PRACTICAL PARAMETERS IN THE USE OF FLOODING FOR TREATING CHRONIC PTSD

While flooding or direct therapeutic exposure (DTE) has been empirical ly validated as an effective primary treatment for PTSD through severa l randomized controlled trials, there is also evidence that relatively few trauma therapists actually use the technique. There are now sever al published reports which document a number of the difficulties in im plementing the treatment with chronic PTSD patients. These problems, r anging from patient refusal to adverse reactions, represent several do mains, including trauma history characteristics, patients' personal ch aracteristics, therapist factors, and treatment environment factors. T he purpose of the present report is to provide an empirical rationale to support the use of individual flooding as a primary form of psychot herapy for chronic combat-related PTSD. Implementation rates for flood ing are compared among expert behavioural trauma therapists versus fie ld use rates for trauma programmes generally. Complications or side-ef fects of flooding are considered. We also identify several predictable sources of difficulty in implementing individual flooding and the pro portions of patients likely to be affected by each type. Finally, prac tical suggestions are offered for improving utilization of flooding, a nd directions for future empirical investigations are explored.