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8 DISCUSSION 201 be caused by the inability to remain standing for longer periods of time. Theoretically, decreasing the positive consequences (reinforcements), and increasing the negative consequences (punishments) of a behavior may make it less likely that an individuals will perform that behavior again. Hence, increasing and/or emphasizing the negative consequences of safety behavior for patients may stimulate the extinction of safety behavior. In line with this, Rattel, Miedl, Blechert, and Wilhelm (2016) found that avoidance decreased when there was cost associated with avoidance for participants (i.e., they had to take a lengthy detour to avoid a potential shock). Additionally, Bublatzky, Alpers, and Pittig (2017), and Pittig, Brand, Pawlikowski, and Alpers (2014) found that rewarding approach decreased avoidance behavior. Future research may investigate if punishing safety behavior and rewarding approach behavior during exposure therapy can increase short- and long- term treatment outcomes. For example, the beneficial effects of exposure might be improved if a patient applies punishments (e.g., doing extra chores around the house) and/or rewards (e.g., having a relaxing bath) for his use of safety and approach behavior, respectively, during exposure exercises. Furthermore, safety behavior may directly trigger danger perceptions and increase threat expectancy (Gangemi et al., 2012; Engelhard et al., 2015; chapter 4, van Uijen & Toffolo, 2015; chapter 5, van Uijen, Leer, et al., 2017; van den Hout et al., 2014, 2016; Vervliet & Indekeu, 2015). Future research may investigate if targeting the idiosyncratic meaning of safety behavior for a patient, for example by cognitive techniques, can increase treatment effectivity and prevent relapse after treatment. Additionally, to prevent that safety behavior after extinction may promote a return of fear (chapter 5, van Uijen, Leer, et al., 2017; Vervliet & Indekeu, 2015) Treanor and Barry (2017) proposed to incorporate safety behavior in the later stages of exposure. They argued that the occasional availability of safety behavior during exposure may allow the safety behavior to become a feature of the extinction context, which might prevent a return of fear due to contextual renewal. In other words, patients might perform exposure exercises with and without safety behaviors,