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2 DO SAFETY BEHAVIORS PRESERVE THREAT BELIEFS? 33 INTRODUCTION Clinical guidelines generally recommend to motivate patients to inhibit all safety behaviors during exposure-based therapy (e.g., Abramowitz, Deacon, & Whiteside, 2011; Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014; Keijsers, van Minnen, & Hoogduin, 2011). Safety behaviors are actions aimed at preventing, minimizing, or escaping a feared outcome (e.g., Deacon & Maack, 2008; Salkovskis, 1991). They are common in individuals with anxiety disorders and are functionally related to the expected threat (Salkovskis, Clark, & Gelder, 1996). For example, a patient with social anxiety disorder may hide her face in social situations, because she fears that others will ridicule and reject her when they see her blush. Safety behaviors can preclude the occurrence of disconfirming experiences, because the patient may misattribute the nonoccurrence of the expected threat to the safety behavior (Salkovskis, 1991). This prevents the violation of negative expectancies (Blakey & Abramowitz, 2016; Craske et al., 2014), and thus prevents extinction. Hiding her face may prevent the patient with social anxiety from learning that others will not ridicule and reject her if they see her blush. However, whether safety behavior is detrimental to the beneficial effects of exposure is an empirical issue, and overall, the findings from various studies are inconsistent. Several studies found unfavorable effects of exposure with safety behavior compared to exposure without safety behavior (e.g., McManus, Sacadura, & Clark, 2008; Salkovskis, Clark, Hackmann, Wells, & Gelder, 1999; Sloan & Telch, 2002). Other studies found that safety behavior 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, 2013; Sy, Dixon, Lickel, Nelson & Deacon, 2011). In a recent review, 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. A meta-analysis, however, did not find differences in