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.