The importance of behaviour in the maintenance of anxiety and panic: A cognitive account
Abstract
The theoretical and empirical basis of commonly accepted propositions concerning the role of behaviour in the practice of behavioural psychotherapy for anxiety problems is considered. A number of problems are identified, and an alternative, more explicitly cognitive hypothesis is described. According to this cognitive account, there is both a close relationship and specific interactions between “threat cognitions” and “safety seeking behaviour”. For any individual, safety seeking behaviour arises out of, and is logically linked to, the perception of serious threat. Such behaviour may be anticipatory (avoidant) or consequent (escape). Because safety seeking behaviour is perceived to be preventative, and focused on especially negative consequences (e.g. death, illness, humiliation), spontaneous disconfirmation of threat is made particularly unlikely by such safety seeking behaviours. By preventing disconfirmation of threat-related cognitions, safety seeking behaviour may be a crucial factor in the maintenance of anxiety disorders. The implications of this view for the understanding and treatment of anxiety disorders are discussed.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
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?
Excessive and inflexible use of safety behaviours maintains anxiety disorder symptoms.
“excessive and inflexible use of such behaviours has been observed to maintain anxiety disorder symptoms [31].”
From Health anxiety, coping mechanisms and COVID 19: An Indian community sample at week 1 of lockdown (2021) · cites this paper as [31]
Misinterpreting unwanted intrusive thoughts causes distress and preoccupation and leads to maladaptive responses (safety-seeking behaviors) such as reassurance seeking, avoidance, neutralizing, or rituals.
“Misinterpreting unwanted, intrusive thoughts in this way not only causes distress and a preoccupation with the thought, it also leads to maladaptive responses performed to minimize anxiety or prevent feared consequences. These “safety-seeking behaviors” might include reassurance seeking, avoidance, neutralizing, or rituals (Salkovskis, 1991).”
From A Comparison of Two Brief Interventions for Obsessional Thoughts: Exposure and Acceptance. (2013) · cites this paper as Salkovskis, 1991
Cites
Psychotherapy by reciprocal inhibition
Wolpe, J. (1968) · Pavlovian Journal of Biological Science · doi:10.1007/bf03000093 · Cited by 3,389 · see citing works
Anxiety, sensitivity, anxiety frequency, and the prediction of fearfulness
Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986) · Behaviour Research and Therapy · doi:10.1016/0005-7967(86)90143-9 · Cited by 3,169 · see citing works
Psychotherapy by Reciprocal Inhibition
Masserman, J. H. (1958) · Archives of Neurology And Psychiatry · doi:10.1001/archneurpsyc.1958.02340090135025 · Cited by 3,087 · see citing works
Cognitive Psychology and Emotional Disorders
Williams, J. M. G. (1988) · UWA Profiles and Research Repository (UWA) · Cited by 1,871 · see citing works
Obsessional-compulsive problems: A cognitive-behavioural analysis
Salkovskis, P. M. (1985) · Behaviour Research and Therapy · doi:10.1016/0005-7967(85)90105-6 · Cited by 1,842 · see citing works
Self-citationPavlovian conditioning: it's not what you think it is
Rescorla, R. A. (1988) · American Psychologist · doi:10.1037/0003-066x.43.3.151 · Cited by 1,542 · see citing works
Seligman, M. (1971) · Behavior Therapy · doi:10.1016/s0005-7894(71)80064-3 · Cited by 1,435 · see citing works
Conditioning and Associative Learning
Hill, W. F., & Mackintosh, N. J. (1984) · The American Journal of Psychology · doi:10.2307/1422540 · Cited by 1,323 · see citing works
The conditioning theory of fearacquisition: A critical examination
Rachman, S. (1977) · Behaviour Research and Therapy · doi:10.1016/0005-7967(77)90041-9 · Cited by 1,191 · see citing works
Marks, I. M. (1987) · Cited by 978 · see citing works
Cognitive psychology and emotional disorders
Brewin, C. R. (1989) · Behaviour Research and Therapy · doi:10.1016/0005-7967(89)90110-1 · Cited by 692 · see citing works
Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems
Salkovskis, P. M. (1989) · Behaviour Research and Therapy · doi:10.1016/0005-7967(89)90152-6 · Cited by 606 · see citing works
Self-citation(1978) · Medical Entomology and Zoology · Cited by 605 · see citing works
Warwick, H. M. C., & Salkovskis, P. M. (1990) · Behaviour Research and Therapy · doi:10.1016/0005-7967(90)90023-c · Cited by 587 · cited 1× · see citing works
“For example, it accounts for medical consultation and reassurance seeking in patients anxious about their health (Salkovskis, 1989a; Salkovskis and Warwick, 1986; Warwick and Salkovskis, 1990); the link between such behaviour and the fear of illness is obvious.”
BackgroundSelf-citationPanic: Psychological Perspectives
Rachman, S. J., & Maser, J. D. (1988) · Medical Entomology and Zoology · Cited by 521 · see citing works
I. Synchrony and desynchrony in fear and avoidance
Rachman, S., & Hodgson, R. (1974) · Behaviour Research and Therapy · doi:10.1016/0005-7967(74)90005-9 · Cited by 500 · see citing works
One-session treatment for specific phobias
Öst, L.-G. (1989) · Behaviour Research and Therapy · doi:10.1016/0005-7967(89)90113-7 · Cited by 498 · see citing works
Sanderson, W. C. (1989) · Archives of General Psychiatry · doi:10.1001/archpsyc.1989.01810020059010 · Cited by 492 · see citing works
Panic—Psychological perspectives
Lindsay, S. (1989) · Behaviour Research and Therapy · doi:10.1016/0005-7967(89)90021-1 · Cited by 477 · see citing works
Salkovskis, P. M., & Warwick, H. M. C. (1986) · Behaviour Research and Therapy · doi:10.1016/0005-7967(86)90041-0 · Cited by 475 · cited 1× · see citing works
“For example, it accounts for medical consultation and reassurance seeking in patients anxious about their health (Salkovskis, 1989a; Salkovskis and Warwick, 1986; Warwick and Salkovskis, 1990); the link between such behaviour and the fear of illness is obvious.”
BackgroundSelf-citation(1989) · Medical Entomology and Zoology · Cited by 451 · see citing works
Exposure and cognitive restructuring for social phobia: A controlled study
Mattick, R. P., Peters, L., & Clarke, J. (1989) · Behavior Therapy · doi:10.1016/s0005-7894(89)80115-7 · Cited by 372 · see citing works
White bears and other unwanted thoughts
Wegner, D. M. (1990) · Cited by 293 · see citing works
Warnke, A. (2014) · Springer eBooks · doi:10.1007/978-3-7091-1501-5_11 · Cited by 290 · see citing works
Mattick, R. P., & Peters, L. (1988) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.56.2.251 · Cited by 277 · see citing works
Agoraphobia, nature and treatment
Mathews, A., Gelder, M., & Johnson, D. W. (1981) · Medical Entomology and Zoology · Cited by 274 · see citing works
Preparedness and phobias: A review.
McNally, R. J. (1987) · Psychological Bulletin · doi:10.1037/0033-2909.101.2.283 · Cited by 268 · see citing works
One-session therapist-directed exposure vs. self-exposure in the treatment of spider phobia
Öst, L.-G., Salkovskis, P. M., & Hellström, K. (1991) · Behavior Therapy · doi:10.1016/s0005-7894(05)80374-0 · Cited by 220 · see citing works
Self-citationAgoraphobia: Nature and treatment
Taylor, C. H. (1982) · Comprehensive Psychiatry · doi:10.1016/0010-440x(82)90163-8 · Cited by 216 · see citing works
Anxiety sensitivity in agoraphobics
McNally, R. J., & Lorenz, M. (1987) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/0005-7916(87)90065-6 · Cited by 212 · see citing works
Behaviour therapy and obsessional ruminations: Can failure be turned into success?
Salkovskis, P. M., & Westbrook, D. (1989) · Behaviour Research and Therapy · doi:10.1016/0005-7967(89)90073-9 · Cited by 197 · see citing works
Self-citationCognitive behaviour therapy for psychiatric problems—A practical guide
de Silva, P. (1990) · Behaviour Research and Therapy · doi:10.1016/0005-7967(90)90031-d · Cited by 193 · see citing works
Thought Suppression Induces Intrusions
Lavy, E. H., & van den Hout, M. (1990) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s0141347300010351 · Cited by 164 · see citing works
Questionnaire dimensions of spider phobia
Watts, F., & Sharrock, R. (1984) · Behaviour Research and Therapy · doi:10.1016/0005-7967(84)90061-5 · Cited by 134 · see citing works
Agoraphobia: A safety-signal perspective
Rachman, S. (1984) · Behaviour Research and Therapy · doi:10.1016/0005-7967(84)90033-0 · Cited by 133 · see citing works
Anxiety Management for Persistent Generalised Anxiety
Butler, G., Cullington, A., Hibbert, G. A., Klimeš, I., & Gelder, M. (1987) · The British Journal of Psychiatry · doi:10.1192/bjp.151.4.535 · Cited by 130 · see citing works
Does escape behavior strengthen agoraphobic avoidance? A replication
Rachman, S., Craske, M. G., Tallman, K., & Solyom, C. A. E. (1986) · Behavior Therapy · doi:10.1016/s0005-7894(86)80069-7 · Cited by 113 · see citing works
The primacy of affect: Some theoretical implications
Rachman, S. (1981) · Behaviour Research and Therapy · doi:10.1016/0005-7967(81)90048-6 · Cited by 94 · see citing works
Does escape behaviour strengthen agoraphobic avoidance? A preliminary study
Silva, P. D., & Rachman, S. (1984) · Behaviour Research and Therapy · doi:10.1016/0005-7967(84)90038-x · Cited by 68 · see citing works
The determinants and treatment of simple phobias
Rachman, S. (1990) · Advances in Behaviour Research and Therapy · doi:10.1016/0146-6402(90)90005-b · Cited by 58 · see citing works
Learning theory approaches to psychiatry
(1983) · Scandinavian Journal of Behaviour Therapy · doi:10.1080/16506078309455655 · Cited by 56 · see citing works
Clark, D. M. (1986) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s0141347300014907 · Cited by 55 · see citing works
Cognitive Science and Behavioural Psychotherapy: Where Behaviour was, There Shall Cognition Be?
Power, M. (1991) · Behavioural Psychotherapy · doi:10.1017/s0141347300011484 · Cited by 23 · see citing works
Behavioral aspects of panic disorder
Marks, I. M. (1987) · American Journal of Psychiatry · doi:10.1176/ajp.144.9.1160 · Cited by 23 · see citing works
The Cognitive Revolution: New Way Forward, Backward Somersault or Full Circle?
Salkovskis, P. M. (1986) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s0141347300014890 · Cited by 15 · see citing works
Self-citationCognitive models and interventions in anxiety
Salkovskis, P. M. (1989) · Current Opinion in Psychiatry · doi:10.1097/00001504-198912000-00017 · Cited by 11 · see citing works
Self-citationClassical Conditioning: Still Going Strong
van den Hout, M., & Merckelbach, H. L. G. J. (1991) · Behavioural Psychotherapy · doi:10.1017/s0141347300011514 · Cited by 10 · see citing works
Marks, M. (1991) · Behaviour Research and Therapy · doi:10.1016/0005-7967(91)90013-s · Cited by 9 · see citing works
The Cognitive Revolution: An Ongoing Evolution
Blackburn, I. M. (1986) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s0141347300014889 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Maximizing exposure therapy: An inhibitory learning approach
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.04.006 · Cited by 2,339 · see citing works
“In phobic samples, the availability and use of safety signals and behaviors has been shown to be detrimental to exposure therapy (Sloan & Telch, 2002), whereas instructions to refrain from using safety behaviors improved outcomes (Salkovskis, 1991).”
Harvey, A. G. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00061-4 · Cited by 1,790 · see citing works
Optimizing inhibitory learning during exposure therapy
Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.10.003 · Cited by 1,607 · see citing works
Sleep and emotion regulation: An organizing, integrative review
Palmer, C. A., & Alfano, C. A. (2017) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2015.12.006 · Cited by 935 · see citing works
A cognitive model of persecutory delusions
Freeman, D., Garety, P. A., Kuipers, E., Fowler, D., & Bebbington, P. E. (2002) · British Journal of Clinical Psychology · doi:10.1348/014466502760387461 · Cited by 888 · see citing works
Chronic pain and posttraumatic stress disorder: Mutual maintenance?
Sharp, T. J., & Harvey, A. G. (2001) · Clinical Psychology Review · doi:10.1016/s0272-7358(00)00071-4 · Cited by 779 · see citing works
Understanding and treating obsessive–compulsive disorder
Salkovskis, P. M. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00049-2 · Cited by 732 · see citing works
Self-citationMorrison, A. P. (2001) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465801003010 · Cited by 673 · 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 · see citing works
Social phobia: the role of in-situation safety behaviors in maintaining anxiety and negative beliefs
Wells, A., Clark, D. M., Salkovskis, P., Ludgate, J., Hackmann, A., & Gelder, M. (1995) · Behavior Therapy · doi:10.1016/s0005-7894(05)80088-7 · Cited by 548 · see citing works
Self-citationEspie, C. A., Broomfield, N. M., MacMahon, K. M. A., Macphee, L. M., & Taylor, L. M. (2006) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2006.03.002 · Cited by 532 · see citing works
Chronic pain: A reformulation of the cognitive-behavioural model
Sharp, T. J. (2001) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(00)00061-9 · Cited by 356 · see citing works
Persecutory delusions: a cognitive perspective on understanding and treatment.
Freeman, D. (2016) · The Lancet Psychiatry · doi:10.1016/s2215-0366(16)00066-3 · Cited by 356 · see citing works
Extinction in human fear conditioning
Hermans, D., Craske, M. G., Mineka, S., & Lovibond, P. F. (2006) · Biological Psychiatry · doi:10.1016/j.biopsych.2005.10.006 · Cited by 328 · see citing works
Moscovitch, D. A. (2009) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2008.04.002 · Cited by 322 · see citing works
Anxiety in the eating disorders: Understanding the overlap
Pallister, E., & Waller, G. (2008) · Clinical Psychology Review · doi:10.1016/j.cpr.2007.07.001 · Cited by 315 · see citing works
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
Self-citationMuse, K., McManus, F., Leung, C., Meghreblian, B., & Williams, J. M. G. (2012) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2011.11.005 · Cited by 303 · see citing works
Self-images play a causal role in social phobia
Hirsch, C. R., Clark, D. M., Mathews, A., & Williams, R. (2003) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(02)00103-1 · Cited by 265 · see citing works
A scientific cognitive-behavioral model of tinnitus: Novel conceptualizations of tinnitus distress.
McKenna, L., Handscomb, L., Hoare, D. J., & Hall, D. A. (2014) · Frontiers in Neurology · doi:10.3389/fneur.2014.00196 · Cited by 232 · see citing works
Towards a model of uncertainty distress in the context of Coronavirus (COVID-19)
Freeston, M., Tiplady, A., Mawn, L., Bottesi, G., & Thwaites, S. (2020) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x2000029x · Cited by 221 · see citing works
Rescripting early memories linked to negative images in social phobia: A pilot study
Wild, J., Hackmann, A., & Clark, D. M. (2008) · Behavior Therapy · doi:10.1016/j.beth.2007.04.003 · Cited by 212 · see citing works
Arch, J. J., & Craske, M. G. (2009) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2009.05.001 · Cited by 208 · see citing works
Optimizing exposure therapy with an inhibitory retrieval approach and the OptEx Nexus
Craske, M. G., Treanor, M., Zbozinek, T. D., & Vervliet, B. (2022) · Behaviour Research and Therapy · doi:10.1016/j.brat.2022.104069 · Cited by 195 · see citing works
The effects of safety behaviors on health anxiety: An experimental investigation
Olatunji, B. O., Etzel, E. N., Tomarken, A. J., Ciesielski, B. G., & Deacon, B. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.07.008 · Cited by 192 · see citing works
Blakey, S. M., & Abramowitz, J. S. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.07.002 · Cited by 186 · see citing works
Cosmetic rhinoplasty in body dysmorphic disorder
Veale, D., De Haro, L., & Lambrou, C. (2003) · British Journal of Plastic Surgery · doi:10.1016/s0007-1226(03)00209-1 · Cited by 186 · 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
Thwaites, R., & Freeston, M. H. (2005) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465804001985 · Cited by 165 · 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
A functional analysis of danger and safety signals in anxiety disorders
Lohr, J. M., Olatunji, B. O., & Sawchuk, C. N. (2007) · Clinical Psychology Review · doi:10.1016/j.cpr.2006.07.005 · Cited by 136 · see citing works
Control theory and psychopathology: an integrative approach.
Mansell, W. (2005) · Psychology and Psychotherapy: Theory, Research and Practice · doi:10.1348/147608304x21400 · Cited by 133 · see citing works
Psychological characteristics and motivation of women seeking labiaplasty
Veale, D., Eshkevari, E., Ellison, N., Costa, A., Robinson, D., Kavouni, A., & Cardozo, L. (2014) · Psychological Medicine · doi:10.1017/s0033291713001025 · Cited by 132 · see citing works
Emotion Regulation in Youth with Emotional Disorders: Implications for a Unified Treatment Approach
Trosper, S. E., Buzzella, B. A., Bennett, S. M., & Ehrenreich, J. T. (2009) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-009-0043-6 · Cited by 128 · see citing works
Clark, D. M. (2004) · Behaviour Research and Therapy · doi:10.1016/j.brat.2004.05.002 · Cited by 123 · see citing works
Exposure therapy in eating disorders revisited
Koskina, A., Campbell, I. C., & Schmidt, U. (2013) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2012.11.010 · Cited by 127 · see citing works
Cognitive Processes in Extinction: Figure 1
Lovibond, P. F. (2004) · Learning & Memory · doi:10.1101/lm.79604 · Cited by 122 · see citing works
Neimeyer, R. A., Kazantzis, N., Kassler, D. M., Baker, K. D., & Fletcher, R. (2008) · Cognitive Behaviour Therapy · doi:10.1080/16506070801981240 · Cited by 113 · see citing works
Panic Attacks and Perception of Inspiratory Resistive Loads in Chronic Obstructive Pulmonary Disease
Livermore, N., Butler, J. E., Sharpe, L., McBain, R. A., Gandevia, S. C., & McKenzie, D. K. (2008) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200711-1700oc · Cited by 113 · see citing works
Therapist perceptions and delivery of interoceptive exposure for panic disorder
Deacon, B. J., Lickel, J. J., Farrell, N. R., Kemp, J. J., & Hipol, L. J. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.02.004 · Cited by 101 · see citing works
Livermore, N., Sharpe, L., & McKenzie, D. (2010) · Respiratory Medicine · doi:10.1016/j.rmed.2010.04.011 · Cited by 99 · see citing works
Avoidance 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
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
An examination of avoidance in major depression in comparison to social anxiety disorder
Ottenbreit, N. D., Dobson, K. S., & Quigley, L. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.03.005 · 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
Self-citationTreatments for blood-injury-injection phobia: a critical review of current evidence
Ayala, E. S., Meuret, A. E., & Ritz, T. (2009) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2009.04.008 · Cited by 87 · see citing works
Taylor, C. T., & Alden, L. E. (2011) · Journal of Abnormal Psychology · doi:10.1037/a0022127 · Cited by 84 · see citing works
Overestimation of Threat and Intolerance of Uncertainty in Obsessive Compulsive Disorder
Sookman, D., & Pinard, G. (2002) · Cognitive Approaches to Obsessions and Compulsions · doi:10.1016/b978-008043410-0/50006-4 · Cited by 77 · see citing works
Anxiety-control strategies: Is there room for neutralization in successful exposure treatment?
Parrish, C. L., Radomsky, A. S., & Dugas, M. J. (2008) · Clinical Psychology Review · doi:10.1016/j.cpr.2008.07.007 · Cited by 73 · see citing works
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
Self-citationSocial anxiety in pre-adolescent children: What do we know about maintenance?
Halldorsson, B., & Creswell, C. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.08.013 · Cited by 64 · see citing works
Increasing intolerance of uncertainty over time: the potential influence of increasing connectivity
Carleton, R. N., Desgagné, G., Krakauer, R., & Hong, R. Y. (2019) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2018.1476580 · Cited by 64 · see citing works
Meulders, A., & Vlaeyen, J. W. S. (2012) · Pain · doi:10.1016/j.pain.2012.04.013 · Cited by 59 · see citing works
Christoforou, M., Sáez Fonseca, J. A., & Tsakanikos, E. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7747 · Cited by 48 · see citing works
A comparison of cognitive and guided mastery therapy of agoraphobia
Hoffart, A. (1995) · Behaviour Research and Therapy · doi:10.1016/0005-7967(94)00056-p · Cited by 54 · see citing works
Milosevic, I., & Radomsky, A. S. (2013) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.27.2.155 · Cited by 46 · see citing works
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].”
BackgroundCarpenter, M. J., Alberg, A. J., Gray, K. M., & Saladin, M. E. (2010) · Clinical Trials · doi:10.1177/1740774510361533 · Cited by 41 · see citing works
Hood, H. K., Carney, C. E., & Harris, A. L. (2011) · Behavior Therapy · doi:10.1016/j.beth.2011.02.004 · Cited by 41 · see citing works
Freeman, D., Lister, R., Waite, F., Galal, U., Yu, L.-M., Lambe, S., Beckley, A., Bold, E., Jenner, L., Diamond, R., et al. (2023) · The Lancet Psychiatry · doi:10.1016/s2215-0366(23)00257-2 · Cited by 40 · see citing works
Leonidou, C., & Panayiotou, G. (2018) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2018.06.001 · Cited by 38 · see citing works
A randomized controlled trial of the judicious use of safety behaviors during exposure therapy
Blakey, S. M., Abramowitz, J. S., Buchholz, J. L., Jessup, S. C., Jacoby, R. J., Reuman, L., & Pentel, K. Z. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.11.010 · Cited by 37 · see citing works
Gústavsson, S. M., Salkovskis, P. M., & Sigurðsson, J. F. (2021) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s135246582100014x · Cited by 33 · see citing works
Self-citationMansell, W., & McEvoy, P. M. (2017) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.06.008 · Cited by 30 · see citing works
Cognitive mechanisms in chronic insomnia: Processes and prospects
Kaplan, K. A., Talbot, L. S., & Harvey, A. G. (2009) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2009.07.007 · Cited by 28 · see citing works
Biological and cognitive theories explaining panic disorder: A narrative review
Kyriakoulis, P., & Kyrios, M. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.957515 · Cited by 24 · see citing works
Levy, H. C., Senn, J. M., & Radomsky, A. S. (2014) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.28.4.303 · Cited by 24 · 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
“Whilst of course the use of safety behaviours in the presence of actual threat, such as a pandemic, is essential to maintain survival, excessive and inflexible use of such behaviours has been observed to maintain anxiety disorder symptoms [31].”
BackgroundBliokas, V. V., Cartmill, T. K., & Nagy, B. J. (2007) · The Clinical Journal of Pain · doi:10.1097/ajp.0b013e31803685dc · Cited by 22 · see citing works
A Comparison of Two Brief Interventions for Obsessional Thoughts: Exposure and Acceptance.
Fabricant, L. E., Abramowitz, J. S., Dehlin, J. P., & Twohig, M. P. (2013) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.27.3.195 · Cited by 18 · see citing works
Lang, T., Helbig-Lang, S., Gloster, A. T., Richter, J., Hamm, A. O., Fehm, L., Fydrich, T., Gerlach, A. L., Ströhle, A., Alpers, G. W., et al. (2012) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/1616-3443/a000139 · Cited by 15 · see citing works
Responsibility causes reassurance seeking, too: An experimental investigation
Leonhart, M. W., & Radomsky, A. S. (2019) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2017.10.005 · Cited by 15 · see citing works
A counterweight model for understanding and treating persecutory delusions.
Freeman, D., Isham, L., & Waite, F. (2025) · Psychological Medicine · doi:10.1017/s0033291725001242 · Cited by 15 · see citing works
“We then move on to a discussion of the defense behaviors – safety-seeking behaviors (Salkovskis, 1991) – that the person adopts to reduce the likelihood of harm.”
Lebrun, C., Gély-Nargeot, M.-C., Maudarbocus, K. H., & Bayard, S. (2020) · Behavioral Sleep Medicine · doi:10.1080/15402002.2018.1546178 · Cited by 12 · see citing works
Funayama, T., Furukawa, T. A., Nakano, Y., Noda, Y., Ogawa, S., Watanabe, N., Chen, J., & Noguchi, Y. (2013) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.12061 · 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
Tully, S., Wells, A., & Morrison, A. P. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.07.052 · Cited by 9 · see citing works
Thampy, M., Sudhir, P. M., Kumar, A., Kashyap, H., Balachander, S., Narayanaswamy, J. C., & Reddy, Y. C. J. (2026) · Indian Journal of Psychological Medicine · doi:10.1177/02537176251347929 · Cited by 5 · see citing works
Malivoire, B. L., Rowa, K., Milosevic, I., & McCabe, R. E. (2024) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465824000213 · Cited by 3 · see citing works
“One way in which overt behaviours maintain chronic worry is by enhancing perceived safety and increasing perceived control over the likelihood of bad outcomes (Clark and Beck, 2010; Salkovskis, 1991).”
Cognitive Therapy for Insomnia
Soehner, A., Kaplan, K., Kanady, J., & Harvey, A. G. (2013) · Encyclopedia of Sleep · doi:10.1016/b978-0-12-378610-4.00199-6
Sources of perceived stress in people with aphasia: a qualitative study
Jewell, C. C., Bergeron, K., Hunting Pompon, R., Pasque, P. A., & Harnish, S. M. (2026) · Aphasiology · doi:10.1080/02687038.2026.2646450 · Cited by 1 · see citing works
“This pattern aligns with theories of safety-seeking behaviors in people with aphasia (Jewell & Harnish, 2024), i.e., actions taken to avoid situations that cause stress or anxiety (Salkovskis, 1991).”
- Authors
- Salkovskis, P. M.
- Affiliations
- Warneford Hospital (GB)
- Corresponding author
- Salkovskis, Paul M.
- ORCID
- Salkovskis, Paul M.
- Venue
- Behavioural Psychotherapy
- Publisher
- Cambridge University Press (CUP)
- Published
- 1991-01
- Volume
- 19
- Issue
- 1
- Pages
- 6-19
- ISSN
- 0141-3473 (ISSN-L)
- 2051-199X
- OpenAlex
- W2122586240
- Cited by
- 780
- References
- 49
- Citations by year
- 2026: 38 · 2025: 48 · 2024: 35 · 2023: 30 · 2022: 43 · 2021: 45 · 2020: 25 · 2019: 48 · 2018: 35 · 2017: 41 · 2016: 22 · 2015: 32 · 2014: 31 · 2013: 33 · 2012: 36
- FWCI
- 4.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behavioural Psychotherapy (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
- anxiety maintenance, panic, safety-seeking behavior, avoidance behavior, escape behavior, anxiety disorders
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
