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Noncontingent exposure to safety signals eliminates safety behaviors in OCD

A treatment based on the noncontingent introduction of stimuli associated with safety signals —external or internal cues produced by safety behaviors — eliminated safety behaviors completely in patients with OCD, study findings demonstrated.

“[Previous] findings demonstrate the potential effects of the noncontingent presentations of reinforcing events on reducing the emissions of behaviors that produce them,” Ioannis Angelakis, PhD, and Jennifer L. Austin, PhD, from the School of Psychology, University of South Wales, Australia, wrote. “A similar treatment protocol designed to reduce or eliminate the engagement in safety behaviors in those with compulsive or related behaviors has yet to be examined. It is possible that a treatment based on the noncontingent presentation of stimuli associated with safety may facilitate the abandonment of safety behaviors, and further improve the acceptability of exposure treatments.”

Noncontingent presentation of events is a common method for treating aberrant behavior in individuals with developmental disorders, according to the authors. Because safety behaviors, defined as “engagement in avoidance within safe environments,” may inhibit daily functioning, researchers examined the effects of noncontingent presentation of safety signals on reducing safety behaviors in 32 adults with low and high OCD.

They asked participants to play a computer game where they gained points by uncovering treasures and avoided loss of these treasures. Participants were told that pressing a foot pedal would allow them to avoid bombs. After they developed avoidance behavior (ie, earned points), participants were exposed to safe environments where no point loss was programmed. In the first contingent test, safety cues, presented as a blue bar, were presented contingent on whether the participant performed a safety behavior, but in the second noncontingent test, safety cues were provided continuously without requiring response.

The results showed that people with high OCD displayed higher rates of safety behaviors compared with those with low OCD; however, exposure to the noncontingent presentation of safety signals eliminated their emission. The investigators found that participants engaged in pedal pressing more consistently in conditions where it produced safety signals (blue bars) than in those where safety signals were offered noncontingently. Furthermore, in conditions where safety signals were produced based on engaging in safety behaviors, those with high OCD performed those behaviors at higher rates than participants with lower OCD. Researchers also observed that pedal presses across the different phases were dependent on OCD scores, with an interaction effect between low and high OCD groups on pedal pressing across contingent and noncontingent presentations of safety signals (P<.001).

“Results confirmed that the noncontingent presentation of safety signals suppressed the emission of safety behavior in participants with both high and low OCD profiles,” Angelakis and Austin wrote. “The noncontingent use of safety cues may provide a sense of security that may help the sufferer resist urges to engage in safety behaviors and potentially lead to more adaptive behavior. However, this possibility needs to be explored by future studies.” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures.