title: The use of safety-seeking behavior in exposure-based treatments for fear and anxiety: Benefit or burden? A meta-analytic review.
abstract: There is a longstanding debate whether allowing safety-seeking behaviors (SSBs) during cognitive-behavioral treatment hampers or facilitates the reduction of fear. In this meta-analysis, we evaluate the impact of SSBs on exposure-based fear reduction interventions. After filtering 409 journal articles, 23 studies were included for systematic review of which 20studies were coded for meta-analysis. For each study, the Standardized Mean Difference (SMD or Hedges' g) of self-reported fear was calculated at post-intervention. Two comparisons were distinguished: I) exposure without safety-seeking behavior (SSB-) versus baseline behavior (BL), and II) exposure with safety-seeking behavior (SSB+) versus BL. The results showed that average effect sizes were in favor of SSB-, (I: SMD=0.31, 95% CI [-0.04, 0.66]), and in favor of BL, (II: SMD=-0.13, 95% CI [-0.37, 0.11]). Neither of the effect sizes were statistically significant (I: Z=1.75, p=.08; II: Z=1.07, p=.28). The current meta-analysis could not provide compelling evidence supporting either the removal or addition of SSB during exposure. More systematic and statistically empowered replications, using comparable research methods, in (non-)clinical settings are needed. Novel insights from fear conditioning research may also shed light on the role of SSB in fear reduction.
authors.affiliation: Research Group on Health Psychology, University of Leuven, Leuven, Belgium; Center for Excellence Generalization Research in Health and Psychopathology, University of Leuven, Leuven, Belgium. Electronic address: ann.meulders@ppw.kuleuven.be.
authors.forename: Ann
authors.initials: A
authors.lastname: Meulders
authors.affiliation: Research Group on Health Psychology, University of Leuven, Leuven, Belgium; Applied Psychology, Thomas More University College, Antwerp, Belgium.
authors.forename: Tom
authors.initials: T
authors.lastname: Van Daele
authors.affiliation: Research Group on Health Psychology, University of Leuven, Leuven, Belgium.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Volders
authors.affiliation: Research Group on Health Psychology, University of Leuven, Leuven, Belgium; Center for Excellence Generalization Research in Health and Psychopathology, University of Leuven, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, The Netherlands.
authors.forename: Johan W S
authors.initials: JW
authors.lastname: Vlaeyen
mesh_terms: D001008:Anxiety Disorders / Q000523:psychology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005239:Fear / Q000523:psychology*; D006801:Humans
keywords: Anxiety; Exposure; Fear; Meta-analysis; Review; Safety-seeking behavior