Safety Behaviors In Generalized Anxiety Disorder: Effects On Symptom Severity And Treatment Outcome

Abstract

Safety behaviors are behaviors performed with the intention of reducing and managing threat. Paradoxically, their use leads to increases in anxiety that maintain symptoms across a variety of anxiety disorders. However, the role of safety behaviors in Generalized Anxiety Disorder (GAD) specifically is not well understood. Preliminary research has shown GAD patients engage more frequently in these behaviors, but it is unclear whether safety behaviors are associated with GAD symptoms above the effects of worry and the extent to which they impact treatment outcomes. The current study examined the role of safety behaviors in GAD; we hypothesized a positive correlation between symptom severity and safety behavior usage above the effects of worry, significantly higher levels of safety behavior usage in GAD patients, and a moderating effect of safety behaviors on treatment outcome, with greater usage leading to poorer treatment outcomes.

The study was a secondary analysis of a computerized worry reduction treatment study. Participants completed the Penn State Worry Questionnaire, Worry Behaviors Inventory, and DSM-5 GAD symptom severity measure at baseline and follow-up. Safety behavior usage was positively correlated with GAD symptom severity controlling for worry (r=.335, p=.020), but did not differ in those with and without a GAD diagnosis. Contrary to predictions, heightened safety behaviors at baseline were associated with better treatment outcomes. The study lends support to the consideration of behavioral symptoms in GAD. Future studies should further clarify the interaction between cognitive and behavioral avoidant strategies in this condition.

            Keywords: Safety behaviors, worry, GAD, behavioral avoidance, cognitive avoidance, computerized worry treatment.