Is Flooding an ethical treatment for people with phobias and OCDs?
Flooding is a treatment process where people who suffer from phobias and other anxiety disorders are exposed to their fears with the goal of reintegrating their repressed emotions with their current awareness. Flooding was invented by Thomas Stampfl in 1967.
Flooding can be seen as quite a good technique as the patient who is undergoing the treatment becomes increasingly more anxious until their anxiety peaks and they realise that they cannot actually get more anxious and therefore, the anxiety lessens and they realise that their fear was irrational, therefore curing them of their fear. Flooding also eradicates the cause of the problem and not just the symptoms unlike anti-psychotic drugs.
However, flooding can also be seen as a vary bad treatment technique as it causes a lot of unnecessary stress to the patient which can be damaging and leave them with other psychological problems especially if they decide to drop out of the treatment which many of them do. Not only that it is also very unnecessary when there are treatments such as client centred therapy, which also gets rid of the cause of the disorder and not just symptoms in a more calm and relaxed way as opposed to flooding the patient with their fear all at once and causing them psychological harm. Flooding does not protect the participant and this is the main reason that I believe it is unethical.
In conclusion, I think that flooding is extremely unethical as it doesn’t protect the participants from harm, mentally or physically and it can cause grave consequences if the participants drop out which many do.
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Flooding is an unethical way of treating a phobia or OCD, other more ethical methods are likely to be more effective. These include treatments such as such as systematic desensitisation or graduated exposure therapy. Systematic desensitisation is more ethical as patients are taught methods to help them cope with the stress and anxiety. Also unlike flooding the patient is gradually introduced to the distressing material. Systematic desensitisation is based on principles connected to classical conditioning. It is believed to be quite successful and is therefore a better option for those suffering from phobias and OCD than flooding.
Although flooding can be seen to be unethical studies have suggested that it is actually an effective treatment technique. Harris (1992) wrote that flooding is an effective treatment and is more cost effective than other methods due to the treatment length. Saying this it is still obviously a stressful treatment and sensitive groups such as children should not be subjected to this. However flooding should still be given as an option to people with phobias or obsessive compulsive disorder and they can decide for themselves with all the information as some people may prefer to get have just a few painful treatment sessions rather than many sessions which are expensive but less stressful.
Harris, C.V. (1992). An analysis of response prevention and flooding procedures in the treatment of adolescent obsessive compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 23, 107-115. doi: 10.1016/0005-7916(92)90008-7
I’d argue that the treatment is an ethical because the therapist would have fully informed consent, it’s the persons choice. The person has chosen to have that treatment therefore the fact it causes stress can not be a reason for it being unethical. Chemotherapy isn’t considered unethical because it causes sickness and hair loss; the cost greatly outweigh the potential benefits. Flooding benefits greatly outweigh the costs if the treatment is successful. It’s not a guarantee that the persons phobia will be eradicated but it’s not a guarantee for any treatment. Therefore I don’t think flooding is unethical because the treatment can be successful and it is the persons choice to have the treatment.
Flooding seems to be very unethical and it doesn’t appear to have many advantages to it, by flooding the person with anxiety until they feel they cannot be anxious anymore does not get to the root cause of the disorder. Other treatments are much better ways of reducing symptoms and getting to the root cause of the disorder, treatments such as Cognitive-Behavioural therapy that convinces the patient that, especially in OCD, that the thoughts about routine and compulsions don’t need to happen. De Haan, Hoogduin, Buitelaar and Keijsers (1998) found that cognitive behaviour therapy was effective in reducing obsessive compulsive disorder symptoms as opposed to drug treatment as it tackles the root cause of the disorder. Flooding is very unethical as it causes psychological harm to the participants and so should not be used as there are not many advantages to it either.
De Haan, E., Hoogduin, K. A. L., Buitelaar, J. K. and Keijsers, G. P. J. (1998) Behaviour therapy versus Clomipramine for the treatment of obsessive-compulsive disorder in children and adolescents. Journal of the American Academy of Child and adolescent psychiatry. 37(10). 1022-1029. DOI: 10.1097/00004583-199810000-00011.
Flooding is justified when it is the means to an end. Obviously it’s a rather dated technique as it was developed during the 1960s and 70s, so there may be better treatments out there. It has however been shown to be a highly effective treatment (Wolitzky-Taylor, Horowitz, Powers & Telch, 2008) for phobias and is more often than not used in tandem with other treatments. I can see why it would be questioned on an ethical level, but this is a treatment which patients willingly consent to. In my opinion flooding can only cause damage if it is applied at the wrong time in the recovery process.
Flooding can be seen as unethical but we must remember that the client has given permission and may leave the treatment at any time. This method of therapy has been shown to be highly effective. another version of treatment is called systematic desensitisation. This is a more progressive method of exposing a client to their fears. The patient will sit down with the therapist and order their fears in a hierarchy. for example the hierarchy for a fear of spiders may start with looking at a photo of a spider and lead up to holding one in their hand. Although this method may take longer it is more ethical as the patient has more control over their progress. A major disadvantage of this therapy is that it is yet to be effective for clients with social phobias or agoraphobia (the fear of open spaces).
Participants often do not have the right to withdraw whilst experiencing flooding as it would otherwise not work. This itself is quite stupid because it only works around 30% of the time.
I would personally say that the technique of flooding is ethical and extremely useful. Although flooding is deemed unethical in terms of the Psychology code of ethics the method has proven to be highly effective in particular cases. With the permission of the participant i don’t understand any reasons to stop the procedure. As you have mentioned in your blog, participants endure an excess amount of distress whilst flooding but surely they are made aware of this before taking part. However there is always the chance the procedure may not work and the participant left in a state of anxiety for nothing, maybe the chance of enhancing the phobia. I believe the participant should be made aware of the potential risks and make a decision themselves by carrying out a cost-benefit analysis.