Israeli clinical psychologist Edna B. Foa (1937-2026) pioneered Prolonged Exposure (PE) Therapy for post-traumatic stress disorder (PTSD) and Exposure and Response Prevention (ExRP) for obsessive-compulsive disorder (OCD). Foa understood the relationship between motivation and psychopathology principally through the mechanisms of fear, avoidance, and emotional processing.

Building on the behavioural learning tradition of Joseph Wolpe (1958) and O. Hobart Mowrer (1947), the information-processing work of Peter J. Lang (1977, 1979), and Stanley Rachman’s (1980) concept of emotional processing, Foa and Michael J. Kozak (1986) proposed that emotions are represented in memory as “fear structures” containing information about a threatening stimulus, the person’s physiological and behavioural responses, and the meaning attached to the threat. Psychopathology develops when such structures become excessively rigid, inaccurate, or disconnected from corrective information, so that relatively safe situations continue to evoke fear and motivate escape, avoidance, or defensive behaviour.

In this account, motivation is therefore not simply an independent cause of psychopathology. The desire to escape perceived danger is understandable and adaptive when danger is genuine, but when fear is based on distorted threat representations, the resulting avoidance can prevent corrective learning and thereby maintain the disorder. Therapeutic exposure works by deliberately approaching feared memories or situations so that new information can be incorporated into the fear structure.

Foa subsequently developed these ideas with Jonathan D. Huppert and Shawn P. Cahill (2006) and applied them particularly to post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD), contributing to the development of prolonged exposure and exposure-and-response-prevention approaches.

From a Christian theological perspective, Foa’s account can be regarded as a useful description of one psychological dimension of disordered fear without being taken as a complete account of human motivation. Scripture recognises fear as a genuine human response to perceived danger (e.g., Psalm 56:3), while also presenting a transformation of the person’s orientation through trust in God, truthful thinking, prayer, courage, and love (Philippians 4:6–8; Romans 12:2; 2 Timothy 1:7; 1 John 4:18). Theologically, Thomas Aquinas similarly distinguished fear as a natural passion concerning future evil from disordered fear, arguing that fear itself is not necessarily sinful but becomes morally problematic when it is contrary to rightly ordered reason and action. This provides an interesting conceptual parallel with Foa’s distinction between adaptive fear and pathological fear, although Aquinas’s account is ultimately grounded in virtue, reason, and humanity’s relationship with God rather than in cognitive-behavioural mechanisms.

Likewise, David Powlison (1995) argued within Biblical counselling that human emotions and behaviour are shaped by what the heart ultimately seeks or trusts, using the Biblical category of idolatry to analyse disordered motivations. From this perspective, Foa’s insight that perceived threat can organise behaviour around avoidance may be complemented, not replaced, by the theological claim that Christian transformation involves reordering desire and trust toward God. Thus, a Christian reading of Foa can affirm the psychological importance of recognising fear, understanding how avoidance maintains psychopathology, and learning through corrective experience, while adding a theological anthropology in which healing also involves truthful perception, rightly ordered loves, dependence upon God, courage in suffering, and growth in Christ rather than merely the reduction of anxiety.

Edna Foa’s work suggests that personal life strategies can be understood partly as learned cognitive–behavioural programmes through which people interpret threats, regulate emotional responses, and decide whether to approach, avoid, or cope with challenging situations. In her emotional-processing theory, Foa and Kozak (1986) proposed that fear is represented in memory as an organised structure containing information about threatening stimuli, one’s responses, and the meaning attached to the danger, so that anxiety can activate an action tendency to escape or avoid. Psychological change occurs when this threat structure is activated and subsequently receives corrective information that modifies previously held expectations about danger, safety, control, and personal coping capacity.

Foa subsequently applied this framework to trauma and PTSD, arguing that deliberate confrontation with avoided memories, situations, and cues can enable new learning and reduce maladaptive avoidance, an approach developed into Prolonged Exposure Therapy (Foa, 1997; Foa et al., 2007; Foa, 2011). In relation to life strategies, the important implication is that individuals do not merely respond passively to circumstances: they carry forward assumptions about what is dangerous, what is manageable, what should be avoided, and what opportunities can safely be pursued, and these assumptions can become self-reinforcing behavioural patterns. Conversely, carefully encountering feared realities while acquiring corrective experience can broaden the repertoire of possible responses. This is particularly relevant to Foa’s research on trauma, where persistent avoidance may preserve threat expectations, whereas emotionally engaged exposure can facilitate new learning (Foa et al., 1995; Foa, 1997).

Foa’s psychological account can be regarded as describing important mechanisms of human functioning rather than providing a complete account of the human person. Christian theology would locate cognitive and behavioural strategies within a larger framework of creation, fall, redemption, vocation, and dependence upon God. Thus, the Biblical injunction to “be transformed by the renewing of your mind” (Romans 12:2) resonates conceptually with the importance of changed patterns of interpretation and action, while 2 Corinthians 10:5 speaks of bringing thoughts into obedience to Christ; Psalm 56:3 (“When I am afraid, I put my trust in you”) and 1 Peter 5:7 connect the experience of threat with trust in God rather than mere self-protection, and James 1:2–4 presents adversity as potentially formative rather than simply something to be escaped. In this sense, Foa’s account can illuminate how fear-based avoidance may constrain a person’s life strategies, while Christian theology adds that the ultimate reorientation of such strategies is not simply from irrational fear to greater psychological control, but towards wisdom, faith, courage, love of neighbour, and trust in God’s providence. This broader theological reframing is consistent with Powlison’s (2003) argument that human struggles should be understood through the lens of Scripture, and with Welch’s (1997) analysis of fear in relation to the competing objects of human and divine significance.