a behavior therapy technique where the person is exposed directly to a maximum intensity anxiety-producing situation or stimulus, either in the imagination or in reality. See implosive therapy. Compare systematic desensitisation.
What is Flooding Therapy?
Flooding therapy is when an individual is directly exposed to an anxiety producing stimulus or situation at its highest level (American Psychological Association, 2023). It is a type of exposure therapy, which means that a stimulus or situation that is anxiety producing is presented to an individual; flooding differs from other types of exposure therapy as it starts at the highest-level stimulus, wherein others, like desensitization, gradually work up to the highest-level stimulus (Grohol, 2016).
Flooding therapy is not the same as emotional flooding; emotional flooding is a deep, emotionally overwhelming experience in response to something that has happened, like an interpersonal success or issue (e.g., marriage, divorce, death, etc.; Smith, 2022). It is a sensation that could happen during a flooding therapy session, but there is no certainty that it will (Smith, 2022).
There are three types of flooding therapy:
- In Vivo- exposing a person to a real-life object or scenario. Not used as often anymore due to heightened psychological stress (Freiheit et al., 2004).
- For example, a therapist puts a person with a fear of spiders in a room of spiders.
- Imaginal- asking a person to picture the object or scenario in their mind.
- For example, a therapist asks a person who is suffering from PTSD to imagine the traumatic event that occurred to them.
- Virtual Reality- creating a virtual simulation of the object or scenario that looks real but is not.
- For example, a therapist puts a virtual reality simulator of a crowded event on a person with social anxiety.
History
This type of therapy was originally discovered by psychologist Thomas Sampfl in 1967 in an experiment where he bombarded patients with 6-9 hours of continuous exposure until fear was lessened. His technique was inspired by exposure therapies at the time and classical conditioning. Classical conditioning, as discovered by Ivan Pavlov in the early 1900s is pairing one item to another unrelated ‘cue’. For example, Pavlov conditioned his dog to pair ringing a bell to feeding time. The flooding technique is attempting to do a similar type of conditioning by replacing fear with a non-fear response through continual fear exposure (Lyons, 2020).
Historically, flooding has been a dividing practice within the therapeutic community. One side suggests that brief exposure reduces fear. Two research studies (i.e., Emmelkamp (1974), de Silva & Rachman (1974)) have proved flooding therapy reduces fear. Emmelkamp found that allowing agoraphobia patients to remove themselves from the feared situation was a successful method of reducing fear (1974). de Silva and Rachman also focused on brief exposures and found significant improvements after the therapy (1974). However, both studies suffered from a small number of patients they were able to prove this method on and ‘brief’ was never fully defined (Emmelkamp, 1974; de Silva & Rachman, 1974; Marshall, 1985).
The other side believes that flooding therapies increase fear, rather than reduce it. Immediately after Sampfl’s method came out, researchers Lader and Mathews proved that while anxiety in a patient remains high, and that fear is not successfully replaced, the fear worsened (1968). Eysenck followed this showing twice that brief exposures increase fear as well. Both animal studies (i.e., Rohrbaugh, & Riccio, 1970; Rohrbaugh et al., 1972; Silvestri et al, 1970; Sartory & Eysenck, 1976) and studies with human subjects (i.e., Miller & Levis, 1971; Stone & Borkovec, 1975; Marshall, 1985) have confirmed this.
What to Expect During Flooding Treatment
This is expected to be a short-term treatment with sessions varying in time with some lasting up to 2-3 hours (Grohol, 2016). Flooding sessions are intended to be used once; however, some patients might need to repeat the flooding session multiple times to reduce their fear or anxiety (Grohol, 2016).
A flooding session will typically follow this framework:
1. A therapist or other professional will guide the patient through the treatment. They will notify the patient that they are allowed to stop the treatment after a reasonable amount of time with the stimulus or situation has occurred.
2. The stimulus or situation will be presented to the patient. Anxiety or fear will likely be at its highest during this point in the therapy.
a. For in vivo flooding, the stimulus or situation will be presented at its highest level in person.
b. For imaginal flooding, the therapist or other professional will ask the patient to think about the stimulus or situation when it produced the most anxiety or fear.
c. For virtual reality flooding, a virtual reality device will be placed on the patient and the situation or object will be virtually placed in front of the patient at the level the patient finds the most fearful or anxiety-provoking.
3. The therapist or other professional will guide the patient through reducing the anxiety or fear on their own that is produced from the stimulus or situation. This can be in the form of breathing or relaxation exercises, or other previously agreed upon methods of anxiety reduction.
a. Emotional flooding can occur and is an overwhelming sense of emotions that requires a focus on relaxation techniques to be reduced (Smith, 2022). The therapist or other professional will attempt to reduce these emotions if emotional flooding occurs.
4. Once the anxiety or fear is reduced OR the patient withdraws from the treatment, the treatment is over.
Finding a flood therapist might take some time. Look for a PET therapist or a therapist who specializes in exposure therapies or flooding therapy, specifically. Psychologytoday.com is a good resource for finding therapists that match your specific needs.
How and What it is Used for Today
Flooding therapy is typically used to treat:
- Phobias- This is the most recognized condition treated with flooding. This technique can help to condition patients to associate positive or neutral reactions in response to their phobias.
- Anxiety Disorders- For anxiety behaviors, flooding is normally done with patients who have identified situations or topics that specifically produce the most anxiety to them. It is often used for social anxiety, fear of public speaking, self-image issues, or being overwhelmed through daily endeavors (e.g., being stuck in traffic). Therapists or trained professionals guide a patient to imagine or engage in the highest level of the situation or topic and gradually reduce their anxiety through exposure.
- Obsessive-Compulsive Disorder (OCD)- As many OCD behaviors are due to underlying fears, this type of flooding therapy is similar to phobias. Therapists or trained professionals will immerse a patient in a situation that would trigger obsessive or compulsive behaviors and guide a patient to not engage in them. This technique attempts to teach patients to realize they do not need ritualistic behaviors to deal with anxiety.
- Post Traumatic Stress Disorder (PTSD)- Therapists and trained professionals have recently been using this technique with PTSD. It is currently being approached with caution as it is fairly new. The situations that trigger an individual are often too dangerous or impossible to replicate so imaginal exposure is often used. Patients are instructed to replay painful memories and re-immerse themselves.
Benefits and Risks: How Effective is Flooding Therapy
Benefits
- Can decrease stress hormones and reactions to triggers (Siegmund et al., 2010).
- Can increase the ability to handle and process fear and anxiety (Erban, 2023).
- Reduces negatives thoughts regarding a situation or stimuli (Erban, 2023).
- Is time and cost effective as one session intends to reduce the anxiety or fear produced from the stimulus or situation (Pederson, 2022).
Risks (these can also be called ‘flooding hazards’)
- Could result in re-traumatization (Erban, 2023).
- Can be stressful for both the patient and therapist (Schumacher et al., 2015).
- Hospitalization can occur, especially when there are previously noted heart problems (Pederson, 2022).
When is this type of therapy not recommended?
- In self-help or by a friend- This type of therapy should only be used by a trained therapist or other professional.
- In the first therapy session with a therapist or other professional- Rapport should be built before starting this type of therapy.
- With a therapist or other professional who is not trained in it specifically, does not have a lot of experience with it, or does not specifically explain what is going to happen to the patient- This is a very specific type of therapy that requires professionality and experience. Ask your therapist or other professional before engaging in this type of therapy as it is not for everyone.
FAQs
What is the difference between flooding and systematic desensitization?
Flooding presents patients with the highest-level stimulus- the one that produces the most fear or anxiety- first. Systematic desensitization gradually builds up the stimuli, starting from a minimally fearful stimulus and building slowly but surely from there.
What are other names for flooding?
Implosive therapy- specifically imaginal flooding OR Prolonged Exposure Therapy (PET)
What causes emotional flooding?
Emotional flooding can occur when stimuli that are overwhelming to an individual are presented to them, resulting in a wave of emotions that an individual is unable to stop (Smith, 2022).
References
American Psychological Association. (2023). Dictionary of Psychology. American Psychological Association. Retrieved May 3, 2023, from https://dictionary.apa.org/flooding
de Silva, P., & Rachman, S. (1984). Does escape behavior strengthen agoraphobic avoidance? A preliminary study. Behaviour Research and Therapy, 22, 87-91.
Emmelkamp, P. M. G. (1974). Self-observation versus flooding in the treatment of agoraphobia. Behaviour Research and Therapy, 12, 229-237.
Eysenck, H. J. (1968). A theory of the incubation of anxiety/fear responses. Behaviour Research and Therapy, 6, 309-322.
Eysenck, H.J. (1976). The learning theory model of neurosis: A new approach. Behaviour Research and Therapy, 14, 251-267.
Erban, E. (2023). What is flooding? Psychology of coping with trauma, anxiety, phobias, and OCD. BetterHelp. https://www.betterhelp.com/advice/psychologists/what-is-flooding-psychology-of-coping-with-trauma-anxiety-phobias-and-ocd/
Freiheit, S. R., Vye, C., Swan, R., & Cady, M. (2004). Cognitive-Behavioral Therapy for Anxiety: Is Dissemination Working? the Behavior Therapist, 27(2), 25–32.
Grohol, J. M. (2016). What is exposure therapy? everything you need to know. Psych Central. https://psychcentral.com/lib/what-is-exposure-therapy#1
Lader, M. H., & Mathews, A. M. (1968). A physiological model of phobic anxiety and desensitization. Behaviour Research and Therapy, 6, 411-421.
Lyons, H. (2020). What is flooding treatment for anxiety?. WithTherapy. https://withtherapy.com/therapist-insights/what-is-flooding/#:~:text=Flooding%20usually%20employs%20either%20in,real%20but%20actually%20is%20not
Marshall, W. L. (1985). The effects of variable exposure in flooding therapy. Behavior Therapy, 16(2), 117-135.
Miller, B. V., & Levis, D . J . (1971). The effects of varying short visual exposure times to a phobic test stimulus on subsequent avoidance behavior. Behaviour Research and Therapy, 9, 17-21
Pedersen, T. (2022). Flooding therapy: What it is and how it works. Psych Central. https://psychcentral.com/blog/ocd-and-flooding-exposure#does-it-work
Rohrbaugh, M., & Riccio, D.C. (1970). Paradoxical enhancement of learned fear. Journal of Abnormal Psychology, 75, 210-216.
Rohrbaugh, M., Riccio, D. C., & Arthur, A. (1972). Paradoxical enhancement of conditioned suppression. Behaviour Research and Therapy, 10, 125-130.
Sartory, G., & Eysenck, H . J . (1976). Strain differences in the acquisition and extinction of fear responses in rats. Psychological Reports, 38, 163-187.
Schumacher S, Miller R, Fehm L, Kirschbaum C, Fydrich T, Ströhle A. Therapists' and patients' stress responses during graduated versus flooding in vivo exposure in the treatment of specific phobia: A preliminary observational study. Psychiatry Res. 2015 Dec 15;230(2):668-75. doi: 10.1016/j.psychres.2015.10.020. Epub 2015 Nov 10. PMID: 26545614.
Siegmund, A., Köster, L., Meves, A. M., Plag, J., Stoy, M., & Ströhle, A. (2011). Stress hormones during flooding therapy and their relationship to therapy outcome in patients with panic disorder and agoraphobia. Journal of Psychiatric Research, 45(3), 339–346. https://doi.org/10.1016/j.jpsychires.2010.07.002
Silvestri, R., Rohrbaugh, M., & Riccio, D. C. (1970). Conditions influencing the retention of learned fear in young rats. Developmental Psychology, 2, 389-395.
Smith, L. (2022). Emotional flooding: Types, symptoms, and more. WebMD. Retrieved May 3, 2023, from https://www.webmd.com/balance/what-is-emotional-flooding#0c17b732-dcab-47dc-aefd-c886e2d7eb35-2-4
Stone, N. M., & Borkovec, T. D. (1975). The paradoxical effect of brief CS exposure on analogue phobic subjects. Behaviour Research & Therapy, 13, 51-54.