The continuous vs discontinuous use of restorative safety behaviors on symptoms of contamination fear: An experimental investigation

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Background and objectivesCognitive-behavioral theorists posit that safety behaviors (SBs) interfere with important exposure processes and should be removed from therapy. However, there is growing evidence to suggest that restorative SBs (RSB; those that allow for full confrontation with a core threat) do not adversely affect exposure outcomes, and their implementation during exposure should be further examined. MethodsThe current study evaluated exposure with the continuous use of RSB (E + CONT) versus discontinuation of RSB (E + DISC), in comparison to exposure with no RSB (ERP). Sixty-seven nonclinical participants completed 15 trials of exposure in which they touched a potentially contaminated stimulus with or without RSB. Behavioral approach tasks were completed at pretreatment, post-treatment, and two-week follow-up to examine changes in subjective distress and degree of behavioral approach. ResultsThe three conditions were not different on clinical symptoms and behavioral approach at post-treatment and follow-up, indicating that the hypothesized superiority effect of E + DISC was not supported. However, ratings obtained during repeated exposure trials indicated that E + DISC evidenced greater symptom reduction following the removal of RSB. LimitationsThe use of a healthy undergraduate sample and standardization of the exposure procedure. ConclusionsAlthough findings were contrary to hypotheses, these data provide added support for the benign role of RSB as compared to conventional exposure. Furthermore, the removal of RSB may lead to more favorable process outcomes during exposure. The theoretical and clinical implications of these findings are discussed, and future directions are provided.