An exploration of the relationship between use of safety seeking behaviours and psychosis: A systematic review and meta-analysis
Sarah Tully, Adrian Wells, Anthony P. Morrison
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.
Key practitioner message
People experiencing psychosis commonly respond to their unusual experiences with behavioural and cognitive strategies intended to manage their difficulties.
In general, reducing safety seeking behaviours, including avoidance and resistance, seems likely to be helpful in the longer term reduction of distress associated with psychosis.
However, it should not be assumed that certain responses are always unhelpful. The clinician should work with each individual to find out what each response style means to them and help them to assess its function and purpose.
Formal evaluation of current and historical advantages and disadvantages of specific strategies could also be helpful.