title: The role of safety behaviors in exposure-based treatment for panic disorder and agoraphobia: associations to symptom severity, treatment course, and outcome.
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.
authors.affiliation: Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany; Department of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany. Electronic address: Sylvia.Helbig-Lang@uni-hamburg.de.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Helbig-Lang
authors.affiliation: Department of Biological and Clinical Psychology, Ernst-Moritz-Arndt University of Greifswald, Greifswald, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Richter
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany; Christoph-Dornier-Foundation for Clinical Psychology, Bremen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lang
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany.
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Gerlach
authors.affiliation: Department of Psychology, Humboldt University of Berlin, Berlin, Germany.
authors.forename: Lydia
authors.initials: L
authors.lastname: Fehm
authors.affiliation: Department of Clinical and Biological Psychology, University of Mannheim, Mannheim, Germany.
authors.forename: Georg W
authors.initials: GW
authors.lastname: Alpers
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Campus Charité Mitte, Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Ströhle
authors.affiliation: Department of Psychiatry und Psychotherapy, Philipps-University of Marburg, Marburg, Germany.
authors.forename: Tilo
authors.initials: T
authors.lastname: Kircher
authors.affiliation: Department of Psychiatry, Psychosomatics & Psychotherapy, University of Würzburg, Würzburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Deckert
authors.affiliation: Department of Psychology, University of Basel, Basel, Switzerland.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Gloster
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany.
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Wittchen
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000379:Agoraphobia / Q000523:psychology / Q000628:therapy*; D001007:Anxiety / Q000523:psychology / Q000628:therapy; D001008:Anxiety Disorders / Q000628:therapy; D016002:Discriminant Analysis; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000523:psychology / Q000628:therapy*; D011594:Psychometrics; D015203:Reproducibility of Results; D012449:Safety; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Agoraphobia; Behavioral assessment; Exposure; Panic disorder; Safety behaviors