Implosive therapy: characteristics and applications

This type of therapy is widely used in the treatment of anxiety crises such as phobias.

There are several psychological techniques for the treatment of phobias, although it is known that the most effective are the techniques that expose the subject to the phobic stimulus.Although it is known that the most effective are the techniques that expose the subject to the phobic stimulus (exposure techniques).

Today we will know one of them, implosive therapya technique of massive exposure proposed by Thomas Stampfl in 1961.

Exposure techniques

The techniques of exposure are used to treat mainly fears and phobias.. They consist of exposing the subject to the phobic object or situation, so that he/she gets used to the anxiety (that he/she learns to tolerate it) that he/she feels when exposed to it.

The objective is to learn that there is no harm and that therefore the stimulus is not dangerous..

For example, it would be exposing a person to darkness and having him/her understand that it is not dangerous, or exposing a person with a dog phobia to a dog and having him/her see that the dog does not bite him/her.

In most phobias, however, the person knows that the fear is irrational, and that the phobic stimulus (or situation) is really not dangerous; however, the person is unable to eliminate the phobia spontaneously if he or she is not exposed to it and understands that "non-association".

Hierarchy of items

Let's look at the first step of exposure techniques.

To apply an exposure technique, first a hierarchy of stimuli should be designed according to the level of anxiety they produce..

Subsequently, the patient should first be exposed to the items that produce the least anxiety, and then move up the scale of items (from less to more anxiety). The hierarchy will be elaborated by the patient together with the therapist.

Difference from systematic desensitization

Unlike systematic desensitization techniques (where the patient applies an incompatible response to anxiety, such as relaxation, upon exposure to the phobic stimulus), exposure to the stimuli is less gradual (the hierarchy is more abrupt). (the hierarchy is more abrupt).

Massive exposure techniques

Within the exposure techniques, we find different types according to the exposure modality (live exposure, symbolic, virtual reality...).

On the other hand, the implosive therapy is within the massive exposure modality, where the therapeutic sessions are of 1 or 2 hours per day for 7 consecutive days.. In this sense, mass exposure techniques are more effective techniques than spaced exposure techniques (e.g. with sessions 1 or 2 days a week).

In turn, we find two types of mass exposure techniques: implosive therapy and flood therapy.

Implosive therapy

Implosive therapy was created by Thomas Stampfl in 1961. Its theoretical basis is based on psychoanalysis and experimental psychology (unlike flooding, flooding is based on psychoanalysis and experimental psychology). (unlike flooding, which we will see below, and which is based solely on experimental psychology).

Exposure to aversive stimuli is by imagination only, and the escape response is not allowed. In flooding, on the other hand, exposure can be live or imagined, and the escape response is possible. Stimulus content is dynamic content.

On the other hand, the hierarchy of stimulus presentation is less gradual than in flooding, ie, the change from a less aversive stimulus to a more aversive stimulus is easier to make.The change is more abrupt.

Flood therapy

Similar to the previous one, but with the commented differences, is the flood therapy, created by Baum in 1968. As we have seen, here the theoretical bases are centered on experimental psychology, and exposure to the stimuli can be either live or imagined. can be either in vivo or in imagination. There may or may not be an escape response during exposure, and the content of the stimuli is realistic.

Both implosive and flood therapy can use hierarchical stimulus presentation, but this is less demanding and graded than in the more abrupt systematic desensitization (SD).

Exposure guidelines

When a subject is exposed to a phobic situation by means of implosive therapy and continues to present anxiety at the time of its application, the phobic stimulus should continue to be maintained, the phobic stimulus should continue to be maintained.. In case the phobia is excessive, then escape to a calm situation will be allowed (only in the case of flooding).

In the case of implosion, the presentation of the stimulus will be continued until the anxiety is reduced, and in the next session the next session will start with an item earlier in the hierarchy, since the last one will not be considered overcome.

Variants and their level of effectiveness

Depending on the characteristics of the exposure technique to be used, there are differences in the degree of effectiveness. Let's take a look at them:

Live and symbolic exposure

As we have seen, in implosive therapy the phobic stimuli will always be presented in imagination. However, it should be noted that the maximum efficacy of exposure techniques are those that present the stimulus live (in real form).

Gradient of exposure

It is known that the maximum efficacy is given when the gradient or intensity of exposure to the stimuli is as abrupt as the patient can tolerate.In this case, implosive therapy would be a good therapeutic option to eliminate phobias, especially if they are to be eliminated quickly.

In any case, a gradual intensity will also be effective, although if it is abrupt it will offer faster results (but it does not necessarily have to be more effective; it will depend on the type of patient).

Interval between sessions

In defining mass exposure techniques, we have also seen that implosive therapy is applied daily (the interval between sessions is short). It will therefore be more effective than if the interval between sessions is short. will be more effective than if the interval between sessions is long (weekly sessions, for example).

Duration of sessions

In implosive therapy, sessions last between 1 and 2 hours. It is known that the effectiveness is maximized when the duration is as long as necessary to facilitate the room (between 30 and 120 minutes). Therefore, in this sense, this technique will be one of the most effective.

However, it is worth commenting that applying overexposure from the moment the fear does not disappear does not improve the results.

Bibliographical references:

• Caballo, V. (1991). Manual de Técnicas de Terapia y Modificación de conducta. S. XXI: Madrid
• Labrador, F.J. et al. (1993). Manual de técnicas de Modificación y Terapia de conducta. Pirámide: Madrid