When Is Seeking Safety Functional? Taking a Pragmatic Approach to Distinguishing Coping From Safety

Abstract

Currently, most exposure-based treatments call for clinicians to assess for and remove all safety behaviors during exposure tasks. However, the notion that safety behaviors are detrimental across all scenarios has recently been challenged, and research regarding the effects of safety behaviors on exposure outcomes is limited and inconsistent. In clinical practice, classifying a strategy as a safety behavior can be a complex and challenging endeavor, particularly when distinguishing between harmful safety behaviors and helpful coping behaviors. We outline an approach that emphasizes the pragmatic truth criterion and uses functional outcomes to classify behaviors as serving either safety or coping functions. Our focus on doing what “works” simplifies decision-making for clinicians and maintains the focus of treatment on enhancing functioning. We propose a model for using functional outcomes to distinguish between safety and coping behaviors and illustrate our approach through case examples.