Post-traumatic stress disorder (PTSD) flooding is a type of exposure therapy used to treat PTSD. It involves exposing someone to memories or reminders of their traumatic event in a safe, controlled environment. The goal is to help them process and overcome the fear and anxiety associated with their memories. Flooding helps people face their fears and gain control over their PTSD symptoms.
How does flooding work?
During flooding therapy, a person is intentionally exposed to traumatic memories, thoughts, feelings or situations that are triggering for them. This is done under the guidance of a mental health professional, such as a psychologist or therapist trained in exposure therapy.
The flooding process usually involves:
- Creating a hierarchy of PTSD triggers from least distressing to most distressing. These may include thoughts, memories, feelings, places, situations, activities, objects or people.
- Gradually exposing the person to items on their hierarchy, starting with less triggering items and working up towards more distressing ones. This is done repeatedly over several therapy sessions.
- Having the person remain in the presence of whatever trigger they are being exposed to until their anxiety has decreased significantly. This allows them to process the memory or thought until it no longer causes as much fear.
- Providing education, support and coping skills training to help the person manage their PTSD symptoms during the exposure process.
By confronting their traumatic memories in a safe environment, the person learns that remembering the trauma does not have to be frightening. Over time, this decreases their overall anxiety, reactivity and PTSD symptoms.
When is flooding used for PTSD treatment?
Flooding is not appropriate for everyone with PTSD. It is primarily used when:
- The person’s PTSD symptoms are severe and disabling.
- Other therapy approaches have not helped improve their symptoms.
- The person has overcome avoidance behaviors enough to tolerate exposure therapy.
- The person is medically stable and does not have any co-occurring issues (like psychosis, suicidal thoughts or substance abuse) that may interfere with treatment.
Additionally, flooding is only conducted by properly trained professionals. They can monitor the person during exposures and provide help managing emotional responses.
What happens during a flooding session?
Flooding sessions are carefully planned out. First, the therapist will work with the patient to create a hierarchy of PTSD triggers. They will also discuss coping strategies to use during the exposure process.
During the session, the therapist will guide the person to recall a traumatic memory or confront something that reminds them of their trauma. This may include things like:
- Looking at photos related to the trauma
- Visiting places associated with the traumatic event
- Recounting memories of the trauma out loud
- Listening to sounds or music that recalls the trauma
- Engaging in movements similar to those during the trauma (like with motor vehicle accidents)
The person will remain exposed to the triggering stimulus until their anxiety reduces by around 50%. This may take anywhere from 30 minutes to 2 hours. The therapist provides support and teaches coping techniques, but does not interrupt the exposure. This process is repeated, moving up the person’s hierarchy over several sessions until even the most distressing memories can be confronted without overwhelming anxiety.
How long does a course of flooding therapy last?
The length of flooding therapy varies based on the severity of someone’s PTSD and how they respond to exposure sessions. A typical course of treatment may last around 5-15 sessions, with 1-2 exposures conducted per session. Each session is usually around 90 minutes long. More complex trauma generally requires more prolonged flooding treatment.
How effective is flooding for treating PTSD?
Studies show that flooding can be very effective at reducing PTSD symptoms for some people. In flooding, 67-90% of people show significant improvement. It seems to be most effective for treating PTSD that stems from one specific traumatic event, like an assault, disaster or accident.
Some of the benefits of flooding for PTSD include:
- Marked reductions in avoidance, numbing and hyperarousal symptoms.
- Lowered anxiety, overall distress and reactivity to trauma reminders.
- Improved ability to manage PTSD triggers and memories.
- Increased sense of control over PTSD symptoms.
Improvements from flooding tend to be maintained long-term as well. One study found flooding effects lasted over 3 years for the majority of PTSD patients.
What are the risks of flooding therapy?
Flooding does involve confronting very distressing memories and situations, at least initially. As such, there are some risks, including:
- Severe distress – Some people may become extremely anxious, have panic attacks, flashbacks or even dissociate during exposures.
- Worsening of symptoms – There is a risk of PTSD symptoms worsening temporarily before they improve. Symptoms like nightmares may get more frequent.
- Dropping out – Some people may find flooding intolerable and discontinue therapy.
- Self-harm – A small number of people may experience increased suicidal thoughts or turn to self-harming behaviors to cope with exposures.
- Relapse – Gains may not be maintained long-term if coping strategies are not learned. Booster sessions are often needed.
These risks emphasize the importance of flooding only being conducted by experienced, qualified professionals. They can monitor patients for adverse reactions and help them manage symptoms.
How can risks be minimized during flooding?
Mental health experts use various strategies to reduce risks and make flooding safer, including:
- Careful screening – Only people who are stable and capable of tolerating exposure are selected.
- Gradual exposures – Starting with less intense triggers can minimize distress.
- Coping skills training – Teaching coping ahead of time provides support.
- Close monitoring – Observing for any warning signs of adverse reactions.
- Calming strategies – Using relaxation skills during/after exposures.
- Medications – Anxiety medication can sometimes ease distress if needed.
- Support system – Having social support and emergency contacts.
The therapist may also adjust the pace of flooding based on how the person responds. With proper precautions, risks can usually be managed successfully.
What are alternatives to flooding for PTSD?
Not everyone is a good candidate for flooding therapy. Some other evidence-based options for PTSD treatment include:
- Cognitive processing therapy – Helps modify unhelpful thoughts related to the trauma.
- Prolonged exposure – Similar to flooding but with more gradual exposures.
- EMDR – Uses eye movements while recalling memories to process trauma.
- Medications – Antidepressants and anti-anxiety medication can help manage symptoms.
- Group therapy – Connects with other PTSD sufferers for support.
Many people benefit from using a combination of therapies. Other non-trauma focused therapies like mindfulness, coping skills training or family therapy can also be helpful.
Is flooding recommended for complex PTSD?
Flooding is generally not the first-line treatment for complex PTSD. Complex PTSD results from prolonged, repetitive trauma, rather than one specific event. This type of trauma often requires a phase-based, multi-modal approach.
Potential concerns with using flooding for complex PTSD include:
- Increased risk of retraumatization due to excessive exposure too soon.
- Worsening of dissociation symptoms or emotional dysregulation.
- Limited effectiveness since there are often multiple overlapping trauma memories.
If flooding is used for complex PTSD, exposures would need to be very gradual and combined with techniques for managing severe emotional reactions, grounding and establishing a sense of safety first.
How can I prepare for a flooding session?
If you will be undergoing flooding therapy, some things that may help you prepare include:
- Learning coping strategies – Have some calming skills ready like deep breathing, mindfulness or progressive muscle relaxation.
- Planning supports – Arrange for someone to drive you home after and offer emotional support.
- Practicing self-care – Get plenty of rest and make time for pleasurable activities too.
- Starting a journal – Writing about your trauma can help you confront memories.
- Listing motivations – Remind yourself why you are doing this hard work.
- Easing into triggers – You could do some controlled exposure practice at home.
Your therapist should guide you through how to get ready. Being open and willing to engage in the difficult process can help flooding be successful.
What should I expect after a flooding session?
Flooding sessions can be mentally and emotionally draining. You may experience:
- Feeling exhausted, shaky or washed out
- Headaches, nausea or other physical symptoms
- Heightened anxiety, depression or irritability
- Trouble concentrating
- Intrusive images or memories from the trauma
These reactions are normal and tend to be temporary. Self-care is important after. Some tips include:
- Let yourself rest and restore
- Do a calming activity you enjoy
- Write about your experience
- Spend time with your support system
- Practice good sleep hygiene
- Drink water and eat nourishing foods
- Limit caffeine, alcohol and stimulant use
- Use your coping skills and be compassionate with yourself
Stay in touch with your therapist about your reactions so they can offer guidance. With time, these residual effects should subside.
How can I get the most out of flooding therapy?
To optimize your flooding treatment, tips include:
- Learning about flooding ahead of time – Understanding the process allows you to prepare.
- Committing to the full course – Don’t give up prematurely before you see benefits.
- Being open and honest – Share all your reactions and feelings with your therapist.
- Pushing yourself to tolerate distress – Stay in exposures until your anxiety reduces substantially.
- Using your coping strategies – Rely on them to manage reactions both during and after sessions.
- Avoiding safety behaviors – Like dissociation or distraction during exposures.
- Practicing outside sessions – Do some controlled exposure homework if recommended.
- Having reasonable expectations – Progress can sometimes feel painfully slow.
Flooding is very challenging, but with courage and commitment, it can be a potent way to overcome PTSD.
Conclusion
Flooding therapy is an intensive, controlled way to confront traumatic memories and desensitize PTSD triggers. While it carries some risks and is not for everyone, flooding can lead to dramatic reduction in symptoms for those with severe, impairing PTSD from a specific trauma. It provides a means of facing one’s fears and breaking free from the debilitating grip of PTSD.
