Flipbook

CHAPTER 8 198 CLINICAL IMPLICATIONS The findings presented in the current dissertation do not provide a straightforward solution to the ongoing discussion about whether safety behavior may be allowed or should be eliminated during exposure therapy (see, for example, Blakey & Abramowitz, 2016; Goetz, Davine, Siwiec, & Lee, 2016; Meulders, Van Daele, Volders, & Vlaeyen, 2016; Ten Broeke & Rijkeboer, 2017; Treanor & Barry, 2017), nor do they specify which safety behaviors should be eliminated or may be allowed, and for whom. Nevertheless, based on the current findings, I will discuss several recommendations for the incorporation and removal of safety behavior in exposure therapy, and suggestions for the treatment of safety behavior in Cognitive Behavioral Therapy (CBT). I want to emphasize that an investigation of these suggestions in a clinical sample, with a real exposure setting, and including the assessment of long- term effects is warranted. ALLOW OR ELIMINATE? In chapter 2, safety behavior that precluded the occurrence of threat prevented extinction learning (van Uijen, Dalmaijer, et al., 2017), which suggests that in the context of stimuli that evoke fear, safety behavior that functions as a conditional inhibitor (i.e., precludes the occurrence of threat) should be eliminated during exposure therapy. This recommendation fits with empirical (e.g., Lovibond et al., 2009), and theoretical (Salkovskis, 1991) justifications for the removal of safety behavior during exposure therapy. Patients may thus be motivated to inhibit the full avoidance of feared situations, and subtle behavioral tricks or aids that prevent threat. Examples are quickly leaving the supermarket to prevent fainting, avoiding giving presentations for colleagues to prevent getting rejected, and opening doors with a tissue to prevent contamination.