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04/05/2012 12:56 PM

Flooding vs Systematic Desensitization.

mimi84Posts: 9269
VIP Member

THis is a long one... bare with me!

Flooding is a form of behavior therapy and based on the principles of respondent conditioning. It is sometimes referred to as exposure therapy or prolonged exposure therapy. As a psychotherapeutic technique, it is used to treat phobia and anxiety disorders including post-traumatic stress disorder. It works by exposing the patient to their painful memories, with the goal of reintegrating their repressed emotions with their current awareness. Flooding was invented by psychologist Thomas Stampfl in 1967. It still is used in behavior therapy today.

Flooding is a psychotherapeutic method for overcoming phobias. This is a faster (yet less efficient and more traumatic) method of ridding fears when compared with systematic desensitization. In order to demonstrate the irrationality of the fear, a psychologist would put a person in a situation where they would face their phobia at its worst. Under controlled conditions and using psychologically-proven relaxation techniques, the subject attempts to replace their fear with relaxation. The experience can often be traumatic for a person, but may be necessary if the phobia is causing them significant life disturbances. The advantage to flooding is that it is quick and usually effective. There is, however, a possibility that a fear may spontaneously recur. This can be made less likely with systematic desensitization, another form of a classical condition procedure for the elimination of phobias

"Flooding" is an effective form of treatment for phobias amongst other psychopathologies. It works on the principles of classical conditioning or respondent conditioning—a form of Pavlov's classical conditioning—where patients change their behaviors to avoid negative stimuli. According to Pavlov, we learn through associations, so if we have a phobia it is because we associate the feared object or stimulus with something negative.

Flooding uses a technique based on Pavlov's classical conditioning that uses exposure. There are different forms of exposure, such as imaginal exposure, virtual reality exposure, and in vivo exposure.[4] While systematic desensitization may use these other types of exposure, flooding uses in vivo exposure, actual exposure to the feared stimulus. A patient is confronted with a situation in which the stimulus that provoked the original trauma is present. The psychiatrist there usually offers very little assistance or reassurance other than to help the patient to use relaxation techniques in order to calm themselves. Relaxation techniques such as progressive muscle relaxation are common in these kinds of classical conditioning procedures. As the adrenaline and fear response has a time limit, theoretically a person will eventually have to calm down and realize that their phobia is unwarranted. Flooding can be done through the use of virtual reality and is fairly effective.

Psychiatrist Joseph Wolpe (1973) carried out an experiment which demonstrated flooding. He took a girl who was scared of cars, and drove her around for hours. Initially the girl was hysterical but she eventually calmed down when she realized that her situation was safe. From then on she associated a sense of ease with cars.

Flooding therapy is not for every individual, and the therapist will discuss with the patient the levels of anxiety they are prepared to endure during the session. It may also be true that exposure is not for every therapist and therapists seem to shy away from use of the technique.

Why flooding is necessary

Phobias by definition are irrational fears, and these phobias can get in the way of everyday life. For example, a person with a phobia of cars would have a hard time crossing the street or even walking around town. For some reason this person has developed the belief that all cars are dangerous and need to be avoided. Often, a person who has developed a phobia of a particular thing or situation will go to extreme lengths to avoid that situation. As long as they avoid exposure to the thing that they fear, they have no way of knowing that it can't hurt them.

Systematic desensitization is a type of behavioral therapy used in the field of psychology to help effectively overcome phobias and other anxiety disorders. More specifically, it is a type of Pavlovian therapy / classical conditioning therapy developed by a South African psychiatrist, Joseph Wolpe. To begin the process of systematic desensitization, one must first be taught relaxation skills in order to extinguish fear and anxiety responses to specific phobias. Once the individual has been taught these skills, he or she must use them to react towards and overcome situations in an established hierarchy of fears. The goal of this process is that an individual will learn to cope and overcome the fear in each step of the hierarchy, which will lead to overcoming the last step of the fear in the hierarchy. Systematic desensitization is sometimes called graduated exposure therapy.

Although as stated earlier that to begin the process of systematic desensitization, the individual must be first taught relaxation skills, it is not the only factor. A study of the contribution and importance of muscle relaxation to systematic desensitization therapy in four different phobic patients. The study proved that during a control phase of therapy if relaxation was taken away it made no or so little difference to the patients' improvement ability to perform in their case. In two cases, when measured by self-rating by removing relaxation it slowed the progress through the hierarchy and therapeutic progress; how ever it was overall small effects if any. Concluding that other variables than relaxation are highly responsible for the therapeutic effectiveness of desensitization. Putting together visualization and relaxation of feared scenes helps certain individuals to attack their feared object or scenario in imagination, and may push them to attack it in reality as well.

Specific phobias are one class of mental illness often treated through the behavior therapy or cognitive–behavioral process of systematic desensitization. When individuals possess irrational fears of an object, such as height, dogs, snakes, and close spaces, they tend to avoid it. Since escaping from the phobic object reduces their anxiety, patients' behavior to reduce fear is reinforced through negative reinforcement, a concept defined in operant conditioning. The goal of systematic desensitization is to overcome this avoidance pattern by gradually exposing patients to the phobic object until it can be tolerated. In classical and operant conditioning terms the elicitation of the fear response is extinguished to the stimulus (or class of stimuli).

Coping strategies

Prior to exposure, the therapist teaches the patient cognitive strategies to cope with anxiety. This is necessary because it provides the patient with a means of controlling their fear, rather than letting it build until it becomes unbearable. Relaxation training, such as meditation, is one type of coping strategy. Administration of an anti-anxiety medicine prior to exposure to the phobia-inducing stimuli is another type of coping strategy. Patients who have serious anxiety that leads to breathing problems might be taught to focus on their breathing or to think about happy situations. Another means of relaxation is cognitive reappraisal of imagined outcomes. The therapist might encourage subjects to examine what they imagine happening when exposed to the phobic object, allowing them to recognize their catastrophic visions and contrast them with the actual outcome. For example, a patient with a snake phobia might realize that they imagine any snake they encounter would coil itself around their neck and strangle them, when this would not actually occur. These patients need to see that not all snakes are large and that most snakes are completely harmless so that they can get over their fear. Research has demonstrated the effectiveness of this technique in helping subjects reduce similar animal phobias.

Progressive exposure

The second component of systematic desensitization is gradual exposure to the feared objects or situations. Continuing with the snake example, the therapist would begin by asking their patient to develop a fear hierarchy, listing the relative unpleasantness of various types of exposure. For example, seeing a picture of a snake in a newspaper might be rated 5 of 100, while having several live snakes crawling on one's neck would be the most fearful experience possible. Once the patient had practiced their relaxation technique, the therapist would then present them with the photograph, and help them calm down. They would then present increasingly unpleasant situations: a poster of a snake, a small snake in a box in the other room, a snake in a clear box in view, touching the snake, etc. At each step in the progression, the patient is desensitized to the phobia through the use of the coping technique. They realize that nothing bad happens to them, and the fear gradually extinguishes.

Which would you choose? Why?


04/05/2012 01:28 PM
Posts: 11259
Group Leader

Systematic desensitization is a good method to try, coping strategies are a necessity, and progressive exposure works well..... Flooding in my opinion is NEVER good.... I don't know if it would be better if someone were expecting and agreed to flooding, but I know from experience that being put into a situation that causes extreme fear and panic has very bad results Sad

04/05/2012 01:36 PM
Posts: 10505
VIP Member

NO flooding!!!! THANK YOU! I will take option #2 any day! Wink

04/05/2012 02:42 PM
mimi84Posts: 9269
VIP Member

I agree!

04/05/2012 06:22 PM
jmickPosts: 13899
VIP Member

I know some therapists I'd like to flood Tongue

04/05/2012 06:27 PM
mimi84Posts: 9269
VIP Member

Laughing Laughing Laughing

04/07/2012 05:02 PM
Posts: 111

I'm gna go with #2...tried flooding and it didn't help me. I'm guessing if I only had a low to moderate level of panic/agor it might work, but right now it would feel too traumatic.

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