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CHAPTER 1 14 There are numerous experimental studies that examine the effects of safety behaviors on exposure outcomes. The typical set-up of these studies is that highly fearful individuals receive an exposure treatment either with or without safety behaviors. For example, Powers, Smits, and Telch (2004) asked students with claustrophobic fear to remain in a small chamber. One group had to use safety behaviors, such as opening a small window to allow access to fresh air. A second group had the availability of these safety behaviors, and a third group was not provided any safety behaviors. Exposure with the use of safety behaviors and exposure with safety behavior availability resulted in smaller reductions of claustrophobic fear than exposure without safety behaviors (Powers et al., 2004). Another example is a study by Milosevic and Radomsky (2013a), in which individuals with spider phobia were encouraged to approach a live spider. Half of them could use safety behavior in the form of protective gear, such as gloves, goggles, and a protective apron, and the other half could not. In this study, exposure with and without the use of these safety behaviors resulted in comparable reductions of a fear of spiders (Milosevic & Radomsky, 2013a). Overall, the empirical evidence to justify the guideline to drop all safety behaviors during exposure therapy is inconsistent. In line with the clinical guidelines, several studies found unfavorable effects of exposure with safety behavior compared to exposure without safety behavior (e.g., McManus, Sacadura, & Clark, 2008; Powers et al., 2004; Salkovskis, Clark, Hackmann, Wells, & Gelder, 1999; Sloan & Telch, 2002). Other studies, however, found that safety behaviors did not reduce the effects of exposure (e.g., Deacon, Sy, Lickel, & Nelson, 2010; Hood, Antony, Koerner & Monson, 2010; Milosevic & Radomsky, 2008), and even enhanced exposure effects (e.g., Milosovic & Radomsky, 2013a; Sy, Dixon, Lickel, Nelson & Deacon, 2011). In a recent review of the literature, Blakey and Abramowitz (2016) concluded that safety behaviors tend to be detrimental to the beneficial effects of exposure, but do not always interfere with the therapeutic effects of exposure. In a meta-analysis, on the other hand, Meulders et al. (2016) did not find differences in