Safety Behaviour Enhances the Acceptability of Exposure

Abstract

Compulsive washing and contamination fears are among the most common symptoms of obsessive-compulsive disorder (OCD). Research suggests that exposure and response prevention (ERP) is effective for OCD. However, ERP is prone to dropouts and refusals, and a substantial proportion of clients therefore do not receive the care they need. A proposed solution involves the judicious use of safety behaviour to enhance the acceptability of exposure-based interventions. The current study aimed to test this proposed solution. Participants were 70 undergraduate students who completed two exposure exercises for contamination fear, one with safety behaviour and one without. Participants then rated the acceptability of the two exercises. Exposure with safety behaviour (ESB) was rated as significantly more acceptable than ERP. Furthermore, subjective fear ratings were lower and behavioural approach to a series of contaminants was greater in the ESB condition. Results demonstrated the acceptability-enhancing potential of safety behaviour in exposure, and are discussed in terms of both theoretical and practical aspects of safety behaviour, exposure, and evidence-based interventions for anxiety disorders.

Keywords::

• OCD
• contamination fear
• anxiety
• safety behaviour
• exposure

Acknowledgements

This project was supported by grant funding from the Canadian Institutes of Health Research awarded to the second author. We wish to thank Michel Dugas and Roisin O'Connor for their helpful comments and suggestions, as well as Lara Yapar and Janice LaGiorgia for their assistance with the project.