The impact of safety behavior on exposure-based fear reduction: a meta-analytic review
Veiligheidsgedragingen – de subtiele dingen die mensen doen om gevreesde uitkomsten tijdens exposure te voorkomen – zijn een veelbesproken onderwerp in de klinische wetenschap. Deze meta-analytische review onderzoekt hun werkelijke effect op angstreductie en geeft het duidelijkste beeld tot nu toe van wanneer ze helpen, wanneer ze schaden, en wat dit betekent voor de praktijk van exposuretherapie.
Samenvatting
There is a longstanding debate whether allowing safety-seeking behaviors (SSBs) during cognitive-behavioral treatment hampers or facilitates the reduction of fear. In this meta-analysis, we evaluate the impact of SSBs on exposure-based fear reduction interventions. After filtering 409 journal articles, 23 studies were included for systematic review of which 20studies were coded for meta-analysis. For each study, the Standardized Mean Difference (SMD or Hedges’ g) of self-reported fear was calculated at post-intervention. Two comparisons were distinguished: I) exposure without safety-seeking behavior (SSB-) versus baseline behavior (BL), and II) exposure with safety-seeking behavior (SSB+) versus BL. The results showed that average effect sizes were in favor of SSB-, (I: SMD=0.31, 95% CI [-0.04, 0.66]), and in favor of BL, (II: SMD=-0.13, 95% CI [-0.37, 0.11]). Neither of the effect sizes were statistically significant (I: Z=1.75, p=.08; II: Z=1.07, p=.28). The current meta-analysis could not provide compelling evidence supporting either the removal or addition of SSB during exposure. More systematic and statistically empowered replications, using comparable research methods, in (non-)clinical settings are needed. Novel insights from fear conditioning research may also shed light on the role of SSB in fear reduction.
Trefwoorden: safety behaviour, exposure therapy, fear reduction, anxiety, meta-analysis, inhibitory learning
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Referentie
Meulders, A., Van Daele, T., Volders, S., & Vlaeyen, J. W. S. (2016). The impact of safety behavior on exposure-based reduction of fear and anxiety: a meta-analytic review. Clinical Psychology Review, 45, 144–156. https://doi.org/10.1016/j.cpr.2016.02.002