The Effects of Safety Seeking Behaviors During Exposure Therapy for Adults With Spider Phobia

Exposure-based cognitive-behavioral therapy (i.e., "exposure therapy"), which entails
repeated and prolonged confrontation with feared situations/stimuli, is the most effective
treatment for anxiety disorders (e.g., arachnophobia). Safety behaviors are actions performed
to prevent, minimize, or escape a feared catastrophe and/or associated distress (e.g.,
wearing thick shoes or gloves when around areas where there might be spiders). It is
understood that safety behaviors contribute to the development and maintenance of anxiety
disorders; accordingly, patients' safety behaviors are traditionally eliminated as soon as
possible during exposure therapy (i.e., "response prevention"). Unfortunately, not everyone
who receives exposure therapy benefits from this approach. To address the limitations of
exposure's effectiveness, some experts have questioned the clinical convention of response
prevention during exposure therapy. Specifically, they propose the "judicious use of safety
behaviors": the careful and strategic incorporation of safety behaviors during exposure
therapy. The controversial role of permitting safety behaviors during exposure has garnered
substantial research attention, yet study findings are mixed. The current study, therefore,
was designed to improve upon the methodological limitations of previous related research and
examine the relative efficacy of traditional exposure with response prevention (E/RP) and the
experimental exposure with the judicious use of safety behaviors (E/JU) in a sample of adults
with arachnophobia. In light of previous related research, several hypotheses were made
regarding the short- (posttreatment) and long-term (1-month follow-up) treatment effects:

1. Primary outcomes: E/RP participants will demonstrate greater improvement in spider
phobia than the E/JU participants along behavioral and self-report symptom measures at
follow-up.

2. Secondary outcomes: Treatment acceptability and tolerability will be higher for E/JU
participants, relative to E/RP participants, before beginning exposures and at
posttreatment, but not at follow-up. In addition, hypothesize that E/RP participants
will report greater reductions in peak distress and greater improvements in distress
tolerance relative to E/JU participants at follow-up.

3. Additional outcome: Exploratory analyses will be conducted to compare the relative rate
of behavioral approach and exposure goal completion between treatment conditions.