What Is… a Safety Behaviour in CBT

In this series, I dig a little deeper into the meaning of psychological terms. This week’s term is safety behaviour.

Safety is supposed to be a good thing, isn’t it? Maybe, but sometimes, the mind will start shouting at you to do things that don’t actually keep you safe and instead just make you anxious, and that’s not a good thing.

Safety behaviour as CBT concept

Safety behaviour is a cognitive behavioural therapy (CBT) concept that refers to avoidance and related behaviours that people may use to try to cope with anxiety. While safety behaviours may decrease anxiety temporarily, they actually reinforce the anxiety response to whatever the feared stimulus may be. And despite what monkey mind is busy telling you, a safety behaviour does not improve your actual physical safety.

These maladaptive behaviours frequently occur in anxiety disorders, OCD, and PTSD, but they’re not disorder-specific. Anyone who’s unable to access more adaptive coping techniques may end up relying on safety behaviours. They’re not a symptom per se, but rather an attempt to manage underlying symptoms.

There are two key types of safety behaviours, preventative and restorative. Preventative behaviours try to keep you out of the anxiety-provoking situation in the first place, while restorative behaviours are used as a way of running for the exit doors when in the midst of an anxiety-provoking situation.

The purpose of the behaviour

A given behaviour may be an adaptive coping strategy or a safety behaviour depending on when and why you’re using it.

Consider the example of carrying a water bottle everywhere you go. Perhaps you’re on a medication that gives you a really dry mouth, to the point that it can make speaking uncomfortable sometimes. If you carry a water bottle so you can problem-solve if this issue comes up, that’s probably an adaptive coping mechanism. This used to be an issue for me, and carrying my water bottle was really no different from being prepared with a couple of tampons in my purse for when my period started. If I forgot it or it, the dry mouth could get annoying, but it wasn’t the end of the world.

On the other hand, let’s say you have anxiety about choking, so you carry a water bottle around with you on the off chance that disaster may strike and you start choking. Each time you stick that water bottle in your bag or check to make sure that it’s there, it reminds you that you’re scared of choking. That’s starting to sound like a safety behaviour. Perhaps you think that the only reason you didn’t choke was because you were prepared by bringing your water bottle. That’s really starting to sound like a safety behaviour.

CBT4Panic has some examples of common safety behaviours here.

Psychological tests

Psychological tests may be used to evaluate the frequency of safety behaviour usage, and you may find you’re surprised by just how often you’re using them without even realizing it. The Subtle Avoidance Frequency Examination and the Social Behaviour Questionnaire measure safety behaviours related to social anxiety, and can give you more detailed examples of some specific safety behaviours.

Safety behaviours and exposure

Prolonged exposure treatment, including exposure and response prevention for OCD, takes advantage of the natural response for anxiety to decrease if a person remains in a situation long enough. The mind and body can only sustain full tilt anxiety related to a particular situation for so long. This usually starts to happen after around 45-60 minutes. The key is to actually remain in the situation until that drop-off occurs. Prolonged exposure has the opposite effect of safety behaviours, in that it causes an initial anxiety spike, then there’s a longer-term drop in anxiety. This natural drop in anxiety reinforces to the brain that the associated situation is not in fact dangerous.

If exposure feels like it’s not working, it may be because you’ve been hanging onto your safety behaviours during your exposures. This gets in the way of your brain learning that the situation you’re exposed to isn’t actually a threat.

Safety behaviours can also be a self-fulfilling prophecy; if you avoid making eye contact with anyone in a social situation because you’re worried that [X] will happen, that very lack of eye contact may be the reason why it seems like no one wants to talk to you. To fully participate in that exposure, it’s important to work on doing it without falling back to the safety behaviour. That may cause a temporary surge in anxiety, but it’s a way for your brain to learn that the social situation does not involve a lion wanting to eat you and is not a threat to your safety.

Getting personal

I’m an avoider.  It’s not so much about avoiding specific things, but more broadly avoiding situations that are likely to produce distressing emotions. I can’t really think of any specific safety behaviours, though. Perhaps it’s because anxiety isn’t really an issue for me; my issue isn’t with having anxiety that something bad might happen, but rather with strong emotional reactions that are prompted by things happening.

I think I’m more of a kill the fly with a bazooka kind of girl than a safety behaviours girl; either I just don’t get into the situation, or I get right up and leave. My avoidance definitely begets avoidance, but I’ve gotten fairly settled in and comfortable with it, so I don’t really see change happening until it starts to make me uncomfortable.

Do you use safety behaviours? In what context?

Resources

• CBG4Panic worksheets
• Centre for Clinical Interventions:
  • Helping Health Anxiety challenging avoidance and safety behaviours module
  • Stepping out of Social Anxiety safety behaviours module
• TherapistAid social anxiety safety behaviours worksheet

References

• Centre for Clinical Interventions: What are safety behaviours?
• Wikipedia: Safety behaviors (anxiety)