Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-19T05:39:44.291Z Has data issue: false hasContentIssue false
  • English
  • Français

Factors that Enhance Treatment Outcome of Cognitive-Behavioral Therapy for Anxiety Disorders

Published online by Cambridge University Press:  07 November 2014

Edna B. Foa ,
Shawn P. Cahill  and
Kristin Pontoski
Get access Rights & Permissions [Opens in a new window]

Abstract

Effective cognitive-behavioral therapy (CBT) programs have been developed for aU of the anxiety disorders. Common elements of CBT for these disorders include exposure to feared objects, situations, activities, thoughts, memories, and sensations; cognitive restructuring of dysfunctional beliefs; and training in anxiety management skills, such as controlled breathing and relaxation. This article describes CBT procedures for anxiety disorders and summarizes the research documenting its efficacy. Next, the article discusses the factors that influence the efficacy of these treatment program. Finally, emotional-processing theory is discussed to explain the efficacy of CBT for anxiety and how this theory can assist in selecting optimal treatment brocedures.

Type
Research Article
Information
CNS Spectrums , Volume 9 , Issue S14: Treatment Resistance: Concepts and Management in Mood and Anxiety Disorders , December 2002 , pp. 6 - 17,35
Copyright
Copyright © Cambridge University Press 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Kessler, RC, McGonagle, KA, Zhao, S, et al.Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51(1): 8–19.Google Scholar
2.Brown, TA, Campbell, LA, Lehman, CL, Grisham, JR, Mancill, RB. Current and lifetime comborbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. J Abnorm Psychol. 2001;110(4):49–58.Google Scholar
3.Swendsen, JD, Merikangas, KR, Canino, GJ, Kessler, RC, Rubio-Stipec, M, Angst, J. The comorbidity of alcoholism with anxiety and depressive disorders in four geographic communities. Compr Psychiatry. 1998;39(4):176–184.Google Scholar
4.DH, Barlow. Anxiety and its Disorders: The Nature and Treatment of Anxiety and Panic. 2nd ed. New York, NY: Guilford Press; 2002.Google Scholar
5.Foa, EB, Kozak, MJ. Emotional processing of fear: exposure to corrective information. Psychol Bull. 1986;99(1):20–35.Google Scholar
6.Goldstein, AJ, Chambless, DL. A reanalysis of agoraphobia. Behau Ther. 1978;9(1):47–59.CrossRefGoogle Scholar
7.Meichenbaum, D. Cognitive Behavior Modification. Morristown, NJ: General Learning Press; 1974.Google Scholar
8.AT, Beck. Cognitive Therapy and the Emotional Disorders. New York, NY: International University Press; 1976.Google Scholar
9.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
10.Wolpe, J. Psychotherapy by Reciprocal Inhibition. Stanford, CA: Stanford University Press; 1958.Google Scholar
11.Lang, PJ, Lazovik, AD. Experimental desensitization of a phobia. J Abnorm Soc Psychol. 1963;66(6):519–525.CrossRefGoogle ScholarPubMed
12.Lang, PJ, Lazovik, AD, Reynolds, DJ. Desensitization, suggestibility and pseudotherapy. J Abnorm Psychol. 1965;70(6):395–402.Google Scholar
13.Paul, GL. Insight Versus Desensitization in Psychotherapy. Stanford, CT: Stanford University Press; 1966.Google Scholar
14.Gelder, MG, Marks, IM. Severe agoraphobia: A controlled prospective trial of behaviour therapy. Br J Psychiatry. 1966;112(484):309–319.Google Scholar
16.Marks, I, Boulougouris, J, Marset, P. Flooding versus desensitization in the treatment of phobic patients: A cross-over study. Br J Psychiatry. 1971;119(551):353–375.Google Scholar
16.McGlynn, FD, Mealiea, WL, Landau, DL. The current status of systematic desensitization. Clin Psychol Rev. 1981;1(2):149–179.Google Scholar
17.Gelder, MG, Banchroft, HJ, Gath, DH, Johnston, DW, Mathews, AM, Shaw, PM. Specific and non-specific factors in behaviour therapy. Br J Psychiatry. 1973;123(575):309–319.CrossRefGoogle ScholarPubMed
18.Bandura, A, Blanchard, EB, Rittet, B. The relative efficacy of desensitization and modeling approaches for inducing behavioral, affective, and attitudinal changes. J Pers Soc Psychol. 1969;13(3):173–199.Google Scholar
19.PMG, Emmelkamp, Wessels, H. Flooding in imagination vs. flooding in vivo: A comparison with agoraphobics. Behav Res Ther. 1975;13(1):7–15.Google Scholar
20.Ost, LG, Ferebee, I, Furmark, T. One-session group therapy of spider phobia: Direct versus indirect treatments. Behav Res Ther. 1997;35(8):721–732.Google Scholar
21.Williams, SL, Turner, SM, Peer, DF. Guided mastery and performance desensitization in treatments for severe acrophobia. J Consult Clin Psychol. 1985;53(2):237–247.Google Scholar
22.Williams, SL, Zane, G. Guided mastery and stimulus exposure treatments for severe performance anxiety in agoraphobics. Behav Res Ther. 1989;27(3):237–245.Google Scholar
23.Clark, DM, Salkovskis, PM, Hackmann, A, Wells, A, Ludgate, J. Gelder, M. Brief cognitive therapy for panic disorder: A randomized controlled trial. J Consult Clin Psychol. 1999;67(4):583–589.Google Scholar
24.Klosko, JS, Barlow, DH, Tassinari, R, Cerny, JA. A comparison between alprazolam and behavior therapy in the treatment of panic disorder. J Consult Clin Psychol. 1990;58(1):77–84.Google Scholar
25.Margraf, J, Schneider, S. Outcome and active ingredients of cognitive-behavioral treatments for panic disorder. Paper presented at: Annual Convention of the Association fot Advancement of Behavior Therapy; 11 1991; New York, NY.Google Scholar
26.Telch, MJ, Lucas, JA, Schmidt, NB, Hanna, HH, Jaimez, TL, Lucas, RA. Group cognitive-behavioral treatment of panic disorder. Behav Res Ther. 1993;31(3):279–287.CrossRefGoogle ScholarPubMed
27.Clark, DM, Salkovoskis, PM, Hackmann, A, Middleton, H, Anastasiades, P, Gelder, MG. A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. Br J Psychiatry. 1994;164(6):759–769.CrossRefGoogle ScholarPubMed
28.Beck, AT, Sokol, L, Clark, DA, Berchick, R, Wright, FA. A crossover study of focused cognitive therapy for panic disorder. Am J Psychiatry. 1992;149(6):778–783.Google ScholarPubMed
29.Craske, MG, Maidenberg, E, Bystritsky, A. Brief cognitive-behaviotal versus nondirective therapy for panic disorder. J Behav Ther Exp Psychiatry. 1995;26(2):113–120.Google Scholar
30.Barlow, DH, Gorman, JM, Shear, MK, Woods, SW. Cognitive-behavioral therapy, imipramine, or their combination fot panic disorder: A randomized controlled trial. JAMA. 2000;283(19):2529–2536.Google Scholar
31.Black, DW, Wesner, RB, Bowers, W, Gabel, J. A comparison of fluvoxamine, cognitive therapy, and placebo in the treatment of panic disotder. Arch Gen Psychiatry. 1993;50(1):44–50.Google Scholar
32.Cottraux, J, Note, ID, Cungi, C, et al.A controlled study of cognitive behaviour therapy with buspirone or placebo in panic disorder with agoraphobia. Br J Psychiatry. 1995;167(5):635–641.Google Scholar
33.Marks, IM, RP, Swinson, Basaglu, M, et al.Alprazolam and exposure alone and combined in panic disorder with agoraphobia: A controlled study in London and Toronto. Br J Psychiatry. 1993;162:776–787.CrossRefGoogle ScholarPubMed
34.Hecker, JE, Fink, CM, Vogeltanz, ND, Thorpe, GL, Sigmon, ST. Cognitive restructuring and interoceptive exposure in the treatment of panic disorder: A crossover study. Behav Cognit Psychother. 1998;26(2):115–131.Google Scholar
35.Ito, LM, de Araujo, LA, VLC, Tess, de Barros-Neto, TP, Asbahr, FR, Marks, IM. Self-exposure therapy for panic disorder. Br J Psychiatry. 2001;178:331–336.Google Scholar
36.Marchione, KE, Michelson, L, Greenwald, M, Dancu, C. Cognitive behavioral treatment of agoraphobia. Behav Res Ther. 1987;25(5):319–328.Google Scholar
37.Mavissakalian, M, Michelson, L, Greenwald, D, Kornblith, S, Greenwald, M. Cognitive-behavioral treatment of agoraphobia: Paradoxical intention vs. self-statement training. Behav Res Ther. 1983;21(1):75–86.Google Scholar
38.Williams, SL, Rappoport, A. Cognitive treatment in the natural environment for agoraphobics. Behav Ther. 1983;14(2):299–313.Google Scholar
39.Craske, MG, Rowe, M, Lewin, M, Noriega-Dimitti, R. Interoceptive exposure versus breathing retraining within cognitive-behavioutal therapy fot panic disorder with agoraphobia. Br J Clin Psychol. 1997;36(1):85–99.Google Scholar
40.Schmidt, NB, Woolaway-Bickel, K, Trakowski, J, et al.Dismantling cognitive-behavioral treatment for panic disorder: Questioning the utility of breathing retraining. J Consult Clin Psychol. 2000;68(3):417–424.Google Scholar
41.Gould, RA, Otto, MW, Pollack, MH. A meta-analysis of treatment outcome for panic disorder. Clin Psychol Rev. 1995;15(8):819–844.Google Scholar
42.Meyer, V. Modification of expectations in cases with obsessional rituals. Behav Res Ther. 1966;4(4):273–280.Google Scholar
43.Meyer, V, Levy, R. Modification of behavior in obsessive-compulsive disorders. In: Adams, HE, Urnikel, P, eds. Issues and Trends in Behavior Therapy. Springfield, IL: Charles C. Thomas; 1973:77–136.Google Scholar
44. Meyer, V, Levy, R, Schnurer, A. The behavioral treatment of obsessive-compulsive disotders. In: Beech, HR, ed. Obsessional States. London, England: Methuen; 1974: 233–258.Google Scholar
45.Foa, EB, Kozak, MJ. Psychological treatment for obsessive compulsive disorder. In: Mavissakalian, MR, Prien, RP, eds. Long-Term Treatments of Anxiety Disorders. Washington, DC: American Psychiatric Press; 1996:285–309.Google Scholar
46.Foa, EB, Liebowitz, MR, Kozak, MJ, et al.Treatment of obsessive compulsive disotder by exposure and ritual prevention, clomipramine, and their combination: A randomized, placebo-controlled trial. Am J Psychiatry. In press.Google Scholar
47.Marks, IM, Stern, RS, Mawson, D, Cobb, J, McDonald, R. Clomipramine and exposure for obsessive-compulsive rituals. Br J Psychiatry. 1980;136:1–25.CrossRefGoogle ScholarPubMed
48.Lindsay, M, Crino, R, Andrews, G. Controlled trial of exposure and response prevention in obsessive-compulsive disorder. Br J Psychiatry. 1997;171:135–139.Google Scholar
49.Hohagen, F, Winkelmann, G, Rasche-Räuschle, H, et al.Combination of behaviour therapy with fluvoxamine in comparison with behaviour therapy and placebo. Br J Psychiatry. 1998;173(Suppl 35):71–78.Google Scholar
50.Cottraux, J, Mollard, E, Bouvard, M, et al.A controlled study of fluvoxamine and exposure in obsessive-compulsive disorder. Int Clin Psychopharmacol. 1990;5(1):17–30.Google Scholar
51.AJLM, Van Balkom, de Haan, E, van Oppen, P, Spinhoven, P, KAL, Hoogduin, van Dyck, R. Cognitive and behavioral therapies alone versus in combination with fluvoxamine in the treatment of obsessive-compulsive disotder. J Nerv Ment Dis. 1998;186(8):492–499.Google Scholar
52.Foa, EB, Steketee, G, Milby, JB. Differential effects of exposute and response prevention in obsessive-compulsive washers. J Consult Clin Psychol. 1980;48(1):71–79.Google Scholar
53.Foa, EB, Steketee, G, Grayson, JB, Turner, RM, Latimer, P. Deliberate exposure and blocking of obsessive-compulsive rituals: immediate and long-term effects. Behav Ther. 1984;15(5):450–472.Google Scholar
54.Foa, EB, Steketee, G, Grayson, JB. Imaginal and in vivo exposure: A comparison with obsessive-compulsive checkets. Behav Ther. 1985;16(3):292–302.Google Scholar
55.Foa, EB, Steketee, G, Turner, RM, Fischer, SC. Effects of imaginal exposute to feared disasters in obsessive-compulsive checkers. Behav Res Ther. 1980;18(5):449–455.Google Scholar
56.Emmelkamp, PM, Visser, S, Hoekstra, RJ. Cognitive therapy vs exposure in vivo in the treatment of obsessive-compulsives. Cognit Ther Res. 1988;12(1):103–114.Google Scholar
57.Emmelkamp, PM, Beens, H. Cognitive therapy with obsessive-compulsive disorder: A comparative evaluation. Behav Res Ther. 1991;29(3):293–300.Google Scholar
58.van Oppen, P, de Haan, E, van Balkom, AJ, Spinhoven, P, Hoogduin, K, van Dyck, R. Cognitive thetapy and exposure in vivo in the treatment of obsessive compulsive disotder. Behav Res Ther. 1995;33(4):379–390.Google Scholar
59.McLean, PD, Whittal, ML, Thordarson, DS, et al.Cognitive vetsus behavior therapy in the group treatment of obsessive-compulsive disorder. J Consult Clin Psychol. 2001;69(2):205–214.Google Scholar
60.Heimberg, RG, Becker, RE. Cognitive-Behavioral Therapy Group Therapy for Social Phobia: Basic Mechanisms and Clinical Strategies. New York, NY: Guilford Press; 2002.Google Scholar
61.Hope, DA, Heimberg, RG, Bruch, MA. Dismantling cognitive-behavioral group therapy for social phobia. Behav Res Ther. 1995;33(6):637–650.Google Scholar
62.Heimberg, RG, Liebowitz, MR, Hope, DA, et al.Cognitive-behavioral group therapy versus phenelzine in social phobia: 12-week outcome. Arch Gen Psychiatry. 1998;55(12):1133–1141.Google Scholar
63.Heimberg, RG, Dodge, CS, Hope, DA, Kennedy, CR, Zollo, LJ, Becker, RE. Cognitive behavioral group tteatment for social phobia: Comparison with a credible placebo control. Cognit Ther Res. 1990;14(1):1–23.Google Scholar
64.Lucas, RA, Teich, MJ. Group versus individual treatment of social phobia. Paper presented at: the 27th Annual Convention of the Association for Advancement of Behavior Therapy; 11 1993; Atlanta, GA.Google Scholar
65.JRT, Davidson, EB, Foa, Huppert, JD, et al.Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia. Arch Gen Psychiatry. 2004;61(10):1005–1013.Google Scholar
66.Stangier, U, Heidenreich, T, Peitz, M, Lauterbach, W, Clark, DM. Cognitive therapy for social phobia: individual versus group treatment. Behav Res Ther. 2003;41(9):991–1007.Google Scholar
67.Clark, DM, Ehlers, A, McManus, F, et al.Cognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo-controlled trial. J Consult Clin Psychol. 2003;71(6):1058–1067.CrossRefGoogle ScholarPubMed
68.Taylor, S. Meta-analysis of cognitive-behavioral tteatments for social phobia. J Behav Ther Exp Psychiatry. 1996;27(1):1–9.Google Scholar
69.Atkeson, BM, Calhoun, KS, Resick, PA, Ellis, EM. Victims of rape: repeated assessment of depressive symptoms. J Consult Clin Psychol. 1982;50(1):96–102.Google Scholar
70.Rothbaum, BO, Foa, EB, Riggs, DS, Murdock, T, Walsh, W. A prospective examination of post-traumatic stress disorder in rape victims. J Trauma Stress. 1992;5(3):455–475.Google Scholar
71.Riggs, DS, Rothbaum, BO, Foa, EB. A prospective examination of symptoms of posttraumatic stress disorder in victims of nonsexual assault. J Interpers Violence. 1995;10(2):201–214.Google Scholar
72.Harvey, AG, Bryant, RA. The relationship between acute stress disorder and posttraumatic stress disorder: A prospective evaluation of motor vehicle accident survivors. J Consult Clin Psychol. 1998;66(3):507–512.Google Scholar
73.Foa, EB, Hearst-Ikeda, D, Perry, KJ. Evaluation of a brief cognitive-behavior program for the prevention of chronic PTSD in recent assault victims. J Consult Clin Psychol. 1995;63(6):948–955.Google Scholar
74.Bryant, RA, Harvey, AG, Basten, C, Dang, ST, Sackville, T. Treatment of acute stress disorder: A comparison of cognitive-behavior therapy and supportive counseling. J Consult Clin Psychol. 1998;66(5):862–866.Google Scholar
75.Bryant, RA, Sackville, T, Dangh, ST, Moulds, M, Guthrie, R. Treating acute stress disorder: An evaluation of cognitive behavior therapy and supportive counseling techniques. Am J Psychiatry. 1999;156(11):1780–1786.Google Scholar
76.Bryant, RA, Moulds, M, Guthrie, R, RDV, Nixon. Treating acute stress disorder following mild traumatic brain injury. Am J Psychiatry. 2003;160(3):585–587.Google Scholar
77.Foa, EB, Rothbaum, BO, Riggs, DS, Murdock, TB. Treatment of posttraumatic stress disorder in rape victims: A comparison between cognitive-behavioral procedures and counseling. J Consult Clin Psychol. 1991;59(5):715–723.Google Scholar
78.Foa, EB, Dancu, CV, Hembree, EA, Jaycox, LH, Meadows, EA, Stteet, GP. A comparison of exposure therapy, stress inoculation training, and their combination fot reducing posttraumatic stress disotder in female assault victims. J Consult Clin Psychol. 1999;67(2):194–200.Google Scholar
79.Marks, I, Lovell, K, Noshirvani, H, Livanou, M, Thrasher, S. Treatment of posttraumatic stress disorder by exposure and/or cognitive restructuring. Arch Gen Psychiatry. 1998;55(4):317–325.Google Scholar
80.Resick, PA, Nishith, P, Weaver, TL, Astin, MC, Feurer, CA. A comparison of cognitive processing therapy with prolonged exposure and a waiting condition fot the treatment of chronic posttraumatic stress disorder in female rape victims. J Consult Clin Psychol. 2002;70(4):867–879.Google Scholar
81.Tarrier, N, Pilgrim, H, Sommerfield, C, et al.A randomized trial of cognitive therapy and imaginal exposure in the treatment of chronic posttraumatic stress disorder. J Consult Clin Psychol. 1999;67(1):13–18.Google Scholar
82.Shapiro, F. Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures. 2nd ed. New York, NY: Guilford; 2001.Google Scholar
83.Cooper, NA, Clum, GA. Imaginal flooding as a supplementary treatment for PTSD in combat veterans: A controlled study. Behav Ther. 1989;20(3):381–391.Google Scholar
84.Glynn, SM, Eth, S, Randolph, ET, et al.A test of behavioral family therapy to augment exposure for combat-related postttaumatic stress disorder. J Consult Clin Psychol. 1999;67(2):243–251.Google Scholar
85.Keane, TM, Fairbank, JA, Caddell, JM, Zimmering, RT. Implosive (flooding) therapy reduces symptoms of PTSD in Vietnam combat veterans. Behav Ther. 1989;20(2):245–260.Google Scholar
86.Cloitre, M, Koenen, KC, Cohen, LR, Han, H. Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment fot PTSD related to childhood abuse. J Consult Clin Psychol. 2002;70(5):1067–1074.Google Scholar
87.Kubany, ES, Hill, EE, Owens, JA. Cognitive trauma therapy for battered women with PTSD: Preliminary findings. J Trauma Stress. 2003;16(1):81–91.Google Scholar
88.Blanchard, EB, Hickling, EJ, Devineni, T, et al.A controlled evaluation of cognitive behaviorial therapy for posttraumatic stress in motot vehicle accident survivors. Behav Res Ther. 2003;41(1):79–96.CrossRefGoogle Scholar
89.Fecteau, G, Nicki, R. Cognitive behavioural treatment of posttraumatic stress disorder after motot vehicle accident. Behav Cognit Psychother. 1999;27(3):201–215.Google Scholar
90.Taylor, S, Thordarson, DS, Maxfield, L, Fedoroff, IC, Lovell, K, Ogrodniczuk, J. Comparative efficacy, speed, and adverse effects of three PTSD treatments: exposute thetapy, EMDR, and relaxation training. J Consult Clin Psychol. 2003;71(2):330–338.Google Scholar
91.Paunovic, N, Ost, LG. Cognitive-behavior therapy vs exposure therapy in he treatment of PTSD in refugees. Behav Res Ther. 2001;39(10):1183–1197.Google Scholar
92.Bryant, RA, Moulds, ML, Guthrie, RM, Dang, ST, RDV, Nixon. Imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of posttraumatic stress disorder. J Consult Clin Psychol. 2003;71(4):706–712.Google Scholar
93.Richards, DA, Lovell, K, Marks, IM. Post-traumatic stress disorder: Evaluation of a behavioral treatment program. J Trauma Stress. 1994;7(4):669–680.Google Scholar
94.Barlow, DH, Rapee, RM, Brown, T. Behavioral treatment fot generalized anxiety disorder. Behav Ther. 1992;23(4):551–570.Google Scholar
95.Borkovec, TD, Costello, E. Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. J Consult Clin Psychol. 1993;61(4):611–619.Google Scholar
96.Butler, G, Fennell, M, Robson, P, Gelder, M. Comparison of behavior thetapy and cognitive behavior therapy in the treatment of generalized anxiety disorder. J Consult Clin Psychol. 1991;59(1):167–175.Google Scholar
97.Arntz, A. Cognitive thetapy versus applied relaxation as treatment of generalized anxiety disorder. Behav Res Ther. In press.Google Scholar
98.Ost, LG, Breitholtz, E. Applied relaxation vs. cognitive thetapy in the treatment of genetalized anxiety disorder. Behav Res Ther. 2000;38(8):777–790.CrossRefGoogle Scholar
99.Borkovec, TD, Newman, MG, Pincus, AL, Lytle, R. A Component analysis of cognitive-behavioral therapy for generalized anxiety disotdet and the role of interpersonal problems. J Consult Clin Psychol. 2002;70(2):288–298.Google Scholar
100.Power, KG, Simpson, MB, Swanson, V, Wallace, LA. A controlled comparison of cognitive-behaviour therapy, diazepam, and placebo, alone and in combination, for the treatment of generalised anxiety disorder. J Anxiety Disord. 1990;4(4):267–292.Google Scholar
101.Foa, EB, Kozak, MJ. Treatment of anxiety disorders: Implications for psychopathology. In: Tuma, A, Maser, JD, eds. Anxiety and the Anxiety Disorders. Hillsdale, NJ: Erlbaum; 1985:421–452.Google Scholar
102.Kozak, MJ, Foa, EB, Steketee, GS. Process and outcome of exposure treatment with obsessive-compulsives: psychophysiological indicators of emotional processing. Behav Ther. 1988;19(2):157–169.Google Scholar
103.Foa, EB, Riggs, DS, Massie, ED, Yarczower, M. The impact of feat activation and anger on the efficacy of exposure treatment for posttraumatic stress disorder. Behav Ther. 1995;26(3):487–499.CrossRefGoogle Scholar
104.Jaycox, LH, Foa, EB, Morral, AR. Influence of emotional engagement and habituation on exposure therapy for PTSD. J Consult Clin Psychol. 1998;66(1):185–192.Google Scholar
105.Pitman, RK, Orr, SP, Altman, B, et al.Emotional processing and outcome of imaginal flooding therapy in Vietnam veterans with chronic posttraumatic stress disorder. Compr Psychiatry. 1996;37(6):409–418.Google Scholar
106.Foa, EB, Grayson, JB, Steketee, GS, Doppelt, HG, Turner, RM, Latimet, PR. Success and failure in the behavioral treatment of obsessive-compulsives. J Consult Clin Psychol. 1983;51(2):287–297.Google Scholar
107.Mattick, R, Peters, L. Treatment of severe social phobia: effects of guided exposure with and without cognitive resttuctuting. J Consult Clin Psychol. 1988;56(2):251–260.Google Scholar
108.Foa, EB, SAM, Rauch. Cognitive changes during prolonged exposure versus prolonged exposure plus cognitive restructuring in female assault survivors with posttraumatic stress disorder. J Consult Clin Psychol. 2004;72(5):879–884.Google Scholar
109.Foa, EB, Franklin, ME, Moser, J. Context in the clinic: How well do cognitive-behavioral therapies and medication wotk in combination? Biol Psychiatry. 2002;52(10):987–997.Google Scholar
110.Chambless, DL, Foa, EB, Groves, GA, Goldstein, AJ. Flooding with brevital in the treatment of agoraphobia: Countereffective? Behav Res Ther. 1979;17(3):243–251.Google Scholar
111.Foa, EB, Cahill, SP. Psychosocial treatments for PTSD: An overview. In: Neria, Y, Gross, R, Marshall, R, Susser, E, eds. 9/11: Public Health in the Wake of Terrorist Attach. Cambridge, United Kingdom: Cambridge University Press. In press.Google Scholar