In the last chapter
I described two basic ways to change behavior based on respondent conditioning:
counterconditioning and extinction. And each of these may be done gradually,
using a hierarchy to slowly approach the situation that elicits the strongest
response; or non- gradually, confronting the situations high on the hierarchy right away. This chapter deals with a variation of
non-gradual extinction. Remember that respondent extinction consists of
presenting the CS to the client over and over without pairing it with the UCS
until the CR no longer occurs. The
first time Carl was on a merry-go-round (CS) he fell off and hit his head on the pavement (UCS) causing much pain and discomfort (UCR). Now
Carl has a basic fear (CR) of getting on a merry-go-round. A non-gradual
extinction approach would consist of getting Carl on the merry-go-round and
keeping him there while ensuring nothing bad happens to him.
The non-gradual extinction approach of flooding consists of
rapidly exposing the client to the CS, while minimizing the client’s escape
from the CS. Hence the approach is sometimes called response prevention. Nesbitt
(1973) reported the case of a 24-year-old female with an intense fear and
aversion of escalators, which she had for seven years, originating from the
time her relatives forced her on an escalator. Treatment consisted of getting
her on an escalator, the first ride with the therapist and then alone. One half
hour of this treatment reduced her fears. Six months later she experienced
little anxiety when on escalators.
The key to flooding is the rapid exposure to the CS rather than more spaced
presentations. This would correspond to continually keeping the woman on the
escalator rather than taking breaks between rides. The assumption is that
this approach will facilitate the extinction, perhaps because the person becomes
too physically exhausted for the CR to occur, perhaps because the response
prevention helps break down avoidance responses which do not have the time
or opportunity to occur.
To date, flooding has almost exclusively been used with situations that
elicit anxiety. A major advantage of flooding is that it is much faster than
gradual approaches such as desensitization. A major disadvantage is that often
it will increase the strength of the CR rather than extinguish it. If a child has a fear of dogs, forcing him to confront a lot of dogs may
increase his fear rather than extinguish it. We do not know enough yet to
be always able to predict whether the anxiety will increase or decrease. Hence
my bias is to generally favor a gradual approach.
Although there has been a moderate amount of research on flooding (Morganstern,
1973; Smith et al., 1973), many unanswered questions still exist in a confounded,
contradictory literature: What is the effect of how anxious the client is?
What is the effect of the amount of anxiety elicited during treatment? What
is the optimal duration of presentation of different anxiety situations? What
are the differences between an imagined CS and an in vivo CS? To what extent
may flooding be accomplished without letting anxiety occur? To the extent
that flooding can be carried out with little or no anxiety, it may be possible
to reduce some of the possible disadvantages of flooding, such as increasing
the associated anxiety. Finally, flooding can be used to reduce avoidance
responses without reducing the associated anxiety (Rachman & Teasdale,
1 974). That is, because of the response prevention component, a person may
learn via flooding not to avoid an anxiety situation, but still feel some
anxiety. When would this be a desirable thing to do?
One problem area in which flooding initially seems effective is the treatment
of obsessive-compulsive neurosis, conditioned anxiety generally associated
with repetitive fixed thoughts (obsessions) and/or ritualistic motor behavior
(compulsions) (Boulougouris & Bassiakos, 1973; Rachman et al., 1973).
Rachman and his associates (1973) used a combination of flooding and modeling
(Chapter 8). The modeling involved the therapist as a model doing the feared
act. One of their cases was a 22-year-old female who for five years had a
fear of “contamination” by dogs, which generalized to many areas of London.
She avoided areas around London where she had been contaminated, and her fears
led her to move repeatedly (five times in three years). She washed her hands
at least 50 times a day, threw away large amounts of contaminated clothing
(especially boots), and cleaned her whole house every day (including curtains,
carpets, floors, and shelves). The treatment involved complete contamination
of her environment in the treatment hospital, shopping expeditions in areas
of the town she avoided, and response prevention of excessive washing. At
the end of treatment, there was no evidence of excessive washing or cleaning
rituals, but she still had some thoughts about contamination.
Flooding is a component of the treatment procedures of a variety of different
therapies, including aspects of encounter groups, gestalt therapy, and primal
therapy. It arises when clients are continually confronted with situations,
memories, thoughts, impressions and criticisms by others, or any other source
of anxiety they are not permitted to escape from, physically or psychologically.
This is often accompanied by strong emotional reactions by the clients. In
psychoanalysis, some of these reactions may be interpreted as abreaction
or catharsis, both meaning the reduction of emotional tension because
of reliving the experience that caused the tension. In different settings
and with different client expectations, the emotion of the clients and/or
the following emotional exhaustion may be associated with what are interpreted
as early childhood memories, memories of previous lives, or metaphysical or
religious experiences. Sargant (1959) suggests that in situations such as
these, as well as in many types of religious and political conversion, the
effect is because of emotion-produced suggestibility. That is, if a person
has his emotions worked upon until he reaches an abnormal condition of anger,
fear, or exaltation, and if this condition is maintained for a while, then
the person may become more open to suggestions about new beliefs and behaviors.
Although flooding has primarily been used with anxiety-producing situations,
it can also be used with other respondently elicited emotions. (Remember
the generality of the respondent extinction and counterconditioning in the
last chapter.) For example, Blanchard (1975) reported the case of a 27-year-old
woman who had unpleasant experiences associated with the death of her fetus.
This led to hatred and revulsion for pregnant women. The treatment included
two one-and-a-half hour flooding sessions, which extinguished her hatred and
fear.
A variation of flooding developed by Stampfl and Levis (1 967) is implosive
therapy or implosion (Ayer, 1972, Frankel 1 972, Morganstern, 1 973
Stampfl, 1970, 1975). Implosive therapy is flooding with these characteristics:
(a) All presentations of anxiety situations are done by having the client
imagine scenes. (Remember throughout this text that treatment based on imagined
situations generalizes surprisingly well to in vivo situations.) (b) The
imagined scenes are often ones of exaggerated or impossible situations designed
to elicit as much anxiety as possible. (c) The scenes are often based on
hypothesized sources of anxiety, some of which are psychodynamic in nature.
These hypothesized sources of anxiety center around such things as hostility
toward parental figures, rejection, sex, and dynamic concepts like Oedipal
complex and death wish.
Treatment usually consists in first having the client imagine an anxietyproducing
scene and realize that, although unpleasant, the anxiety is not unbearable.
Then the client is given a sequence of high anxiety scenes to imagine, often
in order of increasing anxiety, hence a hierarchy to some degree. This treatment,
generally accompanied by strong emotional reactions of the client, is continued
over a few treatment sessions until the anxiety is assessed to have extinguished.
A person with a fear of spiders might be told in detail to imagine a scene
in which, when he bites into a sandwich, spiders come out of the sandwich
and go into his mouth. The scene may continue with detailed descriptions of
the spiders crawling around in the client’s mouth and nose. Or a person who
is afraid to fly in airplanes may be told to imagine a scene in which he is
flying in a plane, the plane blows up, his body is torn into a lot of pieces,
and he experiences the pieces of his body falling to the ground. The scene
may continue with the person’s funeral and a trip to hell. Hogan (1968) has
described the types of scenes he uses in the treatment of snake phobias. These
scenes include such images as a snake crawling in your lap, the snake biting
your fingers, blood dripping from the fingers, squeezing the snake, the snake
biting your face, the snake pulling your eye out and eating it, and the snake
crawling into your eye socket and nose. Another scene might involve falling
into a pit filled with thousands of snakes. Assuming the snake is a symbol
of male sexuality, Hogan might have a female client imagine a large snake
sexually violating her and mutilating her sexual organs.
There are two major problems in the use of implosive therapy. First, from
the orientation of behavior modification, as discussed in this text, it is
not clear why one would use hypothesized or psychodynamic sources of anxiety.
Scenes of snakes attacking a female’s sexual organs may make sense from a
psychoanalytic orientation, but they do not currently follow from a behavioral-experimental
orientation. The second problem, as would be expected from the discussion
of flooding, is that although some clients are reported to improve following
implosion (e.g., Hogan & Kirchner, 1967, 1968; Smith & Sharpe, 1970)
other clients end up with more anxiety being built-in (e.g., Barrett, 1969;
Fazio, 1 970). For example, Barrett (1 969) used implosion for the treatment
of snake phobias in college students. For one student, the images of snakes
became conditioned to having her eyes shut, as she did during treatment. She
then consistently visualized snakes when she shut her eyes, had trouble sleeping,
and could not attend course lectures. The literature and research on implosion
is mixed (e.g., Morganstern, 1 973); and it is difficult to determine the
results of different variations of implosion by different practitioners with
different problems in different types of clients.
An important issue is why implosive therapy, and related flooding procedures,
is effective in some cases. The following are possible explanations: To a
certain extent implosive therapy may be extinction as intended. But if it
is extinction, why use such horrible scenes rather than real life ones? To
what extent do these more anxiety scenes facilitate extinction? In practice
implosion often involves the use of a small hierarchy; and the client is often
asked to imagine alternative ways of responding to the anxiety scenes. This
suggests that part of the effect may be due to counterconditioning. The client
is often encouraged and given incentives to continue steps of the treatment,
thus introducing elements of operant conditioning (Chapter 7).
The high emotion experienced during treatment
may make clients more suggestible, as discussed above, perhaps including suggestions
they are improving. The high emotions may also produce a contrast effect between
imagined and real life situations (Hodgson & Rachman, 1970). If you have
just spent some time imagining spiders doing horrible things to you and are
emotionally exhausted, you may
not react much to the small
spider on the sidewalk outside the clinic. Finally, there is “flight into
health,” meaning the sooner you get better, the fewer of these unpleasant
treatments you will get. Suggestibility, contrast, and flight into health
effects are generally transient, decreasing over time.
Overall, flooding and related procedures, such as implosive therapy, are
fast approaches to extinguishing emotional reactions, primarily anxiety. However,
in some cases more anxiety is built-in rather than extinguished. Research
on when flooding is an effective and desirable treatment, the best way to
carry it out, and how it works is contradictory and incomplete.
Flooding is non-gradual respondent extinction in which the client is
rapidly exposed to the CS while minimizing his escape from the CS. It has been
primarily used in the treatment
of anxiety, including some favorable initial results with obsessive Compulsive neurosis. Implosive therapy is a
flooding procedure using exaggerated Imagined scenes, often drawing on
hypothesized (e.g., psychoanalytic) sources of anxiety. Flooding is usually
faster than gradual approaches such as desensitization, often elicits various
images and emotional reactions, and in some cases results in the clients
becoming more anxious. Considerable research is needed on situations in which
flooding is applicable and the optimal flooding procedures. When flooding appears
effective, the results may be because of phenomena such as extinction, counterconditioning,
operant conditioning, suggestibility, contrast, and flight into health
|
1.
|
What are the differences among counterconditioning, respondent extinction,
flooding, and implosive therapy? |
|
2.
|
Give three different situations in which you would consider using flooding. Why? |
|
3.
|
Outline a flooding program for
a person who is afraid of heights, using both imagined scenes and in vivo
situations. |
|
4.
|
Describe the use of flooding
with a hypothetical case in the reducing of an emotion other than anxiety,
fear, or anger. |
|
5.
|
What are the pros and cons of using hypothesized sources of anxiety in imagined scenes, as in implosive therapy? |
|
6.
|
List three relatively unanswered
questions about flooding. What is your best guess about the answers to
these questions? Why? |
|
7.
|
Describe an experiment in which
you could separate the following possible effects of flooding procedures:
extinction, emotion-induced suggestibility, and contrast effects. |
Morganstern, K. P. Implosive therapy and flooding procedures: A critical
review. Psychological
Bulletin, 1973, 79, 318—334.
Smith, R. D., Dickson, A. L., & Sheppard, L. Review of flooding
procedures (implosion) in animals and man. Perceptual and Motor Skills, 1 973, 37, 351—374.
Stampfl, T. C. & Levis, D. J. Essentials of implosive therapy: A learning-theory-based psychodynamic behavioral therapy. Journal of Abnormal Psychology, 1967, 72