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Biomedical subjects

E B Foa

Publications and source records attributed to E B Foa.

At least 37 records · Page 2Linked to original sources
PubMed2000

Posttraumatic stress disorder: psychological factors and psychosocial interventions.

In this article, we propose that successful processing of traumatic events involves emotional engagement with the trauma memory, organization of the trauma narrative, and correction of dysfunctional cognitions that often follow trauma. We further propose that the success of psychosocial treatments of posttraumatic stress disorder hinges on the ability of the treatments to address impairments in these processes. We focus our presentation of psychosocial interventions on cognitive-behavioral treatments (CBT), since this approach had gained the most empirical support to date, and describe the results of controlled trials that compare the relative efficacy of several CBT interventions.

Adaptation, Psychological↗
PubMed2000

Effectiveness of exposure and ritual prevention for obsessive-compulsive disorder: randomized compared with nonrandomized samples.

The efficacy of exposure and ritual prevention (EX/RP) for reducing symptoms of obsessive-compulsive disorder (OCD) has been demonstrated in several randomized controlled trials (RCTs). However, procedures used in these studies to maximize experimental control may have limited their generalizability to typical clinical practice. Treatment outcome data from 110 clinical patients receiving EX/RP on an outpatient fee-for-service basis were compared with findings from 4 RCTs of EX/RP. Adult patients in the clinical sample were not excluded because of treatment history, concomitant pharmacotherapy, psychiatric comorbidity, age, or OCD severity. Clinical patients achieved substantial and clinically meaningful reductions in their OCD and depressive symptoms following EX/RP, which were comparable with those reported in the RCTs. Findings indicate that EX/RP is a potent treatment for OCD, and its benefits are not limited to select patient samples.

Adult↗
PubMed1999

Interpersonal friction and PTSD in female victims of sexual and nonsexual assault.

This study examines the relationship among features of social relationships, both negative and positive, and later posttrauma pathology. Using a prospective design, 142 female victims of sexual or nonsexual assault were assessed at both 2 weeks and 3 months following the assault. We examined self-reported perceptions of how often the participant has been the recipient of socially supportive actions by others and how often the participant has been engaged in interpersonal friction with others. Degree of interpersonal friction shortly after the assault predicted PTSD severity 3 months later. On the contrary, positive social support did not predict later PTSD severity. These results are consistent with previous studies that underscore the association between negative features of social relationships and PTSD.

Adult↗
PubMed1999

A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims.

Ninety-six female assault victims with chronic posttraumatic stress disorder (PTSD) were randomly assigned to 4 treatment conditions: prolonged exposure (PE), stress inoculation training (SIT), combined treatment (PE-SIT), or wait-list control (WL). Treatment consisted of 9 twice-weekly, individual sessions. Independent evaluations were conducted at pretreatment; posttreatment; and 3-, 6-, and 12-month follow-ups. All 3 active treatments reduced severity of PTSD and depression compared with WL but did not differ significantly from each other, and these gains were maintained throughout the follow-up period. However, in the intent-to-treat sample, PE was superior to SIT and PE-SIT on posttreatment anxiety and global social adjustment at follow-up and had larger effect sizes on PTSD severity, depression, and anxiety. SIT and PE-SIT did not differ significantly from each other on any outcome measure.

Adolescent↗
PubMed1998

Negative interpretation bias in social phobia.

We examined the hypothesis that, compared to non-anxious controls (NACs) and individuals with other anxiety disorders (e.g., individuals with obsessive compulsive disorder; OCs), individuals with generalized social phobia (GSPs) would tend to interpret ambiguous social scenarios as negative when provided with various alternative interpretations. Participants were presented with 22 ambiguous scenarios each followed by three possible interpretations: positive, negative, and neutral. Fifteen scenarios were socially relevant and the remaining 7 were nonsocially relevant. Participants were asked to rank order the three interpretations according to the likelihood that each would come to their mind and to a 'typical person's' mind in similar situations. Results revealed that GSPs (but not NACs or OCs) tended to choose a negative interpretation for ambiguous social scenarios even when a positive interpretation was available. This bias was specific to self-relevant scenarios. These results support the hypothesis that a specific negative interpretation bias may be involved in the maintenance of social phobia.

Adult↗
PubMed1998

Relationship between trauma narratives and trauma pathology.

In this study we examined the relationship between posttrauma pathology and the level of articulation (complexity) in rape narratives recounted by victims shortly after the assault. Degree of articulation was operationalized as the reading level of the narrative as determined by a computer program. Shortly after the trauma, reading level was correlated with severity of anxiety but not with posttraumatic stress disorder (PTSD) symptoms. Degree of the narrative articulation shortly after the trauma, however, was related to severity of later PTSD. These results are consistent with the hypothesis that the less developed trauma narratives hinder recovery from trauma.

Adolescent↗
PubMed1998

Predicting response to exposure treatment in PTSD: the role of mental defeat and alienation.

Not all patients with posttraumatic stress disorder benefit from exposure treatment. The present paper describes two cognitive dimensions that are related to inferior response to exposure in rape victims. First, individuals whose memories during relieving of the trauma reflected mental defeat or the absence of mental planning showed little improvement. Second, inferior outcome was correlated with an overall feeling of alienation or permanent change following the trauma. These results are based on blind ratings of transcripts of exposure treatment sessions from 10 women with good outcome and 10 women with inferior outcome. Patients in the two groups were matched for initial symptom severity and were comparable in many aspects of the assault. Patients who experienced mental defeat, alienation, or permanent change may require cognitive restructuring in addition to exposure.

Adult↗
PubMed1998

Automatic activation and strategic avoidance of threat-relevant information in social phobia.

The authors examined the hypothesis that abnormalities in activation and inhibition of threat-relevant information may account for information-processing biases in social anxiety. Individuals with generalized social phobia (GSP) and nonanxious controls were presented with sentences ending in homographs and in nonhomographs and were asked to make decisions about a cue word that followed each sentence. Half of the homographs had a social-threat implication. Longer response latency to make decisions about sentences ending in homographs compared with sentences ending in nonhomographs is thought to reflect activation of the inappropriate meaning of the homographs. Results revealed that GSPs showed initial activation of inappropriate meanings of socially relevant homographs followed by later inhibition of these meanings. These findings are consistent with a vigilance-avoidance model of information processing of threat-relevant information in social phobia.

Adult↗
PubMed1998

Influence of emotional engagement and habituation on exposure therapy for PTSD.

This study examined 2 process variables, emotional engagement and habituation, and outcome of exposure therapy for posttraumatic stress disorder. Thirty-seven female assault victims received treatment that involved repeated imaginal reliving of their trauma, and rated their distress at 10-min intervals. The average distress levels during each of 6 exposure sessions were submitted to a cluster analysis. Three distinct groups of clients with different patterns of distress were found: high initial engagement and gradual habituation between sessions, high initial engagement without habituation, and moderate initial engagement without habituation. Clients with the 1st distress pattern improved more in treatment than the other clients. The results are discussed within the framework of emotional processing theory, emphasizing the crucial role of emotional engagement and habituation in exposure therapy.

Adolescent↗
PubMed1998

Cognitive-behavioral treatment of pediatric obsessive-compulsive disorder: an open clinical trial.

OBJECTIVE: The purpose of this open clinical trial was to examine the efficacy of cognitive-behavioral treatment involving exposure and ritual prevention for pediatric obsessive-compulsive disorder (OCD). METHOD: Children and adolescents with diagnosed OCD (N = 14) received cognitive-behavioral treatment, seven patients received intensive treatment (mean = 18 sessions over 1 month) and seven received weekly treatment (mean = 16 sessions over 4 months). Eight of these patients received concurrent treatment with serotonin reuptake inhibitors and six received cognitive-behavioral treatment alone. Outcome was assessed via interviewer ratings on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Obsessive Compulsive Rating Scales for Main Fear and Main Ritual, and Hamilton Depression Rating Scale. RESULTS: Cognitive-behavioral treatment was effective in ameliorating OCD symptoms. Twelve of the 14 patients were at least 50% improved over pretreatment Y-BOCS severity, and the vast majority remained improved at follow-up; mean reduction in Y-BOCS was 67% at posttreatment and 62% at follow-up (mean time to follow-up = 9 months). CONCLUSIONS: Results suggest that cognitive-behavioral treatment by exposure and ritual prevention is effective for pediatric OCD. Controlled studies with random assignment to conditions are warranted to evaluate the relative efficacy of cognitive-behavioral pharmacological, and combined treatments.

Adolescent↗
PubMed1997

Strategies of thought control in obsessive-compulsive disorder.

Intrusive anxiety-provoking thoughts are a core feature of obsessive-compulsive disorder (OCD). Recent research suggests that individuals use five different techniques of thought control including: distraction, punishment, re-appraisal, social control, and worry. The purpose of the present study was to examine the strategies of thought control used by OCD patients compared to those used by non-anxious controls. In addition, the relationship of method of thought control and domains of OCD-related psychopathology were investigated. Results revealed that OCD patients used punishment, worry, reappraisal, and social control more often than non-patients. Conversely, distraction was used more often by non-patients than OCDs. Interestingly, punishment was the strongest discriminator of OCDs and non-patients mostly because of the low frequency of its use by non-patients. Furthermore, punishment and worry were the only methods of thought control that correlated with OCD symptomatology. These results suggest that OCD patients may use maladaptive methods of thought control when faced with obsessions.

Adolescent↗
PubMed1997

Psychosocial treatments for posttraumatic stress disorder: a critical review.

Posttraumatic stress disorder (PTSD) has been the subject of growing recognition since its inception in 1980. Owing in part to the relatively recent inclusion of PTSD in the psychiatric nomenclature, research is only beginning to address its treatment in methodologically rigorous studies. In this review, we discuss issues such as prevalence of trauma and of PTSD, and gold standards for treatment outcome research. We then critically review the extant literature on the treatment of PTSD. Finally, we include a discussion of issues specific to various trauma populations and factors that may influence treatment efficacy across types of trauma.

Combat Disorders↗
PubMed1997

Trauma and women: course, predictors, and treatment.

Posttraumatic stress disorder (PTSD) resulting from aggravated assault, rape, or noncrime trauma affects over 4 million women in the United States, according to retrospective studies. Prospective studies reviewed here found that 3 months post assault the prevalence of PTSD was 48% in rape victims and 25% in nonsexual crime victims. Prolonged exposure treatment and stress inoculation training are both effective psychotherapeutic treatments for PTSD. Prolonged exposure involves having the patient relive the traumatic memory and recount the event in detail. This description is audiotaped and the patient is asked to listen to it as part of assigned homework. In vivo exposure to feared objects or situations is also assigned as homework. Stress inoculation training consists of teaching patients a variety of techniques for managing anxiety, including controlled breathing, deep muscle relaxation, thought-stopping, cognitive restructuring, preparation for stressors, covert modeling, and role-play. Both treatments have been proven to be effective alone and in combination in ameliorating chronic PTSD in women after traumatic sexual or nonsexual assault. This efficacy was maintained for 3 months of follow-up.

Adaptation, Psychological↗
PubMed1996

Dissociative experiences and posttraumatic stress disorder among female victims of criminal assault and rape.

This study examines the relationship between posttraumatic stress disorder (PTSD) and dissociative experiences in a sample of 158 recent female assault victims (74 rape, 84 nonsexual assault) and 46 comparison subjects who had not been assaulted within the last year. Results indicated that victims had elevated scores on Dissociative Experiences Scale (DES) as compared to the comparison subjects, but that this elevation was not as high as for other traumatized samples. The level of dissociation reported by assault victims declined significantly over the three month course of the study. DES scores were related to PTSD diagnosis and symptom severity, but only among nonsexual assault victims. In rape victims, there was no correlation between dissociation and PTSD. Recent victims with a history of childhood sexual abuse were significantly more dissociative than those who did not report such a history. These results are discussed with regard to vulnerability factors for developing PTSD subsequent to a criminal assault.

Adult↗
PubMed1996

Cognitive biases in generalized social phobia.

Judgmental biases for threat-relevant stimuli are thought to be important mechanisms underlying the etiology and maintenance of anxiety disorders. The authors hypothesized (a) that people with generalized social phobia (GSP) would rate negative social events but not nonsocial events as more probable and costly than would nonanxious controls (NACs) and (b) that cognitive behavioral treatment would decrease probability and cost estimates for social but not nonsocial events. Participants with GSP and NACs were assessed twice, 14 weeks apart, during which the former received cognitive behavioral therapy. Those with GSP evidenced socially relevant judgmental biases prior to treatment, and these were attenuated following treatment. Reduction in cost estimates for social events, but not in probability estimates, mediated improvement in social phobia. Results are discussed in light of emotional processing theory.

Adult↗
PubMed1995

Change in rape narratives during exposure therapy for posttraumatic stress disorder.

This paper presents a coding system developed to explore changes in narratives of rape during therapy for posttraumatic stress disorder (PTSD) involving repeated reliving and recounting of the trauma. Relationships between narrative categories hypothesized to be affected by the treatment and treatment outcome were also examined. As hypothesized, narrative length increased from pre- to post-treatment, percentage of actions and dialogue decreased and percentage of thoughts and feelings increased, particularly thoughts reflecting attempts to organize the trauma memory. Also as expected, increase in organized thoughts was correlated negatively with depression. While indices of fragmentation did not significantly decrease during therapy, the hypothesized correlation between decrease in fragmentation and reduction in trauma-related symptoms was detected.

Adolescent↗
PubMed1995

Memory for actual and imagined events in OC checkers.

Information-processing theorists have suggested that obsessive-compulsive (OC) checking may be a function of either (1) an impaired memory of emotional events, (2) an attenuated ability to distinguish between real and imagined events or (3) a dissatisfaction with one's recall without actual memory impairment. These hypotheses were tested by having OC and control Ss engage in real and imagined actions. Some of the actions were designed to produce anxiety in the OC Ss while other events were designed to be emotionally neutral. No differences in reality-monitoring ability were found between OC and control Ss. Contrary to our prediction, OC Ss recall of their last actual behavior was superior to controls, but only for those actions that elicited anxiety. OC Ss, but not controls, reported that they desired higher levels of memory vividness than they were able to produce. The potential mechanism whereby dissatisfaction with memory vividness could contribute to repetitive checking is discussed.

Adult↗