Flooding

Description of the Strategy

“When you fall off a horse, you need to get right back on.”

Everyday culture has long recognized the importance of exposing ourselves to things we fear in order to overcome those fears. Parents do this with children quite naturally; Mother nudges her reluctant toddler toward the other children in a playgroup, or Dad encourages his teen to “go for it” and try out for the diving team despite the intimidating height of the diving platform. Fears are simply part of everyday life, and being able to face them rather than avoid them is a crucial element of experiencing, learning, and living a full life. Obviously, using exposure to overcome fear isn't the best idea if the feared object or situation is actually harmful; entering the lion's den (in the literal sense) may not be the most effective method of reducing a fear of lions. The realistic possibility of being eaten by the lion outweighs any potential benefit of reduced fear. In addition, exposure may not be the most adaptive method of responding to a realistic danger; reducing fear may reduce a child's future caution in risky situations and increase the chance of being eaten by that lion (or one of his cousins) at a later date. In short, sometimes fear is a good thing, protecting us from danger. However, other times our fears are unreasonable, out of proportion to realistic danger, or excessive. While entering the lion's den may be unwise, being able to enter a friend's house to pet her gentle kitten is an important part of growing up.

Basics of Exposure-Based Treatment

The psychological literature contains many examples of treatments with demonstrated efficacy for helping individuals overcome unrealistic or excessive fears. Exposure-based techniques, or the psychological equivalent of “getting back on the horse,” have proven quite useful in the treatment of phobias, obsessive-compulsive disorder, and other anxiety disorders in which avoidance plays a prominent role. Two major exposure-based techniques are systematic desensitization and flooding. These techniques share in common several ideas, including the notions that (a) fears develop because the individual anticipates (for any number of reasons) that contact with a particular object or event will result in some negative outcome, (b) by virtue of the anxiety being unrealistic or excessive, the feared negative outcome is also unrealistic or excessive, and would either not actually occur or would not be as catastrophic as anticipated, (c) escape or avoidance of the feared situation is reinforced when [Page 843]the anticipated negative outcome does not occur, and escape/avoidance becomes a conditioned response to both the feared stimulus and feelings of anxiety, and (d) successful treatment of excessive or unrealistic anxiety involves breaking the conditioned pairings of the feared stimulus and the anxious affect (stimulus → anxious affect) and avoidance/escape (stimulus → avoidance/escape) responses.

Where these techniques differ is in the specific ways in which exposure is accomplished and the mechanisms by which anxiety and avoidance are presumed to decline. For example, in systematic desensitization, the individual is first taught relaxation, a physiological response considered to be incompatible with anxiety (or anxiety-antagonistic), and then exposed to the feared object or situation. Using relaxation during exposure sessions is presumed to create a conditioned (relaxation) response to the target object/situation that is physiologically incompatible with the stimulus → anxiety response pairing. Relaxation should “displace” the anxiety such that there is now a conditioned stimulus → relaxation pairing. If the object/situation no longer evokes anxiety, there should be no further need for escape or avoidance. Then the individual can remain in contact with the feared stimulus to learn that it does not lead to the unrealistic feared negative outcome. Variants of systematic desensitization (e.g., distraction, cognitive coping) all emphasize the importance of exposure to the feared stimulus occurring during an anxiety-antagonistic state.

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