Can you believe it? Examining the influence of safety behavior beliefs on speech task outcomes

Beliefs and expectations about treatment have been shown to significantly impact treatment outcomes in medical settings. However, researchers have seldom examined the role of beliefs within the context of cognitive behavioral therapy. Beliefs may be particularly salient for safety behavior (SB) use in exposure therapy, as clinicians often hold opinions about whether judicious SB use facilitates or inhibits treatment. These beliefs may consequently be relayed during psychoeducation, influencing client expectations of SB helpfulness and exposure efficacy. We investigated experimentally the influence of SB beliefs on working memory, speech predictions, speech duration, anxiety, performance, and speech acceptability. Speech anxious undergraduate participants (N = 144) received psychoeducation on exposure and were told (using random assignment) either that SBs: increase anxiety (unhelpful), decrease anxiety (helpful), or were provided with no information on SBs (control). People in the helpful condition only believed the exposure would be more successful. Crucially, exposure expectancy mediated the relationship between the helpful (but not unhelpful) condition and willingness to engage in future exposures. There were no effects of condition on most cognitive, emotional, or behavioral outcomes, suggesting that SBs (and SB beliefs) may have less impact on exposure outcomes than is currently believed.