Year

2019

Degree Name

Doctor of Philosophy (Clinical Psychology)

Department

School of Psychology

Abstract

Background: Safety behaviours are traditionally defined as actions intended to prevent, minimize, or escape a feared outcome and associated distress (Telch & Lancaster, 2012). Despite their negative impacts on anxiety aetiology (Goodson, Haeffel, Raush, & Hershenberg, 2016), maintenance (Beesdo‐Baum et al., 2012), and treatment outcome (Helbig-Lang et al., 2014), safety behaviours are pervasive among anxious adults (Helbig‐Lang & Petermann, 2010), parents of anxious youth (Shimshoni, Shrinivasa, Cherian, & Lebowitz, 2019), and even therapists who treat anxious clients (Waller & Turner, 2016). Cognitive-behavioural models contend that beliefs influence behaviour (Abramowitz, Deacon, & Whiteside, 2019). Therefore, beliefs about safety behaviours may be an important component in decreasing safety behaviour use. Unfortunately, little empirical research has evaluated this relationship. Thus, this thesis is comprised of three studies which aimed to explore the construct of beliefs about safety behaviours and its relationship with safety behaviour use among anxious adults, parents of anxious youth, and therapists of anxious clients.

Method: In Study 1, adults (N = 254) with clinically elevated levels of social anxiety (n = 145) and anxiety sensitivity (n = 109) completed an online survey that included established measures of safety behaviour use, quality of life, anxiety severity, and the Safety Behaviour Scale (SBS) – a measure created for the present thesis to assess transdiagnostic safety behaviour use and beliefs about safety behaviours. Study 2 included parents (N = 313) of treatment-seeking youth with anxiety disorders. Parents completed established measures of parental accommodation, youth anxiety, and the Parental Accommodation Scale (PAS), which was designed for the present thesis to assess beliefs about parental accommodation and parental accommodation use. In Study 3, Australian psychologists (N = 98) completed an online survey that included existing measures of therapist safety behaviour use, negative beliefs about exposure therapy, likelihood to exclude anxious clients from exposure therapy, use of intensifying exposure techniques, and the Exposure Implementation Beliefs Scale (EIBS) – another measure created for the present thesis to assess beliefs about therapist safety behaviours.

Results: Across all three studies, stronger positive beliefs about safety behaviours significantly predicted safety behaviour use. Within each sample, one specific belief or type of belief emerged as a significant predictor of unique variance in safety behaviour use. Among the social anxiety clinical analogue group in Study 1, it was the belief that safety behaviours are necessary to function adequately in everyday life. Within the anxiety sensitivity clinical analogue group in Study 1, it was the belief that safety behaviours are necessary to reduce the likelihood that a feared outcome will occur. In Study 2, it was the type of belief that parental accommodation is necessary to prevent a youth from losing behavioural or emotional control. Lastly within Study 3, it was the type of belief that therapist safety behaviours are necessary to protect the client.

Conclusions: The present thesis demonstrates that efforts to reduce safety behaviour use should involve modifying maladaptive beliefs about safety behaviours. By doing so, it is hoped that treatment – and ultimately the lives – of anxious individuals may be improved.

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Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.