Exposure and response prevention

Finding the safety behaviours that keep anxiety going

Six questions that bring the small protective habits into view, a table to list them in, and a plan for dropping the first one properly.

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A safety behaviour is a small thing you do to make a feared situation easier to get through, such as keeping a bottle of water in hand in the supermarket or rehearsing every sentence before a meeting. Because these have usually become habits, they are harder to see than the main avoidance.

How a safety behaviour keeps the fear in place

Paul Salkovskis set out in 1991 why this matters. If you fear fainting in a crowded shop and hold on to the trolley whenever you feel light-headed, you credit the trolley for never having fainted, and the fear stays however many times you go. In OCD, where these habits are often quiet and mental, the main point of dropping them is to learn that you can handle the anxiety and the doubt without them.

The sheet is for adults and teenagers with panic, social anxiety, health anxiety or OCD, and it is useful before starting to face feared situations on purpose. Prescribed medication, inhalers, adrenaline pens and other medical equipment are never on the list of things to drop, so keep using them as prescribed and speak to your doctor before changing anything.

A worked row

Example row from the list
What I do	When	What it protects me from
Look at my phone and pretend to be reading when I am on my own at the school gate	Pick-up, most days	Another parent seeing I have no one to talk to and thinking I am odd

The third column states the prediction the behaviour guards against, so dropping it becomes a test of something specific. Leave the last column empty until the day you drop it.

Where people get stuck

The safety behaviours that are easiest to miss are the ones that happen in your head, such as reviewing a conversation afterwards, and the ones done by someone else, such as a partner who always drives, which is what the question about someone watching is for. The other difficulty is swapping one behaviour for another, such as carrying mints instead of the water bottle.

On pace, some studies allowed safety behaviours early in treatment without an obvious cost, and the 2016 review by Blakey and Abramowitz did not settle the question. The note on the sheet suggests dropping them completely in one situation at a time.

Exposure and response prevention

Finding the safety behaviours

The small things that keep the doubt alive, and how to drop them

A safety behaviour is anything you do to make the situation feel easier to get through: checking, asking, rehearsing, carrying something, sitting near the door, doing it only when someone else is home.

They matter because of what they do to the learning. While one is in place, anything that goes well can be credited to it, so you never learn that you could have handled the anxiety, and the not knowing, without it. That is the main learning, and with OCD it is nearly all of it; finding out that the feared thing did not happen is a useful second lesson where it can be checked. The research does not settle whether to drop them all at once or cut them down in steps (Blakey and Abramowitz, 2016), so we agree the pace together.

Prescribed medication, inhalers, adrenaline pens and other medical equipment are not safety behaviours to drop. Keep taking and carrying them as prescribed, and speak to your doctor before changing anything.

Questions that find them

What do I do to take the edge off before I go in?
What am I carrying, checking or holding on to?
Who do I check with, and what do I ask them?
What do I do in my head: rehearse, review, count, pray, argue with the thought?
Which one would be hardest to do without?
What would someone watching me not notice?

My list

My list, with 10 blank rows to fill in
What I do	When	What it protects me from	Dropped on

Dropping one

The one I am dropping first

What I think will happen without it

What actually happened

If dropping one outright is too much to start with, drop it in one specific situation and keep it in the others, rather than doing a little of it everywhere.

Using and sharing this sheet

Free to print and use for personal or clinical use, including by other clinicians with their own clients, provided it is unchanged and the footer is left on. Not for sale. You do not need to ask, sign up or give an email address, and the download is not tracked. If you want to adapt the wording for your own service, write your own version rather than editing this one, so that the footer never ends up on something I did not write.

A worksheet, not treatment, advice about your situation or a diagnosis. It is best used alongside a qualified clinician. If using it makes things worse, stop and speak to your GP or clinician. In an emergency call 999. Written by Anxiety CBT Ltd and free to print for personal or clinical use.

Sources

Salkovskis, P. M. (1991). The importance of behaviour in the maintenance of anxiety and panic: a cognitive account. Behavioural Psychotherapy, 19(1), 6-19.
Blakey, S. M., & Abramowitz, J. S. (2016). The effects of safety behaviors during exposure therapy for anxiety: critical analysis from an inhibitory learning perspective. Clinical Psychology Review, 49, 1-15. doi.org/10.1016/j.cpr.2016.07.002 (opens in a new tab)

Written by Dr Daniel O’Rourke, PhD, ABPP, CPsychol, HCPC-registered Clinical Psychologist Last reviewed: September 2026

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