The effects of safety behaviors on health anxiety: An experimental investigation

Olatunji, Bunmi O.; Etzel, Erin N.; Tomarken, Andrew J.; Ciesielski, Bethany G.; Deacon, Brett

doi:10.1016/j.brat.2011.07.008

Cited by 192Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychosomatic Disorders and Their TreatmentsObsessive-Compulsive Spectrum Disorders

The effects of safety behaviors on health anxiety: An experimental investigation

Olatunji, Bunmi O., Etzel, Erin N., Tomarken, Andrew J., Ciesielski, Bethany G., Deacon, Brett·2011·Behaviour Research and Therapy

DOI 10.1016/j.brat.2011.07.008

Open this paper in CoChat — free account

Abstract

The present study examined the extent to which safety behaviors exacerbate symptoms of hypochondriasis (severe health anxiety). Participants were randomized into a safety behavior (n=30) or control condition (n=30). After a baseline period, participants in the safety behavior condition spent one week actively engaging in a clinically representative array of health-related safety behaviors on a daily basis, followed by a second week-long baseline period. Participants in the control condition monitored their normal use of safety behaviors. Compared to control participants, those in the safety behavior condition reported significantly greater increases in health anxiety, hypochondriacal beliefs, contamination fear, and avoidant responses to health-related behavioral tasks after the safety behavior manipulation. In contrast, general anxiety symptoms did not significantly differ between the two groups as a function of the manipulation. Mediational analyses were consistent with the hypothesis that changes in the frequency of health-related thoughts mediated the effects of the experimental manipulation on health anxiety. These findings suggest that safety behaviors are associated with increases in health anxiety, perhaps by fostering catastrophic thoughts about health. The implications of these findings for the conceptualization of hypochondriasis as an anxiety disorder are discussed.

Integrity signals

Registry

Crossref · 10.1016/j.brat.2011.07.008

Cites

68 of 68 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Safety behaviours maintain and exacerbate beliefs that health-related uncertainty cannot be tolerated, creating a self-perpetuating cycle of health anxiety symptoms.
“and maintain and exacerbate beliefs that health-related uncertainty cannot be tolerated [34], creating a self-perpetuating cycle of health anxiety symptoms [35].”
From Health anxiety, coping mechanisms and COVID 19: An Indian community sample at week 1 of lockdown (2021) · cites this paper as [34]
Safety behaviors contribute to the development and maintenance of anxiety disorders.
“the weight of the evidence shows that safety behaviors contribute to the development and maintenance of anxiety disorders (e.g., Deacon & Maack, 2008; Olatunji et al., 2011).”
From Behavioral Experiments for Intolerance of Uncertainty: A Randomized Clinical Trial for Adults With Generalized Anxiety Disorder (2022) · cites this paper as Olatunji et al., 2011

Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
A Simple Sequentially Rejective Multiple Test Procedure
(1979) · Scandinavian Journal of Statistics · doi:10.2307/4615733 · Cited by 21,526 · see citing works
Diagnostic and Statistical Manual of Mental Disorders.
Widiger, T. A. (2000) · Oxford University Press eBooks · doi:10.1037/10518-009 · Cited by 19,767 · see citing works
An inventory for measuring clinical anxiety: Psychometric properties.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.56.6.893 · Cited by 14,407 · see citing works
A comparison of methods to test mediation and other intervening variable effects
MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002) · Psychological Methods · doi:10.1037/1082-989x.7.1.83 · Cited by 9,406 · see citing works
The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and Clinical Tests of Validity in Measuring Physical and Mental Health Constructs
MCHORNEY, C. A., JOHNE, W., & ANASTASIAE, R. (1993) · Medical Care · doi:10.1097/00005650-199303000-00006 · Cited by 6,681 · see citing works
Applied Longitudinal Analysis
Fitzmaurice, G. M., Laird, N. M., & Ware, J. H. (2011) · Wiley Series in Probability and Statistics · doi:10.1002/9781119513469 · Cited by 4,639 · see citing works
Logistic Regression Models
Hilbe, J. M. (2009) · Chapman & Hall/CRC eBooks · doi:10.1201/9781420075779 · Cited by 2,616 · see citing works
Designing Experiments and Analyzing Data: A Model Comparison Perspective
Maxwell, S., & Delaney, H. D. (1990) · Journal of the American Statistical Association · doi:10.2307/2289744 · Cited by 2,593 · see citing works
Logistic Regression Using the SAS System : Theory and Application
Allison, P. D. (1999) · Cited by 2,087 · see citing works
Negative binomial regression
Hilbe, J. M. (2007) · Cambridge University Press eBooks · doi:10.1017/cbo9780511811852.007 · Cited by 1,998 · see citing works
The Analysis of Cross-Classified Categorical Data
Drane, J. W., & Fienberg, S. E. (1979) · Technometrics · doi:10.2307/1267767 · Cited by 1,956 · see citing works
Applied longitudinal analysis
(2004) · Choice Reviews Online · doi:10.5860/choice.42-2265 · Cited by 1,385 · see citing works
The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis
SALKOVSKIS, P. M., RIMES, K. A., WARWICK, H. M. C., & CLARK, D. M. (2002) · Psychological Medicine · doi:10.1017/s0033291702005822 · Cited by 1,351 · see citing works
Distribution of the product confidence limits for the indirect effect: Program PRODCLIN
MacKinnon, D. P., Fritz, M. S., Williams, J. G., & Lockwood, C. M. (2007) · Behavior Research Methods · doi:10.3758/bf03193007 · Cited by 1,328 · see citing works
Designing Experiments and Analysing Data: A Model Comparison Perspective.
Freeman, G. H., Maxwell, S. E., & Delaney, H. D. (1991) · Biometrics · doi:10.2307/2532173 · Cited by 1,229 · see citing works
Designing Experiments and Analyzing Data: A Model Comparison Perspective, Third Edition
Maxwell, S. E., & Delaney, H. D. (1999) · Medical Entomology and Zoology · Cited by 975 · see citing works
Dimensions of Hypochondriasis
Pilowsky, I. (1967) · British Journal of Psychiatry · doi:10.1192/bjp.113.494.89 · Cited by 865 · see citing works
The importance of behaviour in the maintenance of anxiety and panic: A cognitive account
Salkovskis, P. M. (1991) · Behavioural Psychotherapy · doi:10.1017/s0141347300011472 · Cited by 780 · see citing works
Negative Binomial Regression
Hilbe, J. M. (2007) · Cambridge University Press eBooks · doi:10.1017/cbo9780511811852 · Cited by 756 · see citing works
Revision of the Padua Inventory of obsessive compulsive disorder symptoms: Distinctions between worry, obsessions, and compulsions
Burns, G. L., Keortge, S. G., Formea, G. M., & Sternberger, L. G. (1996) · Behaviour Research and Therapy · doi:10.1016/0005-7967(95)00035-6 · Cited by 667 · see citing works
The Analysis of Cross-Classified Categorical Data
Stuart, A., & Fienberg, S. E. (1980) · International Statistical Review · doi:10.2307/1402421 · Cited by 594 · see citing works
Hypochondriasis
Warwick, H. M. C., & Salkovskis, P. M. (1990) · Behaviour Research and Therapy · doi:10.1016/0005-7967(90)90023-c · Cited by 587 · see citing works
Anxiety disorders: Why they persist and how to treat them
Clark, D. M. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00048-0 · Cited by 556 · cited 1× · see citing works
“Contemporary cognitive-behavioral models of anxiety disorders also emphasize the role of safety behaviors in explaining why irrational fears do not self-correct in the face of repeated disconfirmation (Clark, 1999; Salkovskis, 1991; Thwaites & Freeston, 2005).”
Background
The Scientist Practitioner: Research and Accountability in the Age of Managed Care
Hayes, S. C., Barlow, D. H., & Nelson‐Gray, R. O. (1999) · DigitalGeorgetown (Georgetown University Library) · Cited by 417 · see citing works
An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia
Salkovskis, P. M., Clark, D. M., Hackmann, A., Wells, A., & Gelder, M. G. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00153-3 · Cited by 310 · see citing works
The Short Health Anxiety Inventory: Psychometric Properties and Construct Validity in a Non-clinical Sample
Abramowitz, J. S., Deacon, B. J., & Valentiner, D. P. (2007) · Cognitive Therapy and Research · doi:10.1007/s10608-006-9058-1 · Cited by 308 · see citing works
Self-citation
Two psychological treatments for hypochondriasis: A randomised controlled trial
Clark, D. M., Salkovskis, P. M., Hackmann, A., Wells, A., Fennell, M., Ludgate, J., Ahmad, S., Richards, H. C., & Gelder, M. (1998) · British Journal of Psychiatry · doi:10.1192/bjp.173.3.218 · Cited by 270 · see citing works
Safety behaviour: A reconsideration
Rachman, S., Radomsky, A. S., & Shafran, R. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.11.008 · Cited by 263 · see citing works
Health Anxiety, Hypochondriasis, and the Anxiety Disorders
Abramowitz, J. S., Olatunji, B. O., & Deacon, B. J. (2007) · Behavior Therapy · doi:10.1016/j.beth.2006.05.001 · Cited by 261 · see citing works
Self-citation
A controlled trial of cognitive-behavioural treatment of hypochondriasis
Warwick, H. M. C., Clark, D. M., Cobb, A. M., & Salkovskis, P. M. (1996) · British Journal of Psychiatry · doi:10.1192/bjp.169.2.189 · Cited by 240 · see citing works
Applied analysis of variance in behavioral science
Edwards, L. K. (1993) · M. Dekker eBooks · Cited by 233 · see citing works
Obsessive-Compulsive Spectrum Disorders: An Overview
Hollander, E. (1993) · Psychiatric Annals · doi:10.3928/0048-5713-19930701-05 · Cited by 225 · see citing works
The effects of safety-seeking behavior and guided threat reappraisal on fear reduction during exposure: an experimental investigation
Sloan, T., & Telch, M. J. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00007-9 · Cited by 223 · see citing works
Cognitive and perceptual variables in hypochondriasis and health anxiety: A systematic review
Marcus, D. K., Gurley, J. R., Marchi, M. M., & Bauer, C. (2007) · Clinical Psychology Review · doi:10.1016/j.cpr.2006.09.003 · Cited by 218 · see citing works
Tolerate or eliminate? A systematic review on the effects of safety behavior across anxiety disorders.
Helbig‐Lang, S., & Petermann, F. (2010) · Clinical Psychology Science and Practice · doi:10.1111/j.1468-2850.2010.01213.x · Cited by 216 · see citing works
Untitled work
(1998) · PubMed · Cited by 215 · see citing works
General class of covariance structures for two or more repeated factors in longitudinal data analysis
Gałecki, A. T. (1994) · Communication in Statistics- Theory and Methods · doi:10.1080/03610929408831436 · Cited by 210 · see citing works
“If I feel anxious, there must be danger”: Ex-consequentia reasoning in inferring danger in anxiety disorders
Arntz, A., Rauner, M., & Van den Hout, M. (1995) · Behaviour Research and Therapy · doi:10.1016/0005-7967(95)00032-s · Cited by 208 · see citing works
On Using Analysis Of Covariance In Repeated Measures Designs
Delaney, H. D., & Maxwell, S. E. (1981) · Multivariate Behavioral Research · doi:10.1207/s15327906mbr1601_6 · Cited by 195 · see citing works
A taxometric analysis of health anxiety
Ferguson, E. (2009) · Psychological Medicine · doi:10.1017/s0033291708003322 · Cited by 183 · see citing works
Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial
Greeven, A., van Balkom, A. J. L. M., Visser, S., Merkelbach, J. W., van Rood, Y. R., van Dyck, R., Van der Does, A. J. W., Zitman, F. G., & Spinhoven, P. (2007) · American Journal of Psychiatry · doi:10.1176/ajp.2007.164.1.91 · Cited by 183 · see citing works
Disentangling the Effects of Safety-Behavior Utilization and Safety-Behavior Availability During Exposure-Based Treatment: A Placebo-Controlled Trial.
Powers, M. B., Smits, J. A. J., & Telch, M. J. (2004) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.72.3.448 · Cited by 181 · see citing works
The effects of safety behaviors on the fear of contamination: An experimental investigation
Deacon, B., & Maack, D. J. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2008.01.010 · Cited by 174 · see citing works
Self-citation
Safety-Seeking Behaviours: Fact or Function? How Can We Clinically Differentiate Between Safety Behaviours and Adaptive Coping Strategies Across Anxiety Disorders?
Thwaites, R., & Freeston, M. H. (2005) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465804001985 · Cited by 165 · see citing works
Is Hypochondriasis Related to Obsessive-Compulsive Disorder, Panic Disorder, or Both? An Empirical Evaluation
Deacon, B., & Abramowitz, J. S. (2008) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.22.2.115 · Cited by 157 · see citing works
Self-citation
An experimental analysis of hypochondriasis
Abramowitz, J. S., & Moore, E. L. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.04.005 · Cited by 151 · see citing works
Is hypochondriasis an anxiety disorder?
Olatunji, B. O., Deacon, B. J., & Abramowitz, J. S. (2009) · British Journal of Psychiatry · doi:10.1192/bjp.bp.108.061085 · Cited by 142 · see citing works
Self-citation
A contemporary conceptual model of hypochondriasis
Abramowitz, J. S., Schwartz, S. A., & Whiteside, S. P. (2002) · Mayo Clinic Proceedings · doi:10.4065/77.12.1323 · Cited by 139 · see citing works
The relationship between disgust sensitivity, anxiety and obsessions
Thorpe, S. J., Patel, S. P., & Simonds, L. M. (2003) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(03)00058-5 · Cited by 138 · see citing works
Anxiety sensitivity mediates the relationships between childhood learning experiences and elevated hypochondriacal concerns in young adulthood
Watt, M. C., & Stewart, S. H. (2000) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(00)00097-0 · Cited by 129 · see citing works
Body Vigilance in Nonclinical and Anxiety Disorder Samples: Structure, Correlates, and Prediction of Health Concerns
Olatunji, B. O., Deacon, B. J., Abramowitz, J. S., & Valentiner, D. P. (2007) · Behavior Therapy · doi:10.1016/j.beth.2006.09.002 · Cited by 114 · see citing works
Self-citation
A Taxometric Study of Hypochondriasis Symptoms
Longley, S. L., Broman-Fulks, J. J., Calamari, J. E., Noyes, R., Wade, M., & Orlando, C. M. (2010) · Behavior Therapy · doi:10.1016/j.beth.2010.02.002 · Cited by 103 · see citing works
Reducing contamination by exposure plus safety behaviour
Rachman, S., Shafran, R., Radomsky, A. S., & Zysk, E. (2011) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2011.02.010 · Cited by 96 · see citing works
The relationship of hypochondriasis to anxiety disorders
Noyes, R. (1999) · General Hospital Psychiatry · doi:10.1016/s0163-8343(98)00063-2 · Cited by 94 · see citing works
Increased use of safety-seeking behaviors in chronic back pain patients with high health anxiety
Tang, N. K. Y., Salkovskis, P. M., Poplavskaya, E., Wright, K. J., Hanna, M., & Hester, J. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.05.004 · Cited by 89 · see citing works
Hypochondriasis and Panic Disorder
BARSKY, A. J. (1994) · Archives of General Psychiatry · doi:10.1001/archpsyc.1994.03950110078010 · Cited by 87 · see citing works
Hypochondriasis and Obsessive Compulsive Disorder
BARSKY, A. J. (1992) · Psychiatric Clinics of North America · doi:10.1016/s0193-953x(18)30209-0 · Cited by 85 · see citing works
Hypochondriasis and obsessive compulsive disorder: overlaps in diagnosis and treatment.
Fallon, B. A., Javitch, J. A., Hollander, E., & Liebowitz, M. R. (1991) · PubMed · Cited by 67 · see citing works
Neutralizing increases discomfort associated with obsessional thoughts: an experimental study with obsessional patients
Salkovskis, P. M., Thorpe, S. J., Wahl, K., Wroe, A. L., & Forrester, E. (2003) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.112.4.709 · Cited by 65 · see citing works
Longitudinal designs in randomized group comparisons: When will intermediate observations increase statistical power?
Maxwell, S. E. (1998) · Psychological Methods · doi:10.1037/1082-989x.3.3.275 · Cited by 61 · see citing works
Anxiety Sensitivity and Health Anxiety in a Nonclinical Sample: Specificity and Prospective Relations with Clinical Stress
Olatunji, B. O., Wolitzky-Taylor, K. B., Elwood, L., Connolly, K., Gonzales, B., & Armstrong, T. (2009) · Cognitive Therapy and Research · doi:10.1007/s10608-008-9188-8 · Cited by 53 · see citing works
Self-citation
Incremental specificity of disgust propensity and sensitivity in the prediction of health anxiety dimensions
Olatunji, B. O. (2008) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2008.10.003 · Cited by 48 · see citing works
Self-citation
Hypochondriasis: Conceptualization, Treatment, and Relationship to Obsessive Compulsive Disorder
Abramowitz, J. S. (2005) · Annals of Clinical Psychiatry · doi:10.1080/10401230500295339 · Cited by 25 · see citing works
Specificity of Childhood Learning Experiences in Relation to Anxiety Sensitivity and Illness/Injury Sensitivity: Implications for Health Anxiety and Pain
Watt, M. C., O’Connor, R. M., Stewart, S. H., Moon, E. C., & Terry, L. (2008) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.22.2.128 · Cited by 19 · see citing works
Differential effects of safety in extinction of anxious responding to a CO₂ challenge in patients with panic disorder.
Schmidt, N. B., Richey, J. A., Maner, J. K., & Woolaway-Bickel, K. (2006) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.115.2.341 · Cited by 10 · see citing works
New Directions in Health Anxiety: Introduction to the Special Issue
Abramowitz, J. S. (2008) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.22.2.83 · Cited by 7 · see citing works
Untitled work
(1998) · doi:10.1002/(sici)1099-0879(199809)5:3

Flagged first, then by citations

Sorted by citations

Fear of the coronavirus (COVID-19): Predictors in an online study conducted in March 2020
Mertens, G., Gerritsen, L., Duijndam, S., Salemink, E., & Engelhard, I. M. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102258 · Cited by 1,264 · see citing works
“, contamination concern and health anxiety) (see Deacon & Maack, 2008; Engelhard et al., 2015; Olatunji et al., 2011).”
The Short Health Anxiety Inventory: A systematic review and meta-analysis
Alberts, N. M., Hadjistavropoulos, H. D., Jones, S. L., & Sharpe, D. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2012.10.009 · Cited by 267 · see citing works
The effects of safety behaviors during exposure therapy for anxiety: Critical analysis from an inhibitory learning perspective
Blakey, S. M., & Abramowitz, J. S. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.07.002 · Cited by 186 · see citing works
Tracing “Fearbola”: Psychological Predictors of Anxious Responding to the Threat of Ebola
Blakey, S. M., Reuman, L., Jacoby, R. J., & Abramowitz, J. S. (2015) · Cognitive Therapy and Research · doi:10.1007/s10608-015-9701-9 · Cited by 164 · see citing works
Psychological Predictors of Health Anxiety in Response to the Zika Virus
Blakey, S. M., & Abramowitz, J. S. (2017) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-017-9514-y · Cited by 159 · see citing works
Health anxiety disorders: A cognitive construal
Rachman, S. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.05.001 · Cited by 161 · see citing works
Online health research and health anxiety: A systematic review and conceptual integration.
Brown, R. J., Skelly, N., & Chew-Graham, C. A. (2020) · Clinical Psychology: Science and Practice · doi:10.1111/cpsp.12299 · Cited by 140 · see citing works
Anxiety sensitivity and intolerance of uncertainty as potential risk factors for cyberchondria
Norr, A. M., Albanese, B. J., Oglesby, M. E., Allan, N. P., & Schmidt, N. B. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.11.023 · Cited by 138 · see citing works
Brief Online Cognitive Behavioural Intervention for Dysfunctional Worry Related to the COVID-19 Pandemic: A Randomised Controlled Trial
Wahlund, T., Mataix-Cols, D., Olofsdotter Lauri, K., de Schipper, E., Ljótsson, B., Aspvall, K., & Andersson, E. (2021) · Psychotherapy and Psychosomatics · doi:10.1159/000512843 · Cited by 105 · see citing works
Cognitive behavior therapy for health anxiety: systematic review and meta-analysis of clinical efficacy and health economic outcomes
Axelsson, E., & Hedman-Lagerlöf, E. (2019) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1080/14737167.2019.1703182 · Cited by 96 · see citing works
Internet-Based Cognitive Behavioral Therapy Versus Psychoeducation Control for Illness Anxiety Disorder and Somatic Symptom Disorder: A Randomized Controlled Trial
Newby, J. M., Smith, J., Uppal, S., Mason, E., Mahoney, A. E. J., & Andrews, G. (2018) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000248 · Cited by 84 · see citing works
Experiential avoidance in non-suicidal self-injury and suicide experiences: a systematic review and meta-analysis
Angelakis, I., & Gooding, P. (2021) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12784 · Cited by 79 · see citing works
Three decades of increase in health anxiety: Systematic review and meta-analysis of birth cohort changes in university student samples from 1985 to 2017
Kosic, A., Lindholm, P., Järvholm, K., Hedman-Lagerlöf, E., & Axelsson, E. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102208 · Cited by 77 · see citing works
Medical information seeking: Impact on risk for anxiety psychopathology
Norr, A. M., Capron, D. W., & Schmidt, N. B. (2014) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2014.04.003 · Cited by 70 · see citing works
Behavioral Experiments for Intolerance of Uncertainty: A Randomized Clinical Trial for Adults With Generalized Anxiety Disorder
Dugas, M. J., Sexton, K. A., Hebert, E. A., Bouchard, S., Gouin, J.-P., & Shafran, R. (2022) · Behavior Therapy · doi:10.1016/j.beth.2022.05.003 · Cited by 58 · see citing works
The uptake and outcomes of Internet-based cognitive behavioural therapy for health anxiety symptoms during the COVID-19 pandemic
Sharrock, M. J., Mahoney, A. E. J., Haskelberg, H., Millard, M., & Newby, J. M. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102494 · Cited by 46 · see citing works
A Cognitive Behavioral Therapy Chatbot (Otis) for Health Anxiety Management: Mixed Methods Pilot Study
Goonesekera, Y., & Donkin, L. (2022) · JMIR Formative Research · doi:10.2196/37877 · Cited by 43 · see citing works
“Both avoidance and reassurance-seeking maintain the anxiety as the individual foregoes their opportunity to become aware of their ability to cope with their perceived fear [8,9], thus preventing long-term cognitive change [10].”
Background
Fear and death anxiety in the shadow of COVID-19 among the Lebanese population: A cross-sectional study
Chalhoub, Z., Koubeissy, H., Fares, Y., & Abou-Abbas, L. (2022) · PLOS ONE · doi:10.1371/journal.pone.0270567 · Cited by 39 · see citing works
Internet-Based Extinction Therapy for Worry: A Randomized Controlled Trial
Andersson, E., Hedman, E., Wadström, O., Boberg, J., Andersson, E. Y., Axelsson, E., Bjureberg, J., Hursti, T., & Ljótsson, B. (2017) · Behavior Therapy · doi:10.1016/j.beth.2016.07.003 · Cited by 30 · see citing works
Health anxiety in a disease-avoidance framework: Investigation of anxiety, disgust and disease perception in response to sickness cues.
Hedman, E., Lekander, M., Karshikoff, B., Ljótsson, B., Axelsson, E., & Axelsson, J. (2016) · Journal of Abnormal Psychology · doi:10.1037/abn0000195 · Cited by 30 · see citing works
An Examination of the Indirect Effect of Intolerance of Uncertainty on Health Anxiety Through Anxiety Sensitivity Physical Concerns
O’Bryan, E. M., & McLeish, A. C. (2017) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-017-9613-y · Cited by 25 · see citing works
The effectiveness of internet-delivered cognitive behavioural therapy for health anxiety in routine care
Newby, J. M., Haskelberg, H., Hobbs, M. J., Mahoney, A. E. J., Mason, E., & Andrews, G. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.11.087 · Cited by 23 · see citing works
Health anxiety, coping mechanisms and COVID 19: An Indian community sample at week 1 of lockdown
Barron Millar, E., Singhal, D., Vijayaraghavan, P., Seshadri, S., Smith, E., Dixon, P., Humble, S., Rodgers, J., & Sharma, A. N. (2021) · PLoS ONE · doi:10.1371/journal.pone.0250336 · Cited by 21 · see citing works
“However such safety behaviours are negatively reinforcing and maintain anxiety symptoms in the long-term [33] and maintain and exacerbate beliefs that healthrelated uncertainty cannot be tolerated [34], creating a self-perpetuating cycle of health anxiety symptoms [35].”
Background
The mediating effect of mindful non-reactivity in exposure-based cognitive behavior therapy for severe health anxiety
Hedman, E., Hesser, H., Andersson, E., Axelsson, E., & Ljótsson, B. (2017) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2017.04.007 · Cited by 17 · see citing works
An examination of mindfulness skills in terms of affect tolerance among individuals with elevated levels of health anxiety.
O’Bryan, E. M., Luberto, C. M., Kraemer, K. M., & McLeish, A. C. (2018) · Anxiety, Stress, & Coping · doi:10.1080/10615806.2018.1521515 · Cited by 11 · see citing works
An explanatory sequential investigation of the working alliance as a change process in videoconferencing psychotherapy
Norwood, C., Sabin‐Farrell, R., Malins, S., & Moghaddam, N. G. (2021) · Journal of Clinical Psychology · doi:10.1002/jclp.23112 · Cited by 12 · see citing works
Beliefs about safety behaviours in the prediction of safety behaviour use
Meyer, J. M., Kirk, A., Arch, J. J., Kelly, P. J., & Deacon, B. J. (2019) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465819000298 · Cited by 10 · see citing works
Self-citation
Health Anxiety: A Cognitive-Behavioral Framework
Rutter, L., Nota, J. A., Yusufov, M., & Björgvinsson, T. (2018) · Somatoform and Other Psychosomatic Disorders · doi:10.1007/978-3-319-89360-0_11 · Cited by 8 · see citing works
Cognitive and Behavioral Mechanisms of Health Anxiety
Fergus, T. A., & Asmundson, G. J. G. (2019) · The Clinician's Guide to Treating Health Anxiety · doi:10.1016/b978-0-12-811806-1.00004-4 · Cited by 5 · see citing works
Inhibitory Learning-Based Exposure Therapy for Patients With Pathological Health Anxiety: Results From a Single Case Series Study
Sauer, K. S., Bailer, J., Jungmann, S. M., & Witthöft, M. (2023) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2022.08.001 · Cited by 3 · see citing works

Childhood injury prevention in Israel
Hemmo-Lotem, M., Jinich-Aronowitz, C., Silbinger, O., et al. (2000) · Injury Control and Safety Promotion
The role of the ministry of health in preventing injuries and violence
Krug, E. G., & Sminkey, L. (2007) · International Journal of Injury Control and Safety Promotion · doi:10.1080/17457300701587319 · Cited by 2 · see citing works
Cycling to school--a significant health risk?
Kopjar, B., & Wickizer, T. M. (1995) · Injury Prevention · doi:10.1136/ip.1.4.238 · Cited by 20 · see citing works
Analysis of paediatric injuries related to child restraint seats: Are children at higher risk of injury outside the vehicle than inside?
Desapriya, E., Pike, I., & Singhal, A. (2007) · International Journal of Injury Control and Safety Promotion · doi:10.1080/17457300701577252 · Cited by 2 · see citing works
Does improving poison prevention practices reduce childhood poisoning rates
Forjuoh, S. N. (2016) · International Journal of Injury Control and Safety Promotion · doi:10.1080/17457300.2016.1129748 · Cited by 6 · see citing works

Authors: Olatunji, B. O., Etzel, E. N., Tomarken, A. J., Ciesielski, B. G., & Deacon, B.
Affiliations: Vanderbilt University (US)
University of Wyoming (US)
Corresponding author: Olatunji, Bunmi O.
ORCID: Olatunji, Bunmi O.
Tomarken, Andrew J.
Deacon, Brett
Venue: Behaviour Research and Therapy
Publisher: Elsevier BV
Published: 2011-11
Volume: 49
Issue: 11
Pages: 719-728
ISSN: 0005-7967 (ISSN-L)
DOI: 10.1016/j.brat.2011.07.008
OpenAlex: W2127217888
Cited by: 192
References: 68
Citations by year: 2026: 10 · 2025: 12 · 2024: 8 · 2023: 14 · 2022: 27 · 2021: 24 · 2020: 10 · 2019: 10 · 2018: 12 · 2017: 14 · 2016: 11 · 2015: 13 · 2014: 14 · 2013: 5 · 2012: 7
FWCI: 11.13
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Behaviour Research and Therapy (publishedVersion)
PubMed (publishedVersion)
Research Online (University of Wollongong) (submittedVersion)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
Keywords: safety behavior, health anxiety, catastrophic thinking, fear of contamination, avoidance behavior, anxiety disorders
MeSH terms: Adult, Avoidance Learning, Fear, Female, Health Status, Humans, Hypochondriasis, Male, Patient Compliance, Psychiatric Status Rating Scales, Safety, Health Behavior, Case-Control Studies

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

The effects of safety behaviors on health anxiety: An experimental investigation

Abstract

Integrity signals

Claims the paper makes

Claims other papers make about this one

Cites

Cited by

Related

Record

About these checks