Edna Foa, an Israeli American psychologist who pressed her field — and her patients — to more directly confront fear and anxiety, revolutionizing the treatment of post-traumatic stress disorder, died on March 24 at a hospital in Philadelphia. She was 88.
Her death, from complications of pneumonia, was confirmed by her daughter Yael Foa.
Dr. Foa completed her training in the late 1960s, when clinicians tended to treat people with severe anxiety disorders cautiously and gradually. One of her first patients, a woman with an intense fear of objects related to death, had been prescribed a course of “systematic desensitization.”
Dr. Foa was instructed to visit her every day carrying a small stone from a cemetery, bringing the stone a little closer each time until at long last the patient would be able to hold it.
“We started to feel that she will never get better at that rate,” Dr. Foa recalled in a 2018 podcast interview.
Dr. Foa decided to move faster, driving the patient to a funeral home and bringing her inside so that the woman was forced to deal with her distress. Avoiding those feelings, Dr. Foa posited, was actually holding the patient back.
This theory culminated, about a decade later, in Dr. Foa’s landmark innovation.
In the 1980s, she developed prolonged exposure therapy, a structured protocol of eight to 12 90-minute sessions in which the patient recounts a traumatic event in the present tense, lingering on the most vivid and upsetting elements. Then the patient undertakes real life exposure to reminders of the event.
These sessions could be uncomfortable, Dr. Foa acknowledged. But they served to ease the patient’s sensitivity and correct flawed thinking, demonstrating that there was no harm in confronting the feared object, place or event. Over the years that followed, a series of studies supported the approach’s effectiveness.
By the late 2000s, hundreds of thousands of veterans were returning to the United States from Afghanistan and Iraq with symptoms of PTSD. In 2007, the V.A. adopted Dr. Foa’s approach as a first-line treatment for the disorder. By 2010, over 1,000 V.A. therapists nationwide had been trained in her technique.
Patricia Resick, a professor emeritus of psychiatry at Duke, said in an interview that Dr. Foa stood out for her willingness to steer patients through difficult emotions.
“She said it’s better to just start at the worst and go through the whole thing,” said Dr. Resick, who developed cognitive processing therapy, another commonly used treatment for PTSD.
At first, Dr. Resick said, many therapists were reluctant to try prolonged exposure “because it’s uncomfortable to go through the gory details of a traumatic event, for the client and the therapist.”
But, she added, “it is a very good route to change.”
The PTSD field grew hotly contested, and Dr. Foa was a passionate advocate for her approach. “She was highly competitive,” Dr. Resick said. “And I think she had to be, because she had to force her way into a world that wasn’t going to accept her. She did it. She’s a giant.”
Edna Ben Jacob was born on Dec. 28, 1937, in Haifa, in present-day Israel, to parents who had immigrated from Poland. Her father, Abraham, was a manager for a construction company, and her mother, Rivka, kept the home.
When she was 10, her older brother, Uri, died in combat in the 1948 war that followed Israel’s declaration of independence as a Jewish state. The loss left her parents in deep mourning, and four years later, her father died.
Edna trained to teach on a kibbutz, then worked briefly at an institution for juvenile offenders, an experience that led to her interest in becoming a psychologist.
She had a brief early marriage that ended in divorce. Then, as an undergraduate at Bar-Ilan University in Tel Aviv, from which she graduated in 1962, she met Uriel Foa, a professor of psychology there.
The two married and had three daughters, moving to the United States when her husband was invited to teach at the University of Illinois, Urbana-Champaign. The marriage ended in divorce.
She received a master’s degree at the University of Illinois and a Ph.D. at the University of Missouri, both in clinical psychology.
Early on, the focus of her research was phobias and obsessive-compulsive disorder. At Temple University, her first academic appointment, she worked with Joseph Wolpe, one of the pioneers of behavior therapy, who aimed to steer psychotherapy toward empirical science. She also studied with Victor Meyer, a British psychologist who had observed what he called “fear extinguishment” in animals who were forced into contact with something they feared.
Those streams of thought converged in prolonged exposure therapy. While the elements of the treatment were not new, Dr. Foa organized them into a standardized structure. She then tested her technique both with and without medication, and wrote manuals that made her approach available widely.
“It’s kind of like the person who invented cake mixes,” Barbara O. Rothbaum, the director of the Emory Healthcare Veterans Program, said in an interview. “They didn’t invent baking; they didn’t invent the cake. But they made it more accessible and replicable.”
In the early 1990s, Dr. Foa and Dr. Rothbaum tested the therapy as a treatment for rape survivors, and found a striking improvement among the patients. The field gradually came to realize that, as Dr. Rothbaum put it, “PTSD is PTSD,” whether related to combat or other ordeals.
A manual on prolonged exposure therapy written by Dr. Foa and Dr. Rothbaum was translated into nine languages. In 2010, Time magazine named Dr. Foa one of the world’s 100 most influential people.
She taught first at Temple, then at the Medical College of Pennsylvania and finally at the University of Pennsylvania Medical School, where she directed the Center for the Treatment and Study of Anxiety. She came to Penn in 1998 and stopped working full time in 2023, remaining active as a lecturer.
In 1988, she married Charles H. Kahn, a professor of philosophy at the University of Pennsylvania. He died in 2023. Dr. Foa is survived by her three daughters from her second marriage, Dora, Yael and Michelle; five grandchildren, and one great-grandchild.
Her impulse to openly express and examine feelings extended to her personal life.
“Talking through her own feelings, her memories, other people’s feelings and memories, and often difficult ones, painful ones, was not something my mother ever shied from,” said her daughter Michelle. “There was a kind of alignment there.”
“She was not an avoider,” her daughter Yael said.
