The role of safety behaviors in exposure-based treatment for panic disorder and agoraphobia: Associations to symptom severity,treatment course,and outcome |
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| Affiliation: | 1. Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany;2. Department of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany;3. Department of Biological and Clinical Psychology, Ernst-Moritz-Arndt University of Greifswald, Greifswald, Germany;4. Christoph-Dornier-Foundation for Clinical Psychology, Bremen, Germany;5. Department of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany;6. Department of Psychology, Humboldt University of Berlin, Berlin, Germany;7. Department of Clinical and Biological Psychology, University of Mannheim, Mannheim, Germany;8. Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Campus Charité Mitte, Berlin, Germany;9. Department of Psychiatry und Psychotherapy, Philipps-University of Marburg, Marburg, Germany;10. Department of Psychiatry, Psychosomatics & Psychotherapy, University of Würzburg, Würzburg, Germany;11. Department of Psychology, University of Basel, Basel, Switzerland;1. Department of Psychology, Clearview Hall, Binghamton University, 4400 Vestal Parkway East, Vestal, NY 13902, USA;2. Department of Psychology, Weiss Hall, Temple University, 1701 North 13th Street, Philadelphia, PA 19122, USA;3. Department of Family & Community Medicine, University of Arizona College of Medicine, 1642 East Helen Street, Tuscon, AZ 85719, USA;1. Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychology, Stanford University, Stanford, United States;2. Department of Psychology, University of Manitoba, P404 Duff Roblin Building, 190 Dysart Road, Winnipeg, Manitoba R3T 2N2, Canada;3. Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, PsycHealth Centre, PZ433-771 Bannatyne Avenue, Winnipeg, Manitoba R3E 3N4, Canada;1. Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA;2. Ralph H. Johnson VA Medical Center, Charleston, SC, USA;3. Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA;4. McGuire VA Medical Center, Richmond, VA, USA;5. Center for Addictions, Personality, and Emotion Research, University of Maryland, College Park, MD, USA;1. Department of Psychiatry, University of Pennsylvania, PA, USA;2. Department of Psychology, National Taiwan University, Taipei, Taiwan;1. Anxiety Disorders Outpatient Program for Child and Adolescent Psychiatry (PROTAIA), Hospital de Clínicas de Porto Alegre (HCPA), Federal University of Rio Grande do Sul (UFRGS), Brazil;2. Center for Psychological Studies on At-Risk Populations (CEP-Rua), Institute of Psychology, Federal University of Rio Grande do Sul (UFRGS), Brazil;3. Study Group in Psychopathology and Psychological Assessment, Institute of Psychology, Federal University of Rio Grande do Sul (UFRGS), Brazil;4. National Science and Technology Institute for Child and Adolescent Psychiatry (INPD), Hospital de Clínicas de Porto Alegre (HCPA), Brazil;1. Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Bartholins Alle'' 9, 8000 Aarhus C, Denmark;2. Clinic for Anxiety Disorders and OCD, Aarhus University Hospital, Tretommervej 1, 8240 Risskov, Denmark;3. Research Institute, Modum Bad, N-3370, Vikersund, Norway;4. Department of Psychology, University of Oslo, Norway |
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| Abstract: | ![]()
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. |
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| Keywords: | Safety behaviors Panic disorder Agoraphobia Behavioral assessment Exposure |
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