Anxiety disorders are the most common mental health conditions in the U.S., affecting approximately 18 percent of the population. These include obsessive-compulsive disorder (OCD), social anxiety, panic disorder, post-traumatic stress disorder (PTSD) and phobias.
One of the core goals in exposure therapy is to help patients get rid of “safety behaviors” — things they might do to make themselves feel less anxious. For example, a person with social anxiety might avoid every party he’s invited to. In therapy, however, he would be encouraged to stop this avoidance behavior.
Many patients find these safety behaviors difficult to part with in the beginning of treatment, and some even end up dropping out of therapy because of the overwhelming stress and anxiety. This prompted researchers at Concordia University in Montreal to look for ways to make treatment easier to handle for these patients.
In fact, the researchers show that the very behaviors people use to avoid anxiety could become part of an effective treatment, and they assert that it should be the patients who decide when these safety behaviors are no longer necessary.
“Traditionally, psychologists thought that fading out or eliminating these behaviors entirely should be the primary focus of the therapy used to combat anxiety disorders. But we found that changing those behaviors and giving patients greater agency is much more effective,” said senior author Dr.Adam Radomsky, professor in Concordia’s Department of Psychology.
For the study, the researchers followed 157 study participants, ranging from patients with low-level anxiety to those with more severe OCD, as they underwent exposure therapy. But instead of getting rid of safety behaviors entirely, the therapists helped the patients replace old safety habits with new ones.
The researchers found that using new safety behaviors during exposure therapy was slightly more helpful to participants than their usual or typical safety behaviors. They also found that the most important aspect of reducing the use of safety behaviors in therapy is that the patient be the one who decides when they are ready to quit using them.
“This is different from the standard approach in which therapists encourage people to drop their safety behaviors at the outset of the therapy, which often leads people to drop out or refuse the treatment. Under the right conditions, safety behaviors have the potential to make the therapy more effective, and more acceptable,” said researcher Hannah Levy.
Radomsky says the new findings could help therapists personalize treatment for each anxiety patient. “It’s our hope that these findings will help to reduce the number of people who refuse or drop out of cognitive-behavioral therapies and should result in more people getting the help that they need,” he said.
The new findings are published in the Journal of Anxiety Disorders and Cognitive Behaviour Therapy.