Anxiety Patterns: Why Clients Keep Doing What Makes Their Anxiety Worse

Your client already knows the reassurance is temporary.

They know checking their symptoms online at 2:00 a.m. makes health anxiety worse.

They understand that asking their partner, “Are we okay?” ten times a day never creates lasting security.

They know avoiding presentations is making work harder.

They recognize that rewriting an email for forty-five minutes is excessive.

They have completed thought records.

They understand cognitive distortions.

They can tell you exactly how avoidance reinforces anxiety.

And then they do it again.

For therapists, this can become one of the most frustrating moments in anxiety treatment.

The client is insightful.

Motivated.

Intelligent.

They genuinely want change.

Yet the same Anxiety Patterns reappear week after week.

The therapist begins wondering:

“Are we treating the wrong thing?”

“Why isn’t insight translating into behavior?”

“Do they need more coping skills?”

“Am I accidentally reassuring them?”

“Is this resistance?”

“Should I push harder?”

“What fear are we actually treating?”

These questions matter because anxious behavior frequently makes perfect sense in the short term.

Avoidance lowers distress.

Checking reduces uncertainty for a moment.

Reassurance feels relieving.

Overpreparing creates a sense of control.

Perfectionism seems to reduce the chance of criticism.

The behavior is therefore not irrational from the client’s immediate perspective.

It works.

The problem is what it teaches the client over time.

Research-supported cognitive-behavioral models have long emphasized that avoidance and safety behaviors can maintain anxiety by preventing clients from learning that feared situations may be tolerable, manageable, or less dangerous than expected. A recent large study of exposure-based CBT found safety behaviors were common and that more frequent use was associated with less symptom improvement.

The therapist’s job is therefore not simply to convince clients that their behavior is unreasonable.

It is to understand:

What does this behavior protect the client from having to feel, risk, discover, or tolerate?

That question creates a bridge between well-established anxiety treatment principles and the Deconstructing Anxiety framework taught by Todd Pressman, PhD.

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Why Anxiety Patterns Survive Even After the Client Understands Them

Insight is valuable.

But insight alone does not create new learning.

A client can know:

“Flying is statistically safe.”

and still refuse to board a plane.

A client can understand:

“My partner has reassured me twenty times.”

and still desperately want reassurance number twenty-one.

A perfectionistic client can say:

“I know nobody expects this report to be perfect.”

while staying awake until 3:00 a.m. editing it.

Why?

Because anxiety is not merely a factual knowledge problem.

The anxious system asks:

“Yes—but what if?”

What if this time the headache is serious?

What if this time the relationship ends?

What if this presentation exposes me as incompetent?

What if I make the one mistake that destroys everything?

What if I stop checking and something terrible happens?

Clients often use protective strategies not because they believe those strategies produce a fulfilling life, but because not using them feels dangerous.

That distinction changes the therapist’s approach.

Rather than:

“You know reassurance doesn’t work.”

try:

“What feels most dangerous about not asking for reassurance?”

Rather than:

“You need to stop avoiding presentations.”

try:

“What do you predict would happen if you presented without your usual escape plan?”

Rather than:

“Your perfectionism is unhealthy.”

try:

“What would making an ordinary mistake mean about you?”

Now therapy is moving beneath the behavior without abandoning evidence-based assessment.

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What the Therapist Sees vs. What the Client Is Protecting

Anxiety Patterns often look dysfunctional from the outside while feeling protective from the inside.

What the Client Does	What the Therapist May See	What the Client May Be Trying to Prevent
Repeatedly asks for reassurance	Dependence	Rejection, danger, uncertainty
Avoids social events	Social avoidance	Humiliation or exclusion
Overprepares	Perfectionism	Failure, criticism, exposure
Checks physical symptoms	Health anxiety	Missing a dangerous illness
Re-reads messages	Overthinking	Being misunderstood or rejected
Controls family plans	Rigidity	Unpredictability or loss
Procrastinates	Avoidance	Discovering they cannot succeed
Constantly researches	Compulsive certainty-seeking	Making the “wrong” decision
Never delegates	Overcontrol	Someone else’s mistake reflecting on them
Repeatedly apologizes	Reassurance seeking	Anger, disapproval, abandonment

This does not mean every protective behavior hides one universal psychological explanation.

Clients differ.

Culture matters.

Current safety matters.

Trauma matters.

Medical conditions matter.

Relationship realities matter.

The point is to investigate function instead of merely labeling form.

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Therapist Struggle 1: Reassurance Works—For About Five Minutes

A client says:

“I know this sounds ridiculous, but do you think I’m going crazy?”

The therapist responds:

“No. You’re not going crazy.”

Relief.

Then twenty minutes later:

“But are you sure these symptoms aren’t psychosis?”

The therapist explains again.

The client leaves calmer.

The next week, the same question returns.

This is how a caring therapist can unintentionally become part of an anxiety-maintenance loop.

Research examining reassurance seeking across panic disorder, social anxiety, generalized anxiety, and OCD found that reassurance seeking was associated with anxiety symptoms and that reductions during CBT were associated with clinical improvement.

That does not mean clinicians should become cold or refuse every reasonable question.

The challenge is distinguishing information from anxiety-driven certainty seeking.

Consider:

Information seeking

“Can you explain what a panic attack is?”

The therapist provides psychoeducation.

Reassurance loop

“But how do I know with 100% certainty this next panic attack won’t kill me?”

No therapist can provide that kind of certainty.

And repeatedly trying may reinforce the belief:

I cannot tolerate this fear unless someone convinces me I am safe.

A more useful response

“I notice you’ve asked me several versions of this question today. I’m wondering whether answering again will help you long-term—or whether anxiety is asking us to create certainty that nobody can actually guarantee.”

That is a harder intervention.

But it changes the therapeutic task from providing certainty to building capacity to tolerate uncertainty.

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Therapist Struggle 2: The Client Calls It “Being Prepared”

Perfectionism is socially rewarded.

The employee who triple-checks every document may receive praise.

The student who studies twice as long as everyone else may get excellent grades.

The parent who anticipates every possible problem may look highly responsible.

So when therapists challenge perfectionistic behavior, clients may understandably respond:

“What’s wrong with having high standards?”

Often, nothing.

The clinical issue is not excellence.

It is the threat attached to imperfection.

Ask:

“What happens if this is only good enough?”

The client might answer:

“My boss could think I’m incompetent.”

Keep going.

“And if your boss thought that?”

“I might lose respect.”

“And what would that mean?”

“That I’m not actually good at anything.”

Now the therapist has moved from a forty-five-minute email-editing ritual toward the deeper meaning organizing it.

This is one place where Deconstructing Anxiety’s idea of a “core fear” can offer an additional conceptual lens.

The event page explains Todd Pressman, PhD’s model as distinguishing between a deeper feared meaning—called a core fear—and a recurring protective strategy—called a chief defense. Clinical Events appropriately notes that this is Dr. Pressman’s integrative framework rather than a universally established classification of all anxiety disorders.

That distinction is important.

The framework can generate useful questions.

It should not replace diagnosis-specific assessment.

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Therapist Struggle 3: Avoidance Looks Like Relief, So Clients Keep Choosing It

A socially anxious client cancels a dinner.

Anxiety drops immediately.

The brain learns:

Leaving worked.

A person afraid of elevators takes the stairs.

Relief.

A client terrified of conflict keeps quiet.

Relief.

Someone with panic symptoms never exercises because increased heart rate feels dangerous.

Relief.

In the short term, these choices make sense.

But Anxiety Patterns become self-reinforcing when short-term relief prevents corrective learning.

Avoidance can keep the feared prediction untested.

The person never discovers:

• “I could have handled the dinner.”
• “The elevator ride would have ended.”
• “Conflict would not automatically destroy the relationship.”
• “My heart can race without catastrophe.”

This is one reason exposure is such a central behavioral strategy in anxiety treatment.

Clinical Events’ recent clinician guide on exposure emphasizes collaborative assessment, carefully structured practice, reduction of subtle safety behaviors, and learning rather than simply forcing clients to “face fears.”

NIMH also identifies CBT as a research-supported psychotherapy commonly used for generalized anxiety disorder and notes that treatment choice should reflect the person’s needs, preferences, medical situation, and consultation with qualified professionals.

The therapeutic task is not:

Make the client anxious on purpose.

It is:

Help the client discover what anxiety has prevented them from learning.

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Therapist Struggle 4: “Resistance” May Actually Be Protection

A client agrees that exposure makes sense.

You develop a hierarchy.

They choose an exercise.

The following week:

“I didn’t do it.”

Again.

And again.

The therapist starts thinking:

Resistance.

Possibly.

But the word can become lazy clinical shorthand.

Instead ask:

“What would doing the exercise force you to risk?”

A client afraid of rejection may not primarily fear the party.

They may fear:

“If I attend and nobody talks to me, it proves I’m unlikeable.”

The behavioral task therefore carries identity-level meaning.

Another client refuses to reduce checking.

Why?

“If I stop checking and something happens, it will be my fault.”

Now responsibility beliefs are involved.

Another won’t delegate.

“If someone else makes a mistake, everyone will still blame me.”

Now control may be functioning as a defense against shame or helplessness.

This does not mean clinicians should endlessly analyze instead of helping clients change behavior.

It means a behavioral recommendation may become more precise when therapists understand what the behavior is protecting.

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Therapist Struggle 5: Clients Often Want Anxiety Gone Before They Start Living

A client says:

“I’ll apply for the promotion once my anxiety is under control.”

Another says:

“I’ll date again when I stop worrying about rejection.”

Another:

“I’ll travel when I’m confident I won’t panic.”

The problem is that this can make life conditional on the disappearance of anxiety.

Anxiety becomes the gatekeeper.

No living until I feel safe enough.

Therapists can accidentally reinforce this by setting symptom elimination as the only definition of success.

A more flexible goal is:

Can the client move toward a meaningful life while anxiety is present?

This is compatible with several established therapeutic traditions, including exposure-based CBT, acceptance-based approaches, behavioral activation principles, and values-focused work.

It also overlaps with the Deconstructing Anxiety training’s emphasis on moving beyond fear toward meaning, purpose, and fulfillment. The seminar integrates CBT, mindfulness, psychodynamic ideas, and positive psychology within Todd Pressman, PhD’s framework.

The careful phrasing matters:

That framework is an integrative clinical model.

It should complement—not displace—evidence-supported care for specific diagnoses.

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Therapist Struggle 6: The Client Wants Certainty That Therapy Cannot Provide

Much anxiety is built around a painful demand:

Tell me what will happen.

Will the relationship last?

Will the scan be normal?

Will I keep my job?

Will my child be okay?

Will the plane land safely?

Will people like me?

Will I regret my decision?

Clinicians cannot ethically promise certainty where certainty does not exist.

But they can help clients become more capable of living without it.

This may involve:

• distinguishing possibility from probability;
• identifying catastrophic predictions;
• reducing compulsive information gathering;
• examining reassurance cycles;
• testing feared predictions;
• approaching avoided situations;
• building confidence in coping rather than confidence in guarantees.

For generalized anxiety, CBT formulations commonly address overestimation of threat, beliefs about worry, and intolerance of uncertainty. NIMH describes CBT as helping clients identify inaccurate or harmful automatic thinking, understand how thoughts influence emotions and behavior, and change self-defeating behavioral patterns.

That creates a clinically important shift:

From:

“How do I make sure nothing bad happens?”

to:

“If uncertainty exists, how do I want to respond?”

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Therapist Struggle 7: Control Can Look Like Competence

Some anxious clients are extraordinarily organized.

Every appointment scheduled.

Every backup plan ready.

Every possible outcome researched.

They rarely appear “anxious.”

They appear prepared.

But ask:

“What happens when somebody else changes the plan?”

Suddenly the system becomes visible.

The client becomes irritable.

Panicked.

Unable to adapt.

Their organization may not simply be a strength.

It may partly function as an attempt to prevent uncertainty.

A therapist does not need to dismantle healthy planning.

The goal is to determine whether planning serves life—or whether life is increasingly organized around preventing discomfort.

Useful questions include:

• How much time does preparation consume?
• What happens if the plan changes?
• Can the client tolerate delegation?
• Does preparation improve performance—or mainly reduce anxiety?
• What feared outcome is being prevented?
• How much flexibility remains?

The distinction is between:

planning because it is useful

and

planning because not planning feels intolerably dangerous.

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A Clinical Map: Behavior → Relief → Cost → Fear

When therapists feel stuck, simplify the formulation.

For each behavior, identify four components.

Step	Question	Example
Behavior	What does the client do?	Repeatedly asks partner for reassurance
Immediate Relief	What happens right afterward?	Anxiety drops temporarily
Long-Term Cost	What does the behavior reinforce?	Client trusts internal judgment less
Underlying Prediction	What feels dangerous without the behavior?	“If I don’t check, I’ll miss signs they are leaving me.”

This map can be used with:

• checking;
• reassurance;
• perfectionism;
• procrastination;
• avoidance;
• overpreparation;
• compulsive research;
• overcontrol;
• emotional withdrawal.

It helps separate the client’s intention from the behavior’s effect.

The client is not “choosing anxiety.”

They are choosing protection.

Therapy asks whether the protection has become too expensive.

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What Deconstructing Anxiety Adds to the Case Formulation

The Deconstructing Anxiety model asks clinicians to look beneath recurring protective strategies and consider the deeper feared meaning that may organize them.

Within the model, Todd Pressman, PhD identifies five broad “core fear” themes:

• abandonment or loss of love;
• loss of identity;
• loss of meaning;
• loss of purpose;
• death.

Clinical Events already has detailed evergreen resources explaining these categories, so clinicians who want the model itself can review its guide to the five core fears. Clinical Events: Deconstructing Anxiety and the 5 Core Fears

The important clinical caution is that these categories belong to Pressman’s model.

They are not equivalent to DSM diagnostic categories, and they should not be presented as a scientifically established claim that every case of anxiety has exactly one of five causes. The event page itself now makes this distinction explicit.

Used carefully, however, the model can give therapists useful questions:

“If the feared event occurred, what would that mean about you?”

“What do you work hardest to prevent?”

“What would become intolerable if your usual defense were unavailable?”

“What does the anxiety seem to protect?”

“What does your strategy cost you?”

The value lies in improving formulation—not forcing a client into a predetermined category.

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Clinical Scenario 1: The Client Who Needs Constant Relationship Reassurance

Composite example

Aisha has a supportive partner.

There is no current evidence of infidelity or abandonment.

Yet several times a day she asks:

“Are you still happy with me?”

“Was that text cold?”

“Are you annoyed?”

“Do you still love me?”

Her partner reassures her.

Relief lasts briefly.

Then another ambiguous cue appears.

A delayed response.

A tired expression.

A short message.

The cycle restarts.

The therapist could simply say:

“Stop asking for reassurance.”

But that ignores the function.

Instead they map:

Trigger: ambiguous interpersonal cue
Prediction: “They’re pulling away.”
Defense: reassurance seeking
Immediate result: relief
Long-term result: greater dependence on external confirmation
Possible deeper meaning: “If someone leaves, it proves I am unlovable.”

Now treatment can address both the behavioral cycle and the meaning attached to rejection.

Reduction of reassurance can become a behavioral experiment rather than a punishment.

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Clinical Scenario 2: The Perfectionist Who Is “Doing Everything Right”

Composite example

Marcus is an attorney.

He has never missed a major deadline.

He consistently receives positive reviews.

Yet every document takes twice as long as necessary.

He checks emails six times.

He works late most nights.

His therapist points out that the workload is unsustainable.

Marcus responds:

“That’s why I’m successful.”

The therapist could debate whether perfectionism is good or bad.

A better approach is to examine the prediction.

“What do you think happens if you send something that is very good but not perfect?”

Marcus eventually says:

“People will realize I’m not as intelligent as they think.”

Now the Anxiety Patterns around overpreparation are connected to a feared meaning.

The behavioral experiment may not be:

“Stop caring about your work.”

It might be:

Send one low-stakes email after one careful review instead of six.

Then observe:

• What did Marcus predict?
• What happened?
• What did anxiety say afterward?
• Did he engage in covert checking?
• What new learning occurred?

This is where conceptual depth and behavioral change can work together.

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Clinical Scenario 3: Health Anxiety and the Endless Search for Certainty

Composite example

Samantha notices a mild headache.

She searches symptoms online.

The search produces frightening possibilities.

She checks again.

She asks a family member.

She schedules an appropriate medical visit.

The physician provides reassurance.

For two days, she feels better.

Then she notices mild dizziness.

The process begins again.

Therapy should never tell clients to ignore genuine medical symptoms.

But once appropriate medical evaluation is integrated, repeated checking may become part of the anxiety cycle itself.

The therapist can ask:

“What does the next search promise you?”

Samantha says:

“If I research enough, I’ll know I’m safe.”

That reveals the impossible contract:

Complete certainty in exchange for more checking.

The work becomes helping Samantha distinguish responsible healthcare behavior from anxiety-driven certainty seeking.

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Clinical Scenario 4: The Client Who Avoids Because “It’s Just Not Worth It”

Composite example

Daniel has social anxiety.

He declines invitations.

He tells himself:

“I don’t even like parties.”

Maybe he genuinely does not.

But therapy explores what happens when attendance becomes unavoidable.

Daniel becomes intensely anxious about:

• having nothing interesting to say;
• visibly blushing;
• awkward silence;
• other people judging him.

His avoidance has gradually reduced his social world.

This is where Anxiety Patterns can masquerade as preference.

The therapist should not pressure introverted clients into becoming extroverts.

Instead ask:

“If anxiety disappeared for one evening, would you choose to go?”

Daniel answers:

“Yes.”

Now avoidance is interfering with choice.

That provides a clearer rationale for treatment.

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When “Doing the Opposite” Is Useful—and When It Is Too Simplistic

One feature of the Deconstructing Anxiety model is a practice described as “Doing the Opposite”—challenging the habitual defense linked to fear.

Conceptually, this may resemble:

• behavioral experiments;
• response prevention;
• exposure;
• deliberately reducing safety behaviors;
• values-consistent action.

The event page appropriately describes the goal as measured action, not reckless confrontation.

That distinction matters.

If a client’s defense is:

Never disagree because people may leave

a measured opposite might be:

Express one authentic low-stakes preference.

Not:

Start a major confrontation.

If the defense is:

Check every email six times

the opposite might be:

Reduce checking gradually in selected low-risk situations.

Not:

Stop reviewing important professional documents entirely.

If the defense is:

Avoid all elevators

the intervention may resemble graded exposure.

Clinical change should remain:

• collaborative;
• diagnosis-informed;
• appropriately paced;
• culturally responsive;
• consistent with genuine safety.

“Do the opposite” should never mean ignore real danger.

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A Practical Therapist Framework: FIND THE LOOP

Use this as a case-conceptualization aid rather than a validated diagnostic instrument.

F — Find the Trigger

What starts the anxiety sequence?

A sensation?

A thought?

An ambiguous text?

A performance demand?

Uncertainty?

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I — Identify the Prediction

What does the client believe may happen?

“I’ll embarrass myself.”

“They’ll leave.”

“I’ll lose control.”

“The symptom means cancer.”

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N — Name the Protective Strategy

What does the client do to prevent the outcome?

• avoid;
• check;
• reassure;
• control;
• overprepare;
• research;
• withdraw.

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D — Determine the Immediate Reward

What relief does the strategy provide?

This explains why the behavior survives.

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T — Track the Long-Term Cost

Does the behavior:

• increase dependence?
• shrink the client’s life?
• strengthen threat beliefs?
• consume time?
• damage relationships?
• prevent corrective learning?

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H — Hypothesize the Deeper Meaning

What would the feared outcome mean?

Treat this as a hypothesis, not a fact.

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E — Experiment

Design a collaborative change.

Reduce a safety behavior.

Approach a feared situation.

Tolerate an unanswered question.

Express a preference.

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L — Learn From the Outcome

What happened?

What did the client predict?

Was the feared outcome absent, less severe, or more manageable than expected?

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O — Observe Covert Defenses

Clients may stop visible reassurance while reassuring themselves mentally.

They may attend the social event but spend the entire time hiding near the exit.

Behavioral presence does not automatically equal new learning.

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O — Orient Toward Life

What does the client want more of besides less anxiety?

Connection?

Purpose?

Creativity?

Career growth?

Freedom?

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P — Plan Repetition

One successful experiment rarely rewrites years of anxious learning.

Practice needs repetition across contexts.

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Don’t Turn Every Anxiety Case Into the Same Formula

This is a crucial clinical safeguard.

A client with OCD requires disorder-specific understanding.

A client with panic symptoms may need medical considerations.

Trauma-related fear should not automatically be treated identically to generalized worry.

Actual stalking is not “relationship anxiety.”

Real discrimination is not a cognitive distortion.

Financial instability is not simply intolerance of uncertainty.

Cultural expectations can change how behavior should be understood.

The Deconstructing Anxiety model is most useful as an additional formulation lens, not a replacement for comprehensive assessment.

The event page itself emphasizes applying different approaches according to clinician assessment, including CBT/exposure, mindfulness, psychodynamic ideas, and positive psychology.

Strong treatment asks:

What diagnosis and evidence matter here?

and

What meaning and function matter here?

Those questions can coexist.

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Continuing Education: When Clients Know Better but Still Can’t Do Differently

Clinical Events’ live virtual program Deconstructing Anxiety: A New Approach to Understanding and Treating Anxiety Disorders is scheduled for September 26, 2026, from 10:00 AM–1:15 PM ET and offers 3 CE credits.

The presenter is Todd Pressman, PhD, a New Jersey psychologist, author, educator, and developer of the Deconstructing Anxiety framework. The program covers identifying core fear and chief defense, evidence-based approaches to anxiety, CBT, exposure, mindfulness, positive psychology, resistance, and movement toward meaning and fulfillment.

For clinicians trying to understand recurring Anxiety Patterns, the value of this kind of training is not simply learning another list of symptoms.

It is developing sharper questions:

• What exactly is the client afraid will happen?
• What do they do to prevent it?
• How does that strategy help immediately?
• How does it cost them later?
• What deeper meaning might make the defense feel necessary?
• What established treatment does this diagnosis require?
• What behavioral experiment could create new learning?
• What life is the client trying to build beyond anxiety?

Clinicians can review the specific Deconstructing Anxiety training here: Deconstructing Anxiety: A New Approach to Understanding and Treating Anxiety Disorders

For current continuing-education opportunities across trauma, anxiety, ethics, clinical practice, and other behavioral-health topics, use the evergreen Clinical Events schedule. The schedule currently includes the September 26 Deconstructing Anxiety program as well as additional anxiety-focused professional training.

Clinicians can also browse the complete Clinical Edge Blog for therapist-focused articles and evidence-informed clinical resources.

For more specific internal reading, Clinical Events’ Anxiety Disorders Exposure Therapy guide explores exposure, safety behaviors, clinical pacing, and common therapist misconceptions.

Frequently Asked Questions

Conclusion: Stop Asking Only “How Do We Reduce the Anxiety?”

Clients often enter treatment desperate to stop worrying.

Therapists understandably want to help them feel better.

But recurring Anxiety Patterns frequently survive because they are doing something important for the client.

They protect.

They reassure.

They create temporary certainty.

They reduce distress.

They prevent feared experiments.

And that is precisely why they can become so costly.

The therapist’s job is not simply to remove the behavior.

It is to understand the contract the behavior has made with fear:

“If I keep doing this, maybe the thing I cannot tolerate will never happen.”

Once that contract becomes visible, therapy gains new options.

The clinician can still challenge catastrophic thoughts.

Still use exposure.

Still reduce avoidance.

Still address reassurance.

Still work with uncertainty.

But the intervention can also ask what the feared outcome means to the client and why the protective strategy feels so necessary.

That combination can help therapists move from:

“Why won’t this client stop?”

to:

“What would stopping require them to face?”

And eventually:

“How can we help them discover that they can face it without organizing their entire life around protection?”

The aim is not to create a fearless client.

Fear is part of being human.

The aim is to create greater freedom of response.

The client can notice fear without automatically checking.

Feel uncertainty without immediately seeking reassurance.

Risk an imperfect performance.

Enter the conversation.

Take the trip.

Make the decision.

Allow someone else to help.

And build a life in which Anxiety Patterns no longer make every important choice.

That is the shift from simply managing anxiety to understanding what maintains it—and helping clients discover that protection is not the only path available.

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U.S.-BASED PROFESSIONAL RESOURCES

National Institute of Mental Health — Generalized Anxiety Disorder
NIMH provides current U.S. information on GAD and notes that CBT is a research-supported psychotherapy commonly used to treat it. NIMH: Generalized Anxiety Disorder

PubMed / U.S. National Library of Medicine — Reassurance Seeking Research
This study examined reassurance seeking across anxiety disorders and OCD and its change during CBT. PubMed: Reassurance seeking in anxiety disorders and OCD

PubMed / U.S. National Library of Medicine — Safety Behavior During Exposure-Based CBT
A 2026 multicenter study examined safety behaviors across thousands of exposure exercises and found that more frequent safety behavior was associated with less symptom improvement. PubMed: Safety behavior during exposure-based CBT