The role of safety behaviors in exposure-based treatment for panic disorder and agoraphobia: Associations to symptom severity, treatment course, and outcome

• Published in: Journal of anxiety disorders Vol. 28; no. 8; pp. 836 - 844
• Main Authors: Helbig-Lang, Sylvia, Richter, Jan, Lang, Thomas, Gerlach, Alexander L., Fehm, Lydia, Alpers, Georg W., Ströhle, Andreas, Kircher, Tilo, Deckert, Jürgen, Gloster, Andrew T., Wittchen, Hans-Ulrich
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ltd 01.12.2014; Elsevier
• Subjects: Activities of Daily Living; Adult; Adult and adolescent clinical studies; Agoraphobia; Agoraphobia - psychology; Agoraphobia - therapy; Anxiety - psychology; Anxiety - therapy; Anxiety Disorders - therapy; Anxiety disorders. Neuroses; Behavior therapy. Cognitive therapy; Behavioral assessment; Biological and medical sciences; Discriminant Analysis; Exposure; Female; Humans; Implosive Therapy - methods; Male; Medical sciences; Middle Aged; Panic disorder; Panic Disorder - psychology; Panic Disorder - therapy; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychometrics; Psychopathology. Psychiatry; Reproducibility of Results; Safety; Safety behaviors; Surveys and Questionnaires; Treatment Outcome; Treatments; Safety behaviors; Behavioral assessment; Exposure; Agoraphobia; Panic disorder; Symptomatology; Panic; Treatment; Defensive behavior; Treatment efficiency; Anxiety disorder; Severity score; Behavior therapy
• ISSN: 0887-6185; 1873-7897; 1873-7897
• DOI: 10.1016/j.janxdis.2014.09.010

•Safety behavior is suggested to have deleterious effects in exposure-based therapy.•We examined safety behavior effects in treatment of panic disorder/agoraphobia.•Frequent safety behavior use was associated to symptom severity and impairment.•Safety behavior use during treatment was partially linked to detrimental treatment outcome.•Further research is needed to disentangle dimensions of safety behaviors. The potentially detrimental effects of safety behaviors during exposure therapy are still subject to debate. Empirical findings are inconsistent, and few studies have investigated effects of idiosyncratic safety behavior manifestations during exposure or in everyday life. These limitations might be due to a lack of appropriate measures that address individual safety behaviors. We examined psychometric properties and predictive value of the Texas Safety Maneuver Scale (TSMS), a questionnaire specifically targeting safety behaviors in panic disorder and agoraphobia. Effects of safety behavior use, both during everyday life and during therapy, were examined using data from a multicenter RCT of N=268 patients that aimed at evaluating efficacy and mechanisms of action of two variants of an exposure-based therapy. The TSMS total score demonstrated good internal consistency (α=0.89), and it showed significant correlations with selected measures of baseline anxiety and impairment. The proposed factor structure could not be replicated. Frequent safety behavior use at baseline was associated with actual safety behavior during exposure exercises. Pronounced in-situ safety behavior, but not baseline safety behavior was associated to detrimental treatment outcome. The results underline the relevance of a rigorous safety behavior assessment in therapy. The actual relationship between safety behavior use and treatment outcome is yet to determine.