Flooding in vivo as research tool and treatment method for phobias: a preliminary report.

F LOODING IN VW0 is a method of treating phobias by rapid exposure in real life to the feared object or situation, maintaining maximum tolerable anxiety until it begins to diminish, then continuing closer and closer exposure until the patient or client is comfortable in the situation which was previously feared.‘vZ Informally, flooding in vivo is one of the most ancient of therapeutic methods, i.e., overcoming one’s fears by facing them. Interestingly, one of its first public proposals by a mental health professional came from Freud3 in 1919. writing that the analysis of a phobia could only go so far without insisting that the patient enter the feared situation and struggle with the anxiety in real life. Though he did not use the term “flooding,” Guthrie” published several anecdotal accounts of successful application of the procedure. Systematic research on flooding under its current name was begun in the late 1960’s by Marks and his colleagues at the Maudsley Institute in London.1s2.5,6 These early investigations showed flooding to be safe, effective, and acceptable to patients, in spite of the intense anxiety which it arouses. It may in fact be the most rapid and effective of all available methods for treating phobias.’ While a rapid and efficient method of treating phobias would be a noteworthy advance, this alone would be of limited import, since, from a public health standpoint, phobias are among the lesser problems facing psychiatry. However, the significance of flooding may not be limited to this. Several of its characteristics make it more researchable than almost any other procedure in psychiatry. It is intense, rapid, simple, and tied specifically to a definable and controllable stimulus situation. In psychiatry, clinical events with these properties are rare indeed. Among the phenomena occurring during flooding and offering themselves for systematic investigation, are: (1) anxiety: for experimental analysis by psychological, physiological, and pharmacological approaches; (2) other reactions by patients; (3) psychotherapeutic change: allowing investigation of biological and psychosocial factors effecting its rate, quality, and durability; and (4) therapist behavior and therapist-patient interaction. The generality of findings arising from the study of flooding must of course be evaluated. If, as is often said, all psychotherapeutic methods have a common