Disentangling the effects of safety-behavior utilization and safety-behavior availability during exposure-based treatment: a placebo-controlled trial.

The primary aim of the current study was to further investigate the deleterious effects of safety-seeking behaviors on fear reduction by disentangling the effects of perceived availability of threat-relevant safety behaviors during treatment versus their actual use. Participants (N=72) displaying marked claustrophobic fear were randomly assigned to 1 of 5 conditions: (a) exposure only (EO), (b) exposure with phobic safety-behavior availability (SBA), (c) exposure with safety-behavior utilization (SBU), (d) credible placebo treatment (PL), or (e) wait list (WL). High end-state functioning rates at posttreatment were as follows: EO = 94%, SBA = 45%, SBU = 44%, PL = 25%, and WL = 0%. Findings suggest that it is the perception of the availability of safety aids as opposed to their actual use that exerts a disruptive effect on fear reduction. Clinical implications are discussed.