Flooding therapy is one of several widely utilized behavioral treatment methodologies that have proven extremely beneficial toward helping people expose and face fear and anxieties. These therapies are based upon a primary principle of learning referred to as extinction or habituation.The idea here is that fear occurs in response to certain cues (snakes, crowds, public speaking etc.) due to conditioning (learned associations). Thus, by promoting exposure to fear eliciting cues, the fear response gradually decreases (undergoes exctinction) since the brain learns that there is no biological danger likely to ensue. So, as an example, if you were to watch a scary movie, say, oh, I don’t know…Halloween, during the first viewing, you might experience significant fear, anticipation, or horror. But let’s say you had an opportunity to watch it a number of times. With surprising speed, the degree of fear would lessen. With repeated viewings, it might even appear silly, or boring. After all, a movie is just shadow, light, and sound waves. There is nothing of intrinsic substance present. What makes a movie work is the shared audience experiences, conditioning, beliefs along with perhaps some archetypal fears (non conditioned) thrown in to boot. But as Mark Twain once stated…”The worst fears in life never happened”.
Halloween and Fear Exposure: “It’s only a movie”
Flooding therapy, is a procedure wherein a person is “flooded” with fear related stimuli to maximally provoke extinction. This can be done in real life through in vivo flooding, or in imagery with imaginal flooding. In in vivo flooding, one is prompted to face one’s fears directly, in a graduated or maximal manner. So, if one is afraid of snakes, one may start by viewing pictures of snakes in books and magazines. Then perhaps viewing snakes at a pet shop or zoo. Then perhaps touching a snake while someone else handles and controls the snake. All the while, one is asked to rate fear on a subjective units of distress (SUDS) scale which is a 1-10 subjective rating scale (10 being maximal fear). The idea is that over time, and with repeated or prolonged exposure, one will see the arousal gradually dropping. Similar procedures can be done for a number of fears and phobias (needles/injections, rodents, heights, closed in spaces, germs/contamination, public speaking etc.).
Many fears, due to their nature, cannot be faced in an actual or controlled manner. So, for example, one’s irrational fears of having cancer or HIV, fears of dying or loss of control, are more able to be confronted in one’s imagery. Similarly, for those who have undergone extreme trauma, whether through combat, violent crime, or natural disaster, are probably more likely to be able to face fear eliciting cues in imagery.Quite often, there is much more than just fear embedded in the avoided cues.
As an example, I have had the honor to work with a number of Vietnam war veterans. They were asked to recount critical battle or other traumatic scenes in order to help them to face the fear, anger, guilt, loss and helplessness that are often contained in the memories. Because of the fact, that more diverse and often deeply embedded cues need to be faced to produce lasting relief, I more often utilize another very powerful fear exposure technique. More on that in the next blog.
Another good blog on this topic: http://www.portlandpsychotherapyclinic.com/training/blog/experiential-avoidance-and-its-relevance-ptsd
As always, please feel free to provide comments, personal experiences or questions to help make this a more dynamic experience.
Flooding and Fear exposure: facing “The Horror”
