Guide Flooding and Implosive Therapy: Direct Therapeutic Exposure in Clinical Practice

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The American Journal of Psychiatry. Exposure Therapy for Anxiety: Principles and Practice. Guilford Press. Cochrane Database of Systematic Reviews. Cure and care of neuroses: theory and practice of behavioral psychotherapy.

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New York: Wiley. Behav Res Ther.


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    Overall, she reported that the implosive therapy was effective in helping her to deal with her previous incest experience. She related, in fact, that by the follow-up session she found the treatment rather "boring. She reported that her husband developed a drinking problem and felt uncomfortable when she was not drinking. This situation resulted in considerable marital discord and the patient's eventual return to alcohol abuse. At the time of the follow-up interview, she had separated from her husband and was residing in a three-quar- terway house for alcohol abusers.

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    Despite thorough probing during the interview, the patient denied the possibility that remaining conflicts over the incest experience contributed to her marital and recent drinking prob- lems. Rather, she attributed her difficulties partially to her husband's own drinking and to heavy drinking peers on the military base where she had lived. Self- report, physiological, and behavioral measures all demonstrated notable decreases by the follow-up implosive therapy session. Moreover, this improvement appeared to generalize to current life stressors as assessed during generalization probes and through self-monitoring of incest-related events.

    The impact of the implosive therapy was first observed in the SCL change measure. Although this measure may be naturally susceptible to habituation, the finding does appear consistent with other research showing that physiological measures often are the first to show evidence of extinction in anxiety reduction treatment Mathews, It should be noted that not all anxiety was extinguished during treatment sessions.

    Presentation of the implosive scene would be expected to induce anxiety in any person, though most can accept the scene for what it is, mere thoughts, images, etc. For this patient, however, the thoughts and images had such intense meaning due to her previous trauma that she was unable to accept them for what they were, was unable to control them, and made desperate attempts to avoid them.

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    Repeated exposure to these intrusive thoughts and images, in the absence of avoidance behavior appeared to extinguish these conditioned stimulus complexes such that the patient was able to cope with her trauma more effectively. Although treatment sessions were intense, explicit, and induced high levels of arousal, careful monitoring revealed no harmful effects of the treatment procedure. As with any treatment, however, the decision to use implosive therapy in a sexual assault case should take into account its applicability and acceptability to the individual patient and provision should be made for careful monitoring of treatment effects.

    The results of this case are somewhat tempered by the patient's ad- justment with respect to her drinking problem during the second 6 months of follow-up.

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    This adjustment problem, however, appeared more a result of the patient's resumption of alcohol abuse in response to peer pressure and new life problems than to specific stimulus cues of the incest trauma. Whereas implosive therapy may effectively treat de- bilitating anxiety associated with the past trauma, it cannot necessarily be expected to eliminate other existing problems nor provide alternative coping strategies for new life problems when they arise.

    Extended aftercare and provision of other treatment interventions will likely be required.

    Nevertheless, the present study provides initial evidence supporting the efficacy of implosive therapy for treating the intrusive thoughts and anx- iety that are associated with the traumatic effects of sexual assault. For individuals with multiple adjustment problems and few social supports, it seems clear that a multifaceted treatment approach must be employed to maintain therapeutic gains. Impact of aftercare arrangements on the maintenance of treatment success in abusive drinkers.

    Addictive Behaviors, 8, American Psychiatric Association. Diagnostic and statistical manual of mental disorders 3rd ed. Washington, DC: Author. Atkeson, B. Repeated assessment of depressive symptoms. Journal of Consulting and Clinical Psychology, 50, Becker, J. Behavioral treatment of victims of sexual assault. Turner, K.

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    Assessment of anxiety. Ciminero, K. Burgess, A. Rape: Victims of crisis. Bowie, MD: Robert J. Brady Co. Ellis, E. An examination of differences between multiple- and single-incident victims of sexual assault. Journal of Abnormal Psychology, 91, Fairbank, J. Flooding for combat-related stress disorders: Assessment of anxiety reduction across traumatic memories. Behavior Therapy, 13, Keane, T. A behavioral approach to assessing and treating post-traumatic stress disorders in Viet- nam veterans. R, Figley Ed. Imaginal flooding in the treatment of a post- traumatic stress disorder.

    Levis, D. Implementing the technique of implosive therapy. Foa Eds. A review of the theoretical rationale and empirical support for the extinction approach of implosive flooding therapy. Hersen, R. Miller Eds. New York: Academic.

    Flooding and Implosive Therapy: Direct Therapeutic Exposure in Clinical Practice

    Marshall, W. Flooding therapy: Effectiveness, stimulus characteristics, and the value of brief in vivo exposure. Behaviour Research and Therapy, 15, Mathews, A. Psychophysiologlcal approaches to the investigation of desensi- tization and related procedures. Psychological Bulletin, 76, Norris, J. Factors related to the psychological impacts of rape on the victim. Journal of Abnormal Psychology, 90, Shipley, R. Flooding and implosive therapy: Are they harmful? Pitman, R. Compr Psychiatry , 37 6 : J Clin Psychiatry , 52 1 : Resick, P. Richards, D. Four case studies.

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