Edna B Foa

University of Pennsylvania | UP · Center for the Treatment and Study of Anxiety

This powerful client workbook is written in an encouraging and easy-to-understand style specifically for women who have been sexually assaulted and have developed chronic symptoms of posttraumatic stress disorder (PTSD). Clients learn how cognitive-behavioral therapy has helped other victims and how it can work for them. This book explains how to d...

In this review we describe the intricate interrelationship among basic research, conceptualization of psychopathology, treatment development, treatment outcome research, and treatment mechanism research and how the interactions among these areas of study further our knowledge about psychopathology and its treatment. In describing the work of Edna F...

Telehealth technology may reduce the effect of treatment barriers and improve participation in treatment for veterans with posttraumatic stress disorder (PTSD). The present study is an ongoing randomized controlled trial comparing the effectiveness of prolonged exposure (PE) delivered via in person or home-based video telehealth modalities. A total...

Prolonged Exposure (PE) Therapy receives most of its empirical support from trials conducted with civilian posttraumatic stress disorder (PTSD) populations. There has been only limited research on its use with military personnel with combat-related PTSD, and as a consequence, there has been less clinical discussion detailing its application with ac...

This chapter provides the therapist with introductory information on the program, reviews the COPE treatment and how it works, and discusses what type of patients are most appropriate for the COPE therapy. In addition, it provides the therapist with the diagnostic criteria for post-traumatic stress disorder (PTSD) and substance use disorders.

This chapter provides the therapist with an outline of the COPE treatment and components of each session (e.g. check-in, review homework, post-traumatic stress disorder [PTSD] focus, substance use disorder focus). Questions regarding who can deliver the therapy are addressed, as well as questions regarding the role of medications. Finally, special...

Chapter 9 outlines session seven of the COPE treatment program, which involves an imaginal exposure exercise, and discusses strategies for managing high-risk thoughts (such as developing alternative ways of thinking, goal-directed thinking, and the use of perspective).

This chapter describes session 3 of the COPE therapy. The therapist will be guided in this chapter on how to provide the rationale for in vivo exposure exercises and will generate an in vivo hierarchy with the patient. This chapter provides the therapist with instructions for how to teach patients to use the Subjective Units of Distress Scale (SUDS...

Chapter 4 presents the second session of the COPE treatment program. This session discusses common reactions to trauma (such as anxiety, flashbacks, increased vigilance, avoidance, guilt, and depression), as well as the importance of developing an awareness of cravings and triggers.

This chapter describes session 4 of the COPE therapy. This session is dedicated to conducting the first imaginal exposure. The therapist will be guided in this chapter on how to provide the rationale for imaginal exposure, as well as how to conduct and process the imaginal exposure. In addition, the therapist will be guided on how to handle problem...

Chapter 11 discusses the ninth session of the COPE treatment sessions. This session introduces the concept of seemingly irrelevant decisions (SIDs),which may not involve making a direct choice of whether to use, but can move you one step at a time closer to using. Common SIDs are presented, as well as strategies for recognizing SIDs.

This chapter describes session 8 of the COPE therapy. This chapter instructs the therapist to conduct and process the imaginal exposure. The therapist is shown how to teach patients skills for effectively refusing offers to use alcohol or drugs, and a role-play is conducted during the session.

This chapter describes session 9 of the COPE therapy. This chapter instructs the therapist to conduct and process the imaginal exposure. Then, the therapist is shown how to help patients increase their awareness and understanding of ‘seemingly irrelevant decisions.‘

This chapter describes the last session (session 12) of the COPE therapy for post-traumatic stress disorder (PTSD) and substance use disorders. In this chapter, the therapist is instructed to assess the patient’s progress since the beginning of treatment and review areas in need of continued work. Finally, this chapter instructs the therapist on ho...

This chapter describes session 1 of the COPE therapy for post-traumatic stress disorder (PTSD) and substance use disorders. It provides the therapist with an overview of the COPE treatment program and how it works, reviews the treatment contract, addresses goals for therapy, and guides the therapist on how to teach the breathing retraining exercise...

This chapter describes session 10 of the COPE therapy. This chapter instructs the therapist to conduct and process the imaginal exposure. Then, this chapter shows the therapist how to help patients increase their awareness and understanding of anger. The chapter instructs the therapist to review constructive and destructive anger, and triggers for...

Chapter 2 aims to help the patient determine if the COPE program is right for them. This includes a discussion of the characteristics of people for whom COPE has been designed, and strategies to enhance a patient’s motivation for treatment.

Chapter 3 outlines the first treatment session of the COPE program. This includes a detailed outline of the program and the treatment procedures used, the development of treatment goals and the treatment contract. Breathing exercises designed to reduce stress are also explored.

Chapter 6 outlines the fourth COPE treatment session. This session explored imaginal exposures, their purpose, and how they help overcome PTSD. The first imaginal exposure exercise takes place with the help of the therapist and the experience is discussed.

Chapter 7 outlines session five of the COPE treatment program, which continues to focus on imaginal exposure techniques, reviews their purpose and benefits, and performs a second imaginal exposure exercise. Planning for emergencies is also explored, including the development of strategies to deal with triggers that can emerge from stressful life ev...

This chapter describes session 11 of the COPE therapy. This chapter instructs the therapist to conduct and process the final imaginal exposure. Next, this chapter shows the therapist how to teach the patient effective anger management techniques.

Chapter 10 outlines the eighth session of the COPE program. This session focuses on the development of skills to effectively refuse alcohol or drugs when they are presented (including nonverbal and verbal refusal behaviors).

Chapter 13 outlines the eleventh COPE program session. A final imaginal exposure is performed, and the chapter discusses anger management strategies (such as reassessment of the situation, and challenging thoughts using the ABC model)

Chapter 14 explores the twelfth and final COPE program treatment session, which reviews the progress that has been made since the beginning of treatment on both PTSD symptoms and substance use. Steps for the patient to take to continue progress following the conclusion of the treatment sessions are also explored.

Chapter 8 discusses the sixth COPE treatment session. This session involves a review of the patient’s goals and progress with regards to their substance abuse, and an imaginal exposure exercise. High-risk thoughts are also introduced and explored. These include the desire for escape or relaxation, socialization, nostalgia, or testing control.

This chapter describes session 5 of the COPE therapy. The therapist’s instructions for how to provide and process imaginal exposure are reviewed in this chapter. Then, the therapist will be guided on how to help the patient generate a personal emergency coping plan for high-risk situations that may increase risk for using alcohol or drugs. The diff...

This chapter describes session 2 of the COPE therapy. It guides the therapist through the common reactions to traumatic experiences, such as fear and anxiety, avoidance, intrusive memories, trouble concentrating, sleep impairment, and irritability. Next, cravings for alcohol or drugs are reviewed for the therapist, as well as common triggers, inclu...

This chapter describes session 6 of the COPE therapy. The therapist will be guided in this chapter on how to address ‘hot spots.‘ Finally, the therapist will be guided on how to teach patients ways to increase their awareness and understanding of high-risk thoughts for using alcohol or drugs. The chapter reviews common high-risk thoughts for using...

Morally injurious events appear to be capable of producing posttraumatic stress disorder (PTSD) although these events may not involve actual or perceived life threat or fear, horror, or helplessness. Researchers have questioned whether exposure therapies can address PTSD that develops as a result of these events. The current report presents evidenc...

The prevalence rates for combat-related posttraumatic stress disorder (PTSD) in U.S. military personnel returning from deployments to Iraq and Afghanistan indicate a significant demand for efficacious treatments that can be delivered in military-relevant formats. According to research with civilian and veteran populations, prolonged exposure is a f...

In this paper I describe some of my professional experiences as a female, both as a graduate student and throughout my career. My own experience was unique because I began graduate school a few months after arriving in the U.S. with limited knowledge of English in a very competitive and demanding program , in addition to the fact that I was a facul...

Examines the quality of a range of different instruments available for the assessment of posttraumatic stress disorder (PTSD) in order to provide a heuristic structure that clinicians might employ when selecting a particular instrument for their clinical or research purposes. To qualify for a diagnosis of PTSD, an individual must be exposed to a tr...

This chapter is an abridged version of an extensive chapter that Edna and Uriel Foa published in 1976 in which the basic tenets of their resource theory of social exchange are outlined. The authors discuss a variety of details and issues such as the definition and classification of resources as well as the reciprocal relationship between the struct...

PTSD and substance use disorder are often comorbid in combat veterans. Abstinence has been historically required before PTSD treatment, to maximize the effect of PTSD treatment and minimize the risk that psychologically challenging treatments, such as exposure to combat stimuli, will lead to increased substance use. Co-treatment might be more effec...

Although medical service delivery via home-based telehealth technology (HBT) is gaining wider acceptance in managing chronic illnesses such as diabetes or chronic obstructive pulmonary disease, few studies have tested HBT applications of psychotherapy. Clinicians, administrators, and researchers question whether delivering psychotherapeutic service...

Few studies have examined predictors of parental accommodation (assessed with the Family Accommodation Scale-Parent Report) among families of children with obsessive-compulsive disorder (OCD). No studies have examined this phenomenon using empirically derived subscales of the Family Accommodation Scale-Parent Report (i.e., Caregiver Involvement, Av...

OBJECTIVE: The present study was designed to evaluate the psychometric properties of the Brazilian Portuguese version of the Obsessive-Compulsive Inventory - Revised. METHOD: The Obsessive-Compulsive Inventory - Revised was administered toa total of 260 participants: a clinical sample of 130 patients with anxiety disorders (64 with a diagnosis of o...

The present study was designed to evaluate the psychometric properties of the Brazilian Portuguese version of the Obsessive-Compulsive Inventory - Revised. The Obsessive-Compulsive Inventory - Revised was administered to a total of 260 participants: a clinical sample of 130 patients with anxiety disorders (64 with a diagnosis of obsessive-compulsiv...

Empirically based studies have demonstrated that prolonged exposure therapy effectively reduces posttraumatic stress disorder (PTSD) symptoms in a vast range of traumas, yet reports of the efficacy of such therapies in combat- and terror-related PTSD are scarce. In this article, we examine the efficacy of prolonged exposure therapy in combat- and t...

In recent years, several practice guidelines have appeared to inform clinical work in the assessment and treatment of posttraumatic stress disorder. Although there is a high level of consensus across these documents, there are also areas of apparent difference that may lead to confusion among those to whom the guidelines are targeted-providers, con...

Scant research has examined the effect of neuropsychological (NP) functioning on treatment outcome in pediatric obsessive-compulsive disorder (OCD). This study sought to address this gap in existing research. A total of 63 youths were included in this study and asked to complete the Rey-Osterrieth Complex Figure (ROCF) and specific subtests of the...

Cognitive-behavioral therapy (CBT) consisting of exposure and response prevention (EX/RP) is efficacious as a treatment for obsessive-compulsive disorder (OCD). However, about half of patients have a partial or poor response to EX/RP treatment. This study examined potential predictors and moderators of CBT augmentation of pharmacotherapy, to identi...

This paper reviews published randomized trials in North America to determine whether minority groups are underrepresented in clinical trials of OCD. A search of the literature produced 40 randomized trials of both adults and children with OCD, conducted in the U.S. and Canada from 1989 to 2009 (N = 3777). The groups included in this review were Cau...

Background: Postraumatic stress disorder (PTSD) is associated with significant health risk, illness, and functional impairment, e.g., Green and Kimerling [2004: Physical Health Consequences of Exposure to Extreme Stress. Washington, DC: American Phychological Association] Kimerling et al. [2000: Trauma and Health: J Trauma Stress 13:115–128]. Metho...

This case study presents an overview of the conceptualization and treatment of two veterans of the Iraq War who presented for combat-related treatment at a Veterans Administration Medical Center. In addition to posttraumatic stress disorder (PTSD) symptoms of reexperiencing, arousal, and avoidance, the veterans exhibited compulsive checking behavio...

The literature on behavioural treatment for post-traumatic stress disorder (PTSD) is reviewed. Two sets of behavioural procedures have been commonly employed in the treatment of anxiety disorders in general and in the treatment of PTSD specifically: exposure based procedures and anxiety management techniques (AMT). Both sets of procedures appear to...

Growing research has examined parental accommodation among the families of children with obsessive-compulsive disorder (OCD). However, these studies have utilized a parent-report (PR) version of a measure, the Family Accommodation Scale (FAS) that has never received proper psychometric validation. In turn, previously derived subscales have been dev...

This paper presents the rationale, design, and methods of the Pediatric Obsessive-Compulsive Disorder Treatment Study II (POTS II), which investigates two different cognitive-behavior therapy (CBT) augmentation approaches in children and adolescents who have experienced a partial response to pharmacotherapy with a serotonin reuptake inhibitor for O...

Background: Several studies have demonstrated that obsessive–compulsive disorder (OCD) is associated with interference in quality of life (QOL) and functional impairment. However, these studies did not compare individuals in remission to individuals who continue to have the disorder, predominantly used comparisons with norms and not with a matched...

Interpersonal sensitivity to ambiguous facial expressions of emotions was examined using individual growth modeling. Generalized socially phobic (n=54), depressed (n=44), comorbidly socially phobic and depressed individuals (n=39), and non-clinical controls (n=65) were assessed on an emotion labeling task. Patients were as good as controls in label...

Longitudinal clinical trials in psychiatry have used various statistical methods to examine treatment effects. The validity of the inferences depends upon the different method's assumptions and whether a given study violates those assumptions. The objective of this paper was to elucidate these complex issues by comparing various methods for handlin...

There has been considerable controversy about whether generalized social phobia (GSP) and avoidant personality disorder (APD) are redundant diagnostic categories. In light of the ongoing controversy, more data are needed to help determine whether GSP and APD are independent constructs. Data were obtained from 335 people seeking treatment for GSP at...

The present study describes the process of translation into Brazilian Portuguese and the cross-cultural adaptation of the Obsessive-Compulsive Inventory and the Obsessive-Compulsive Inventory-Revised scales. The Obsessive-Compulsive Inventory was developed with the purpose of measuring the intensity of the various symptoms that characterize the obs...

Several symptom screening instruments have been developed to identify trauma survivors at risk for chronic posttraumatic stress disorder, but few of these have been thoroughly evaluated to date. In this study, a range of symptom combination scoring rules derived from the literature were applied to the Posttraumatic Diagnostic Scale and evaluated in...

D-cycloserine (DCS), a glutamatergic partial N-methyl-d-aspartate (NMDA) agonist, can facilitate extinction learning related to cued fear in animals and humans. We predicted that DCS would accelerate obsession-related distress reduction in patients with obsessive-compulsive disorder (OCD) undergoing extinction-based exposure therapy. We administere...

Prolonged exposure (PE) therapy has been found efficient in reducing posttraumatic stress disorder (PTSD) symptoms mostly among rape victims, but has not been explored in combat-related PTSD. Five patients with severe chronic PTSD, unresponsive to previous treatment (medication and supportive therapy) are described. Patients were evaluated with the...

The presence of a comorbid tic disorder may predict a poorer outcome in the acute treatment of pediatric obsessive-compulsive disorder (OCD). Using data from the National Institute of Mental Health (NIMH)-funded Pediatric OCD Treatment Study (POTS) that compared cognitive-behavior therapy (CBT), medical management with sertraline (SER), and the com...

Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/48739/1/boscarino_fears of terrorism_2006.pdf

The effects of prolonged imaginal exposure sessions (60 minutes; n=60) were compared with those of shorter exposure sessions (30 minutes, n=32) for patients with chronic posttraumatic stress disorder (PTSD). Consistent with the authors' hypothesis, patients who received 30-minute imaginal exposure sessions showed less within-session habituation tha...

Unlabelled: Whereas trauma-associated arousal has been linked fairly consistently with elevations in both glucocorticoids and catecholamines, neuroendocrine correlates of hyperarousal in the context of posttraumatic stress disorder (PTSD) have been more variable. Further, neuroendocrine predictors of the development of PTSD following trauma have b...

Emotional processing theory developed by E. B. Foa and M. J. Kozak (1986) has informed the conceptualization of anxiety disorders and the development of effective treatments for these disorders, including posttraumatic stress disorder (PTSD). This article presents a summary and update of emotional processing theory as it applies to the treatment of...

A variety of reactions are observed after a major trauma. In the majority of cases these resolve without any long-term consequences. In a significant proportion of individuals, however, recovery may be impaired, leading to long-term pathological disturbances. The most common of these is post-traumatic stress disorder (PTSD), which is characterized...

Objective: The purpose of the study was to test the relative and combined efficacy of clomipramine and exposure and ritual prevention in the treatment of obsessive-compulsive disorder (OCD) in adults. Sero-tonin reuptake inhibitors (SRIs) and cogni-tive behavior therapy by exposure and ritual prevention are both established treatments for OCD, yet...

We sought to determine whether adults with obsessive–compulsive disorder (OCD) who respond to intensive exposure and response (ritual) prevention (EX/RP) with or without clomipramine (CMI) fare better 12 weeks after treatment discontinuation than responders receiving CMI alone. After receiving 12 weeks of treatment (EX/RP, CMI, EX/RP+CMI, or pill p...

Obsessive-compulsive disorder (OCD), which has a prevalence of 1 in 200 in children and adolescents, carries with it significant functional morbidity. A growing empirical literature supports the efficacy of short-term treatment with OCD-specific cognitive-behavior therapy (CBT) or medication management with a selective serotonin reuptake inhibitor....

This paper provides an overview of several treatment interventions for trauma-related disturbances in adult victims of crime. Following a brief discussion of mental health service utilization among crime victims, we describe interventions for acute and chronic reactions to trauma. We present some controlled studies of psychosocial treatments for po...

Brief screening instruments appear to be a viable way of detecting post-traumatic stress disorder (PTSD) but none has yet been adequately validated. To test and cross-validate a brief instrument that is simple to administer and score. Forty-one survivors of a rail crash were administered a questionnaire, followed by a structured clinical interview...

Background Brief screening instruments appear to be a viable way of detecting post-traumatic stress disorder (PTSD) but none has yet been adequately validated. AimsTo test and cross-validate a brief instrumentthat is simple to administer and score. Method Forty-one survivors of a rai l crash were administered a questionnaire, followed by a structur...

The diagnosis of pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) requires a prospectively determined association between group A beta-hemolytic streptococcal (GABHS) infection and obsessive-compulsive disorder (OCD) or tic disorder. Screening for GABHS infection imposes a significant burden on both pa...

Socially anxious individuals are characterized by an attentional bias for threat-related information. However, this attentional bias to threat may be attenuated [Behav. Res. Ther. 34 (1996) 945] when these individuals are anxious. In the present study, we attempted to increase subjects' Stroop interference by changing the frequency of words to nonw...

Reports on the development and preliminary validation of the Child PTSD Symptom Scale (CPSS) for children and adolescents. The CPSS is a new instrument that was developed to assess the severity of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) posttraumatic stress disorder symptoms in childre...

Patterns of recovery from sexual and nonsexual assault were examined. Two studies containing data from female victims of these assaults were analyzed. In Study 1, victims (N = 101) underwent 12 weekly assessments with measures of posttraumatic stress disorder (PTSD), depression, and state anxiety. In Study 2, victims (N = 108) underwent monthly ass...

An estimated 30% to 50% of cocaine-dependent individuals meet criteria for lifetime PTSD. This comorbidity has detrimental effects on clinical presentation, and treatment course and outcome. Cocaine dependence is associated with increased rates of exposure to trauma, more severe symptoms, higher rates of treatment attrition and retraumatization, an...

Individuals (n = 39) participated in an outpatient, 16-session individual, manual-guided psychotherapy designed to treat concurrent PTSD and cocaine dependence. Therapy consisted of a combination of imaginal and in-vivo exposure therapy techniques to treat PTSD symptoms and cognitive-behavioral techniques to treat cocaine dependence. Although the d...

The present study examined the proposition that inflated responsibility is implicated in obsessive compulsive disorder (OCD). Compared to non-anxious control participants (NACs), and an anxious control group with generalized social phobia (GSPs), we predicted that individuals with OCD (OCs) would exhibit a greater urge to rectify situations involvi...

The psychometric properties of the PTSD Symptom Scale (PSS) were evaluated in a clinical sample of severely injured in-patients after a traffic accident (n = 123). The PSS contains 17 items which were derived from the DSM-III-R criteria of posttraumatic stress disorder (PTSD), The results indicate that the PSS has satisfactory reliability and valid...

Posttraumatic stress disorder (PTSD) gained the status of a psychiatric disorder in 1980, although the syndrome had already been recognized widely for many years. PTSD is distinguished by alternations between reexperiencing of the traumatic event that triggered the PTSD in the first place and avoidance and numbing. Increased arousal (e.g., exaggera...

Understanding memory processes in social anxiety is important because these individuals often report negative memories of anxiety-provoking situations and because of the recent emphasis on learning and memory in models of anxiety. The authors examined the effect of learning on memory for negative social, positive social, and nonsocial information u...

The authors used a noise judgment task to investigate implicit memory bias for threat in individuals with generalized social phobia (GSP). Participants first heard neutral sentences (e.g., "The manual tells you how to set up the tent.") and social-threat sentences (e.g., "The classmate asks you to go for drinks."). Implicit memory for these sentenc...

Laboratory studies using word-list paradigms have provided evidence that nontraumatized individuals falsely recall or recognize events that never occurred. In the present study, H. L. Roediger and K. B. McDermott's false-memory paradigm (1995) was utilized to examine possible source monitoring deficits in individuals with PTSD. Traumatized individu...