Flooding Exposure Therapy: Facing Your Fears Head-On.

Edited by Emma Locker

It’s difficult to assess whether mental illness is at an all-time high in the United States due to a lack of long-term data and shifting definitions of mental health and illness. However, most people believe mental health issues are rising, particularly among young adults.

Young Americans are growing increasingly anxious in this digital age. These findings have caused public interest in therapy and relaxation techniques over recent years. One product of this trend is rising curiosity around flooding and exposure therapy.

What is flooding therapy, and how does it work?

Flooding therapy (a.k.a. imaginal exposure) is a form of behavioral therapy developed by psychologist Thomas Stampfl in 1967. Flooding therapy primarily focuses on treating individuals with psychological disorders. These include obsessive-compulsive disorder (OCD), extreme phobias, post-traumatic stress disorder (PTSD), and other anxiety disorders. Flooding therapy helps patients confront their fears in a safe and controlled environment. The belief is that by facing your fears, you can reduce the intensity of those fears and eventually overcome them.

Flooding therapy skips the gradual exposure phase of exposure therapy (more on this later) and goes straight to prolonged exposure, whereby patients face their fears and undergo long periods of fear. Therapists talk the patient through the experience to help them stay in control during this treatment method. 

Flooding therapy is considered a very effective form of systematic desensitization. However, it can also make some patients extremely anxious. This is why only highly experienced professionals should administer and monitor the sessions.

It’s important to note that every person responds differently to therapy. This is why therapists must develop treatment plans with the patient in mind. It’s also important for patients to communicate as openly as possible in therapy.

A Brief Intro to How Exposure Therapy Works

Exposure therapy is a type of cognitive-behavioral therapy (CBT) targeting anxieties and phobias. Ultimately, it was designed to help people combat their fears. During exposure therapy sessions, therapists use several tried and tested techniques. These include role-playing, psychodramas, and other desensitization strategies.

This form of therapy is commonly used as part of a larger treatment plan for anxiety or other mental health conditions. Its goal is to help patients gain control over their emotions and reactions, even in triggering situations.

What Makes Flooding Therapy Different?

Unlike traditional exposure therapy, practitioners don’t implement flooding therapy over extended periods, an approach called “gradual exposure.” Instead, they expose the patient to their fear or trigger in an intense, unplanned manner (“prolonged exposure”). The patient then processes their experience and reactions for the therapist to register.

In contrast, exposure therapy takes place over several sessions spanning weeks or months. Therapists expose patients to their fear or trigger in a much more controlled format, such as via an image of the feared object. Both therapist and patient then work to intellectualize emotions around the experience together.

Let’s compare two example strategies that differentiate traditional exposure and flooding techniques below.

• Exposure
  In vivo exposure systematically exposes patients to their triggers in real-life settings, starting small and working up in intensity. Arachnophobes, for instance, may start by seeing an image of a spider and work up to handling spiders under close supervision. Practitioners do this to reduce the individual’s fear and anxiety levels. In vivo exposure is a particularly popular technique for patients with common phobias.
• Flooding
  Implosion Therapy is a similar technique to flooding but involves imagining the fear rather than actually exposing the person to these things. It’s typically used to treat conditions like PTSD and obsessive-compulsive disorder. The goal of implosion therapy is to reduce the patient’s fear and anxiety around the target stimulus.

Assessing the Efficacy of Flooding Therapy in Three Case Studies

A 2006 case study from the UK’s National Health Service (NHS) Guildford and Waverley Primary Care Trust documented the treatment of a 32-year-old woman with Down’s syndrome and haphephobia (intense fear of being touched). The patient had suffered a recent traumatic head injury.

According to the case study, in vivo flooding intervention “resulted in a substantial change in tolerance of physiotherapists’ touching of feet to the extent rehabilitation was able to proceed within the bounds of expectation had a phobia not been evident.”

The study also noted, “The results […] extend the evidence for the utility of such behavioral interventions to people with complex disability and unusual phobias in neurological rehabilitation systems.”

Other case studies have since been published, including one conducted by London’s Institute of Psychiatry in the same year describing the successful treatment of phonophobia (fear of sound) in a 9-year-old girl.

A 2013 study from Quebec’s St-Jean de Dieu Hospital documented the in vivo flooding treatment of a 43-year-old policeman with hoplophobia (fear of guns). After only 66 minutes, “behavioral and physiological measurements [of hoplophobia] both showed a tendency towards extinction.”

Who is Flooding Suitable For?

Flooding therapy is recommended for people with a strong motivation to change. Ideal candidates are those for whom other forms of treatment have failed. It also helps if they can tolerate high levels of anxiety.

PTSD patients

PTSD patients often have more intense reactions to trauma than the general population. PTSD can manifest in a variety of ways, including flashbacks and heightened anxiety. People with PTSD may also suffer from depression, substance abuse, and insomnia.

People with OCD

OCD is a unique disorder that’s difficult to understand for those who have no experience with it. OCD causes intrusive, irrational, and obsessive thoughts, often leading to compulsive behaviors. People with OCD often feel compelled to repeatedly perform specific actions to reduce anxiety. They also usually have difficulty controlling their thoughts and feel alienated from their peers.

People with phobias

People with phobias have extreme, irrational fears of specific situations, objects, or activities. The concern can be so intense and overwhelming that they prevent the person from leading an everyday life. People with intense phobias typically avoid whatever triggers their fear, which disrupts their daily routines and relationships.

Virtual Reality Exposure Therapy: A Novel Approach to Flooding

An exciting new development in the world of exposure therapy is virtual reality. According to Dr. Gabriel Aramovich, psychiatrist and neuroscience researcher at UC San Francisco, “[virtual reality] bridges us between office-based, imaginal exposure and being there.”

VR technology shows promise as a new means of exploring patients’ fear responses. Most notably, people can utilize it anywhere — whether that’s a therapist’s office or the comfort of home.

Finding a Flooding Therapist Near You

If you’re looking for a flooding therapist, searching online is the best place to start. Many mental health professionals have profiles on websites offering searchable databases of providers. Use filters to narrow down options and find nearby specialists in flooding therapy.

Many professional organizations offer directories of members who specialize in flooding therapy. Use these resources to find therapists near you with expertise in flooding.

This article was fact-checked by Eric Van Buskirk