Cited by 548Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and AssessmentsPsychotherapy Techniques and Applications

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Social phobia: The role of in-situation safety behaviors in maintaining anxiety and negative beliefs

Wells, Adrian, Clark, David M., Salkovskis, Paul, Ludgate, John, Hackmann, Ann, Gelder, Michael·1995·Behavior Therapy

DOI 10.1016/s0005-7894(05)80088-7

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Safety Behaviors and Social Anxiety: An Examination of the Social Phobia Safety Behaviours Scale
Kocovski, N. L., MacKenzie, M. B., Albiani, J. J., Battista, S. R., Noel, S., Fleming, J. E., & Antony, M. M. (2015) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-015-9498-6 · Cited by 13
“When individuals with social anxiety disorder are instructed to disengage from their typical safety behaviors, they experience a significant decrease in anxiety; in addition, exposure is more effective when instructions to stop performing safety behaviors are included compared to exposure without such instructions (e.…”
Background
Combining Cognitive-Behavioral Therapy and Pharmacotherapy for the Treatment of Panic Disorder
Smits, J. A. J., O’Cleirigh, C. M., & Otto, M. W. (2006) · Journal of Cognitive Psychotherapy · doi:10.1891/jcop.20.1.75 · Cited by 12
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The role of excessive reassurance seeking: An eye tracking study of the indirect effect of social anxiety symptoms on attention bias
Taylor, D. L., Kraines, M. A., Grant, D. M., & Wells, T. T. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.02.039 · Cited by 11
Intentions matter: Avoidance intentions regulate anxiety via outcome expectancy.
Ng, A., & Lovibond, P. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.03.007 · Cited by 11
Health anxiety is associated with fearful imagery of contracting COVID-19: An experimental study
Benke, C., Schönborn, T., Habermann, N., & Pané‐Farré, C. A. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.11.014 · Cited by 10
“In a line with etiological models of HA (Warwick and Salkovskis, 1990) and evidence from studies in posttraumatic stress disorder or anxiety disorder patients (Wells et al., 1995; Hackmann and Holmes, 2004; Hirsch et al., 2006; Hirsch and Holmes, 2007; Holmes and Mathews, 2010), it has been proposed that intrusive ima…”
Background
Reconceptualizing the Self
Stopa, L. L. (2009) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2008.11.001 · Cited by 11
Factor Structure and Other Psychometric Properties of the Social Phobia Inventory in Korean Samples
Cho, Y., Choi, Y.-H., Kim, S., & Hong, S. (2018) · Measurement and Evaluation in Counseling and Development · doi:10.1080/07481756.2018.1435188 · Cited by 11
“Moreover, several training segments for simulated exposure with dropping safety behaviors (Kim, 2005; Wells et al., 1995), video-feedback trainings (i.”
Background
ATTENTIONAL FOCUS AND FEAR OF BLUSHING: A CASE STUDY
Mulkens, S., Bögelts, S. M., & de Jong, P. J. (1999) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465899272062 · Cited by 11
“Dysfunctional beliefs might be influenced through the experience of disconfirming information, in the case of TCT by becoming more aware of the task and the environment (cf. Clark & Wells, 1995), and in the case of EXP by dropping the safety behaviours (cf. Wells et al., 1995).”
BackgroundInfluential
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
“, 2008; Sloan and Telch, 2002) and eliminating safety behaviours is associated with enhanced treatment outcome (Kim, 2005; Morgan and Raffle, 1999; Wells et al., 1995).”
Background
Exposure reduces negative bias in self-rated performance in public speaking fearful participants
Cheng, J. M., Niles, A. N., & Craske, M. G. (2016) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2016.07.006 · Cited by 13
“Finally, cognitive preparation that encouraged participant to challenge their negative thoughts during exposure also led to enhanced outcome in anxiety and performance-related cognitions (Wells et al., 1995).”
Background
How Are Service Dogs for Adults with Post Traumatic Stress Disorder Integrated with Rehabilitation in Denmark? A Case Study
Glintborg, C., & Hansen, T. G. B. (2017) · Animals · doi:10.3390/ani7050033 · Cited by 14
“At the same time, safety behaviors have been described as a major cause of continuing anxiety and a reason why people may not desensitize to unrealistically feared stimuli during exposures [28].”
Background
Interaction Effects of Behavioral Inhibition System/Behavioral Activation System and Cost/Probability Biases on Social Anxiety
Ito, R., Kobayashi, N., Yokoyama, S., Irino, H., Takebayashi, Y., & Suzuki, S. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02536 · Cited by 10
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
The effects of dropping in‐situation safety behaviors in the treatment of social phobia
García‐Palacios, A., & Botella, C. (2003) · Behavioral Interventions · doi:10.1002/bin.125 · Cited by 11
Social Anxiety, Social Anxiety Disorder, and the Self
Alden, L. E., & Regambal, M. J. (2010) · Elsevier eBooks · doi:10.1016/b978-0-12-375096-9.00016-x · Cited by 10
Avoidance Behavior Prevents Modification of Fear Memory During Reconsolidation
Nitta, Y., Takahashi, T., Haitani, T., Sugimori, E., & Kumano, H. (2018) · Psychological Reports · doi:10.1177/0033294118811116 · Cited by 10
“In addition, avoidance behavior can reportedly prevent the effect of exposure therapy for anxiety disorders (Salkovskis, Clark, Hackmann, Wells, & Gelder, 1999; Wells et al., 1995).”
Background
Panic Disorder and Agoraphobia
Bouman, T. K., & Emmelkamp, P. M. G. (1996) · Springer eBooks · doi:10.1007/978-1-4899-1528-3_2 · Cited by 11
Relational Processes in Social Anxiety Disorder
Alden, L. E., Regambal, M. J., & Plasencia, L. (2014) · Wiley eBooks · doi:10.1002/9781118653920.ch8 · Cited by 13
Catch the drift: Depressive symptoms track neural response during more efficient decision-making for negative self-referents
Castagna, P. J., Waters, A. C., Edgar, E. V., Budagzad-Jacobson, R. S., & Crowley, M. J. (2023) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2023.100593 · Cited by 9
“…study self-referential processing of emotional stimuli, and therefore, is a suitable candidate for a task assessing self-concept, an important phenotype of major depression (Beck, 2008; Beevers et al., 2019) and social anxiety (Clark and Wells, 1995; Dainer-Best et al., 2018; Wells et al., 1995).”
Background
Perceived changes in mental health and social engagement attributed to a single psychedelic experience in autistic adults: results from an online survey
Stroud, J., Rice, C., Orsini, A., Schlosser, M., Lee, J., Mandy, W., & Kamboj, S. K. (2024) · Psychopharmacology · doi:10.1007/s00213-024-06685-8 · Cited by 11
“…explored in future work is that this change may be explained by reductions in social anxiety, as social anxiety often involves safety behaviours aimed to mask anxiety or feared perceptions of the self, leading to social interaction being experienced as ‘forced’ or ‘unnatural’ (Wells et al. 1995).”
In-situation safety behaviours as a factor in the maintenance and treatment of sexual dysfunctions
Frank, E., Noyon, A., Höfling, V., & Heidenreich, T. (2010) · Sexual & Relationship Therapy · doi:10.1080/14681990903433703 · Cited by 9
“While these multiple factors interact in a complex way (Suls & Rothmann, 2004), recent research in anxiety disorders has mainly focused on a cognitive perspective (Clark & Wells, 1995 ), which has helped to improve both theoretical understanding and treatment of these disorders.”
Background
Being Shy at School
Rudasill, K. M., & Kalutskaya, I. N. (2014) · Sex Roles · doi:10.1007/s11199-014-0345-0 · Cited by 9
Why safety behaviour may not be that bad in the treatment of anxiety disorders: The commitment to future exposures
de Ruiter, C., Reininghaus, J. K., van der Stap, D. V., & Engelhard, I. M. (2011) · Cited by 9
Development and Initial Test of the Safety Behaviors in Test Anxiety Questionnaire: Superstitious Behavior, Reassurance Seeking, Test Anxiety, and Test Performance
Knoll, R. W., Valentiner, D. P., & Holzman, J. B. W. (2016) · Assessment · doi:10.1177/1073191116686685 · Cited by 12
Panic Disorder and Agoraphobia
Salkovskis, P. M. (1998) · Elsevier eBooks · doi:10.1016/b0080-4270(73)00200-5 · Cited by 9
Self-citation
The Relationship between Three Subtypes of Safety Behaviors and Social Anxiety: Serial Mediating Effects of State and Trait Post-Event Processing
Kim, D., Kang, H.-Y., & Ahn, J.-K. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.987426 · Cited by 8
“During PEP, individuals with SAD create negative images of themselves in social situations (Clark and Wells, 1995).”
BackgroundResultInfluential
Efficacy of a novel safety behavior elimination intervention for posttraumatic stress symptoms: Results from a randomized controlled trial
Bedford, C. E., & Schmidt, N. B. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.07.002 · Cited by 8
Personality subtypes in adults with social anxiety disorder - novelty seeking makes the difference
Chung, M., Seib‐Pfeifer, L., Elling, C., Geiser, F., Forstner, A. J., Schumacher, J., & Conrad, R. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04484-z · Cited by 10
Social memory characteristics of non-clinical college students with social anxiety
Gong, H., Cao, Q., & Li, M. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.01.075 · Cited by 8
Die Wirksamkeit ambulanter Psychotherapie der Sozialen Angststörung in einer universitären Ambulanz
Heinrichs, N., Nowak, C., Oertel, J., & Kröger, C. B. (2009) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/1616-3443.38.3.181 · Cited by 9
Empirically Supported Psychological Treatments for Social Phobia
Fresco, D. M., & Heimberg, R. G. (2001) · Psychiatric Annals · doi:10.3928/0048-5713-20010801-07 · Cited by 7
Living and Learning: Reproducing Beliefs in Selective Experience
Elwin, E. (2012) · Journal of Behavioral Decision Making · doi:10.1002/bdm.1770 · Cited by 8
Behandeling van angst om te blozen, trillen of zweten
Bögels, S. M., & Scholing, A. (1995) · Tijdschrift voor Psychotherapie · doi:10.1007/bf03079232 · Cited by 8
The Role of Anxiety Control Strategies in Imaginal Exposure
Koerner, N., & Fracalanza, K. (2012) · Springer eBooks · doi:10.1007/978-1-4614-3342-2_12 · Cited by 8
Inhibition of Hypervigilance in the Treatment of Traumatic Simple Phobias: Three Case Examples
Lee, A. S. Y., Vaughan, K., & Armstrong, M. S. (1999) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/j.1440-1614.1999.00586.x · Cited by 8
“[14], who showed that the inhibition of safety behaviours in social phobia resulted in an improved outcome for therapeutic exposure.”
Background
Psychosocial Treatments for Social Phobia
Masia, C. L., & Schneier, F. R. (1999) · CNS Spectrums · doi:10.1017/s1092852900012505 · Cited by 8
Cognitive Therapy for Social Phobia
Adrian Wells, A. (2002) · Wiley eBooks · doi:10.1002/9780470713020.ch8 · Cited by 8
Can dialectical behavior therapy skills group treat social anxiety disorder? A brief integrative review
Villalongo Andino, M., Garcia, K. M., & Richey, J. A. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1331200 · Cited by 7
“Several models of SAD emphasize the role of difficulties in ER, mainly decreased emotional awareness, emotional hyper-reactivity, and difficulty regulating the emotional experience (Clark and Wells, 1995; Rapee and Heimberg, 1997; Clark and McManus, 2002; Goldin et al., 2009).”
BackgroundInfluential
An Examination of Feedback Seeking in Individuals With Social Anxiety Disorder, Generalized Anxiety Disorder, or No History of Mental Disorder Using a Daily Diary Method
Wilson, G. A., Koerner, N., & Antony, M. M. (2018) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.32.1.15 · Cited by 7
“Although PFS and NFS can be understood as falling under the broad umbrella of safety behaviors, these specific constructs are rarely explicitly identified and discussed within cognitive and behavioral models of SAD (Wells et al., 1995) and little is known about the specific characteristics of FS in this clinical popul…”
Background
TERAPIA COGNITIVO-COMPORTAMENTAL BREVE PARA TRANSTORNO DE ANSIEDADE SOCIAL: ESTUDO DE CASO
de Almeida, E. R., & Moreno, A. L. (2014) · LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) · Cited by 7
Developing a brief telematic cognitive behavioral therapy for the treatment of social isolation in young adults
Rossetti, M. G., Perlini, C., Girelli, F., Zovetti, N., Brambilla, P., Bressi, C., & Bellani, M. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1433108 · Cited by 7
Acceptability, feasibility, and utility of a safety aid reduction treatment in underserved veterans: a pilot investigation
Raines, A. M., Chambliss, J. L., Norr, A. M., Sanders, N., Smith, S., Walton, J. L., True, G., Franklin, C. L., & Schmidt, N. B. (2022) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2022.2130819 · Cited by 7
A preliminary investigation of continuous and intermittent exposures in the treatment of public speaking anxiety.
Seim, R. W., Waller, S. A., & Spates, C. R. (2010) · International Journal of Behavioral Consultation and Therapy · doi:10.1037/h0100903 · Cited by 7
Focus-of-attention behavioral experiment: an examination of a therapeutic procedure to reduce social anxiety
Renner, K. A., Valentiner, D. P., & Holzman, J. B. W. (2016) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2016.1225814 · Cited by 7
“There is some evidence from single-session studies for the benefits of adding instructions to exposure to focus externally (Wells & Papageorgiou, 1998) and drop safety behaviors (Wells et al., 1995).”
Background
Predictors of benzodiazepine use in a transdiagnostic sample of panic disorder, social anxiety disorder, and obsessive-compulsive disorder patients.
Laurito, L. D., Loureiro, C. P., Dias, R. V., Vigne, P., Menezes, G., Freire, R., Stangier, U., & Fontenelle, L. F. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.02.013 · Cited by 5
Manualized Cognitive-Behavioral Treatment of Social Anxiety Disorder
Shorey, R. C., & Stuart, G. L. (2012) · Clinical Case Studies · doi:10.1177/1534650112438462 · Cited by 7
“That is, individuals with SAD often have excessive self-focused attention, which may be in an attempt to prevent one from embarrassing or humiliating themselves in social situations (Wells et al., 1995).”
Background
Avatar-Based Feedback in Job Interview Training Impacts Action Identities and Anxiety
Hosseini, S., Quan, J., Deng, X., Miyake, Y., & Nozawa, T. (2024) · IEEE Transactions on Affective Computing · doi:10.1109/taffc.2024.3363835 · Cited by 12
“…changes in participants who received the avatar-based feedback can be explained by an increase in anxiety in the control group during the feedback session and the fact that socially anxious individuals have a tendency against self-disclosure [85], which could jeopardize a successful job inter-view.”
Background
Unconditioned stimulus devaluation decreases the generalization of costly safety behaviors
Wong, A. H. K., Franzen, M., & Wieser, M. J. (2024) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2024.102847 · Cited by 6
Event‐related potentials of social comparisons in depression and social anxiety
Paz, V., Nicolaisen‐Sobesky, E., Fernández‐Theoduloz, G., Pérez, A., Constantino, F. C., Martínez‐Montes, E., Kessel, D., Cabana, Á., & Gradin, V. B. (2024) · Psychophysiology · doi:10.1111/psyp.14643 · Cited by 6
Shyness and self-consistency and congruence among Chinese adolescents: mediating role of social comparison orientation and moderating role of self-focused attention
Yu, Y., & Sun, H. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1418123 · Cited by 9
Putting on your best face: investigating social anxiety in Instagram users
Toh, L.-A., Millear, P. M. R., Allen, A., & Kannis‐Dymand, L. (2022) · Australian Psychologist · doi:10.1080/00050067.2022.2061328 · Cited by 6
“Although previous studies have examined the role of safety behaviours in maintaining SA in face-to-face social interactions, few have explored their impact on social media interactions (Wells et al., 1995).”
Background
Embodiment in Clinical Disorders and Treatment
Riskind, J. H., Schrader, S. W., & Loya, J. M. (2021) · Springer eBooks · doi:10.1007/978-3-030-78471-3_22 · Cited by 6
The Nature and Treatment of Social Anxiety
Carpenter, J. K., Curtiss, J. E., & Hofmann, S. G. (2017) · Wiley eBooks · doi:10.1002/9781118877142.ch5 · Cited by 6
The scientific status of safety behaviors in body dysmorphic disorder
Patel, T. A., Summers, B. J., & Cougle, J. R. (2024) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2024.100911 · Cited by 5
Early phase testing of functional imagery training as an intervention for anxiety
Andrade, J., Kavanagh, D. J., Bowditch, C., Mackriel, E., Ravenhill, E., Sime, A., Trumfield, E., Watts, J., & May, J. (2025) · Behaviour Research and Therapy · doi:10.1016/j.brat.2025.104786 · Cited by 5
Psychometric properties of the brief fear of negative evaluation scale—Straightforward items
Baldanzini, G., Bottesi, G., Carleton, R. N., & Granziol, U. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1572752 · Cited by 5
Social Anxiety and Social Surrogacy in College Roommate Relationships
Boucher, E. M., & Cummings, J. A. (2017) · European Journal of Personality · doi:10.1002/per.2090 · Cited by 7
“…during social interactions, including planning their social exchanges in advance (Arkin & Grove, 1990), engaging in safety behaviours during actual interactions (e.g. Wells et al., 1995) or interacting with others via computer-mediated communication rather than face-to-face (e.g. Pierce, 2009).”
Background
Interpersonal Patterns in Social Anxiety Disorder: Predictors and Outcomes of Cognitive-Behavioral Therapy
Swee, M. B., Butler, R. M., Ross, B. V., Horenstein, A., O’Day, E. B., & Heimberg, R. G. (2021) · Cognitive Therapy and Research · doi:10.1007/s10608-020-10192-3 · Cited by 6
“One maintaining factor in this feedback loop may be the use of safety behaviors, defined as subtle or overt behavioral strategies employed to mitigate perceived social risks and decrease anxiety (Wells et al. 1995; for a review of the role of safety behaviors in social anxiety, see Piccirillo et al. 2016).”
Background
The Role of Safety Behaviors in the Relationship between Social Anxiety and Marijuana Use Problems
Mueller, N. E., McDermott, K. A., & Cougle, J. R. (2021) · Substance Use & Misuse · doi:10.1080/10826084.2021.1922449 · Cited by 5
“Safety behaviors enable avoidance of a feared stimulus, and as a result, exposure therapy cannot be implemented most effectively when safety behaviors are used (Wells et al., 1995).”
Background
Effects of Safety Behavior Fading on Bulimic Symptoms and Drive for Thinness
Stentz, L. A., Wilver, N. L., McDermott, K. A., & Cougle, J. R. (2022) · Cognitive Therapy and Research · doi:10.1007/s10608-022-10311-2 · Cited by 5
“SBs can be paradoxical in that they are employed to decrease or eliminate appearance-related anxiety or discomfort, but they may actually maintain and exacerbate symptoms in the long-run (Clark, 1999; Salkovskis, 1991; Wells et al., 1995; Wilver et al., 2020; Summers & Cougle, 2018) found that among a cohort of underg…”
Background
Threat belief determines the degree of costly safety behavior: Assessing rule-based generalization of safety behavior with a dimensional measure of avoidance.
Wong, A. H. K., & Pittig, A. (2022) · Behaviour Research and Therapy · doi:10.1016/j.brat.2022.104158 · Cited by 6
Reduction of costly safety behaviors after extinction with a generalization stimulus is determined by individual differences in generalization rules
Wong, A. H. K., Lee, J. C., Engelke, P., & Pittig, A. (2022) · Behaviour Research and Therapy · doi:10.1016/j.brat.2022.104233 · Cited by 5
Safety-Seeking Behaviors and Anxiety Maintenance in People With Aphasia: A Viewpoint
Jewell, C. C., & Harnish, S. M. (2024) · American Journal of Speech-Language Pathology · doi:10.1044/2024_ajslp-23-00419 · Cited by 5
Helping Exposure Succeed: Learning Theory Perspectives on Treatment Resistance and Relapse
Powers, M. B., Vervliet, B., Smits, J. A. J., & Otto, M. W. (2009) · Springer eBooks · doi:10.1007/978-1-4419-0612-0_3 · Cited by 5
“Nonetheless, it is important to note that the result of the heuristic is similar to those derived from a cognitive perspective that seeks to use experience from “behavioral experiments” to provide unambiguous opportunities to change beliefs underlying anxiety disorders (e.g., Wells et al., 1995 ).”
BackgroundResult
Culturally Competent CBT
Ashworth, K. J., Randall, J. A., Millen, A., & Rosqvist, J. (2011) · Clinical Case Studies · doi:10.1177/1534650111435163 · Cited by 7
The Cognitive-Behavioral Treatment of Social Phobia
Feeney, S. L. (2004) · Clinical Case Studies · doi:10.1177/1534650103259621 · Cited by 5
“As Salkovskis (1991) and Wells et al. (1995) have pointed out, these behaviors are problematic for two reasons.”
Background
Levels of perceived control and treatment response in a brief partial hospital setting
Wadsworth, L. P., Wessman, I. D., Beard, C., & Björgvinsson, Þ. (2019) · Neurology Psychiatry and Brain Research · doi:10.1016/j.npbr.2019.08.001 · Cited by 5
False safety behavior use among Black adults
Buckner, J. D., Zvolensky, M. J., Ferrie, M. L., & Morris, P. E. (2022) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2022.2139291 · Cited by 5
“…anxiety, depression, and STB. Cognitive behavioral therapy (CBT) is a type of psychosocial intervention that reduces FSB use (Cuming et al., 2009; Wells et al., 1995) and some CBTs have thus been developed to specifically target FSB to reduce anxiety and related symptoms (Riccardi et al., 2017;…”
Background
Using signals associated with safety in avoidance learning: computational model of sex differences
Radell, M. L., Beck, K. D., Pang, K. C. H., & Myers, C. E. (2015) · PeerJ · doi:10.7717/peerj.1081 · Cited by 6
“Instead, the absence of an aversive consequence may be attributed to performing the avoidance behavior, reducing treatment effectiveness (McManus, Sacadura & Clark, 2008; Salkovskis et al., 1999; Wells et al., 1995).”
Background
From Fear to Avoidance: Factors Associated with the Onset of Avoidance in People who Fear Social Situations
Sunderland, M., Crome, E., Stapinski, L. A., Baillie, A., & Rapee, R. M. (2016) · Journal of Experimental Psychopathology · doi:10.5127/jep.055216 · Cited by 5
“Although avoidance of social situations is not a requirement for diagnosis of social anxiety disorder, it plays a central role in models of social anxiety (e.g. Rapee & Heimberg, 1997; Wells et al., 1996).”
Background
Introduction: Rethinking the Model - Refining the Method
Neudeck, P., & Wïttchen, H. (2012) · Springer eBooks · doi:10.1007/978-1-4614-3342-2_1 · Cited by 5
Agoraphobia
Emmelkamp, P. M. G., & Powers, M. B. (2009) · Springer eBooks · doi:10.1007/978-0-387-09757-2_26 · Cited by 5
Racism and Anxiety in a Black American Sample: The Role of Mediators and a Brief Mindfulness Manipulation
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Psychotherapeutic Interventions for Phobias: A Review
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Social Anxiety Disorder
du Toit, P. L., & Stein, D. J. (2002) · Wiley eBooks · doi:10.1002/9780470986844.ch7 · Cited by 5
Social Anxiety Disorder
Ledley, D. R., Erwin, B. A., Morrison, A. S., & Heimberg, R. G. (2017) · Psychopathology · doi:10.1002/9781394258949.ch2 · Cited by 5
Mechanisms of Action in the Treatment of Social Anxiety Disorder
Otto, M. W., Safren, S. A., & Hearon, B. A. (2014) · Social Anxiety · doi:10.1016/b978-0-12-394427-6.00027-3 · Cited by 5
Reducing safety behaviors to prevent anxious symptoms: a pre-registered prevention intervention study
Gorman, E. L., Goodson, J. T., & Haeffel, G. J. (2023) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2023.2237671 · Cited by 4
“These studies have found that reducing safety behaviors enhances treatment outcomes across anxiety disorders (Farrell et al., 2019; McManus et al., 2008; Morgan & Raffle, 1999; Wells et al., 1995).”
The standalone effect of safety behavior manipulations: A systematic review and meta-analysis
Goodson, J. T., Patel, T. A., Zech, J. M., Sala, M. C., & Cougle, J. R. (2026) · Clinical Psychology Review · doi:10.1016/j.cpr.2026.102703 · Cited by 4
The Influence of Temperament, Theory of Mind, Inhibitory Control, and Prosocial Behavior on Child Anxiety Symptoms in the First Five Years of Life
Valdes, V., Craighead, L. W., Nelson, C. A., & Enlow, M. B. (2024) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-024-01250-5 · Cited by 4
“Adult models that account for the maintenance of anxiety disorders have relied on cognitive behavioral frameworks (Clark, 1986; Salkovskis et al., 1998; Wells et al., 1995).”
Avoiding Treatment Failures in Social Anxiety Disorder
Hofmann, S., Richey, J., Asnaani, A., & Sawyer, A. T. (2010) · Springer eBooks · doi:10.1007/978-1-4419-0612-0_10 · Cited by 2
“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, Gruter-Andrew, & Shafran, 2000).”
Background
Do Obsessions and Compulsions Play a Role in Social Anxiety Disorder?
Bjornsson, A. S., & Phillips, K. A. (2013) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000009 · Cited by 4
“glass tightly, avoiding eye contact) can contribute to maintaining SAD and that asking patients with SAD to drop their safety behaviors can enhance treatment efficacy.(18,20)”
Background
The impact of alcohol use disorders and alcohol consumption on treatment-seeking individuals with social anxiety disorder
Subotic-Kerry, M., Baillie, A., Stapinski, L. A., Abbott, M. J., MacDonald, J., Gaston, J. E., & Rapee, R. M. (2021) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2021.85.2.100 · Cited by 4
Registered report: Initial development and validation of the eating disorders safety behavior scale
Reilly, E. E., Bohrer, B. K., Sullivan, D. J., Essayli, J. H., Farrell, N. R., Brown, T. A., Gorrell, S., Anderson, L. M., Cooper, M., Schreyer, C. C., et al. (2021) · International Journal of Eating Disorders · doi:10.1002/eat.23479 · Cited by 5
“If an individual approaches a feared stimulus, engages in a safety behavior, and their feared outcome does not occur, they may attribute the disconfirmation to the safety behavior, rather than learning that their expectancy was violated (Wells et al., 1995).”
BackgroundInfluential
Breathing Retraining for Individuals Who Fear Respiratory Sensations: Examination of Safety Behavior and Coping Aid Hypotheses
Lickel, J. J., Carruthers, B. R., Dixon, L. J., & Deacon, B. J. (2013) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.27.2.111 · Cited by 4
“…response (e.g., Morgan & Raffle, 1999; Salkovskis, Clark, Hackmann, Wells, & Gelder, 1999; Schmidt, Richey, Maner, & Woolaway-Bickel, 2006; Wells et al., 1995); thus, concerns that breathing retraining may be used as a safety behavior among individuals with high anxiety sensitivity…”
Background
Circumventing the Vasovagal Fainting Response
Seim, R. W., Willerick, M. S., Gaynor, S. T., & Spates, C. R. (2008) · Clinical Case Studies · doi:10.1177/1534650108316932 · Cited by 4
How do the cost bias and probability bias influence social anxiety symptoms?
Shirotsuki, K., Sasagawa, S., & Nomura, S. (2010) · The Japanese journal of psychology · doi:10.4992/jjpsy.81.381 · Cited by 4
“…SAD症状と区別するため，大学生の社会的状況における認知・行動・不安感情を社会不安症状と記述する。方法調査対象大学生 319名に質問紙調査を行い，項目の回答に不備のない 290 名（男性 116 名，女性 167 名，不明 7 名; 平均年齢 20.06 歳，SD＝1.63)を分析の対象とした（有効回答率 90.9％）。調査は，大学の講義の終了後に行った。調査が強制でないこと，個人の情報が保護されることを教示した上で，研究の主旨に同意した場合，回答を依頼した。調査材料 Short Fear of Negative Evaluation scale Short…”
Influential
Revisiting the Social Surrogate Hypothesis: Social Anxiety and Recruiting Others for Social Events
Boucher, E. M., & Cummings, J. A. (2014) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2014.33.7.653 · Cited by 4
“It is unclear, specifically, whether or not social surrogacy should be considered a positive coping strategy, or a safety behavior (Wells et al., 1995) with potential negative consequences.”
Background
Development and Preliminary Validation of the Threat Appraisal Questionnaire for Children (TAQ-C)
Francis, R., Hawes, D. J., Abbott, M. J., & Costa, D. S. J. (2016) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-016-9584-4 · Cited by 4
“In contrast, social threat in Social Phobia tends to be more related to ‘avoidance of’ or ‘safety’ behaviours in social situations which require meeting new people, being observed, or performing in front of others (American Psychiatric Association 2013; Hofmann 2007; Wells et al. 1995).”
Chapter 7. Generalized Anxiety Disorder
Huppert, J. D., & Rynn, M. A. (2004) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615377138.lg07 · Cited by 4
Social Anxiety Disorder
Bruce, L. C., & Heimberg, R. G. (2013) · Wiley eBooks · doi:10.1002/9781118528563.wbcbt38 · Cited by 6
Associations between stuttering avoidance and perceived patient-centeredness of health care interactions
Mallipeddi, N. V., Aulov, S., & Perez, H. R. (2022) · Journal of Fluency Disorders · doi:10.1016/j.jfludis.2022.105918 · Cited by 3
Adverse Childhood Experiences and Symptom Severity in Social Anxiety Disorder: The Role of Emotion Regulation
Karaağaç, M., & İmre, O. (2024) · Journal of Interpersonal Violence · doi:10.1177/08862605241285409 · Cited by 4
“Previous studies of SAD have shown that emotion irregularity or difficulties related to emotion regulation play an important part in the pathophysiology of the disease (Hofmann, 2007; Wells et al., 1995).”
Social phobia: maintenance models and main components of CBT.
Marom, S., Aderka, I. M., Hermesh, H., & Gilboa‐Schechtman, E. (2009) · PubMed · Cited by 3
An empirical analysis of Moscovitch’s reconceptualised model of social anxiety: How is it different from fear of negative evaluation?
Kizilcik, I. N., Gregory, B., Baillie, A., & Crome, E. (2015) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2015.11.005 · Cited by 4
Transdiagnostische expositionsbasierte Behandlung von Angststörungen
Neudeck, P., Brahm, C. I., & Hamm, A. O. (2017) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/1616-3443/a000446 · Cited by 3
Validation of Korean version of Subtle Avoidance Frequency Examination(SAFE)
구훈정, Kwon, J., & Yang, E. (2012) · The Korean Journal of Clinical Psychology · doi:10.15842/kjcp.2012.31.3.004 · Cited by 3
Social Anxiety Disorder
Shin, J., Grossman, J. T., Rodriguez, C. R., & Rodebaugh, T. L. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00228-4 · Cited by 3

Authors: Wells, A., Clark, D. M., Salkovskis, P., Ludgate, J., Hackmann, A., & Gelder, M.
Affiliations: University of Oxford (GB)
ORCID: Clark, David M.
Salkovskis, Paul
Venue: Behavior Therapy
Publisher: Elsevier BV
Published: 1995
Volume: 26
Issue: 1
Pages: 153-161
ISSN: 0005-7894 (ISSN-L)
DOI: 10.1016/s0005-7894(05)80088-7
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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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Social phobia: The role of in-situation safety behaviors in maintaining anxiety and negative beliefs

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