What you do to feel safe

Safety behaviours are usually invisible to the client until pointed out. Asking “what do you do to feel safer in the situation” produces a partial list at first. The client names the obvious ones, missing the ones that have become so automatic they don’t register. The full list usually emerges across treatment as the client’s awareness sharpens, but the first pass is the foundation.

This worksheet is the identification tool that sits before any safety-behaviour work. It captures the situations the client tries to manage with safety behaviours, the specific behaviours used, the perceived benefit, and most importantly the question of what might have happened without the behaviour. The last question is the clinically richest one.

Use it for any anxiety case where avoidance and safety behaviours are part of the maintenance cycle. OCD, social anxiety, panic with agoraphobia, health anxiety, generalised anxiety with covert rumination as a safety behaviour. Run it as one of the early homework assignments, before exposure planning, with the expectation that you’ll revisit and add to it as treatment progresses.

The clinical move at submission review. Look at the answers to “what might have happened if you hadn’t used the behaviour.” Catastrophic answers (“I’d have lost my mind”, “I’d have died”, “people would have realised something was wrong with me”) are reporting the feared outcomes that exposure work needs to target directly. Those are the predictions that need to be tested. Concrete, manageable answers (“I’d have been late”, “I’d have felt embarrassed for a while”) are reporting softer targets that may or may not be the right places to start. The catastrophic ones are usually where the work has the largest leverage.

A pattern to expect. The first list is short. By the third or fourth session, after the client has been thinking about it, additional behaviours surface that didn’t make the original list. That’s not a failure. That’s increased awareness. Re-assign the worksheet at month two and month four, and compare the lists across time as a data point on the client’s growing recognition of the maintenance cycle.

Another pattern: clients who list extensive safety behaviours but report low distress about them. Worth checking. Sometimes that’s accurate adaptation. Sometimes it’s the client minimising how much the behaviours are costing them, often because they’ve never let themselves consider the cost.

In my-cbt, the worksheet is one of the bundled system templates. Assign it from the case file early in anxiety work and re-assign it as awareness builds. The submissions save in the case file as a running record of how the client’s understanding of their own safety behaviours has evolved.