Flooding and Implosive Therapy: Direct Therapeutic Exposure in Clinical Practice

by Patrick A. Boudewyns (Editor)

Overview

Behavior therapists often "desensitize" clients by exposing them to an anxiety-eliciting stimulus such as a phobic object. The premise is that repeated exposures will eventually reduce or extinguish the fear. This process is called therapeutic exposure. Many therapists would agree that therapeutic exposure is an effective treatment for several anxiety disorders. However, the "directness" with which therapeutic exposure should be encouraged for a client is much debated. Many feel that direct therapeutic exposure, more commonly known as flooding or implosive therapy, causes clients an excessive amount of anxiety, and may therefore produce long-lasting and harmful side effects. In response to these concerns, one well-known behavior therapy technique, systematic desensitization, was designed to expose clients to imagined fear stimuli slowly and under relaxing conditions so as not to elicit anxiety. In the first chapter of this book, we show that these concerns are based on false assumptions. When used properly, direct therapeutic exposure is not harmful. In Chapters 2 and 3, we review the literature on the process and outcome of flooding and implosive therapy from a practical, clinical perspective. This literature shows that these treatments are effective and efficient for certain psychiatric disorders. In Chapter 4, we describe the treatments we offer our clients and show how learning theory can be used to help develop the procedure and content of therapy. Chapter 5 provides case examples with transcripts of typical therapy sessions. This book can be used as a handbook for therapists or students.

Product Details

ISBN-13:	9781468443721
Publisher:	Springer US
Publication date:	11/25/2012
Edition description:	Softcover reprint of the original 1st ed. 1983
Pages:	236
Product dimensions:	5.98(w) x 9.02(h) x 0.02(d)

Table of Contents

1 Direct Therapeutic Exposure.- What Is Direct Therapeutic Exposure?.- For Which Disorders Is Direct Therapeutic Exposure Effective?.- Early False Assumptions Lead to Concerns about Effectiveness.- Concerns about Resensitization and/or the Incubation Effect.- Does Direct Therapeutic Exposure Harm Clients?.- 2 Research on Nonpatient Populations.- Animal Analogue Research.- The Conditioned-Avoidance Response.- Effect of Amount of CS Exposure during Extinction.- The Effect of Food.- Effects of Graded CS Exposure.- Effect of Drugs.- Effect of Forced Movement.- Effect of Flooding to an “Irrelevant” Stimulus.- Serial CS and Resistance to Extinction.- Summary.- Human Analogue Research.- Duration of Exposure.- Fear Enhancement (Incubation) with Exposure.- Mode of Cue Presentation.- In Vivo versus Fantasy Exposure.- The Validity of Using Imagery in Direct Exposure Techniques.- Scene Content.- Flooding versus Systematic Desensitization.- Effect of Drugs.- Summary.- 3 Research on Patient Populations.- Issues in the Treatment of Anxiety Disorders with Therapeutic Exposure.- In Vivo versus Imaginal (Fantasy) Exposure.- Optimal Length of Exposure Session.- Homework Exposure.- Group versus Individual Treatment.- The Effect of Group Cohesiveness on Exposure.- Client Response during Treatment.- Psychotropic Medications with Exposure.- Graded versus Nongraded Exposure.- Treating Obsessive Thoughts Unaccompanied by Compulsion.- Direct Exposure versus Other Psychotherapeutic Techniques in Treating Anxiety Disorders.- Exposure Techniques Used with Other Disorders.- Psychiatric Inpatients and Outpatients.- Agitated Depression.- Alcoholism.- Emotionally Disturbed Retardates.- Heroin Addiction.- Insomnia.- Summary.- Case Reports.- Adult Phobias with Obsessive-Compulsive Features.- Techniques Using Variations of Flooding or Implosive Therapy.- Flooding and Implosive Therapy with Children.- 4 Theory and Technique.- Implosive Therapy: Theory and Technique.- Task of the Therapist.- The Therapist-Client Relationship.- Informed Consent.- Detective Work.- Therapeutic Programming and Initial Diagnostic Interviews.- Neutral Scene Presentation.- Implosive Sessions.- Use of Implosive Therapy with Other Therapies.- Scene Content Areas.- The Flooding Technique.- Imaginal Flooding.- In Vivo Flooding.- 5 Case Examples.- Chronic Posttraumatic Stress Disorder.- First Interview.- Second Interview.- Treatment.- Simple (Specific) Phobia.- Heights.- Flying.- Insects, Snakes, and Other Small Animals.- Contamination.- Automobile Driving.- Fear of Dental Procedures.- Medical and Surgical Problems.- Social Phobia.- Public Speaking.- Urinating in Public Restrooms.- Agoraphobia.- Panic Disorders.- Obsessive-Compulsive Disorders.- Epilogue.- References.- Author Index.