What Is Flooding? The Psychology Of Coping With Trauma, Anxiety, Phobias, And OCD

Flooding is a type of exposure therapy that is used in treating invasive and distressing psychological thoughts, primarily phobias, via the use of intense and immediate exposure to negative stimuli. While other types of exposure therapies, such as systematic desensitization, may gradually build a patient up from smaller and less calamitous examples of stimuli in their treatment, flooding generally starts with the most difficult aspects from the very beginning.

How does flooding work?

Examples of conditioning in exposure therapy

In 1897, the Russian physiologist Ivan Pavlov conducted a classical conditioning experiment in which he trained his dogs to associate the sound of a metronome (the stimulus, in this case) with food. Therefore, the dogs were conditioned to salivate upon hearing that particular tone from then on, even when food was not present.

Another example of conditioning is food poisoning. Our bodies may go into defense mode after such an unpleasant ordeal, and we may strongly want to avoid eating that particular dish again in the future. Even if we know the dish may not make us sick again, we may associate it with sickness and be repulsed by it. In this case, we are conditioned by the experience to avoid a specific food due to our minds "learning" (or being conditioned to believe) that it was associated with unpleasant sensations and results.

On the other hand, positive conditioning is the desired result of the flooding technique. This form of therapy is conducted by bringing a negative concept to us to recondition our mind to view it in a positive or neutral light and encourage us to respond accordingly. This is done to alleviate (or at least lessen) our fears, triggers, and other behaviors.

When receiving flooding as treatment, we may be exposed to what has triggered such strong negative responses in us, such as a phobia. Therapists may encourage us to practice various forms of relaxation methods throughout the process, thereby eventually calming ourselves in the presence of our particularly undesirable trigger. This works to "rewire," or positively condition, our minds to no longer react so intensely when presented with that trigger again in the future. 

By associating with the negative event, the goal is for us to become desensitized to it to an extent. This allows us to better cope in daily life.

How is flooding used in the treatment of various conditions?

This type of therapy can be done via immersive techniques, with the assistance of virtual reality exposure, images, or in-person (vivo exposure). With successful flooding treatment, we may experience the following:

• Decreased stress hormones and reactions to triggers
• Increased sense of capability in handling our fears and anxieties
• Reduced negative associations regarding situations or particular stimuli
• Increased emotional processing regarding fears and the world around us

Flooding is not a treatment appropriate for all individuals and all situations, and not all mental health professionals choose to use it in therapy.

Flooding as a treatment method

Flooding, as one of the many variations of exposure therapy, is sometimes appropriate in the treatment of numerous mental health conditions such as anxiety, trauma, phobias, and obsessive-compulsive behaviors (OCD). While it may not be suitable for every person seeking treatment, flooding may greatly reduce the invasive and stressful responses for us when we experience triggering stimuli.

Flooding as a treatment for post-traumatic stress disorder

In the treatment of post-traumatic stress disorder (PTSD), exposure therapy may need to be approached with caution due to the severity of the experiences that induced the post-traumatic symptoms in the first place. But flooding may still be a viable therapy option for reducing those incapacitating responses to negative stimuli. A psychologist will be able to determine what type of exposure is the best based on the circumstances that led to the PTSD.

With the factors of a traumatic situation generally being too dangerous or impossible to replicate in standard exposure therapy—such as a car accident or an attack—mental health professionals will often use an alternative variation known as imaginal exposure. 

This method involves having the individual imagine the aspects of their trauma and replay those painful memories in their mind under the guidance of a licensed professional, while vividly describing them as much as possible. This allows the individual to be re-immersed in the trauma while in a safe environment and under the care of a psychologist who can provide support in keeping them calm and assisting in the reconditioning process. Through this flooding therapy, we may gradually learn to manage our reactions to flashbacks, memories, and triggers related to the event that caused the post-traumatic stress disorder.

Flooding as treatment for anxiety

Exposure therapy can sometimes be an appropriate behavior therapy treatment if we struggle with anxiety or anxiety-related disorders. If we were to experience social anxiety, our mental health professional might encourage us to counter this aversion head-on by going into a public place, social event, or crowded room. While directly stimulated by the issue that bothers us the most, we may be instructed to practice relaxation techniques and exercises until we’re capable of remaining calm in the undesired circumstances.

The aim of this prolonged exposure is for us to grow so we can overcome our fear and lessen our fight or flight response to certain stimuli. We may still be a bit uncomfortable in public or crowded places, but it may only pertain to general overstimulation if we genuinely prefer smaller groups or solitary activities on our own. The goal of flooding is to desensitize us to the sights, sounds, and smells around us and realize that others in public are simply going about their business.

Some therapists are even utilizing virtual reality for flooding. This can help mitigate some of the barriers that prevent patients from participating in this exposure therapy, such as difficulties in arranging exposure and the lack of providers trained to offer the treatment.

Anxiety-based treatment via in-person or online therapy can also be beneficial for us if we have a fear of speaking in front of others, if we’re dealing with self-image issues, or even if we’re overly affected by something like being stuck in traffic. All of these are issues that may have resulting anxieties that can be reduced by flooding, exposure, or another form of conditioning. Mental health professionals may help us remain calm when faced with situations that trigger these high levels of anxiety.

Flooding for the treatment of phobias

Phobias are one of the most recognized conditions treated with flooding or exposure therapy. In general therapy, therapists often recommend being gradually exposed, building up from smaller triggers to those with the most significance. However, flooding starts on the opposite side of the spectrum.

If we reach out to a mental health professional due to an extreme fear of dogs that impacts us to the point that we’re unable to go on a walk, we may likely be instructed to expose ourselves to dogs in a safe environment. This could be petting or holding a dog (one possibly belonging to a friend or relative to ensure good temperament) and "enduring" the interaction until our anxiety and adrenaline calm down and pass – telling your nervous system that your natural fear response is a false alarm. There are also specially trained therapy dogs and their knowledgeable trainers who can help with this in a controlled environment. 

Known as in vivo exposure, this direct exposure may help condition us to associate positive or neutral reactions in response to coming across dogs in less familiar settings. If this is achieved, it may lead to overcoming phobias entirely.

For other (non-animal) phobias, such as being in a moving vehicle or being afraid of the dark, it may be easy to be immediately placed in these situations safely and remain in them, sometimes for several hours, until the appropriate calming techniques are applied. In time, this prolonged exposure can lead to systematic desensitization of the fear as we learn to apply relaxation techniques and calm our mind.

The goal of flooding is to recondition the brain in one session, but it may not be successful the first time. This is because we can quickly remove ourselves from the stimuli before the exposure therapy has time to re-condition our responses to our specific fears. If this occurs, we may be exposed to harsh symptoms that need to be addressed in order to heal, and a time limit for each session may be appropriate.

Flooding as a tool to overcome OCD

The behaviors we experience with OCD can often be due to underlying fears. For example, we may believe that repetitive and often specifically numbered actions may resolve or prevent our worst fear from happening. Or, these repetitive or numbered actions may help to distract and calm us from whatever fear or trigger is present.

Flooding, in this context, allows us to be fully immersed in a situation that would trigger our compulsive behaviors. A mental health professional in a flooding session can guide us to not engage in any of them while experiencing distress. This can be anything from coming into contact with "contaminated" surfaces (whether truly contaminated or not) to addressing certain thoughts that provoke obsessive-compulsive behaviors.

In OCD, these disruptive and compulsive behaviors are often an avoidance tactic to circumvent experiencing certain fears. We may convince ourselves that the behaviors are somehow preventative actions against the particular negative stimuli. 

OCD becomes a concern when these behaviors begin affecting our lives. By not allowing ourselves to indulge in these ritualistic activities, but still being exposed to whatever it may be that triggers them, exposure therapy may help us to learn that our obsessive-compulsive actions have no significant impact on the outcome of the situation at hand. This also may allow us to realize that we can handle the amount of anxiety induced by a situation without always relying on ritualistic or obsessive behaviors.

Further information regarding flooding

Though flooding can be a successful tool in treating numerous psychological conditions, it may not be for everyone. Furthermore, not every mental health professional will be willing to engage in this method for therapeutic purposes. Symptoms successfully treated with exposure therapy may be a component of other psychological conditions that may require further treatment.

Recent research is increasingly exploring techniques by which exposure therapy can be delivered to patients online. A psychology study launched in 2016 is testing the effects of treating people with eating disorders and other forms of anxiety with imaginal exposure therapy delivered online. This treatment asks patients, via remote counseling, to face their anxiety source through imagination exercises. While flooding and exposure therapies are often considered in-person techniques, psychologists and therapists continue to find new and creative ways to apply them to people online who perhaps can't get in-person mental health care. 

Internet-based therapy has many benefits such as being easily available for people with limited ways of getting therapy. Moreover, online therapy is typically more affordable as it requires less time to take off work for an appointment. 

According to a study by the World Psychiatry Association, online therapy can “better serve minority groups who may have less approach to mental health services, and to persons in countries where mental health services are less developed.”

Online therapy with BetterHelp

If you believe that you might be able to benefit from flooding or another form of exposure therapy, connect with a mental health professional via BetterHelp. 

Online counselors at BetterHelp are available to answer your questions on flooding psychology, administer treatment, and direct you to further resources. Read what others have to say about their experiences with BetterHelp counselors below.

“I’m so thankful to be working with Melissa. I felt a positive connection with her during our first session. Melissa listens and validated that my concerns are real. I’m now starting to understand how my stress or fears might be linked to some childhood trauma. I look forward to each session and learning more about myself along with new ways to cope.”

“Most times in my life I have seen therapy as a four-letter word. I find myself, for a change, looking forward to my appointments with Amanda. Often I find myself questioning the process but Amanda is always there with kind words and ways to challenge my fears. Her work is priceless and too is the clear personal connection she forms. I am so happy I gave BetterHelp a change and was blessed to be matched with Amanda.”