This paper explores the hypothesis that fear activation during exposure treatment promotes improvement. Twelve female assault victims diagnosed with posttraumatic stress disorder (PTSD) received treatment that included prolonged repeated reliving of the assault in imagination. Two measures of fear activation were used: facial fear expression coded from videotapes of the first reliving session and the client's highest reported distress score during the same session. The results indicated that clients who evidenced more severe PTSD prior to treatment displayed more intense facial fear expressions during the first reliving of the assault and benefitted more from treatment than did clients who had less severe PTSD and displayed less fear. In contrast, clients who reported more anger prior to treatment tended to display less fear expression during reliving of the trauma and benefitted less from treatment than less angry clients. The relationship of pretreatment PTSD and anger severity to improvement seems to be mediated by fear facial expression and were not simply a product of regression toward the mean of extreme pretreatment scores. The results are discussed within an emotional processing theory of fear.

The impact of fear activation and anger on the efficacy of exposure treatment for posttraumatic stress disorder