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CHAPTER 5 124 There are various reasons to hypothesize that safety behaviors may also be involved in the return of fear. Safety behaviors are basically avoidance behaviors to minimize the feared outcome, such as a patient with panic disorder who may carry anxiolytics to feel safe going to the supermarket (e.g., Salkovskis, 1991). They function as safety signals and influence threat expectancy. They are common in individuals with anxiety disorders and can be problematic in treatment, because they can maintain threat expectancy. This was shown in a de novo fear conditioning experiment by Lovibond, Mitchell, Minard, Brady, and Menzies (2009), which entailed a mix of classical and instrumental conditioning. In a Pavlovian (i.e., classical) acquisition phase, participants learned that two neutral stimuli (A and C, which both served as CS+) were followed by shock (US), and one stimulus (B, which served as CS-) was not. Next, in an instrumental conditioning phase, participants learned to use safety behavior during presentation of stimulus A by pressing a button on a response box that effectively cancelled the shock. During a subsequent fear extinction phase, stimulus C was no longer followed by shock. The experimental group, but not the control group, was given the opportunity to use safety behavior during C trials. All participants in the experimental group used safety behavior on all C trials. In the following test phase, safety behavior was no longer available for any stimulus. Threat expectancy for C remained high in the experimental group, whereas it had decreased in the control group (Lovibond et al., 2009). Using safety behavior during unreinforced CS presentations thus preserved the subjective threat value of the CS. Because safety behaviors can prevent fear extinction, clinical guidelines recommend to motivate patients to drop all safety behaviors during exposure-based therapy (e.g., Abramowitz, Deacon, & Whiteside, 2011; Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014; Keijsers, van Minnen, & Hoogduin, 2011). However, if individuals continue to use safety behavior after exposure-based therapy, they may again misattribute safety to their own behavior rather than to innocuous properties of the CS.