Flooding

Domain II · Behavioural & cognitive · Isaac Marks · 1971 · Maudsley

What it is

Flooding confronts the client with a strong dose of feared cues at or near the top of the hierarchy, rather than working up step by step, and keeps them there with no escape. The original learning-theory account was Mowrer's two-factor model: fear is conditioned to cues and kept alive by avoidance.…

Format

• Phase A – Assessment and suitability (1–2 sessions, 50–60 min).
• Phase B – Preparation and consent (1 session).

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• This is a distinct, manualised treatment. Use its own manual.
• Re-emerging avoidance between sessions as the client winds down.
• 'I only coped because you were there.' Plan solo practice to address this.
• A client who agrees out of shame or to please you. Look for real choice, not compliance.
• New safety behaviours replacing old ones. Fear that only stays low while the safety behaviour is present.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.