Flooding, in psychology terms, sometimes referred to as in vivo exposure therapy, is a form of behaviour therapy and desensitisation — or exposure therapy—based on the principles of respondent conditioning. As a psychotherapeutic technique, it is used to treat phobia and anxiety disorders including post-traumatic stress disorder (PTSD). 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 is still used in behaviour therapy today.
Flooding is a psychotherapeutic method for overcoming phobias. In order to demonstrate the irrationality of the fear, a psychologist would put a person in a situation where they would face their phobia. 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 desensitisation, another form of a classical condition procedure for the elimination of phobias.
How it Works
“Flooding” works on the principles of classical conditioning or respondent conditioning—a form of Pavlov’s classical conditioning—where patients change their behaviours to avoid negative stimuli. According to Pavlov, people can learn through associations, so if one has a phobia, it is because one associates the feared stimulus with a negative outcome.
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. While systematic desensitisation 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 psychologist 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. The theory is that the adrenaline and fear response has a time limit, so a person should eventually have to calm down and realize that their phobia is unwarranted. Flooding can be done through the use of virtual reality and has been shown to be fairly effective in patients with flight phobia.
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 panicky but she eventually calmed down when she realized that her situation was safe. From then on she associated a sense of ease with cars. Psychologist Aletha Solter used flooding successfully with a 5-month-old infant who showed symptoms of post-traumatic stress following surgery.
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.
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Systematic desensitisation, or graduated exposure therapy, is a behaviour therapy developed by the psychiatristJoseph Wolpe. It is used when a phobia or anxiety disorder is maintained by classical conditioning. It shares the same elements of both cognitive-behavioural therapy and applied behaviour analysis. When used in applied behaviour analysis, it is based on radical behaviourism as it incorporates counterconditioning principles. These include meditation (a private behaviour or covert conditioning) and breathing (a public behaviour or overt conditioning). From the cognitive psychology perspective, cognitions and feelings precede behaviour, so it initially uses cognitive restructuring.
The goal of the therapy is for the individual to learn how to cope with and overcome their fear in each level of an exposure hierarchy. The process of systematic desensitisation occurs in three steps. The first step is to identify the hierarchy of fears. The second step is to learn relaxation or coping techniques. Finally, the individual uses these techniques to manage their fear during a situation from the hierarchy. The third step is repeated for each level of the hierarchy, starting from the least fear-inducing situation.
In 1947, Wolpe discovered that the cats of Wits University could overcome their fears through gradual and systematic exposure. Wolpe studied Ivan Pavlov’s work on artificial neuroses and the research done on elimination of children’s fears by Watson and Jones. In 1958, Wolpe did a series of experiments on the artificial induction of neurotic disturbance in cats. He found that gradually deconditioning the neurotic animals was the best way to treat them of their neurotic disturbances. Wolpe deconditioned the neurotic cats through different feeding environments. Wolpe knew that this treatment of feeding would not generalize to humans and he instead substituted relaxation as a treatment to relieve the anxiety symptoms.
Wolpe found that if he presented a client with the actual anxiety inducing stimulus, the relaxation techniques did not work. It was difficult to bring all of the objects into his office because not all anxiety inducing stimuli are physical objects, but instead are concepts. Wolpe instead began to have his clients imagine the anxiety inducing stimulus or look at pictures of the anxiety inducing stimulus, much like the process that is done today.
Three steps of desensitisation
There are three main steps that Wolpe identified to successfully desensitize an individual.
Establish anxiety stimulus hierarchy
1. The individual should first identify the items that are causing the anxiety problems. 2. Each item that causes anxiety is given a subjective ranking on the severity of induced anxiety. 3. If the individual is experiencing great anxiety to many different triggers, each item is dealt with separately. 4. For each trigger or stimulus, a list is created to rank the events from least anxiety-provoking to most anxiety-provoking.
Learn the mechanism response
1. Relaxation training, such as meditation, is one type of best coping strategies. 2. Wolpe taught his patients relaxation responses because it is not possible to be both relaxed and anxious at the same time. 3. In this method, patients practice tensing and relaxing different parts of the body until the patient reaches a state of serenity. 4. This is necessary because it provides the patient with a means of controlling their fear, rather than letting it increase to intolerable levels. 5. Only a few sessions are needed for a patient to learn appropriate coping mechanisms. 6.Additional coping strategies include anti-anxiety medicine and breathing exercises. 7. Another example of relaxation is cognitive reappraisal of imagined outcomes. 8. The therapist might encourage patients to examine what they imagine happening when exposed to the anxiety-inducing stimulus and then allowing for the client to replace the imagined catastrophic situation with any of the imagined positive outcomes.
Connect stimulus to the incompatible response or coping method by counter conditioning
1. In this step the client completely relaxes and is then presented with the lowest item that was placed on their hierarchy of severity of anxiety phobias. 2. When the patient has reached a state of serenity again after being presented with the first stimuli, the second stimuli that should present a higher level of anxiety is presented. 3. This will help the patient overcome their phobia. This activity is repeated until all the items of the hierarchy of severity anxiety is completed without inducing any anxiety in the client at all. 4. If at any time during the exercise the coping mechanisms fail or became a failure, or the patient fails to complete the coping mechanism due to the severe anxiety, the exercise is then stopped. 5. When the individual is calm, the last stimuli that is presented without inducing anxiety is presented again and the exercise is then continued depending on the patient outcomes.
Example
A client may approach a therapist due to their great phobia of snakes. This is how the therapist would help the client using the three steps of systematic desensitisation:
Establish anxiety stimulus hierarchy
1. A therapist may begin by asking the patient to identify a fear hierarchy. 2. This fear hierarchy would list the relative unpleasantness of various levels of exposure to a snake. 3. For example, seeing a picture of a snake might elicit a low fear rating, compared to live snakes crawling on the individual—the latter scenario becoming highest on the fear hierarchy.
Learn coping mechanisms or incompatible responses
1. The therapist would work with the client to learn appropriate coping and relaxation techniques such as meditation and deep muscle relaxation responses.
Connect the stimulus to the incompatible response or coping method
1. The client would be presented with increasingly unpleasant levels of the feared stimuli, from lowest to highest—while utilising the deep relaxation techniques (i.e. progressive muscle relaxation) previously learned. 2. The imagined stimuli to help with a phobia of snakes may include: a picture of a snake; a small snake in a nearby room; a snake in full view; touching of the snake, etc. 3. At each step in the imagined progression, the patient is desensitised to the phobia through exposure to the stimulus while in a state of relaxation. 4. As the fear hierarchy is unlearned, anxiety gradually becomes extinguished.
Uses
Specific Phobias
Specific phobias are one class of mental disorder often treated via systematic desensitisation. When persons experience such phobias (for example fears of heights, dogs, snakes, closed spaces, etc.), they tend to avoid the feared stimuli; this avoidance, in turn, can temporarily reduce anxiety but is not necessarily an adaptive way of coping with it. In this regard, patients’ avoidance behaviours can become reinforced – a concept defined by the tenets of operant conditioning. Thus, the goal of systematic desensitisation is to overcome avoidance by gradually exposing patients to the phobic stimulus, until that stimulus can be tolerated. Wolpe found that systematic desensitisation was successful 90% of the time when treating phobias.
Test Anxiety
Between 25 and 40 percent of students experience test anxiety. Children can suffer from low self-esteem and stress-induced symptoms as a result of test anxiety. The principles of systematic desensitisation can be used by children to help reduce their test anxiety. Children can practice the muscle relaxation techniques by tensing and relaxing different muscle groups. With older children and college students, an explanation of desensitisation can help to increase the effectiveness of the process. After these students learn the relaxation techniques, they can create an anxiety inducing hierarchy. For test anxiety these items could include not understanding directions, finishing on time, marking the answers properly, spending too little time on tasks, or underperforming. Teachers, school counsellors or school psychologists could instruct children on the methods of systematic desensitisation.
Recent Use
Desensitisation is widely known as one of the most effective therapy techniques. In recent decades, systematic desensitisation has become less commonly used as a treatment of choice for anxiety disorders. Since 1970 academic research on systematic desensitisation has declined, and the current focus has been on other therapies. In addition, the number of clinicians using systematic desensitisation has also declined since 1980. Those clinicians that continue to regularly use systematic desensitisation were trained before 1986. It is believed that the decrease of systematic desensitisation by practicing psychologist is due to the increase in other techniques such as flooding, implosive therapy, and participant modelling.
This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Systematic_desensitization >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.
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