Flooding in imagination vs flooding in vivo: A comparison with agoraphobics

In this investigation of agoraphobic patients, 3 different flooding procedures were compared: (1) prolonged exposure in vivo, (2) flooding in the imagination by a ‘live’ therapist and (3) a combination of flooding in the imagination and flooding in vivo. After an intermediate-test all clients were treated by the self-observation method, with a minimum of therapeutic intervention. Assessments were made at the beginning of treatment, during and at the end of treatment and at the follow-up one month later. Assessments were carried out by the therapist (in vivo measurement; phobic anxiety and avoidance scales; anxious mood and panic), by an independent observer (idem. minus in vivo measurement) and by the client (phobic anxiety and avoidance scales; FSS; social anxiety scale; SDS and I-E scale). Prolonged exposure in vivo plainly proved to be superior to flooding in the imagination. Combined flooding resulted in a greater improvement than flooding in the imagination, though only on the therapist's ratings. Self-observation did not add much to the effect of prolonged exposure in vivo and of flooding combined whereas self-observation, preceded by flooding in the imagination, resulted in a significant improvement on nearly all the variables.