Forty-three Vietnam veterans seeking psychological services at a Los Angeles Veterans Administration medical center were assigned to positive and negative groups of PosttraumaticStressDisorder(PTSD) based on the Diagnostic andStatistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980). Subjects were extensively assessed to examine the relative contributions of premilitary adjustment, military adjustment, and extent of combat exposure to the development of combat-related, chronic PTSD. In addition, groups were compared on profiles from the Minnesota Multiphasic Personality Inventory (MMPI) and a psychological problem checklist. Results of multiple regression analyses demonstrated that combat exposure and, to a lesser degree, military adjustment were significantly related to PTSD symptomatology, whereas premilitary adjustment was not. Discriminant function analyses showed that the MMPI had moderate ability to correctly classify subjects on the basis of PTSD diagnosis. However, problem checklist items indicative of anxiety-based disorders, particularly generalized anxiety and pervasive disgust, formed a discriminant function that correctly classified more than 90% of study subjects. Results were discussed in terms of implications for an empirically derived conceptualization of PTSD and further research directions.

While flooding or direct therapeutic exposure (DTE) has been empirically validated as an effective primary treatment for PTSD through several randomized controlled trials, there is also evidence that relatively few trauma therapists actually use the technique. There are now several published reports which document a number of the difficulties in implementing the treatment with chronic PTSD patients. These problems, ranging from patient refusal to adverse reactions, represent several domains, including trauma history characteristics, patients' personal characteristics, therapist factors, and treatment environment factors. The purpose of the present report is to provide an empirical rationale to support the use of individual flooding as a primary form of psychotherapy for chronic combat‐related PTSD. Implementation rates for flooding are compared among expert behavioural trauma therapists versus field use rates for trauma programmes generally. Complications or side‐effects of flooding are considered. We also identify several predictable sources of difficulty in implementing individual flooding and the proportions of patients likely to be affected by each type. Finally, practical suggestions are offered for improving utilization of flooding, and directions for future empirical investigations are explored.

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