Exposure plus response prevention versus exposure plus safety behaviours in reducing feelings of contamination, fear, danger and disgust. An extended replication of Rachman, Shafran, Radomsky & Zysk (2011) Marcel A. van den Hout * , Iris M. Engelhard, Marieke B.J. Toffolo, Sophie L. van Uijen Utrecht University, The Netherlands article info Article history: Received 18 October 2010 Received in revised form 29 December 2010 Accepted 17 February 2011 Keywords: Contamination Disgust OCD Exposure and safety behaviour (ESB) Exposure and response prevention (ERP) Cognitive behaviour therapy (CBT) abstract Background and objectives: Safety behaviours are widely held to impede the beneficial effects of exposure, certainly in OCD. Recently, Rachman, Radomsky, Shafran, and Zysk (2011) challenged this view. Healthy volunteers repeatedly touched a contaminant in two sessions. Half of the participants did not engage in safety behaviours after touching (exposure þ response prevention), while the other half did (exposure þ safety behaviours, i.e., cleaning hands with a hygienic wipe). Scores of contamination, fear, danger, and disgust decreased in both sessions and the effects were not impeded by safety behaviours. Three potential artefacts were identified in the Rachman et al. study: a no-treatment control group was lacking, the stop rules for ending exposure differed between conditions, and positive expectations may have been induced in the safety behaviours group. We tried to critically replicate the main findings. Method: The Rachman et al. (2011) study was replicated, with 44 volunteers but stop rules and expec- tations were similar between treatments, and effects were also assessed in a no-intervention control group. Results: Relative to the control condition, both exposure interventions induced reliable decreases in feelings of contamination, fear, danger, and disgust. The decline followed an exponential curve with the largest gains at the first trials of each session. Limitations: Findings were obtained from a non-clinical sample. Conclusion: The findings attest to the robustness of the Rachman et al. findings, and challenge the notion that safety behaviours should be dismissed categorically in exposure treatments. Ó 2011 Elsevier Ltd. All rights reserved. 1. Introduction Current cognitive models of the maintenance of OCD assign a crucial role to Safety Behaviours (SBs). Fears of, for instance, contamination are held to persist because SBs, like washing, prevent disconfirmation of the irrationality of the fear (Salkovskis, 1991). In line with this contention, encouraging the patient to confront feared objects while abstaining from any SB is crucial to exposure and response prevention, the most recommended treat- ment for OCD (e.g.,National Institute of Mental Health, 2009). Clinically and theoretically, it seems plausible that SBs maintain OCD and other anxiety disorders, but this is an empirical issue. Earlier studies found that if SBs remain intact during exposure, the therapeutic effects are less (Kim, 2005), while even the perceived availability of safety aids has negative effects on fear reduction (Powers, Smits, & Telch, 2004). Alternatively, experimental work on agoraphobia (Rachman, Craske, Tallman, & Solymon, 1986) and snake phobia (Milosevic & Radomsky, 2008) has shown that the availability of safety strategies during exposure therapy may have no negative effects and even increase the benefits of exposure. Building on these studies and referring to the treatment of OCD, Rachman, Shafran, Radomsky, and Zysk (2011) recently challenged the next to universal assumption that the beneficial effects of in vivo exposure on situational contamination, fear, danger, and disgust (CFDD), is impeded by SB. Out of six potential contaminants, 80 healthy volunteers each selected the object that he/she found the most contaminating. In two sessions of approximately 40 min each, separated by 2 weeks, participants touched the object 20 times (session 1) and 16 times (session 2). Half of the participants complied with the Response Prevention instruction and did not * Corresponding author. Prof. Clinical and Health Psychology, Utrecht University, PO Box 80140, 3508 TC Utrecht, The Netherlands. Tel.: þ31 30 253 9216; fax: þ31 30 253 7482. E-mail address: m.vandenhout@uu.nl (M.A. van den Hout). Contents lists available at ScienceDirect Journal of Behavior Therapy and Experimental Psychiatry journal homepage: www.elsevier.com/locate/jbtep 0005-7916/$ e see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.jbtep.2011.02.009 J. Behav. Ther. & Exp. Psychiat. 42 (2011) 364e370