Cited by 360Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesObsessive-Compulsive Spectrum DisordersPosttraumatic Stress Disorder Research

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The Efficacy of Exposure Therapy for Anxiety-Related Disorders and Its Underlying Mechanisms: The Case of OCD and PTSD

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Foa, Edna B., McLean, Carmen P.·2016·Annual Review of Clinical Psychology

DOI 10.1146/annurev-clinpsy-021815-093533

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Abstract

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 Foa and her colleagues in anxiety disorders, we demonstrate how emotional processing theory of anxiety-related disorders and their treatment using exposure therapy have generated hypotheses about the psychopathology of posttraumatic stress disorder and obsessive-compulsive anxiety disorder that have informed the development and refinement of specific treatment protocols for these disorders: prolonged exposure and exposure and response (ritual) prevention. Further, we have shown that the next step after the development of theoretically driven treatment protocols is to evaluate their efficacy. Once evidence for a treatment's efficacy has accumulated, studies of the mechanisms involved in the reduction of the targeted psychopathology are conducted, which in turn inform the theory and further refine the treatments. We conclude our review with a discussion of how the knowledge derived from Foa and colleagues' programmatic research together with knowledge emerging from basic research on extinction learning can inform future research on the psychopathology of anxiety disorders and their treatments.

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“Moreover, ending safe could have introduced new, incompatible information to the original fear structure, constituting an important mechanism of exposure therapy (Foa & McLean, 2016).”
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Lombardi, A., & Rodríguez, C. I. (2019) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.33.3.185 · Cited by 3
“…to feared Pdf_Folio:185 © 2019 Springer Publishing Company 185 http://dx.doi.org/10.1891/0889-8391.33.3.185 186 Lombardi and Rodriguez objects or ideas (real or imagined) while refraining from their response (compulsive behaviors; Foa & McLean, 2016; Koran et al., 2007; Koran & Simpson, 2013).”
BackgroundInfluential
PRELIMINARY STUDY OF THE EFFECTS OF POST-RETRIEVAL EXTINCTION ON THE RETURN OF CONDITIONED RESPONSES IN HUMANS
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White, E. J., Wray, J. M., & Shepardson, R. L. (2020) · Families Systems & Health · doi:10.1037/fsh0000543 · Cited by 3
“However, exposure therapy (ET), arguably the most effective intervention for anxiety (Deacon & Abramowitz 2004; Foa & McLean, 2016; Pompoli et al., 2018; Olatunji, Cisler, & Deacon, 2010), has received little attention in the PC-based anxiety treatment literature.”
Background
Cognitive behavioral therapy (CBT)
Westhoff, M., Bhattacharya, S., & Hofmann, S. G. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-96023-6.00024-5 · Cited by 6
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“Individuals with OCD respond to anxiety-or fear-producing stimuli in one of two ways (Foa & McLean, 2016).”
Background
Emotional clarity and awareness predict obsessive–compulsive disorder symptoms during exposure and response prevention in a naturalistic treatment sample
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BackgroundMethod
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Background
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“Exposure therapy is a first-line behavioral treatment for anxiety, obsessive-compulsive, and trauma-related disorders that involves repeated contact with feared stimuli, contexts, and scenarios (Foa and McLean, 2016; Reid et al., 2021; McLean et al., 2022).”
Background
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Method
Cognitive and Behavioral Therapies
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Method
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Method
الهناء الذاتی وعلاقته باستراتیجیات التنظیم الانفعالی والمخططات الوجدانیة وما وراء الانفعال لدى طلاب الجامعة (دراسة فی نمذجة العلاقات)
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“…addressing several presenting concerns, such as mood and anxiety disorders, eating disorders, post-traumatic stress, personality disorders, and alcohol use disorders (Beck, 2021; David et al., 2018; Fairburn, 2008; Foa and McLean, 2016; Ledley et al., 2020; Linehan, 1993; Matusiewicz et al., 2010).”
Background
How Does Virtual Reality Exposure Treatment Change the Brain Function of Acrophobia Patients? A Randomized Controlled Trial
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“Shielding and Healing”
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“Exposure was rated as a second-line intervention, despite prior evidence that exposure seems necessary for clinically significant symptom change (Taylor et al., 2003; Foa and McLean, 2016).”
Background
Recovering from Post-Traumatic Stress Disorder symptoms: A study on the combination of art and mindfulness
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Method
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“PE is based on emotional processing theory, and the core treatment component, exposure to trauma-related cues, is thought to facilitate emotional processing through refraining from avoidance behaviours (Foa & Kozak, 1986; Foa & Mclean, 2016).”
Veterans' experiences of somatic experiencing and prolonged exposure therapies for post‐traumatic stress disorder: A qualitative analysis
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Final Session
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Self-citation
Stress-Related Disorders
Leong, F. T. L. (2008) · Sage eBooks · doi:10.4135/9781412963978.n131 · Cited by 1
Freeze! The Impact of a Guided Imagery Intervention on Looming Vulnerability and Subclinical Contamination-OCD Symptoms
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Investigação dos efeitos do comportamento verbal durante a extinção pós-recuperação sobre o retorno do medo
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Kainate receptor auxiliary subunits NETO1 and NETO2 in anxiety and fear-related behaviors
Mennesson, M. (2019) · Työväentutkimus Vuosikirja
Foundations of Prolonged Exposure
Rauch, S. A. M., Rothbaum, B. O., Smith, E. R., & Foa, E. B. (2020) · Oxford University Press eBooks · doi:10.1093/med-psych/9780190081928.003.0001
Self-citation
Tailoring Treatment to the Individual
Foa, E. B., Hembree, E. A., ROTHBAUM, B. O., & Rauch, S. A. M. (2019) · Oxford University Press eBooks · doi:10.1093/med-psych/9780190926939.003.0008
Self-citation
Assessing Trauma Survivors and Implementing PE in Practice
Foa, E. B., Hembree, E. A., ROTHBAUM, B. O., & Rauch, S. A. M. (2019) · Oxford University Press eBooks · doi:10.1093/med-psych/9780190926939.003.0002
Self-citation
Intermediate Sessions
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“일각에서는 노출치료가 대상자의 증상을 악화 시킬 수 있다고 보고 되고 있으나[9], 일반 적으로 안전한 환경에서의 노출은 외상 후 스트레스 장애의 증 상 중 불안, 우울을 감소시키는데 효과적이며[7], 그 효과가 장기 적으로 지속된다는 장점을 지닌 것으로 간주되고 있다[10].”
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Session 3
Foa, E. B., Hembree, E. A., ROTHBAUM, B. O., & Rauch, S. A. M. (2019) · Oxford University Press eBooks · doi:10.1093/med-psych/9780190926939.003.0005
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Brondolo, E. N. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-815680-3.00001-3
Session 2
Foa, E. B., Hembree, E. A., ROTHBAUM, B. O., & Rauch, S. A. M. (2019) · Oxford University Press eBooks · doi:10.1093/med-psych/9780190926939.003.0004
Self-citation
Session 1
Foa, E. B., Hembree, E. A., ROTHBAUM, B. O., & Rauch, S. A. M. (2019) · Oxford University Press eBooks · doi:10.1093/med-psych/9780190926939.003.0003
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Case Management
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An investigation of the relationship between mobile phone use in social media and college student anxiety
Fan, Z. (2023) · Journal of Education Humanities and Social Sciences · doi:10.54097/ehss.v9i.6450
“Finally, speak in a public setting [11].”
اليقظة العقلية كمنبئ بالتجهيز الانفعالي لدى طلاب الجامعة
عبده, س. ع. ز. (2023) · مجلة جامعة جنوب الوادى الدولية للعلوم التربوية · doi:10.21608/musi.2023.214616.1123
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Additional file 2 of Causality of genetically determined metabolites on anxiety disorders: a two-sample Mendelian randomization study
Xiao, G., He, Q., Liu, L., Zhang, T., Zhou, M., Li, X., Chen, Y., Chen, Y., & Qin, C. (2022) · Figshare · doi:10.6084/m9.figshare.21376260
The role of expectancy violation in extinction learning: a two-day virtual reality fear conditioning studyPreprint
Gromer, D., Stegmann, Y., & Gamer, M. (2024) · doi:10.31234/osf.io/hcjmz
Anxiety and Phobias
Kennair, L. E. O., Lindner, M., Hagen, K., & Larsen, S. M. (2024) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197544754.013.59
The Ethics and Experience of Brief Therapy: The Case of Exposure Therapy
Jessup, S. C., & Olatunji, B. O. (2024) · CBT: science into practice · doi:10.1007/978-3-031-60746-2_2
Cognitive and Behavioral Therapies
Thase, M. E., Khazanov, G. K., & Wright, J. H. (2024) · Springer eBooks · doi:10.1007/978-3-030-51366-5_35 · Cited by 1
Allaying the fears: Midomafetamine with therapy is a medicine
Nutt, D. J., Hawrot, T., Hunt, P., & Schlag, A. K. (2024) · Drug Science Policy and Law · doi:10.1177/20503245241274079
“Consequently, the pharmacological effects of MDMA enhance the effectiveness of the current gold-standard treat-ment, which is extinction-based psychotherapy (Foa and McLean, 2016).”
Technology exposure elicits increased acceptance of autonomous robots and avatars
Craig, S., Lavan, S., Altarawneh, E., Chandola, D., Khan, W., Pepler, D. J., & Jenkin, M. R. M. (2024) · IEEE RO-MAN · doi:10.1109/ro-man60168.2024.10731380
“Given the ample evidence that exposure to a feared stimulus can reduce the negative emotions associated with it [47], apprehension towards new technologies may be alleviated through repeated exposure.”
Background
Perceptions and Use of Extended‐Duration Exposure Therapy Amongst Psychologists
Caton, R., & Graham, B. M. (2025) · Journal of Clinical Psychology · doi:10.1002/jclp.23767

Authors: Foa, E. B., & McLean, C. P.
Affiliations: University of Pennsylvania (US)
ORCID: Foa, Edna B.
McLean, Carmen P.
Venue: Annual Review of Clinical Psychology
Publisher: Annual Reviews
Published: 2016-03-28
Volume: 12
Issue: 1
Pages: 1-28
ISSN: 1548-5943 (ISSN-L)
1548-5951
DOI: 10.1146/annurev-clinpsy-021815-093533
OpenAlex: W1923241527
Cited by: 360
References: 134
Citations by year: 2026: 31 · 2025: 38 · 2024: 45 · 2023: 42 · 2022: 36 · 2021: 29 · 2020: 50 · 2019: 42 · 2018: 23 · 2017: 14 · 2016: 9
FWCI: 1.98
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Annual Review of Clinical Psychology (publishedVersion)
PubMed (publishedVersion)
Funders: University of Pennsylvania
National Institute on Alcohol Abuse and Alcoholism
National Institute of Mental Health
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords: exposure therapy, anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, prolonged exposure, exposure and response prevention, emotional processing theory, extinction learning, therapeutic mechanisms, treatment efficacy, psychopathology
MeSH terms: Anxiety Disorders, Humans, Implosive Therapy, Obsessive-Compulsive Disorder, Stress Disorders, Post-Traumatic, Treatment Outcome

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The Efficacy of Exposure Therapy for Anxiety-Related Disorders and Its Underlying Mechanisms: The Case of OCD and PTSD

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