The DOI matches its Crossref record; 117 of the 117 references it cites were found in a registry or an index.
Emotional processing of fear: Exposure to corrective information.
Abstract
In this article we propose mechanisms that govern the processing of emotional information, particularly those involved in fear eduction. Emotions are viewed as represented by information structures in memory, and anxiety is thought to occur when an information structure that serves as program to escape or avoid danger is activated. Emotional processing is defined as the modification of memory structures that underlie emotions. It is argued that some form of exposure to feared situations is common to many ps chotherapies for anxiety, and that confrontation with feared objects or situations is an effective treatment. Physiological activation and habituation within and across exposure ession are cited as indicators ofemotional processing, and variables that influence activation and habituation of fear responses are examined. These variables and theindicators are analyzed to yield an account of what information must be integrated for emotional processing of a fear structure. The elements of such a structure are vi wed as cognitive representations of the stimulus characteristic of the fear situation, the individual's responses in it, and aspects of its meaning for the individual. Treatment failures are interpreted with respect to the interference of cognitive defenses, autonomic arousal, mood state, and erroneous ideation with reformation of targeted fear structures. Applications of the concepts advanced here to therapeutic practice and to th broader study of psychopathology arediscussed.
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In the citing paper
“WSH is considered a necessary pre-requisite for the second piece of incompatible information, which derives from between-session habituation (BSH) over repeated occasions of exposure.”
From Does habituation matter? Emotional processing theory and exposure therapy for acrophobia (2010) · cites this paper as Foa & Kozak, 1986
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“BSH is purported to form the basis for long term learning, and to be mediated by changes in the meaning proposition, in the form of lowered probability of harm (i.e., risk) and lessened negativity (i.e., valence) of the stimulus.”
From Does habituation matter? Emotional processing theory and exposure therapy for acrophobia (2010) · cites this paper as Foa & Kozak, 1986
Experimental — accuracy not yet measuredIn the citing paper
“According to this theory, interfering anxiety is acquired when a neutral stimulus is paired with a fear response and generalized via classical conditioning; anxiety is then maintained over time by the negative reinforcement of avoidance behaviors that decrease anxiety in the short-term but interfere with natural extinction of the conditioned fear [76, 77].”
From Intolerance of Uncertainty and Parental Accommodation: Promising Targets for Personalized Intervention for Youth Anxiety. (2020) · cites this paper as [76]
In the citing paper
“If one or both of these domains do not demonstrate reactivity to an emotional stimulus, the full fear structure has not been accessed and habituation is unlikely.”
From A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a contrast avoidance model of worry (2011) · cites this paper as Foa and Kozak (1986)
In the citing paper
“According to Foa and Kozak (1986), however, a demonstration of emotional processing requires reactivity upon exposure at both subjective and physiological levels.”
From A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a contrast avoidance model of worry (2011) · cites this paper as Foa and Kozak (1986)
In the citing paper
“a crucial component of the Contrast Avoidance Model, as noted throughout the paper and based on Foa and Kozak (1986), states that the absence of emotional contrast during exposure may itself fail to produce the emotional processing necessary to reduce fear associations.”
From A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a contrast avoidance model of worry (2011) · cites this paper as Foa and Kozak (1986)
In the citing paper
“Habituation theory has long been the primary theoretical basis of exposure therapy and has been integral to theories of exposure such as emotional processing theory (Foa & Kozak, 1986).”
From Are within- and between-session changes in distress associated with treatment outcomes? Findings from two clinical trials of exposure for eating disorders (2024) · cites this paper as Foa & Kozak, 1986
In the citing paper
“Initial fear activation is thought to be an indication that the exposure is appropriately targeting the core fear.”
From Are within- and between-session changes in distress associated with treatment outcomes? Findings from two clinical trials of exposure for eating disorders (2024) · cites this paper as Foa & Kozak, 1986
In the citing paper
“This pattern partially matches the assumptions of emotional processing theory, which posits that there should be an initial peak in fear during exposure (i.e., initial fear activation; Foa & Kozak, 1986).”
From Are within- and between-session changes in distress associated with treatment outcomes? Findings from two clinical trials of exposure for eating disorders (2024) · cites this paper as Foa & Kozak, 1986
In the citing paper
“This finding opposes the assumptions of emotional processing theory, which posits that within-session decreases in distress represent a consolidation of learning during the session and allow for the integration of new information into fear structures (Foa & Kozak, 1986).”
From Are within- and between-session changes in distress associated with treatment outcomes? Findings from two clinical trials of exposure for eating disorders (2024) · cites this paper as Foa & Kozak, 1986
In the citing paper
“As defined by Foa and Kozak (1986), emotional processing is the course by which new information is introduced into an existing fear structure in order to change emotional responding.”
From Does change in distress matter? Mechanisms of change in prolonged exposure for PTSD (2014) · cites this paper as Foa & Kozak, 1986
In the citing paper
“as well as within-session habituation (e.g., Borkovec & Sides, 1979; Foa & Kozak, 1986, 1997; Grayson et al., 1982; Kozak, Foa, & Steketee, 1998; Lang, Melamed, & Hart, 1970; Watson & Marks, 1971)”
From Does change in distress matter? Mechanisms of change in prolonged exposure for PTSD (2014) · cites this paper as Foa & Kozak, 1986
In the citing paper
“This argues against theories that purport necessity of between-session habituation as a key therapeutic mechanism (Foa & Kozak, 1986; Rachman, 1980).”
From Does change in distress matter? Mechanisms of change in prolonged exposure for PTSD (2014) · cites this paper as Foa & Kozak, 1986
In the citing paper
“habitual thoughts, feelings, behaviors, and goals are easily activated automatically, pulling us toward common well-worn directions as opposed to being sensitive to the unique hedonic or utilitarian value of acting differently (Aarts & Dijksterhuis, 2000; Foa & Kozak, 1986).”
From Psychological flexibility as a fundamental aspect of health (2010) · cites this paper as Foa & Kozak, 1986
In the citing paper
“PE is based on emotional processing theory (Foa and Kozak, 1985, 1986), which suggests that traumatic events are not processed emotionally at the time of the event.”
From Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions (2018) · cites this paper as Foa and Kozak, 1986
In the citing paper
“According to cognitive-behavioral theories of PTSD, negative attributions regarding the cause and meaning of trauma (e.g., self-blame, the world is dangerous) and avoidance of trauma reminders (e.g., thoughts/feelings associated with the assault, situations that remind the individuals of the assault) prevent natural recovery from PTSD symptoms (Ehlers & Clark, 2000; Foa & Kozak, 1986; Foa et al.,”
From PTSD in the Year Following Sexual Assault: A Meta-Analysis of Prospective Studies (2023) · cites this paper as Foa & Kozak, 1986
In the citing paper
“For these reasons, exposure therapy is often thought to rely on other processes such as habituation [46], UCS revaluation [56], or contextualization [7].”
From Memory and Forgetting (2018) · cites this paper as [46]
In the citing paper
“One prominent rationale for prolonged exposure suggested the mechanism was initial fear activation followed by habituation of fear within and between treatment sessions [46], but the evidence for this is weak [47, 48].”
From Memory and Forgetting (2018) · cites this paper as [46]
In the citing paper
“What these have in common is that the treatment targets problematic aspects of the trauma memory, whether by techniques such as exposure (Foa & Kozak, 1986), restructuring (Ehlers & Clark, 2000), or dual-task interference (Van den Hout & Engelhard, 2012).”
From Intrusive memories of trauma: A target for research bridging cognitive science and its clinical application (2019) · cites this paper as Foa & Kozak, 1986
In the citing paper
“According to the cognitive model of OCD [6–8], emotional processing theory [9], and Wells’ metacognitive model [10–12], dysfunctional beliefs play an important role in the development as well as maintenance of OCD.”
From Metacognitive Training for Obsessive-Compulsive Disorder: A study protocol for a randomized controlled trial (2020) · cites this paper as [9]
In the citing paper
“Even more relevant, the behavioral treatment of anxiety by exposure is based on the idea that during exposure, the patient first exhibits a steady increase in physiological activation, anxiety, and arousal, which then should be resolved during later stages of exposure through processing of fear-incompatible experience (Foa & Kozak, 1986).”
From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Foa & Kozak, 1986
In the citing paper
“EPT purports that exposure is maximal when (1) fear is activated (IFA), (2) fear subsides within sessions (WSH), and (3) fear subsides between sessions (BSH).”
From Does habituation matter? Emotional processing theory and exposure therapy for acrophobia (2010) · cites this paper as Foa & Kozak, 1986
In the citing paper
“EPT purports that exposure is maximal when (1) fear is activated (IFA), (2) fear subsides within sessions (WSH), and (3) fear subsides between sessions (BSH).”
From Does habituation matter? Emotional processing theory and exposure therapy for acrophobia (2010) · cites this paper as Foa & Kozak, 1986
In the citing paper
“EPT purports that the effects of exposure therapy derive from activation of a ‘fear structure’ and integration of information that is incompatible with it, resulting in the development of a non-fear structure that replaces (Foa & Kozak, 1986) or competes with (Foa & McNally, 1996) the original one.”
From Does habituation matter? Emotional processing theory and exposure therapy for acrophobia (2010) · cites this paper as Foa & Kozak, 1986
In the citing paper
“EPT purports that exposure is maximal when (1) fear is activated (IFA), (2) fear subsides within sessions (WSH), and (3) fear subsides between sessions (BSH).”
From Does habituation matter? Emotional processing theory and exposure therapy for acrophobia (2010) · cites this paper as Foa & Kozak, 1986
In the citing paper
“‘Intrusive memories’—typically of emotional events—are a form of involuntary recall and have been theorized to play a critical role in the development and maintenance of various psychological disorders [24–29], such as PTSD, and also including depression [30,31], bipolar disorder [32,33], social anxiety [34], agoraphobia [35], spider phobia [36] and health anxiety [37].”
From Multiple memory systems, multiple time points: How science can inform treatment to control the expression of unwanted emotional memories (2018) · cites this paper as [28]
In the citing paper
“These acute stressors have been shown to exacerbate fear responding across the lifespan (Bremner et al., 2005; Teicher et al., 2003), including emotional, cognitive, and behavioral forms of avoidance (Foa & Kozak, 1986; Marx & Sloan, 2002)”
From A transdiagnostic minority stress treatment approach for gay and bisexual men's syndemic health conditions (2015) · cites this paper as Foa & Kozak, 1986
In the citing paper
“effective fear extinction is the foundation of PE treatment (Foa and Kozak, 1986; Rothbaum and Davis, 2003; Smith et al., 2017).”
From Augmenting Prolonged Exposure therapy for PTSD with intranasal oxytocin: a randomized, placebo-controlled pilot trial (2018) · cites this paper as Foa and Kozak, 1986
In the citing paper
“Thus, PTSD may manifest from a persisting conditioned fear response independent of the original trauma and difficulty learning that stimuli previously associated with a trauma are no longer so.”
From D-cycloserine augmentation of exposure therapy for post-traumatic stress disorder: a pilot randomized clinical trial (2014) · cites this paper as Foa and Kozak, 1986
In the citing paper
“In humans with PTSD, the matrix of sensory stimuli embedded in the traumatic memory serve as cues that evoke a conditioned fear response in the absence of the original trauma (the unconditioned aversive stimuli).”
From D-cycloserine augmentation of exposure therapy for post-traumatic stress disorder: a pilot randomized clinical trial (2014) · cites this paper as Foa and Kozak, 1986
In the citing paper
“Individuals with PTSD have not learned that the stimuli associated with their trauma are now safe.”
From D-cycloserine augmentation of exposure therapy for post-traumatic stress disorder: a pilot randomized clinical trial (2014) · cites this paper as Foa and Kozak, 1986
In the citing paper
“One novel treatment approach follows from the hypothesis that PTSD is a disorder of emotional learning (Foa and Kozak, 1986).”
From D-cycloserine augmentation of exposure therapy for post-traumatic stress disorder: a pilot randomized clinical trial (2014) · cites this paper as Foa and Kozak, 1986
In the citing paper
“This finding seems plausible as real life anxiety-related cues can much easier activate anxiety reactions in individuals with an anxiety disorder than in individuals without an anxiety disorder [11].”
From A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders (2014) · cites this paper as [11]
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Worry and Generalized Anxiety Disorder
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Temporal dynamics in the relation between presence and fear in virtual reality
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Effects of D-cycloserine on extinction of learned fear to an olfactory cue
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A Cognitive-Behavioral Treatment Targeting Intolerance of Uncertainty
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An Inhibitory Learning Approach to Cognitive-Behavioral Therapy for Children and Adolescents
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An update on the efficacy of psychological treatments for obsessive-compulsive disorder in adults
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“For example, Meyer (1966) proposed that patients’ expectations are altered in ERP, and Foa & Kozak (1986) argued that corrective information is incorporated into activated fear structures.”
BackgroundMorina, N. (2011) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0b013e3182392aae · Cited by 81
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Intensive Mindfulness Training and the Reduction of Psychological Distress: A Preliminary Study
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Overestimation of Threat and Intolerance of Uncertainty in Obsessive Compulsive Disorder
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Virtual Reality Exposure for PTSD Due to Military Combat and Terrorist Attacks
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The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm
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“…of anxiety by exposure is based on the idea that during exposure, the patient first exhibits a steady increase in physiological activation, anxiety, and arousal, which then should be resolved during later stages of exposure through processing of fearincompatible experience (Foa & Kozak, 1986).”
BackgroundAnxiety-control strategies: Is there room for neutralization in successful exposure treatment?
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Moral injury: An overview of conceptual, definitional, assessment, and treatment issues
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Effects of state anxiety on selective processing of threatening information
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Does change in distress matter? Mechanisms of change in prolonged exposure for PTSD
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“As defined by Foa and Kozak (1986), emotional processing is the course bywhich new information is introduced into an existing fear structure in order to change emotional responding.”
BackgroundInfluentialPeritraumatic dissociative experiences, trauma narratives, and trauma pathology
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Trauma narratives: it’s what you say, not how you say it
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“As proposed by Foa and Kozak (1986), through directly confronting these fearful stimuli, in the absence of escape, avoidance and ritualizing, the relationship between the fear stimulus and memory structures is modified and the fear elicited by the stimulus can decrease.”
BackgroundDoes fear reactivity during exposure predict panic symptom reduction?
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An experimental analogue study into the role of abstract thinking in trauma-related rumination
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Enhancing Inhibitory Learning: The Utility of Variability in Exposure
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“The predominant rationale guiding exposures in CBT for the past two decades has been Emotion Processing Theory [82], which emphasizes self-reported extinction and/or extinction retention via SUDS as the key measures of therapeutic exposure.”
Alvares, G. A., Balleine, B. W., & Guastella, A. J. (2014) · PLoS ONE · doi:10.1371/journal.pone.0094778 · Cited by 63
Borkovec, T. D., Newman, M. G., & Castonguay, L. G. (2003) · CNS Spectrums · doi:10.1017/s1092852900018642 · Cited by 66
Psychological Mechanisms of Effective Cognitive–Behavioral Treatments for PTSD
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Inside the Mental Voting Booth: An Impression-Driven Process Model of Candidate Evaluation
Lodge, M., & Stroh, P. (1993) · Explorations in Political Psychology · doi:10.1215/9780822396697-011 · Cited by 66
Metadata
- Authors
- Foa, E. B., & Kozak, M. J.
- Affiliations
- Temple University (US)
- ORCID
- Foa, Edna B.
- Venue
- Psychological Bulletin
- Published
- 1986-01
- Volume
- 99
- Issue
- 1
- Pages
- 20-35
- ISSN
- 0033-2909 (ISSN-L)
- 1939-1455
- OpenAlex
- W2152676810
- Cited by
- 5,396
- References
- 117
- Citations by year
- 2026: 160 · 2025: 205 · 2024: 197 · 2023: 189 · 2022: 256 · 2021: 208 · 2020: 310 · 2019: 261 · 2018: 245 · 2017: 194 · 2016: 207 · 2015: 245 · 2014: 226 · 2013: 205 · 2012: 195
- FWCI
- 34.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Bulletin (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (MH-31634)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
- Keywords
- fear, emotional processing, anxiety, memory structure, exposure therapy, habituation, physiological activation, mental representation, treatment failure, cognitive defense, autonomic arousal, mood states, psychopathology
- MeSH terms
- Adaptation, Psychological, Behavior Therapy, Desensitization, Psychologic, Emotions, Fear, Humans, Mental Recall, Set, Psychology
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