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CHAPTER 1 18 et al. (2014, 2017) found that anxious individuals use safety behavior as information about the danger in a situation, “I avoid, so there must be danger”. Additionally, three studies found that safety behaviors exert a causal influence on anxiety. First, Deacon and Maack (2008) investigated the effects of safety behavior on the fear of contamination in healthy participants with high and low levels of contamination fear. Participants spent one week actively engaging in a wide range of contamination-related safety behaviors on a daily basis (e.g., washing and disinfecting hands excessively, and trying to avoid touching public door handles). This increased contamination fear in all participants, irrespective of their initial level of contamination fear. Second, Olatunji, Etzel, Tomarken, Ciesielski, and Deacon (2011) compared a group of participants that engaged in a large array of health- related safety behaviors for one week (safety behavior condition) to a group of participants that monitored their usual safety behavior (control condition). Olatunji et al. (2011) found that participants in the safety behavior condition reported higher levels of health anxiety, hypochondriacal beliefs, and avoidant responses to health- related behavioral tasks than participants in the control condition. Third, in a fear conditioning experiment, Engelhard, van Uijen, van Seters, and Velu (2015) investigated the effect of using safety behavior in response to a safety cue (i.e., a CS that has never been paired with shock; CS-). Participants who displayed safety behavior (i.e., they could avoid a potential subsequent shock) to a CS- subsequently had higher threat expectations to this cue when it was presented without safety behavior than participants who were not given the opportunity to avoid. Together, these findings suggest that even in healthy individuals, the mere act of engaging in safety behaviors can increase fear and anxiety. Safety behavior may thus contribute to the exacerbation of pathological anxiety symptoms. It remains unknown if checking behavior, the most commonly observed safety behavior in patients with OCD (i.e., in 80% among those with lifetime OCD; Ruscio, Stein, Chiu & Kessler, 2010), contributes to the severity of fears in OCD.