Flooding and Implosive Therapy: Anxiety Induction Therapies

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Flooding and Implosive Therapy Anxiety Induction
Therapies

• Chapter Ten

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No pain, no gain?

• Anxiety induction therapies, also referred to as
  Prolonged/intense exposure therapies, maximize
  the clients anxiety with large doses of anxiety
  provoking stimuli. The idea being that a
  reduction will take place after the initial
  increase.

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The goal

• Is for the client to experience the threatening
  situation and concomitant high anxiety without
  engaging in the maladaptive anxiety reducing
  response (in other words, avoidance behavior).

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Flooding and Implosive Therapy

• Flooding refers to in vivo or imaginal exposure
  to highly anxiety-evoking stimuli for a prolonged
  period of time with ever experiencing the
  negative consequences.

• Implosive therapy an imaginal prolonged exposure
  therapy in which the scenes are exaggerated and
  include hypothesized stimuli related to the fear.

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Flooding Basic procedures

• First, the individual is exposed to stimuli that
  elicit high levels of anxiety.
• Second, the client is exposed to this stimuli for
  a prolonged period of time without engaging in
  anxiety reducing behaviors.

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In vivo flooding

• Rather than having the client imagine the
  anxiety-producing stimuli, the actual stimuli is
  used.

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Why does it work?

• Through the process of classical conditioning, a
  previously neutral stimuli becomes associated
  with with a threat. Subsequently, the previously
  neutral event cause the person to feel anxious.

UCS (meat powder)
UCR (Salivation)
NS (Bell)
CR
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Secondly

• Through operant conditioning, the person learns
  to engage in an anxiety-reducing response, and is
  negatively reinforced. Thus, ensuring that the
  behavior will continue.

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Imaginal Flooding

• Follows the same basic process, except that the
  person now imagines the anxiety-producing
  stimuli. An advantage being that there are no
  restrictions related to what can be addressed. Is
  used when in vivo may be unethical, such as with
  a rape victim.

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Eye Movement Desensitization and Reprocessing

• A newer, controversial technique that involves
  three steps
• 1. Assessment and preparation
• 2. Imaginal flooding
• 3. Cognitive restructuring

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Assessment and Preparation

• Client identifies a traumatic image that produces
  anxiety
• Identified the physical associations
• Assess the level of anxiety using a 0-10 SUDS
  scale (less anxiety to more anxiety)
• Identify a maladaptive belief associated with the
  event
• Think of an adaptive belief that would address
  the distress

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Imaginal Flooding Phase

• Client imagines the event while verbalizing the
  faulty belief and focusing on the physical
  sensations.
• During this time the client is told to track the
  therapists index finger that is moved rapidly
  across the field of vision
• Finally, client is told to block out the
  experience, take a deep breath, and rate the
  experience using the SUDS scale

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Effective?

• Unlike flooding, where the research supports its
  use, the initial research on EMDR was flawed and
  subsequent research does not support the efficacy
  of this technique. Thus, although unpleasant,
  flooding has been shown to be effective.

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Implosive Therapy

• This technique is designed to eliminate avoidance
  behaviors by the process of extinction.
• Thomas Stampfl (1961) presented the first use of
  the term implosion, followed by an abundance of
  work in this area.
• Psychodynamic overtone since the assumption is
  that the fear was learned in childhood.

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Concerns related to Implosive Therapy

• The use of hypothesized anxiety-producing cues
  derived from the therapists psychoanalytic
  interpretations.
• The exaggeration of the scenes to heighten the
  anxiety
• The elaboration of the scenes as they are
  presented.

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Ethical issues...

• The projected trauma that the person is asked to
  visualize is beyond what could normally be
  expected. Thus, this is also inconsistent with
  the theoretical underpinnings, since it is only
  suppose to re-create childhood experiences.

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Implosive Therapy in Perspective

• Initially research was impressive. However, it
  was later determined that many of these studies
  were methodologically flawed. Thus, its use has
  been questioned and limited.