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 PTSD, data in support of this theory, and clinical examples of how the theory can be used to assist in the treatment of clients with PTSD. Common difficulties confronted during exposure therapy for PTSD, including underengagement and overengagement, are discussed in the context of emotional processing theory and suggestions for how to manage these difficulties are presented.
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Bremner, J.D., Krystalo, J.H., Southwick, S.M., & Charney, D.S. (1995). Functional neuroanatomical correlates of the effects of stress on memory. Journal of Traumatic Stress, 8(4), 527–553.
Chaplin, E.W., & Levine, B.A. (1981). The effects of total exposure duration and interrupted versus continuous exposure in flooding therapy. Behavior Therapy, 12, 360–368.
Cochran, B., Pruitt, L.D., Fukada, S., Zoellner, L.A., Feeny, N.C., Butt, Z., & Wuyek, L. (2003). Why? Why? Why? A qualitative analysis of women’s reasons for choice of PTSD treatment. Paper presented at the Anxiety Disorder Association of America Annual Conference, Toronto, ON.
Feeny, N.C., Zoellner, L.A., Fukuda, S., Stucka, J., Vigil, S., Arlien, C., et al. (2004). Prolonged exposure and sertraline for PTSD: Moving toward effectiveness. Paper presented at annual ITSSS conference, New Orleans, LA.
Foa, E.B., & Cahill, S.P. (2001). Emotional processing in psychological therapies. In N.J. Smelser & P.B. Bates (Eds.), International encyclopedia of the social and behavioral science (pp. 12363–12369). New York: Elsevier.
Foa, E.B., & Kozak, M.J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20–35.
Foa, E.B., & Rauch, S.A.M. (2004). Cognitive changes during prolonged exposure versus prolonged exposure plus cognitive restructuring in female assault survivors with posttraumatic stress disorder. Journal of Consulting & Clinical Psychology, 72(5), 879–884.
Foa, E.B., & Riggs, D.S. (1993). Post-traumatic stress disorder and rape. In J. Oldham, M.B. Riba, & A. Tasman (Eds.), American psychiatric press review of psychiatry (Vol. 12, pp. 273–303). Washington, DC: American Psychiatric Press. (Reprinted Post-traumatic stress disorder: A clinical review, pp. 133–163, by R. S. Pynoos, (Ed.), 1994, Lutherville, MD: Sidran Press).
Foa, E.B., & Rothbaum, B.O. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. New York: Guilford.
Hembree, E.A., Rauch, S.A.M., & Foa, E.B. (2003). Beyond the manual: The insider’s guide to prolonged exposure therapy for PTSD. Cognitive and Behavioral Practice, 10, 22–30.
Jaycox, L.H., Foa, E.B., & Morral, A.R. (1998). Influence of emotional engagement and habituation on exposure therapy for PTSD. Journal of Consulting and Clinical Psychology, 66, 185–192.
Lang, P.J. (1977). Imagery in therapy: An information processing analysis of fear. Behavior Therapy, 8, 862–886.
Lang, P.J. (1979). Bio-informational theory of emotional imagery. Psychophysiology, 16, 495–512.
Lang, P.J., Melamed, B.G., & Hart, J. (1970). A psychophysiological analysis of fear modification using an automated desensitization procedure. Journal of Abnormal Psychology, 76, 220–234.
Nader, K., Schafe, G.E., & Le Doux, J.E. (2000). Fear memories require protein synthesis in the amygdale for reconsolidation after retrieval. Nature, 406(6797), 722–726.
Pitman, R.K., Orr, S.P., Altman, B., & Longpre, R.E. (1996). Emotional processing and outcome of imaginal flooding therapy in Vietnam veterans with chronic posttraumatic stress disorder. Comprehensive psychiatry, 37(6), 409–418.
van Minnen, A., & Foa, E.B. (2005). The effects of long versus short imaginal exposure on treatment outcome of PTSD. Manuscript under review.
van Minnen, A., & Hagenaars, M. (2002). Fear activation and habituation patters as early process predictors of response to prolonged exposure treatment in PTSD. Journal of Traumatic Stress, 15(5), 359–367.
Zoellner, L.A., Feeny, N.C., Cochran, B., & Pruit, L. (2003). Treatment choice for PTSD. Behaviour Research and Therapy, 41, 879–886.
Zoellner, L.A., Feeny, N.C., McDavid, J., Moore, S., Fukada, S., Vigil, S., et al. (2004). Moving toward effectiveness: An open comparison of sertraline and prolonged exposure in the treatment of PTSD. Paper presented at annual meeting of the Anxiety Disorders Association of America, Miami, FL.
We thank Shawn Cahill and Jonathan Huppert for their comments and suggestions on an earlier version of this manuscript.
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Rauch, S., Foa, E. Emotional Processing Theory (EPT) and Exposure Therapy for PTSD. J Contemp Psychother 36, 61 (2006). https://doi.org/10.1007/s10879-006-9008-y
- Exposure therapy
- Emotional processing