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4 SAFETY BEHAVIOR INCREASES OBSESSION-RELATED COGNITIONS 95 INTRODUCTION Safety behavior is common in both anxiety- and obsessive compulsive related disorders (American Psychiatric Association, 2013), and refers to actions aimed at preventing or minimizing a feared outcome (Salkovskis, 1991). Patients with social phobia, for instance, avoid eye contact because they fear rejection, patients with panic disorder quickly sit down when they feel their heart beat rising to avoid a heart attack, and patients with obsessive compulsive disorder (OCD) frequently check gas stoves, light switches, or electrical outlets, because they fear the catastrophe of their house burning down under their responsibility. Although these behaviors seem useful to patients and provide anxiety relief in the short term, they actually play a pivotal role in the maintenance of pathological anxiety in the long term (Clark, 1999; Salkovskis, Thorpe, Wahl, Wroe, & Forrester, 2003). Most importantly, safety behaviors cause a misattribution of safety, which prevents the acquisition of information that disconfirms inaccurate threat beliefs (Salkovskis, 1991), and divert attentional recourses away from this information (Sloan & Telch, 2002). For instance, in patients with OCD, the non-occurrence of their house burning down may erroneously be attributed to the repeated checking of the gas stove (i.e., safety behavior). In addition to their role in the maintenance of symptoms, safety behavior seems to contribute directly to the exacerbation and development of anxiety and OCD symptoms. To illustrate, individuals with hypochondriasis may increase health anxiety by constantly checking their body (e.g., feeling for lumps, inspecting skin spots; see Abramowitz, Schwartz, & Whiteside, 2002), and patients with checking compulsions paradoxically enhance memory uncertainty by perseverative checking (Boschen & Vuksanovic, 2007). Recently, Engelhard, van Uijen, van Seters, and Velu (in press) showed that even in healthy individuals, the use of safety behavior leads to threat expectations to objectively safe stimuli. In a conditioning experiment, participants who displayed safety behavior (i.e., they could avoid a potential