Review of Pathological anxiety: Emotional processing in etiology and treatment.

Abstract

BARBARA OLASOV ROTHBAUM Pathological Anxiety: Emotional Processing in Etiology and Treatment New York: Guilford, 2006, 272 pages (ISBN: 1-59385-223-1, US$32.00, Hardcover) Reviewed by HENNYA. WESTRA This book is a tribute to the work of Edna B. Foa whose model of emotional processing (developed in collaboration with Michael J. Kozak) has had a profound impact on the understanding and treatment of individuals with pathological anxiety. The chapters are derived in large part from a conference in May 2004 in Philadelphia, Pennsylvania, in honour of Professor Foa. Contributors to the book include a virtual who's who of experts in the theory and treatment of anxiety. The book provides a comprehensive review of significant advancements in the understanding of anxiety since Foa's seminal articles. The authors each credit Foa's thinking and empirical work with having strongly influenced the direction of their own research. The book's preface overviews the achievements of Dr. Foa's academic career and the introductory chapter to the book (by Foa, Huppert, & Cahill) provides a useful update on emotional processing theory since its introduction. Emotional processing theory conceptualizes the nature of anxiety disorders and the psychological mechanisms of effective treatment. In addition to facilitating our understanding of anxiety, it also points to important mechanisms of change underlying successful anxiety treatment such as the importance of activation of underlying fear structures and the incorporation of new information that is incompatible with the pathological elements of the fear structure. In particular, it highlights the importance of avoidance in maintaining pathological fear structures and thus the necessity of in vivo exposure (or emotional engagement with the feared stimuli) in reshaping them. Exposure is posited to underlie successful treatment since it provides corrective information challenging propositions in the underlying fear structure such as exaggerated estimates of the costs and anticipated harm of contact with the phobic stimulus. Moreover, Foa's body of empirical work in the treatment of Obsessive Compulsive Disorder (OCD) and PostTraumatic Stress Disorder (PTSD) identifies the parameters of successful exposure work such as prolonged exposure and a decrease in peak intensity of fear across treatment sessions. In the chapter by Richard McNaIIy, a graph is presented showing the strong and continuing impact of Foa's work by revealing that citations of Foa and Kozak's seminal 1986 article increased linearly from its original publication. The first section of the book provides a series of chapters on theoretical conceptualizations of various anxiety disorders stemming from emotional processing theory. It includes chapters on emotional encoding of fear-related information, recollection of forgotten trauma, imagery and the anxiety disorders, and predictors of PTSD memories and appraisals. The chapter by Andrew Mathews on emotional encoding and memory in anxiety is particularly noteworthy for its excellent review of research suggesting that fear memories may not be encoded in a form that can be accessed using traditional tests of verbal memory. The chapter also outlines possible neural processes underlying the cognitive modulation of encoding and reviews data suggesting that effortful control can alter encoding biases maintaining pathological anxiety. The chapter by Peter Lang and colleagues on physiological reactivity during exposure to fearful imagery also provides a rich complement to the book by outlining how a simple reflex measure can reliably discriminate among different types of anxiety. Richard McNally's chapter on forgotten memory demonstrates the farreaching impact and heuristic importance of emotional processing theory beyond behaviour therapy for phobic disorders, to relevance for controversial issues of repressed and forgotten memories. …