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3 DISCONFIRMING CONTAMINATION-RELATED THREAT BELIEFS 65 INTRODUCTION In patients with anxiety disorders safety behavior (SB) maintains threat beliefs, and thereby anxiety, because it prevents them from obtaining evidence that disconfirms their excessive threat beliefs (e.g., Salkovskis, 1991). Patients are therefore encouraged to inhibit their SB during exposure (i.e., exposure response prevention or ERP), in order not to misattribute the non-occurrence of a catastrophe to the SB. Rachman, Radomsky, and Shafran (2008), however, called for a reconsideration of the categorical rejection of SB during treatment. They argued that there is no evidence that all SBs necessarily prevent disconfirmatory experiences, and that the incorporation of SB in exposure could facilitate treatment and may reduce drop-out and refusal. Recent research suggests that adding SB to exposure can indeed enhance treatment acceptability (Milosevic & Radomsky, 2013a; Levy & Radomsky, 2014; Levy, Senn & Radomsky, 2014), although other studies did not find differences in acceptability between exposure with SB (E+SB) and without SB (E+RP; see, for example, Deacon, Sy, Lickel, & Nelson, 2010; Milosevic & Radomsky, 2013b). Additionally, although several studies have shown unfavorable effects of E+SB compared to E+RP (e.g., Salkovskis, Clark, Hackmann, Wells, & Gelder, 1999; McManus, Sacadura, & Clark, 2008), other studies suggest that SB is not always detrimental to the beneficial effects of exposure. E+SB and E+RP resulted in comparable reductions in fear of snakes (Milosevic & Radomsky, 2008), fear of spiders (Hood, Antony, Koerner & Monson, 2010; Milosovic & Radomsky, 2013b), claustrophobic fear (Deacon et al., 2010; Sy, Dixon, Lickel, Nelson & Deacon, 2011), and feelings of contamination (Rachman, Shafran, Radomsky, & Zysk, 2011; van den Hout, Engelhard, Toffolo, & van Uijen, 2011; van den Hout, Reininghaus, van der Stap, & Engelhard, 2012). Overall, findings concerning SB effects on exposure outcomes are mixed. In a recent literature review, Blakey and Abramowitz (2016) concluded that while SB is not always detrimental to the beneficial effects of exposure, it does tend to interfere with therapeutic effects. However, a meta-analysis