Between-session companionship in therapy: why it matters
Phobia therapy works one hour a week, but life is the other 167. Good between-session companionship multiplies progress.
A safety behaviour is any action, object or thought you use to feel safer in a feared situation. Bringing water on a flight "in case". Always sitting near the door at the restaurant. Carrying unopened Diazepam tablets. Going on a difficult journey only with your partner.
In the short term, safety behaviours work: they lower anxiety enough to let you face the situation. In the medium term they are one of the main reasons exposure does not work and phobias get stuck.
The mechanism is subtle but devastating.
When you face a feared situation with a safety behaviour and nothing happens, your brain does not learn "the situation was safe". It learns "the situation was safe because I did X". The result: X becomes essential and the underlying fear stays intact.
Concrete example: a person with claustrophobia goes up in a lift carrying a water bottle and squeezing it hard. The trip ends fine. Conclusion of the brain: "the lift was tolerable because I was holding the water". Next time, no water? No trip. The water bottle has not solved the phobia: it has prevented its solution.
Honest question: in the situation that scares me, what would I be incapable of doing without?
If the answer is "going with my partner", "bringing water", "tablets in my bag", "specific music", "specific clothing": those are your safety behaviours.
It is not always obvious. Some are very subtle:
Not everything is safety behaviour. There are reasonable cautions that have nothing to do with phobia:
| Real care | Safety behaviour |
|---|---|
| Wearing seatbelt in car | Always sitting in back seat from fear of being driver |
| Carrying anti-allergy medication if you have allergy | Carrying medication "in case" without having allergy |
| Long boots into countryside with adders | Long boots into a city park "in case there's a spider" |
| Drinking water if you're really thirsty | Drinking water as ritual on every flight |
| Avoiding flying with severe ear infection | Never flying because "it could be dangerous" |
The clean test: would I do this if I did not have phobia? If the answer is "no, I do it because of my phobia", probable safety behaviour.
Just as you have a ladder of feared situations, you can have a ladder of safety behaviour retirement.
Example for aerophobia, behaviour "drinking water during turbulence":
In a typical exposure programme, retirement of safety behaviours starts when you have already gone up 2-3 steps of the main ladder. Doing both things at once (climbing ladder + retiring everything) is usually too much.
Withdrawing a safety behaviour can produce a transient spike in anxiety. That is normal and expected. The day you fly without your water bottle, your SUDS will probably be higher than the previous flight with water.
That spike is the work. The brain is finally exposed to the situation without the crutch and can finally learn it is tolerable on its own.
To bear it:
Some are not actions but internal cognitive processes:
These are harder to retire because they are automatic and invisible. But they count and contaminate the exposure equally.
Not all safety behaviours need disappearing. Some are habits without clinical impact ("I like flying with my favourite hoodie"). Concrete criterion:
If you can do the situation without the behaviour and your SUDS does not spike more than 2 points, the behaviour is no longer safety: it is preference. You can keep it.
The aim is not flying robotically without any object. It is the experience not being conditioned by the absence of those objects.
Safety behaviours are subtle, intelligent, almost invisible. They are the brain trying to take care of you with the resources it has. The work is not despising them — it is recognising they had their function and gradually outgrowing them. The day you fly without your water bottle and nothing happens is the day the phobia really loses ground.
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Phobia therapy works one hour a week, but life is the other 167. Good between-session companionship multiplies progress.
The goal of working through a phobia is not to eliminate fear. It is for fear not to be at the wheel of your life.
Some phobias can be worked alone. Others need professional help from the start. Here are the criteria for telling them apart.
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