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LIT-1491: The standalone effect of safety behavior manipulations: A systematic review and meta-analysis

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StatusActive — read in full 2026-10-24 (NOTE-1128) from the NIH author manuscript in PubMed Central, not the closed version of record; worth reading as the first meta-analysis of safety-behaviour manipulations made outside exposure. Reducing them lowered symptoms against control (d = 0.43, about 0.31 after trim-and-fill, with significant Egger asymmetry), instructed increases raised symptoms (d = 0.65, five studies), and the size of the safety-behaviour change moderated the symptom effect. The literature is small, mostly appearance and social anxiety in young, largely non-clinical samples, and largely from the senior author's group. It says nothing about how safety behaviours act.
Version3
Tagspsychopathology-and-treatment
Cited as “paper” byNOTE-1128 — Goodson et al. — The standalone effect of safety behavior manipulations
Cited as “source” byTHEORY-903 — In a 2026 meta-analysis of standalone safety-behaviour manipulations outside exposure, mostly with young non-clinical or subclinical adults and mostly on appearance concerns and social anxiety, reducing safety behaviours lowered symptoms relative to control (d = 0.43, about 0.31 after adjustment for publication bias), and instructed increases raised them (d = 0.65, five studies)

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Goodson, J. T., Patel, T. A., Zech, J. M., Sala, M. C. & Cougle, J. R. (2026). The standalone effect of safety behavior manipulations: A systematic review and meta-analysis. Clinical Psychology Review 124: 102703. doi:10.1016/j.cpr.2026.102703.

Key takeaways

From the reading, NOTE-1128. The manuscript has no page numbers; locations are sections.

  • Both directions move symptoms. Reduction against control: d = 0.43 (k = 16). Instructed increase: d = 0.65 (five studies, all non-treatment experiments with healthy college samples) (Results).
  • Bias. For the symptom effect of reduction, Egger’s test is significant and trim-and-fill gives d = 0.31: “publication bias and small-study effects cannot be ruled out” (Results).
  • Dose-response across studies. “for every 1-point increase in SB effect size, the effect size for clinical symptoms increased by 0.23” (Results). No other planned moderator moderated it.
  • Who was studied. Mostly appearance concerns and social anxiety, “most of the participants included in this review and meta-analysis were young women” (Discussion). One PTSD study, no panic or agoraphobia.
  • Expectancy as an alternative. Every treatment trial gave a rationale, and the authors allow that effects “may be in part due to expectancy effects” (Discussion).

Why this is here

The exchange cited it at turn U15, unnamed, for the effect of reducing safety behaviours on its own. The abstract confirms the counts and the figure: d = 0.43 is the effect of reduction on symptoms. It adds the converse, that increasing safety behaviours raises symptoms (d = 0.65), and evidence of publication bias.

Corrected 2026-10-24, from the reading. The counts and d = 0.43 are right. Publication bias was shown for the symptom outcome of reduction (the adjusted estimate is d = 0.31), and could not be tested for the increase studies. The “moderators” are only two: study type, for the effect on safety behaviours, and the size of the safety-behaviour change, for symptoms. For CLAIM-446 it supports the premise that protective behaviour does causal work on symptoms. It is silent on the claim’s distinctive thesis, since no included study separates belief from defensive authority. Filed from it: THEORY-903.

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