Social phobia: the role of in-situation safety behaviors in maintaining anxiety and negative beliefs
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These constructs produce a positive feedback loop that sustains social anxiety by preventing exposure despite repeated successful social encounters.
“These constructs produce a positive feedback loop that sustains social anxiety by preventing exposure despite repeated successful social encounters (Wells et al., 1995).”
From Can dialectical behavior therapy skills group treat social anxiety disorder? A brief integrative review (2024) · cites this paper as Wells et al., 1995
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“Clinical studies on exposure therapy show that access to safety behaviors can interfere with the beneficial effects of an exposure situation (Lovibond, Mitchell, Minard, Brady, & Menzies, 2009; Salkovskis, Clark, Hackmann, Wells, & Gelder, 1999; Wells et al., 1995).”
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“That is, Salkovskis (1991) and Wells et al. (1995) showed that requesting anxious clients to refrain from ‘within situation safety behaviors’ led to greater improvement after an exposure session than no instructions regarding safety behaviors, although how well clients refrained from those…”
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“As a result, the individual with SAD anticipates social mishaps and engages in avoidance and/or safety behaviors (Wells et al., 1995), followed by post-event rumination (Mellings & Alden, 2000; Rachmann, Grüter-Andrew, & Shafran 2000).”
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“In certain instances, individuals who approach a feared situation will attribute their ability to navigate the situation to the safety behavior (Wells et al. 1995).”
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“…way that people with anxiety disorders adopt certain behaviours in order to prevent some feared catastrophe (Salkovskis, 1991, 1996; Clark, 1996; Wells et al., 1995), those with distressing delusional beliefs initiate attempts to avert any negative outcomes that are implied in the delusional…”
BackgroundAcceptance and mindfulness-based therapy: New wave or old hat?
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“As a result, individuals with SAD anticipate social mishaps and engage in avoidance and/or safety behaviors (Wells et al., 1995), followed by post-event rumination (McManus, Sacadura, & Cark, in press; Mellings & Alden, 2000; Rachmann, Grüter-Andrew, & Shafran, 2000).”
BackgroundClark, D. M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M., Grey, N., Waddington, L., & Wild, J. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.3.568 · Cited by 603 · see citing works
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“Second, therapy experiments that attempt to assess the short-term impact of discrete therapy maneuvers have shown that several of the procedures involved in the CT program (dropping safety behaviors, shifting to an external focus of attention, and using video feedback) have beneficial effects over and above those obta…”
ResultSelf-citationWeeks, J. W., Heimberg, R. G., Fresco, D. M., Hart, T. A., Turk, C. L., Schneier, F. R., & Liebowitz, M. R. (2005) · Psychological Assessment · doi:10.1037/1040-3590.17.2.179 · Cited by 557 · see citing works
“For example, socially anxious individuals exhibit a variety of subtle behaviors aimed at avoiding potential negative evaluation ( Wells et al., 1995 ).”
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“And, of course, the deleterious effects of down- regulating (avoiding) emotion through reliance on talismen or safety signals have been conclusively demonstrated (Salkovskis, Clark, Hackman, Wells, & Gelder, 1999; Sloan & Telch, 2002; Wells et al., 1995).”
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“Cognitive approaches target beliefs regarding personal defects that could lead to ridicule or censure by others in social situations (Beck & Emery 1985), and a recent extension focuses on the elimination of safety behaviors that retard the disconfirmation of those beliefs (Wells et al. 1995).”
BackgroundThe treatment of social anxiety disorder
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“Indeed, there is evidence that analyzing and halting safety behaviors enhances the efficacy of exposure (Wells et al., 1995).”
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“Specifically, it has been suggested that while undergoing exposure therapy, patients will try to reduce their unpleasantly high fear levels by engaging in overt or covert safety behaviors that reduce those fear levels (“within situation safety”; Wells et al., 1996; Salkovskis et al., 1999).”
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“There is evidence that the type of processes identi®ed in the present experiment generalise beyond panic to other anxiety problems where avoidance and safety behaviours are prominent such as social phobia (Wells et al., 1995; Clark, 1996).”
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“…in higher social-evaluative anxiety (Langer and Rodebaugh, 2013) and the reduction of safety seeking behaviours leads to lower social-evaluative anxiety and reductions in anxiety-related self-judgements (Morgan and Raffle, 1999; Taylor and Alden, 2010, 2011; Wells et al., 1995; see also Table 4).”
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Self-citationSafety behaviour: A reconsideration
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“According to models of self-focus in social anxiety (e.g., Clark & Wells, 1995), when anxious individuals enter a social interaction, they focus attention on the self for the purposes of monitoring selfpresentation .”
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“This follows logically—concerns of doing “too well” (ie, FPE) could result in social threat, and DPSO with regard to others could function as a mental safety behavior (Wells et al, 1995 ; in addition to DPSO-Self), whereas concerns of doing “not well enough” (ie, FNE) would be associated with attributing any positive…”
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“Our fi ndings are consistent with recent studies showing that patients ’ use of safety-seeking behaviors during exposure exert a negative effect on treatment outcome with both PDA patients (Salkovskis et al., 1999) and social phobics ( Wells et al., 1995 ).”
BackgroundResultInfluentialA cognitive-behavioral model of social anxiety disorder
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“Similar concerns have been put forward for social phobia [63].”
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“…highly compatible with attributional and expectancy-based models of learning: if a subject attributes the absence of an expected outcome to the inhibitory stimulus, then there is no reason to revise the causal status of the target stimulus (see also Salkovskis et al., 1996; Wells et al., 1995).”
BackgroundInterpersonal consequences of the pursuit of safety
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“It is encouraging, however, that these results are consistent with earlier research on patients with social phobia ( Wells et al., 1995 ).”
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“In a case series of eight socially phobic patients, Wells et al. (1995) found that, as predicted, exposure plus decreased safety behaviours was significantly better than exposure alone in reducing anxiety and catastrophic beliefs.”
BackgroundKashdan, T. B., Farmer, A. S., Adams, L. M., Ferssizidis, P., McKnight, P. E., & Nezlek, J. B. (2013) · Journal of Abnormal Psychology · doi:10.1037/a0032733 · Cited by 162 · see citing works
“When people with SAD rely on such safety behaviors, they inadvertently contribute to the maintenance of their social anxiety symptoms (Wells et al., 1995).”
BackgroundCognition-behaviour links in the persistence of panic
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“Wells et al. (1995) reported significantly greater efficacy of one session of in vivo exposure combined with a decrease in safety behaviors compared with a single session of exposure alone.”
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The effect of the decreased safety behaviors on anxiety and negative thoughts in social phobics
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Sales Call Anxiety: Exploring What it Means When Fear Rules a Sales Encounter
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“Barlow 1988; Rachman 1998; Wells et al. 1995).”
ResultPowers, 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
“Wells et al. (1995) treated 8 socially phobic patients in a counterbalanced within-subjects design.”
BackgroundResultSalkovskis, P. M., Hackmann, A., Adrian Wells, A., Gelder, M., & Clark, D. M. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.02.008 · Cited by 143 · see citing works
“In both the Wells et al. (1995) and the Salkovskis et al. (1999) studies, the periods of exposure were very brief (15min).”
BackgroundSelf-citationPhobic disorders and panic in adults: A guide to assessment and treatment.
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A functional analysis of danger and safety signals in anxiety disorders
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Self-focused attention before and after treatment of social phobia
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“…consistent with the notion that self-focused attention is part of social phobics' coping attempts to prevent an embarrassing and humiliating situation which interferes with the processing of information that could provide discon®rming evidence against their negative beliefs (Wells et al., 1995).”
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Control theory and psychopathology: an integrative approach.
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“Coping efforts include not only worry and diversion of attention to potential social threat stimuli (Clark & Wells, 1995; Wells & Clark, 1997) but safety behaviors intended to avert feared social catastrophes (Wells et al., 1995).”
BackgroundDoes Reducing Safety Behaviours Improve Treatment Response in Patients with Social Phobia?
Morgan, H., & Raffle, C. (1999) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/j.1440-1614.1999.00599.x · Cited by 128 · see citing works
“Patients with social phobia are exposed to social situations daily but often do not experience reduction in anxiety [3,4].”
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Safety behaviour does not necessarily interfere with exposure therapy
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“For example, individuals with social anxiety disorder may grip objects tightly to avoid shaking while reading to a group or rehearse sentences in their mind and speak quickly to counter the fear of talking inappropriately (Wells et al., 1995).”
BackgroundCognitive Processes in Extinction: Figure 1
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“For example, Salkovskis and his colleagues (see Salkovskis 1991; Wells et al. 1995) have drawn attention to the problem of “safety behaviors” in exposure therapy for anxiety disorders.”
BackgroundNeuropsychiatric Symptoms of Fragile X Syndrome
Tsiouris, J. A., & Brown, W. T. (2004) · CNS Drugs · doi:10.2165/00023210-200418110-00001 · Cited by 120 · see citing works
Virtual Social Interactions in Social Anxiety—The Impact of Sex, Gaze, and Interpersonal Distance
Wieser, M. J., Pauli, P., Grosseibl, M., Molzow, I., & Mühlberger, A. (2010) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2009.0432 · Cited by 115 · see citing works
“28 The research on the avoidance behavior of socially anxious individuals in social interactions is, however, so far scarce.”
Differential effects of safety behaviour subtypes in social anxiety disorder
Plasencia, M. L., Alden, L. E., & Taylor, C. T. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.07.005 · Cited by 115 · see citing works
Brief cognitive therapy for social phobia: a case series
Wells, A., & Papageorgiou, C. (2001) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(00)00036-x · Cited by 109 · see citing works
“In order to abbreviate this treatment, modifications were based on theory (Wells & Matthews, 1994), empirical research supporting treatment components (Harvey, Clark, Ehlers & Rapee, 2000; Wells et al., 1995; Wells & Papageorgiou, 1998, 1999, 2000), and our clinical experience in delivering the intervention.”
MethodLovibond, P. F., Saunders, J. C., Weidemann, G., & Mitchell, C. J. (2008) · Quarterly Journal of Experimental Psychology · doi:10.1080/17470210701503229 · Cited by 109 · see citing works
“It is worth noting that the expectancy account of the relationship between avoidance and anxiety is consistent with contemporary cognitive behavioural models of clinical anxiety and its treatment (eg, Salkovskis, Clark, & Gelder, 1996 ; Wells et al, 1995 ).”
ResultMcMillan, D., & Lee, R. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.01.003 · Cited by 108 · see citing works
Graham, J. R., West, L. M., Martinez, J. H., & Roemer, L. (2016) · Cultural Diversity & Ethnic Minority Psychology · doi:10.1037/cdp0000073 · Cited by 105 · see citing works
Examining the relationship between shame and social anxiety disorder: A systematic review
Swee, M. B., Hudson, C. C., & Heimberg, R. G. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2021.102088 · Cited by 99 · see citing works
Fauville, G., Luo, M., Queiroz, A. C. M., Lee, A., Bailenson, J., & Hancock, J. (2023) · Computers in Human Behavior Reports · doi:10.1016/j.chbr.2023.100271 · Cited by 85 · see citing works
“First, Bailenson (2021) argued that seeing one ’ s reflection in an “ all day mirror ” can be stressful and make individuals expend more cognitive effort on focusing on how they appear to others (Wells et al., 1995).”
Kashdan, T. B., Julian, T., Merritt, K., & Uswatte, G. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.03.010 · Cited by 170 · see citing works
“Self-protective efforts include restriction of emotional expression, safety behaviors, such as talking and moving very little, and cognitive strategies, such as mentally scrutinizing and filtering language before verbalization for the sole purpose of effortful impression management to prevent rejection (prevention mod…”
BackgroundAvoidance behavior in chronic pain research: a cold case revisited
Volders, S., Boddez, Y., De Peuter, S., Meulders, A., & Vlaeyen, J. W. S. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.11.003 · Cited by 97 · see citing works
“…et al., 2005a; de Jong, Vlaeyen, Onghena, Goossens et al., 11 2005b; Vlaeyen, de Jong, Geilen, Heuts, & van Breukelen, 2001; Vlaeyen, de Jong, Geilen, 12 Heuts, & van Breukelen, 2002) as well as randomized controlled trials (Leeuw et al., 2008; 13 Linton et al., 2008; Woods & Asmundson, 2008).”
Otto, M. W., Pollack, M. H., & Sabatino, S. A. (1996) · Behavior Therapy · doi:10.1016/s0005-7894(96)80028-1 · Cited by 98 · see citing works
Mulkens, S., Bögels, S. M., de Jong, P. J., & Louwers, J. (2001) · Journal of Anxiety Disorders · doi:10.1016/s0887-6185(01)00073-1 · Cited by 96 · see citing works
“Exposure in vivo The EXP treatment was based on the latest insights into active exposure components, that is, refraining from subtle avoidance strategies (like averting the eyes or the body when blushing, wearing make-up) and dropping safety behaviors (Wells et al., 1995).”
MethodInfluentialExposure therapy for obsessive-compulsive disorder: an optimizing inhibitory learning approach
Arch, J. J., & Abramowitz, J. S. (2015) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2014.12.002 · Cited by 96 · see citing works
Wong, J., Gordon, E. A., & Heimberg, R. G. (2012) · Handbook of Evidence-Based Practice in Clinical Psychology · doi:10.1002/9781118156391.ebcp002027 · Cited by 96 · see citing works
A Weakly Supervised Learning Framework for Detecting Social Anxiety and Depression
Salekin, A., Eberle, J. W., Glenn, J. J., Teachman, B. A., & Stankovic, J. A. (2018) · Proceedings of the ACM on Interactive Mobile Wearable and Ubiquitous Technologies · doi:10.1145/3214284 · Cited by 90 · see citing works
“Socially anxious people’s social avoidance and safety behavior to reduce or hide their anxiety [100] also can limit others’ knowledge of their distress.”
BackgroundMethodInfluentialHandbook of Brief Cognitive Behaviour Therapy
(2001) · International Journal of Health Care Quality Assurance · doi:10.1108/ijhcqa.2001.06214dae.012 · Cited by 90 · see citing works
Moscovitch, D. A., Rowa, K., Paulitzki, J. R., Ierullo, M. D., Chiang, B., Antony, M. M., & McCabe, R. E. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.05.002 · Cited by 91 · see citing works
“, Moscovitch, Suvak, & Hofmann, 2010), while also promoting submissive withdrawal from social situations (Weeks, Rodebaugh, Heimberg, Norton, & Jakatdar, 2009), including outright avoidance or escape, or the more subtle use of safety behaviors (e.g., Alden & Bieling, 1998; Cuming et al., 2009; McManus, Sacadura, & Cla…”
BackgroundIncreased 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
“The introduction of the concept of SSB has led to significant advances in the theoretical understanding and clinical management of a range of anxiety disorders (e.g., Salkovskis, Clark, Hackmann, Wells, & Gelder, 1999; Wells, Clark, Salkovskis, & Ludgate, 1995 ); its specific application to the study of chronic pain u…”
BackgroundSelf-citationThe Effects of Safety Behavior Directed Towards a Safety Cue on Perceptions of Threat.
Engelhard, I., van Uijen, S. L., van Seters, N., & Velu, N. (2015) · The Behavior Therapist · doi:10.1016/j.beth.2014.12.006 · Cited by 85 · see citing works
“Safety behavior is thought to play a crucial role in the persistence of such danger beliefs (Clark, 1999; Rachman et al., 2008; Salkovskis, 1991; Wells et al., 1995).”
BackgroundExploring the role of behavioral submissiveness in social anxiety
Weeks, J. W., Heimberg, R. G., & Heuer, R. (2011) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2011.30.3.217 · Cited by 88 · see citing works
“as safety behaviors (Wells et al., 1995), with emphasis placed on refraining from these behaviors while engaging in therapeutic exposures (i.”
BackgroundSafety behaviors and judgmental biases in social anxiety disorder
Taylor, C. T., & Alden, L. E. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.11.005 · Cited by 88 · see citing works
“Using a case-controlled experimental design with eight SAD patients, Wells et al. (1995) found that encouraging patients to reduce safety behaviors during exposure to idiosyncratic feared situations significantly reduced patients’ belief that their feared outcome had occurred compared to exposure…”
MethodTaylor, C. T., & Alden, L. E. (2011) · Journal of Abnormal Psychology · doi:10.1037/a0022127 · Cited by 84 · see citing works
“First, previous studies have either measured only intrapersonal outcomes associated with safety bebaviors (i.e., anxiety-related outcomes and fear-related beliefs; e.g., Kim, 2005; Wells et al., 1995) or examined the intra- and interpersonal effects of safety behaviors independently (McManus et al.”
InfluentialEffects of safety behaviors on fear reduction during exposure
Hood, H. K., Antony, M. M., Koerner, N., & Monson, C. M. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.08.006 · Cited by 84 · see citing works
Evidence-based assessment of anxiety disorders in adults.
Antony, M. M., & Rowa, K. (2005) · Psychological Assessment · doi:10.1037/1040-3590.17.3.256 · Cited by 83 · see citing works
Social anxiety predicts avoidance behaviour in virtual encounters
Rinck, M., Rörtgen, T., Lange, W., Dotsch, R., Wigboldus, D. H. J., & Becker, E. S. (2009) · Cognition & Emotion · doi:10.1080/02699930903309268 · Cited by 82 · see citing works
“Wells et al. (1995) called these ‘‘in-situation safety behaviours’’, such as avoiding eye contact, avoiding talking about oneself, and talking quickly.”
BackgroundSafety-Seeking and Coping Behavior During Exposure Tasks with Anxious Youth
Hedtke, K. A., Kendall, P. C., & Tiwari, S. (2009) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374410802581055 · Cited by 81 · see citing works
“…coding manual were chosen to assess variables specific to exposure tasks that are hypothesized to be related to treatment outcome based on previous research (e.g., Salkovskis et al., 1999; Wells et al., 1995), therapist experience, and a qualitative examination of previous videotaped CBT sessions.”
BackgroundMethod
- Authors
- Wells, A., Clark, D. M., Salkovskis, P., Ludgate, J., Hackmann, A., & Gelder, M.
- Affiliations
- University of Oxford (GB)
- Venue
- Behavior Therapy
- Publisher
- Elsevier BV
- Published
- 1995
- Volume
- 26
- Issue
- 1
- Pages
- 153-161
- ISSN
- 0005-7894 (ISSN-L)
- OpenAlex
- W2151136747
- Cited by
- 548
- References
- 22
- Citations by year
- 2026: 16 · 2025: 13 · 2024: 29 · 2023: 18 · 2022: 19 · 2021: 26 · 2020: 13 · 2019: 21 · 2018: 23 · 2017: 18 · 2016: 23 · 2015: 21 · 2014: 35 · 2013: 22 · 2012: 27
- FWCI
- 11.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behavior Therapy (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- social anxiety disorder, safety behavior, exposure therapy, anxiety maintenance
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