Practical Parameters in the Use of Flooding for Treating Chronic PTSD

Abstract

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.

Therapist use of cognitive behavior therapy and eye movement desensitization and reprocessing components for the treatment of posttraumatic stress disorder in practice settings

“…Exposure sessions for PTSD have the most empirical evidence, but are also the most underused treatment ( Farrell et al, 2013 ; Harned et al, 2013 ). Reasons for this, as cited by therapists, range from exposure carrying a high risk of harm to clients, to clients being unable to tolerate exposure, therapist characteristics such as anxiety and self-efficacy, but mostly, lack of use of EST’s, and exposure sessions specifically, is related to therapist training ( Foy et al, 1996 ). Research has shown the key barriers to using exposure therapy in practice are in fact therapist factors, and not client factors.…”

Posttraumatic stress disorder treatment preference: cognitive processing therapy, prolonged exposure therapy, or pharmacotherapy?

“…Health care providers consistently underutilize exposure-based therapies-both for PTSD (Becker, Zayfert, &Anderson, 2004;Foy, Kagan, McDermott, Leskin, Sipprelle, & Paz, 1996;Rosen et al, 2004) and other anxiety disorders (Freiheit, Vye, Swan, & Cady, 2004)-and this underutilization stems from a variety of reasons, including lack of training, perceptions of suitability or patients' ability to handle such treatment, time constraints, and clinician personal preference and/or psychotherapeutic orientation (Becker, Darius, & Schaumberg, 2007).…”

A controlled study into the (cognitive) effects of exposure treatment on trauma therapists

“…Several therapists seemed to be ashamed of doing so, because of cognitions such as 'I 'm a professional, I should be able to cope with it' or 'If I suffer from complaints, that shows that I'm incompetent'. There is consensus in the literature that supervision is of great importance for therapists, especially for trauma therapists (Foy et al, 1996;Litz & Roemer, 1996;Pearlman & Saakvitne, 1995;Richards et al, 1994;Schauben & Frazier, 1995), regardless of their years of experience in the field.…”