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CHAPTER 8 200 Nevertheless, incorporating approach-supportive behaviors in exposure therapy could have positive effects on the acceptability and effectivity of exposure therapy. THE TREATMENT OF SAFETY BEHAVIOR IN COGNITIVE BEHAVIORAL THERAPY (CBT) The implicit assumption of exposure therapy has been that safety behavior would decrease following fear extinction (Treanor & Barry, 2017). However, fear extinction does not diminish safety behavior (chapter 5, van Uijen, Leer, et al., 2017; Vervliet & Indekeu, 2015). Additionally, fear acquisition results in avoidance tendencies (Krypotos, Effting, Arnaudova, Kindt, & Beckers, 2014), which are also resistant to fear extinction and may act as a precursor of overt avoidance (Krypotos, Arnaudova, Effting, Kindt, & Beckers, 2015). Instructing patients to inhibit their safety behavior during exposure therapy may thus not extinguish safety behavior, and the return of safety behavior after treatment may promote relapse. The long-term effects of exposure therapy might be improved by directly targeting the extinction of safety behavior. Operant conditioning research indicates several ways in which behavior may be extinguished (Bouton, 2016). Operant conditioning is a type of learning in which the strength of a behavior is modified by the behavior’s consequences, such as reward or punishment. Positive consequences (reinforcements) make it more likely that the individuals will perform the behavior again, whereas negative consequences (punishments) make it less likely that individual will perform the behavior again (Korrelboom & Ten Broeke, 2014; Ten Broeke & Rijkeboer, 2017). For a panic disorder patient, quickly sitting down when experiencing dizziness is reinforced by the nonoccurrence of fainting, and by an immediate decrease of dizziness and fear. On the long term, however, the negative consequences of this safety behavior may be the persistence of the irrational fear of fainting, and the functional impairment that may