Use Of Safety Behaviors Research Articles

The Role of Safety Behaviors in the Relationship between Social Anxiety and Marijuana Use Problems

Background: Social anxiety has been associated with higher levels of and more problematic marijuana use. Research suggests that safety behaviors may play a role in the development and maintenance of marijuana problems. However, the safety behaviors that are most commonly associated with social anxiety have not been investigated, nor has the potential moderating role of gender on this relationship. Method: A diverse sample of regular marijuana users (N = 279) completed measures of social anxiety, safety behaviors related to social situations, and marijuana use problems. Results: Social anxiety and safety behavior use were both positively correlated with marijuana use problems. These relationships were stronger in men than in women. Among men only, tendencies to use safety behaviors to cope with social situations accounted for the relationship between social anxiety symptoms and marijuana-related problems. Discussion: The avoidant coping style that characterizes safety behaviors in social anxiety may also underlie problematic patterns of marijuana use, particularly for men. The present study is the first to report an association between safety behaviors in social situations and marijuana use problems and suggests the importance of examining the effect of reducing safety behaviors in social situations, in regular marijuana users with comorbid social anxiety.

Domestic and Family Violence and its Association with Mental Health Among Pregnant Women Attending Antenatal Care in a Tertiary Hospital of Eastern Nepal.

Pregnancy has been identified as a vulnerable period for both the initiation and escalation in severity of domestic and family violence. There is a significant dearth of scholarly literature documenting the relationship of domestic and family violence with the mental health and quality of life among pregnant women of Nepal. Baseline data of 140 women enrolled in a trial of a psychosocial intervention for abused pregnant women were analysed. Face-to-face interviews were conducted using standardised scales. Prevalence of domestic and family violence and mental health conditions were estimated and inferential statistics were used to assess the association of domestic and family violence with mental health, quality of life, social support, and use of safety behaviours. The lifetime prevalence of domestic and family violence was found to be 27.7% (n = 173), followed by 17.1% of women (n = 107) fearing someone in their family. Domestic and family violence in the last 12 months was significantly associated with anxiety (p = 0.001), depression (p = 0.005), quality of life (p < 0.05), and perceived social support (p = 0.001). Use of safety behaviours (p = 0.037) was significantly low among women reporting domestic and family violence in the past year as well as during the current pregnancy (p = 0.017). There exists a high psychological morbidity among pregnant women exposed to domestic and family violence. The findings support the need of implementing a screening and support intervention for abused women seeking antenatal services.

Can you believe it? Examining the influence of safety behavior beliefs on speech task outcomes

Beliefs and expectations about treatment have been shown to significantly impact treatment outcomes in medical settings. However, researchers have seldom examined the role of beliefs within the context of cognitive behavioral therapy. Beliefs may be particularly salient for safety behavior (SB) use in exposure therapy, as clinicians often hold opinions about whether judicious SB use facilitates or inhibits treatment. These beliefs may consequently be relayed during psychoeducation, influencing client expectations of SB helpfulness and exposure efficacy. We investigated experimentally the influence of SB beliefs on working memory, speech predictions, speech duration, anxiety, performance, and speech acceptability. Speech anxious undergraduate participants ( N = 144) received psychoeducation on exposure and were told (using random assignment) either that SBs: increase anxiety (unhelpful), decrease anxiety (helpful), or were provided with no information on SBs (control). People in the helpful condition only believed the exposure would be more successful. Crucially, exposure expectancy mediated the relationship between the helpful (but not unhelpful) condition and willingness to engage in future exposures. There were no effects of condition on most cognitive, emotional, or behavioral outcomes, suggesting that SBs (and SB beliefs) may have less impact on exposure outcomes than is currently believed.

Fears of receiving compassion from others predict safety behaviour use in social anxiety disorder over and above fears of negative self-portrayal

Why do people with social anxiety disorder (SAD) engage in the use of safety behaviours? While past research has established that fears of negative self-portrayal are strongly associated with safety behaviour use in SAD, no research to date has investigated the potential role of fears of receiving compassion. Both types of fears could motivate those with SAD to engage in safety behaviours in order to keep others at a distance. In the present study, 150 participants with a clinical diagnosis of SAD completed measures of fears of negative self-portrayal, fears of receiving compassion, and safety behaviour use. Multiple regression analyses revealed that when controlling for self-portrayal fears, fears of receiving compassion significantly predicted increased use of safety behaviours overall, as well as the use of avoidance and impression management subtypes. Furthermore, there was a significant interaction effect in which greater fears of receiving compassion predicted greater use of impression management at lower levels of self-portrayal fears. We discuss the implications of our findings for addressing safety behaviours in the treatment of SAD.

Longitudinal Impact of the myPlan App on Health and Safety Among College Women Experiencing Partner Violence.

The objective of this study was to examine differences in change over time in health and safety outcomes among female college students randomized to myPlan, a tailored safety planning app, or usual web-based safety planning resources. Three hundred forty-six women (175 intervention, 171 control) from 41 colleges/universities in Oregon and Maryland completed surveys at baseline, 6- and 12-months from July 2015 to October 2017. Generalized estimating equations were used to test group differences across time. Both groups improved on four measure of intimate partner violence (IPV; Composite Abuse Scale [CAS], TBI-related IPV, digital abuse, reproductive coercion [RC]) and depression. Reduction in RC and improvement in suicide risk were significantly greater in the myPlan group relative to controls (p = .019 and p = .46, respectively). Increases in the percent of safety behaviors tried that were helpful significantly reduced CAS scores, indicating a reduction in IPV over time in the myPlan group compared to controls (p = .006). Findings support the feasibility and importance of technology-based IPV safety planning for college women. myPlan achieved a number of its objectives related to safety planning and decision-making, the use of helpful safety behaviors, mental health, and reductions in some forms of IPV.

Speech and Anxiety Management With Persistent Stuttering: Current Status and Essential Research.

Purpose The purpose of this review article is to provide an overview of the current evidence base for the behavioral management of stuttering and associated social anxiety. Method We overview recent research about stuttering and social anxiety in the context of contemporary cognitive models of social anxiety disorder. That emerging evidence for self-focused attention and safety behavior use with those who stutter is considered in relation to current treatment approaches for stuttering: speech restructuring and social anxiety management. Results The emerging information about social anxiety and stuttering suggests a conflict between the two clinical approaches. For those clients who wish to control their stuttering and where speech restructuring is deemed the most suitable approach, it is possible that speech restructuring may (a) induce or increase self-focused attention, (b) promote the use of safety behaviors, and (c) become a safety behavior itself. This conflict needs to be explored further within clinical and research contexts. Conclusions The issues raised in this review article are complex. It appears that evidence-based speech treatment procedures are in conflict with current best-practice treatment procedures that deal with social anxiety. In this review article, we propose directions for future research to inform the development of improved treatments for those who stutter and recommendations for interim clinical management of stuttering.

Effectiveness of Group Cognitive Therapy for Social Anxiety Disorder in Routine Care

AbstractSocial anxiety disorder (SAD) is a prevalent chronic condition with a large demand for treatment. This community outpatient study examined the effectiveness of a group intervention version of the established one-to-one cognitive therapy derived from the Clark and Wells model for SAD. Questionnaires were completed pre-treatment and post-treatment for SAD symptoms (Social Phobia Scale, Social Interaction Anxiety Scale), depressive symptoms (BDI-II), self-focused attention, safety behaviours (Social Phobia Weekly Summary Scale and Subtle Avoidance Frequency Examination), and impaired functioning (Work and Social Adjustment Scale). From an initial sample of 159 participants, 101 completed at least seven of the nine weekly group sessions (Mage = 34.1 years, SDage = 10.8 years, 53% female). Significant improvements were demonstrated on all measures. Large effect sizes were found for social anxiety symptoms and safety behaviour use. Self-focused attention, depressive symptoms, and impaired functioning had moderate effect sizes. Effect sizes for anxiety (d = 1.00 and 1.32) and mood measures (d = 0.71) were as high, or in some cases, higher than previous group treatment studies. Results suggest group cognitive therapy for SAD based on the Clark and Wells model is effective in a clinical setting for individuals with moderate/severe and treatment-resistant social anxiety.

Anxiety and safety behavior usage during the COVID-19 pandemic: The prospective role of contamination fear

The coronavirus (COVID-19) pandemic has broadly increased anxiety and changed individual behavior. However, there is limited research examining predictors of pandemic-related changes, and the majority of existing research is cross-sectional in nature, which limits causal inference. Given functional links with disease avoidance processes, individual differences in contamination fear may be especially relevant in predicting responses to COVID-19. Accordingly, the present study prospectively examines contamination fear and obsessive-compulsive washing symptoms as predictors of anxiety and safety behaviors in response to COVID-19 in a student sample (N = 108). To examine specificity, anxiety and safety behaviors in response to seasonal influenza are also examined. In the early stages of the pandemic (March 2020), coronavirus-related anxiety was higher than flu-related anxiety (d = 1.38). Obsessive-compulsive washing symptoms also increased from before the pandemic (d = 0.4). Although baseline contamination fear and obsessive-compulsive washing symptoms did not significantly predict coronavirus-related anxiety, contamination fear did significantly predict safety behavior usage in response to both COVID-19 and influenza. The specificity of the prospective association between contamination fear and the use of safety behaviors are discussed in the context of the global COVID-19 pandemic and the broader literature on the role of safety behaviors in anxiety.

Antenatal-Based Pilot Psychosocial Intervention to Enhance Mental Health of Pregnant Women Experiencing Domestic and Family Violence in Nepal.

Survivors of domestic and family violence (DFV) report poorer quality of life and worsening mental health. This study evaluated the effect of a counseling and education intervention on the mental health and help-seeking behaviors among pregnant women living with DFV. A parallel pilot randomized controlled trial was performed among 140 pregnant women attending an antenatal clinic of a tertiary hospital of Nepal. Using computer-generated random numbers, participants were randomized to the intervention group (a counseling session, an information booklet about DFV, and contact details of the counselor) or a control group (usual care plus a booklet containing contact details of local DFV support services). Outcome measures included mental health, quality of life (QOL), self-efficacy, social support, and safety planning behaviors. Analyses followed intention-to-treat, using the generalized estimating equation model. Intervention participants showed significant improvements in anxiety (β = -3.24, p < .001) and depression (β = -3.16, p < .001) at postintervention. Such improvements were also sustained at follow-up assessment (p < .001). Significant group and time interaction for QOL, social support, use of safety behaviors, and self-efficacy (p < .05) revealed a greater increase in these outcome measures among intervention participants at both follow-up assessments compared with the control group. This pilot integrated intervention showed promising outcomes in improving the mental health, social support, and the use of safety behaviors among women with DFV. This intervention could be incorporated into regular antenatal care as a strategy to identify and support victims of DFV. Larger controlled trials with longer follow-up are needed to support and expand on the current findings regarding the effectiveness of a psychosocial intervention targeting victims of DFV in resource-constrained settings.

Exploring the impact of safety behaviour use on cognitive, psychophysiological, emotional and behavioural responses during a speech task.

There is a debate among researchers and clinicians regarding whether the judicious use of safety behaviours (SBs) during exposure therapy is helpful or detrimental. Central to this debate is the premise that SBs may interfere with one's ability to gather disconfirmatory evidence. No study to date has assessed how SB use may impact cognitive mechanisms implicated during an exposure-like task. We investigated multiple cognitive, emotional, psychophysiological and behavioural underpinnings of exposure with and without SBs. Speech anxious participants (n = 111) were randomly assigned to deliver an evaluated speech with or without SBs. Self-reported anxiety ratings and psychophysiological arousal measures were recorded at baseline, in anticipation of the speech, and following the speech. Measures of working memory, ability to gather disconfirmatory evidence, speech duration, objective and subjective speech performance, and speech task acceptability were administered. There were no differences between conditions on working memory, self-reported anxiety, psychophysiological arousal, ability to gather disconfirmatory evidence, speech duration, or objective and subjective speech performance. All participants were able to gather disconfirmatory evidence. However, condition did influence willingness to deliver future speeches. Our sample was largely female undergraduate students, and we offered only a small number of specific safety behaviours. Judicious SB use may not necessarily be detrimental, but clients may believe them to be more helpful than they actually are.

Interventions for women who report domestic violence during and after pregnancy in low- and middle-income countries: a systematic literature review

BackgroundDomestic violence is a leading cause of social morbidity and may increase during and after pregnancy. In high-income countries screening, referral and management interventions are available as part of standard maternity care. Such practice is not routine in low- and middle-income countries (LMIC) where the burden of social morbidity is high.MethodsWe systematically reviewed available evidence describing the types of interventions, and/or the effectiveness of such interventions for women who report domestic violence during and/or after pregnancy, living in LMIC. Published and grey literature describing interventions for, and/or effectiveness of such interventions for women who report domestic violence during and/or after pregnancy, living in LMIC was reviewed. Outcomes assessed were (i) reduction in the frequency and/or severity of domestic violence, and/or (ii) improved physical, psychological and/or social health. Narrative analysis was conducted.ResultsAfter screening 4818 articles, six studies were identified for inclusion. All included studies assessed women (n = 894) during pregnancy. Five studies reported on supportive counselling; one study implemented an intervention consisting of routine screening for domestic violence and supported referrals for women who required this. Two studies evaluated the effectiveness of the interventions on domestic violence with statistically significant decreases in the occurrence of domestic violence following counselling interventions (488 women included). There was a statistically significant increase in family support following counselling in one study (72 women included). There was some evidence of improvement in quality of life, increased use of safety behaviours, improved family and social support, increased access to community resources, increased use of referral services and reduced maternal depression. Overall evidence was of low to moderate quality.ConclusionsScreening, referral and supportive counselling is likely to benefit women living in LMIC who experience domestic violence. Larger-scale, high-quality research is, however, required to provide further evidence for the effectiveness of interventions. Improved availability with evaluation of interventions that are likely to be effective is necessary to inform policy, programme decisions and resource allocation for maternal healthcare in LMIC.Trial registrationSystematic review registration number: PROSPERO CRD42018087713.

Therapist beliefs about exposure therapy implementation

Abstract Exposure therapy is consistently indicated as the first-line treatment for anxiety-related disorders. Unfortunately, therapists often deliver exposure therapy in an overly cautious, less effective manner, characterized by using their own ‘therapist safety behaviours’. Cognitive behavioural models postulate that beliefs about therapist safety behaviours are related to their use; however, little is known about the beliefs therapists hold regarding therapist safety behaviour use. The present study aimed to identify the beliefs exposure therapists have regarding the necessity of therapist safety behaviours and to examine the relationship between this construct and therapist safety behaviour use. Australian psychologists (n = 98) completed an online survey that included existing measures of therapist safety behaviour use, therapist negative beliefs about exposure therapy, likelihood to exclude anxious clients from exposure therapy, and use of intensifying exposure techniques. Participants also completed the Exposure Implementation Beliefs Scale (EIBS), a measure created for the present study which assesses beliefs regarding the necessity of therapist safety behaviours. Beliefs about the necessity of therapist safety behaviours – particularly in protecting the client – significantly predicted therapist safety behaviour use. Findings suggest that exposure therapy training media should aim to decrease therapist safety behaviour use by addressing beliefs about the necessity of therapist safety behaviours, especially in protecting the client. Key learning aims (1) To understand what therapist safety behaviours are in the context of exposure therapy. (2) To identify common beliefs about therapist safety behaviours. (3) To understand how beliefs about therapist safety behaviours relate to therapist safety behaviour use. (4) To consider how exposure therapy delivery may be improved by modifying beliefs about therapist safety behaviours. (5) To explore how beliefs about therapist safety behaviours may be modified to reduce therapist safety behaviour use.

Perpetuating factors of social anxiety: a serial mediation model.

There is evidence that individuals with high levels of social anxiety utilize more safety behaviours and experience more post-event processing than those with lower levels of social anxiety. There are also data to suggest that the relationship between safety behaviour use and social anxiety symptoms is mediated by perceived control of one's anxiety. Furthermore, it has been suggested that post-event processing influences anticipatory anxiety for a future social situation. A direct link between the perpetuating factors of social anxiety described above has not been established in the literature. The aim of the current study was to test a model examining the relationship between these constructs. Participants first completed a battery of questionnaires. They then participated in an impromptu, 3-minute speech and were informed they would be videotaped. Following the speech, participants completed measures of anxiety and were instructed to return the following week. During the second session, they were informed they would deliver an additional speech and provided ratings of their anxiety in anticipation of delivering the second speech. The results of a serial mediation support that greater levels of social anxiety lead to less perceived control over one's anxiety, leading to increased safety behaviour use. The increase in safety behaviours led to an increase of post-event processing which resulted in greater anticipatory anxiety for a future speech task. This study provides novel evidence for the importance of perceived control in the genesis of social anxiety, which has implications for treatment.

Sub-types of safety behaviours and their effects on social anxiety disorder.

Cognitive models suggest that social anxiety disorder (SAD) is maintained through the use of safety behaviours. Previous reports propose that these safety behaviours can be subdivided into two main categories: avoidance and impression management. Study 1 investigates whether certain safety behaviours are specific to SAD. The social behaviour questionnaire was administered to individuals with SAD (N = 106), post-traumatic stress disorder (N = 28) and non-patient controls (N = 59). A factor analysis (N = 164) replicated the previously reported avoidance and impression management subtypes. Scores for both subtypes were significantly higher in individuals with SAD than in individuals with post-traumatic stress disorder or non-patient controls. Study 2 investigated the causal role of such safety behaviours using an experimental design in a non-clinical population (N = 96). Pairs of participants each engaged in two conversations. In one of the conversations, a randomly selected participant performed either avoidance or impression management safety behaviours. In the other conversation, neither participant was instructed to use safety behaviours. Each participant rated their own anxiety and performance as well as rating the other person. Videos of the conversations were also rated. Both types of safety behaviour increased anxiety in the person performing the safety behaviour. The avoidance subtype also had broader effects on the other person that were largely absent from the impression management subtype. Taken together the studies provide support for the distinction between safety behaviour subtypes and have implications for the treatment of SAD.

The Safe Pregnancy study - promoting safety behaviours in antenatal care among Norwegian, Pakistani and Somali pregnant women: a study protocol for a randomized controlled trial

BackgroundIntimate partner violence (IPV) around the time of pregnancy is a recognized global health problem with damaging consequences. However, little is known about the effect of violence assessment and intervention during pregnancy. We hypothesise that routine enquiry about IPV during pregnancy, in combination with information about IPV and safety behaviours, has the potential to increase the use of these behaviours and prevent and reduce IPV.MethodsThe Safe Pregnancy study is a randomised controlled trial (RCT) to test the effectiveness of a tablet-based intervention to promote safety behaviours among pregnant women. Midwives include women who attend routine antenatal care. The intervention consists of a screening questionnaire for violence and information about violence and safety behaviours through a short video shown on a tablet. The materials are available in different languages to ensure participation of Norwegian, Urdu, Somali and English-speaking women. Eligible women answer baseline questions on the tablet including the Abuse Assessment Scale (AAS). Women who screen positive on the AAS will be randomized to an intervention video that contains information about violence and safety behaviours and women in the control group to a video with general information about a healthy and a safe pregnancy. All women receive information about referral resources. Follow up will be at three months post-partum, when the woman attends the maternal and child health centre (MCHC) for the baby’s check-up. Outcome measures are: Use of safety behaviours and quality of life (primary outcomes), prevalence of violence, mental health measures and birth outcomes (secondary outcomes). Intention to treat analysis will be performed.DiscussionThe project will provide evidence on whether enquiry about violence and a short video intervention on a tablet is effective and feasible to prevent or reduce harm from IPV among women who attend antenatal care.Trial registrationThis study is registered in ClinicalTrials.gov. Identifier: NCT03397277 (Registered 11th January 2018).

Patterns and Usefulness of Safety Behaviors Among Community-Based Women Survivors of Intimate Partner Violence.

Women who experience intimate partner violence (IPV) use a variety of safety strategies to reduce the frequency and severity of violence, including both informal and formal help-seeking. The purpose of this study was to identifying patterns of engagement in safety behaviors by U.S. women from outside of formal service settings, examine which factors are associated with different patterns of use, and examine the perceived usefulness of safety strategies among women who used them. Cross-sectional data from 725 women experiencing IPV were used for these analyses. A cluster analysis revealed three clusters of safety behavior use among the IPV survivors: Exploring Safety Options, Avoiding the Justice System, and Trying Everything. The trying everything cluster had high rates of use across all of the safety behaviors; they also reported the highest levels of physical, sexual, and psychological IPV. The exploring safety options cluster used the fewest safety behaviors and had the lowest level of IPV. Higher violence was related to a higher likelihood of finding safety planning helpful and a lower likelihood of finding leaving home helpful. Women who were currently living with their partner were less likely to find talking with a professional, making a safety plan, or leaving home helpful. Higher decisional conflict-uncertainty about what safety decisions would be best-was almost universally related to greater likelihood of not finding safety behaviors helpful. The study findings reinforce the importance of working with survivors to tailor safety plans with strategies that reflect their situation, and provide insights into for which tailoring of resource recommendations may be made.

Beliefs about safety behaviours in the prediction of safety behaviour use.

Safety behaviours are ubiquitous across anxiety disorders and are associated with the aetiology, maintenance and exacerbation of anxiety. Cognitive behavioural models posit that beliefs about safety behaviours directly influence their use. Therefore, beliefs about safety behaviours may be an important component in decreasing safety behaviour use. Unfortunately, little empirical research has evaluated this theorized relationship. The present study aimed to examine the predictive relationship between beliefs about safety behaviours and safety behaviour use while controlling for anxiety severity. Adults with clinically elevated levels of social anxiety (n = 145) and anxiety sensitivity (n = 109) completed an online survey that included established measures of safety behaviour use, quality of life, and anxiety severity. Participants also completed the Safety Behaviour Scale (SBS), a measure created for the current study which includes a transdiagnostic checklist of safety behaviours, as well as questions related to safety behaviour use and beliefs about safety behaviours. Within both the social anxiety and anxiety sensitivity groups, positive beliefs about safety behaviours predicted greater safety behaviour use, even when controlling for anxiety severity. Certain beliefs were particularly relevant in predicting safety behaviour use within each of the clinical analogue groups. Findings suggest that efforts to decrease safety behaviour use during anxiety treatment may benefit from identifying and modifying positive beliefs about safety behaviours.

Interventions for reducing and/or controlling domestic violence among pregnant women in low- and middle-income countries: a systematic review

BackgroundDomestic violence (DV) during pregnancy is recognized as a global health problem associated with serious health consequences for both the mother and her baby. Several interventions aimed at addressing DV around the time of pregnancy have been developed in the last decade, but they are primarily from developed countries. Low- and middle-income countries (LMICs) are facing both a mounting burden of DV as well as severe resource constraints that keep them from emulating some of the effective interventions implemented in developed settings. A systematic review was conducted to examine the approaches and effects of interventions designed for reducing or controlling DV among pregnant women in LMICs.MethodsElectronic databases were systematically searched, and the search was augmented by bibliographic reviews and expert consultations. Two reviewers assessed eligibility and quality of the studies and extracted data independently. The third reviewer was involved to resolve any discrepancies between the reviewers. Due to the limited number of studies and varied outcomes, a meta-analysis was not possible. Primary outcomes of this review included frequency and/or severity of DV and secondary outcomes included mental health, safety behaviours, and use of community resources. In addition, findings from the critical appraisal of studies were utilised to inform the initial draft of Theory of Change (ToC).ResultsOnly five studies (two randomized trials and three non-randomized trials) met the eligibility criteria. The interventions consisting of supportive counselling demonstrated a reduction in DV and an improvement in use of safety behaviours. One study has embedded the DV intervention into an existing program on human immunodeficiency virus (HIV). Limited evidence could be drawn for outcomes such as quality of life and the use of community resources.DiscussionThis review attempted to address the knowledge gap by collating evidence on interventions aimed at addressing DV among pregnant women in LMICs. The development of a ToC was critical in understanding how certain activities led to the desired outcomes. This ToC can guide the design of future research and development of practice guidelines. The participatory involvement of the stakeholders is recommended to refine the current ToC to support its further development for practice.Systematic review registrationPROSPERO, CRD42017073938

Safety behaviors, experiential avoidance, and anxiety: A path analysis approach

Avoidance has long been viewed as an etiological mechanism of anxiety disorders. Of more recent focus within this literature is the distinction between avoidance that is trait-based (experiential avoidance) versus contextual (safety behaviors). Whereas both experiential avoidance and safety behaviors have been studied within anxiety research, no known studies have evaluated the direct and indirect relationships of these forms of avoidance in predicting critical outcomes, particularly in conjunction with symptom severity. To address this gap, the current study assessed social anxiety and panic symptoms, experiential avoidance, use of preventive and restorative safety behaviors, and quality of life to determine the direct and indirect contributions of trait-based and contextual avoidance in predicting clinically relevant outcomes via path analysis. U.S. adults with elevated social anxiety or panic symptoms (n = 254) were recruited online. Results from path analysis showed that, across groups, the relationship between symptoms and quality of life was indirectly accounted for by use of preventive safety behaviors. Further, for participants with panic symptoms (but not for those with social anxiety symptoms), experiential avoidance predicted quality of life even after accounting for use of preventive safety behaviors. The results of this study indicate that trait-based and contextual avoidance contribute significantly to clinically relevant outcomes.

Psychometric Properties of the Safety Maneuver Scale for Adolescents (SMS-A) and Relationship to Outcomes of a Transdiagnostic Treatment.

Safety behaviors are common in anxiety and have been thought to reduce the efficacy of exposure therapy, although some investigations have indicated that safety behaviors may have a non-significant or beneficial impact on exposure efficacy. There have been few investigations of the characteristics and impact of safety behavior use in youth compared to adults, and no known validated, transdiagnostic youth measure of safety behaviors exists. In Study 1, we investigated the psychometric properties of a transdiagnostic measure of adolescent safety behavior use. In Study 2, we examined the relationship between safety behavior use and treatment outcome in 51 anxious and depressed adolescents. Results of Study 1 supported the measure's psychometric properties, while results of Study 2 revealed that decreased safety behavior use is associated with better treatment outcomes. This investigation supports the importance of safety behavior reduction and provides a tool for further investigating adolescent safety behavior use.