Before Edna Foa, there was little hope of recovery for those suffering from post-traumatic stress disorder. Existing treatments were rarely scientifically rigorous, and remission rates were low. With her prolonged exposure therapy, which she developed in the 1980s and 1990s, the Haifa-born Foa developed an intervention that dramatically improved the treatment of PTSD, turning what was a chronic, relapsing condition into something that could actually be cured.
Described by her peers as a “true giant” and a “powerhouse,” Foa died on Tuesday at 88 in Philadelphia, having trained a generation of therapists in Israel and around the world in her methods, which revolutionized not only the treatment of PTSD but also obsessive-compulsive disorder and other mental illnesses.
“There’s so many people in the world whose lives have been improved by what she did, people with PTSD who have their lives back, people with OCD who have their lives back,” Sheila Rauch, professor in psychiatry at in the Department of Psychiatry and Behavioral Sciences at Emory University’s School of Medicine, told eJP. She trained under Foa in 2000 while she was an intern at the University of Pennsylvania. Foa hired her as staff at the school, and they held training and research together until Foa died this week.
She “was the most influential person as far as my career and what I do research on and how I do research,” Rauch said. “She was just a powerhouse.”
Mooli Lahad, who founded the Israeli mental health nonprofit Community Stress Prevention Center, first met Foa in 2002, during the Second Intifada. “About 1,000 people died [in the wave of terror], and about 10,000 were injured, and so many others had suffered from trauma and anxiety,” Lahad told eJewishPhilanthropy this week.
Prior to meeting Foa, Lahad was doing his best to support clients suffering from PTSD, but there was no known way to reduce their symptoms. During the 1980s and 90s, Foa had been developing a new intervention, prolonged exposure therapy (PE), a form of cognitive behavioral therapy that treated PTSD by safely and gradually exposing clients to their fears, allowing them to confront them and take power over their lives. The intifada provided her with fertile ground to explore the intervention, and Lahad was in her first class of trainees.
“I was very surprised and excited about the idea that you can work on trauma in a very focused way,” said Lahad, who is now considered one of the top experts in psychological trauma, not only in Israel but internationally. “I found the fact that you can measure [the intervention] and [that] you can prove the mental health [of a client] improves within a reasonable and manageable time to be fascinating.”
Foa’s intervention took nine to 12 sessions, each 90 minutes long, and it showed results. According to the National Library of Medicine, the therapy has been proven to curb symptoms of PTSD 65-80% of the time.
Born in pre-state Palestine in December 1937, Foa earned her undergraduate degree in psychology at Bar-Ilan University, her master’s degree in clinical psychology at the University of Illinois and her doctorate from the University of Missouri. She knew loss firsthand, as her brother, Uri, seven years her senior, died in Israel’s War of Independence.
In addition to her work with PTSD, Foa was an expert in working with people suffering from OCD, mastering exposure and response prevention, a similar intervention to PE that safely exposed clients to the stimuli that provoked anxiety and obsessions.
For her work, Foa was named one of Time magazine’s 100 most influential people in 2010 and was awarded the Distinguished Scientific Contributions to Clinical Psychology Award from the American Psychological Association and the Lifetime Achievement Award from the International Society for Traumatic Stress Studies.
When Foa first began telling people about PE, “some people said that talking about the trauma would make their patient worse,” Foa told Psychology Tools in January.
“The public initially – and actually you still sometimes encounter it – thinks that it’s somehow going to cause harm to process trauma memories, but people with post-traumatic stress disorder, they’re already encountering the intrusions every day, and what they need to learn to do is essentially desensitize the memories and change their relationship with the intrusive thoughts,” Chris Molnar, clinical psychologist and president at the META and Psychological Wellness Center and continuing education chair of the Philadelphia Behavior Therapy Association, told eJP.
Molnar trained under Foa for three years in the early 90s, before attending graduate school. By the time Molnar started her master’s degree, she was already considered an expert because of all she learned from Foa, she said.
“She just wanted to understand the causes [of OCD and PTSD, which were then considered anxiety disorders]. She wants to know ‘what’s the truth’ more than anything,” Molnar said, adding that it is unheard of that one person had such an impact on two conditions, OCD and PTSD. Although Foa did not invent exposure therapy for OCD, she is the person to make the treatment implementable worldwide, Molnar said.
Foa’s determination to alleviate suffering took “courage,” and she eventually proved her detractors wrong, Molnar said. Many of the people who once stood against Foa’s interventions now train therapists in the practice, she noted.
After Lahad’s training with Foa, he traveled to Philadelphia, where she was the founding director of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania, a program that Foa was connected to until her death. She partnered with Lahad, making his CSPC — based in the northern Israeli city of Kiryat Shmona — the center of her work in Israel, where she trained a generation of Israeli therapists in PE, partnering with the American Jewish Joint Distribution Committee, Israel’s Education Ministry and the army’s clinical psychologist.
For much of her life, Foa split her time between the two countries, spending as much as half a year in Israel training therapists out of the CSPC until 2011, when she began working at the Israeli Center for Training in Prolonged Exposure at the Cohen-Harris Resilience Center in Tel Aviv.
“The whole concept of being very focused and targeted on the trauma and not [beating] around the bush is very much the legacy of Edna Foa,” Lahad said. During his original visit to Philadelphia, he told Foa, “All your protocols are either on handouts or oral; we have to make a book.” Because of this, the first guide to PE was written in Hebrew, with the English version, a landmark book in the profession, Prolonged Exposure Therapy for PTSD, published in 2007.
Unlike many mental health researchers, who are seen as not being able to understand what it is actually like to work with clients, Foa treated patients throughout her career. “She still always saw patients because she valued it for the input that it gives to her research questions and her implementation questions,” Rauch said.
Additionally, Foa wrote guides in a style that was easy for practitioners to understand and implement, Rauch said. “She was influential in getting manuals to be a standard practice and then testing those manuals.” Foa was also a pioneer in studying treatment through the combined use of therapy and medication.
Foa’s influence was felt throughout the world, Lahad said. “Trauma is not for Israel,” he said. “Trauma is everywhere. Now, trauma and post-trauma is one of the most common problems of so many people around the world.”
Lahad has met therapists who had trained with Foa in every country he’s worked in. In Japan, he met therapists trained by her in person. In Sri Lanka and Ukraine, he met therapists trained by her. The entire time she worked with Lahad, Foa insisted on being present for every training session. She performed training in Israel as recently as last week, increasing her time spent in the country post-Oct. 7, when so many were struggling with trauma after the terror attacks and subsequent two-plus year of war.
Since Foa’s death, tributes have poured in across social media.
“We are deeply saddened to learn of the passing of Dr. Edna Foa, a true giant in the field of traumatic stress,” the International Society for Traumatic Stress Studies wrote in a Facebook post. “Dr. Foa’s groundbreaking work transformed the understanding and treatment of trauma-related disorders, leaving an enduring impact on clinicians, researchers, and countless individuals worldwide.”
“We were privileged to be her students and to work, teach, and research alongside her,” peers at the Israeli Prolonged Exposure Training Center wrote in a tribute. “Many patients suffering from PTSD testify to their debt to Prof. Foa and her method for their improvement and return to life.”