The standalone effect of safety behavior manipulations: A systematic review and meta-analysis

Safety behaviors are maladaptive behavioral and mental strategies individuals may employ to prevent or avoid a negative symptom. While reducing safety behaviors have been a core component of cognitive-behavioral treatments, recent research has begun examining the efficacy of standalone safety behavior manipulations. Some have examined the effect of increasing the behaviors in a non-treatment experimental context while others have examined the effect of reducing these behaviors in both non-treatment and treatment contexts. In this systematic review and meta-analysis we examined the efficacy of these manipulations. A total of 26 studies were included in our review and 19 were eligible for our meta-analyses. We examined the effect of safety behavior manipulations on both safety behavior frequency and the primary symptoms within the studies. We found that relative to control, safety behavior reduction led to significantly greater reductions in safety behaviors (d = 0.52, 95% CI [0.36, 0.68]) and symptoms (d = 0.43, 95% CI [0.27, 0.59]). We also found that relative to control, safety behavior increase conditions led to significantly greater safety behaviors (d = 2.96, 95% CI [2.14, 3.78]) and clinical symptoms (d = 0.65, 95% CI [0.46, 0.83]). Some moderators emerged, and evidence of publication bias was found. Altogether, the present study provides support for the potential role safety behaviors may play in a range of disorders. Further, standalone manipulations targeting safety behaviors may be an efficacious method of reducing symptoms of psychopathology, but further research will be necessary to better understand the efficacy of this approach.