Pathological Anxiety: Emotional Processing in Etiology and Treatment

288 Pages·2005·2.13 MB·English

by  Barbara Olasov Rothbaum

Emotional Processing
in Etiology and Treatment
Edited by
BARBARA OLASOV ROTHBAUM
THE GUILFORD PRESS
New York London
© 2006 The Guilford Press
A Division of Guilford Publications, Inc.
72 Spring Street, New York, NY 10012
www.guilford.com
All rights reserved
No part of this book may be reproduced, translated, stored in a
retrieval system, or transmitted, in any form or by any means,
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Printed in the United States of America
This book is printed on acid-free paper.
Last digit is print number: 9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Pathological anxiety : emotional processing in etiology and treat-
ment / edited by Barbara Olasov Rothbaum.
p. ; cm.
Includes bibliographical references and index.
ISBN 1-59385-223-1 (alk. paper)
1. Anxiety—Treatment. 2. Cognitive therapy. 3. Imagery
(Psychology) I. Rothbaum, Barbara Olasov.
[DNLM: 1. Anxiety Disorders—therapy. 2. Anxiety Disorders
—etiology. 3. Anxiety Disorders—physiopathology. 4. Cognitive
Therapy—methods. 5. Fear—psychology. 6. Imagery (Psycho-
therapy)—methods. WM 172 P297 2005]
RC531.P38 2006
616.85′2206—dc22 2005010330
About the Editor
Barbara Olasov Rothbaum, PhD, is a tenured Professor of Psychiatry and
Director of the Trauma and Anxiety Recovery Program at Emory Univer-
sity Schoolof Medicine.Dr.Rothbaum specializesinresearchonthetreat-
ment of individuals with affective disorders, particularly anxiety and
posttraumatic stress disorder (PTSD). She has won both state and national
awards for her research, and is an invited international speaker within her
field. She has published numerous journal articles, book chapters, and
booksonthetreatmentofPTSD,andisaDiplomateinBehavioralPsychol-
ogy of the American Board of Professional Psychology. Currently, Dr.
Rothbaum serves as President of the International Society for Traumatic
Stress Studies (ISTSS), and is a former Associate Editor of the Journal of
TraumaticStress.Sheisapioneerintheapplicationofvirtualrealitytothe
treatment of psychological disorders.
Dr. Rothbaum had the pleasure of working with Dr. Edna B. Foa in
Philadelphiafrom1986to1990and hascontinuedtocollaboratewithDr.
Foa over the years.
v

CCoonnttrriibbuuttoorrss
Contributors
Laura B. Allen, MA, Center for Anxiety and Related Disorders, Boston
University, Boston, Massachusetts
David H. Barlow, PhD, Center for Anxiety and Related Disorders,
Boston University, Boston, Massachusetts
Evelyn Behar, MS, Department of Clinical Psychology, The Pennsylvania
State University, University Park, Pennsylvania
T. D. Borkovec, PhD, Department of Psychology, The Pennsylvania State
University, University Park, Pennsylvania
Shawn P. Cahill, PhD, Department of Psychiatry and Center for the
Treatment and Study of Anxiety, University of Pennsylvania,
Philadelphia, Pennsylvania
David M. Clark, PhD, Department of Psychology, Institute of Psychiatry,
London, United Kingdom
Bruce N. Cuthbert, PhD, Department of Psychology, University of
Minnesota, Minneapolis, Minnesota
Jonathan R. T. Davidson, MD, Anxiety and Traumatic Stress Program,
Duke University Medical Center, Durham, North Carolina
Anke Ehlers, PhD, Department of Psychology, Institute of Psychiatry,
London, United Kingdom
Norah C. Feeny, PhD, Departments of Psychiatry and Psychology, Case
Western Reserve University, Cleveland, Ohio
vii
viii Contributors
Edna B. Foa, PhD, Department of Psychiatry and Center for the
Treatment and Study of Anxiety, University of Pennsylvania,
Philadelphia, Pennsylvania
Martin E. Franklin, PhD, Center for the Treatment and Study of
Anxiety, University of Pennsylvania, Philadelphia, Pennsylvania
Elizabeth A. Hembree, PhD, Department of Psychiatry, University of
Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Jonathan D. Huppert, PhD, Department of Psychiatry and Center for the
Treatment and Study of Anxiety, University of Pennsylvania,
Philadelphia, Pennsylvania
Terence M. Keane, PhD, National Center for PTSD, VA Boston
Healthcare System, Boston University School of Medicine, Boston,
Massachusetts
Peter J. Lang, PhD, Department of Clinical and Health Psychology,
University of Florida, Gainesville, Florida
Michael R. Liebowitz, MD, Anxiety Disorders Clinic, New York State
Psychiatric Institute, New York, New York
John S. March, MD, MPH, Department of Child and Adolescent
Psychiatry, Duke University Child and Family Study Center, Duke
University Medical Center, Durham, North Carolina
Andrew Mathews, PhD, MRC Senior Scientist, MRC Cognition and
Brain Sciences Unit, Cambridge, United Kingdom
Richard J. McNally, PhD, Department of Psychology, Harvard
University, Cambridge, Massachusetts
Lisa M. McTeague, MS, Department of Clinical and Health Psychology,
University of Florida, Gainesville, Florida
David Riggs, PhD, Department of Psychiatry and Center for the
Treatment and Study of Anxiety, University of Pennsylvania,
Philadelphia, Pennsylvania
Barbara Olasov Rothbaum, PhD, Department of Psychiatry and Trauma
and Anxiety Recovery Program, Emory University School of Medicine,
Atlanta, Georgia
Katherine Shear, MD, Bereavement and Grief Program, Western
Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania
Helen Blair Simpson, MD, PhD, Anxiety Disorders Clinic, New York
State Psychiatric Institute, New York, New York
PPrreeffaaccee
Preface
The understanding and treatment of anxiety disorders has advanced rap-
idly in the past 10 years. Particularly important advances include the com-
parison of psychotherapy and pharmacotherapy and, in some cases, the
combination of psychotherapy and pharmacotherapy. Almost all mental
healthprofessionalscomeintocontactwithpatientssufferingfromanxiety
disorders, and this volume addresses the theoretical, assessment, and prac-
tical treatment issues likely to touch the professional lives of researchers
and practitioners alike.
The considerable progress made in psychotherapy for these debilitat-
ingconditionslargelyhingesonEdnaB.Foa’stheoreticalandclinicalwork
onexposuretherapy,firstinobsessive–compulsivedisorder(OCD),thenin
posttraumatic stress disorder (PTSD), and more recently in social phobia.
Sheisadistinguishedscholar,teacher,andclinicalresearcherinpsychologi-
cal science, particularly within the anxiety disorders.
This volume results in large part from a conference held in May 2004
in Philadelphia, Pennsylvania, in honor of Professor Foa. Many of the au-
thorsofchaptersinthisbookwerepresentersatthatmeeting.However,we
have included chapters by many more authors in order to round out this
volumetocoveralloftheanxietydisordersandtopresentthelatestinthe-
ory and treatment of pathological anxiety, especially the contribution of
emotional processing theory to current thinking. The contributors collec-
tively summarize the state of the art in the anxiety disorders field, identify
gaps in our knowledge, and stimulate future steps for clinicalresearch and
the dissemination of empirically supported interventions.
Ourlistofauthorsisaninternational“who’swho”inthefieldofanx-
iety,andweareproudtopresentthisvolumetoyou.Asitwasinlargepart
theresultofatributetoEdnaFoa’slifetimeofworkinthearea,Ibeginthe
book with a brief history of her life.
EdnaB.FoawasborninHaifa,Israel,onDecember28,1937,andre-
ceived her undergraduate education in Israel, coming to the United States
for her graduate education in 1966. Her entire career as an academic pro-
fessional has been spent in Philadelphia, first at Temple University, then at
ix
x Preface
theMedicalCollegeofPennsylvania,and,since1998,attheDepartmentof
Psychiatry at the University of Pennsylvania School of Medicine. In 1979,
she founded the Center for the Treatment and Study of Anxiety, where,
with the collaboration of many colleagues, she has been conducting her
research and clinical activities.
Edna Foa was drawn to psychology as an adolescent, when she discovered
thewritingsofSigmundFreudandbecamefascinatedwithpsychoanalysis.
Aftergraduating fromhighschool,shewenttoanormalschooltotrainto
work with delinquent children. Her teacher of psychology there was a
trained psychoanalyst who encouraged her to write her final thesis on the
Freudian explanation of childhood delinquency.
Afterworkingfor2yearsinaboardingschoolfordelinquentchildren,
she continued to study psychology at Bar-Ilan University, where she re-
ceivedherBAin1962.AtBar-Ilan,herclinicalpsychologyteachersallrep-
resented psychoanalytic or psychodynamic orientations; none of them
thought that psychotherapy could or should be studied empirically. How-
ever, at Bar-Ilan Foa was also exposed to research in experimental and so-
cialpsychologyandbecameextremelyinterestedbothinthescienceofpsy-
chology and in empirical research. This interest was fostered by her late
husband, Uriel G. Foa, who was then the chair of the university’s Depart-
ment of Psychology and a distinguished researcher in social psychology.
Herfirstcontactwithbehaviortherapyandbehaviormodificationoc-
curredattheUniversityofIllinois,whereshereceivedherMAin1970under
thesupervisionofO.HobartMowrer.Inthe1960s,theclinicalprogramin
theDepartmentofPsychologyatUrbanawasoneofthestrongholdsofbe-
havior therapy and modification; its faculty included Leonard Ullmann,
LeonardKrasner,andGordonPaul,tonameonlyafew.There,Foafirstbe-
cameacquaintedwiththeworkofJosephWolpeandwiththeintegrationof
experimentalpsychologyconceptsintopsychopathologyandtreatment.Her
educationalexperienceattheUniversityofIllinois,togetherwithUrielFoa’s
mentoring in research methodology, marked the beginning of her
professional career.
AftercompletingherPhDin1970attheUniversityofMissouriatCo-
lumbia, she was awarded a postdoctoral fellowship from the National In-
stitute of Mental Health to work with Wolpe at Temple University, the
mecca of behavior therapy at the time. There she had the opportunity to
meetleadersinthefield,manyofwhominfluencedherconceptualandem-
pirical work. Of particular importance for her was the influence of Peter
Lang and Stanley Rachman.