. And the result is striking. My most recent presentation I gave had me observing to my wife, "Hey babe, this is really cool- I had a couple hours this morning where I didn't even think about it!" Nor was I very stressed. This takes time and growth.
You don't require a clinical diagnosis to grasp the value and benefit of catching and releasing safety behaviors. In fact, there's so much potential for the tools that almost anyone can benefit from them, whether you want to learn to work quicker, be more gentle with yourself, increase your processing speed and/or general "bandwidth" of stress tolerance.
In Conclusion. So in our world (especially the Western world) where safety is everything, go ahead and take a pause and evaluate some of your thoughts and behaviors. Ask for feedback from someone you respect (or find someone who can speak honestly to you). Do you have any limits in any sphere of life from checking, reassurance, safety aids, avoidance, or mental maneuvers? Do people say you're "tightly wound," perfectionistic, demanding, or unrealistic? Are you overly cautious? Are most people around you doing things you'd like to do but just can't? Go find the ways you "play it safe" but don't need to, and your life will be better for it.
APA PsycNet. (n.d.). Retrieved November 10, 2020, from https://psycnet.apa.org/record/2019-52029-002
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: exposure to corrective information. Psychological Bulletin, 99, 20–35.
Blakey, S. M., Abramowitz, J. S., Buchholz, J. L., Jessup, S. C., Jacoby, R. J., Reuman, L., & Pentel, K. Z. (2019). A randomized controlled trial of the judicious use of safety behaviors during exposure therapy. Behaviour Research and Therapy, 112, 28-35. doi:10.1016/j.brat.2018.11.010
Behaviour Research and Therapy, 112, 28-35. doi:10.1016/j.brat.2018.11.010
Korte, K. J., Norr, A. M., & Schmidt, N. B. (2018). Targeting Safety Behaviors in the Treatment of Anxiety Disorders: A Case Study of False Safety Behavior Elimination Treatment. American Journal of Psychotherapy, 71(1), 9-20. doi:10.1176/appi.psychotherapy.20180001
Riccardi, C. J., Korte, K. J., & Schmidt, N. B. (2017). False safety behavior elimination therapy: A randomized study of a brief individual transdiagnostic treatment for anxiety disorders. Journal of Anxiety Disorders, 46, 35–45.
Salkovskis, P. M., Clark, D. M., Hackmann, A., Wells, A., & Gelder, M. G. (1999). An experimental investigation of the role of safety-seeking behaviors in the maintenance of panic disorder with agoraphobia. Behaviour Research and Therapy, 37, 559–574.
Schmidt, N. B., Buckner, J. D., Pusser, A., Woolaway-Bickel, K., & Preston, J. L. (2012). Randomized control trial of False Safety Behavior Elimination Therapy (F-SET): A unified cognitive behavioral treatment for anxiety psychopathology. Behavior Therapy, 43, 518–532.
Telch, M. J., PhD. (n.d.). False Safety Behaviors: Their Role in Pathological Fear. Retrieved November 10, 2020, from https://labs.la.utexas.edu/telch/files/2015/08/Safety-Behavior-Handout-latest-8.1.15-1.pdf
Wells, A., Clark, D. M., Salkovskis, P., Ludgate, J., Hackmann, A., & Gelder, M. (1995). Social phobia: the role of in-situation safety behaviors in maintaining anxiety and negative beliefs. Behavior Therapy, 26, 153–161.
A Psychotherapists' thoughts on healthy living.
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