An exploration of the relationship between use of safety‐seeking behaviours and psychosis: A systematic review and meta‐analysis

Abstract

Safety-seeking behaviours are responses employed to protect against perceived threat. In relation to anxiety disorders, safety-seeking behaviours have been implicated in both the formation and maintenance of distress. Several studies have highlighted similar findings in relation to psychosis; however, this literature has not yet been synthesized. This review is, therefore, being conducted in order to synthesize the literature on safety seeking in people with psychosis to increase the understanding of this relationship. A systematic search identified and included 43 studies comprising 2,592 participants, published between 1995 and 2015. The results indicated that people experiencing psychosis commonly respond to their experiences with behavioural and cognitive strategies intended to manage their difficulties. In relation to safety seeking, avoidance, and resistance, there was a pattern that these responses are associated with increased distress and appraisals of threat. The results relating to engagement response styles showed the opposite pattern. These results provide support for cognitive models of safety seeking and psychosis with many of the meta-analyses reported here showing a clear pattern of association between behavioural responses and distress. However, the results reported within individual studies are mixed. This appears to be particularly true with the response style of distraction, with our analyses unable to clarify this relationship. It is possible that the mixed results could reflect the complexities in defining safety seeking and distinguishing it from coping in this population. The clinical implications of this are discussed.

Cognitive Restructuring and Graded Behavioral Exposure for Persecutory Paranoia and Agoraphobic Anxiety in Complex Psychosis

“…Cognitive interpretation biases can be defined as an intellectual overestimation of danger in the environment, among which emotional reasoning refers to one’s propensity to draw conclusions about a situation on the basis of own bodily and emotional experiences rather than objective information (Alkozei, Cooper, & Creswell, 2014). Consequently, a range of safety behaviors, which are individual responses employed to protect against perceived threat (Tully, Wells, & Morrison, 2017), were utilized (maintaining social isolation, and keeping tools, such as hammers and screwdrivers, at close reach). These, in turn, maintained his preoccupation with voices and prevented reality testing, thus interfered with disconfirmation of paranoid beliefs.…”

Does the Beck Cognitive Insight Scale predict change in delusional beliefs?

“…Individuals with psychosis often experience lasting symptoms which remain despite antipsychotic medication (Lieberman et al ., 2005). Persistent psychotic symptoms can cause important distress and have a negative impact on the person's social functioning and quality of life (Chaix et al ., 2014; Tully, Wells, & Morrison, 2017). Among the core symptoms of psychosis, we find delusional beliefs.…”

Urban remediation: a new recovery-oriented strategy to manage urban stress after first-episode psychosis

“…These tactics seem to help regulating interactions with the urban milieu be it physical or social [14]. A word of caution may be warranted as it may be argued that these tactics are similar to safety-seeking behaviors [58], which may promote some form of 'retreat' and increase distress down the line. We believe however that these tactics are different from safety-seeking behaviors because they were identified in patients who actually go in to the city and theses tactics thus seem to help patient's mobility.…”