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Implosive therapy (or implosion therapy; Stampfl & Levis, 1968) is a form of exposure therapy similar to the imaginal form of flooding, with which it can be confused.

Although there are similarities, the terms implosive therapy and flooding cannot be used interchangeably. Both implosive therapy and flooding expose the client to anxiety arousing stimuli for prolonged durations. Flooding deals with the actual stimulus or its image, while in implosion therapy anxiety is aroused by only imagining the simuli (without direct contact). Further, implosive therapy involves imagined scenes that are often exaggerated by a therapist and often relate to the client's most feared fantasy. Finally, the anxiety that is provoked during implosive therapy is often addressed using psychodynamic approaches, in the sense that ultimately the client is afraid of death, humiliation, estrangement, or injury. Although there was great concern expressed about this technique when it was introduced, subsequent research on imaginal exposure, which operates on the same principle of extinction has shown that the technique can be employed safely for Posttraumatic Stress Disorder. 

In flooding you might be asked to picture spider, perhaps at various distances so the you become desensitized to the image. On the other hand, in implosive therapy, you might be asked to imagine the spider entering your mouth as you sleep if that was an anticipated underlying aspect of your fear. The theory states that people who are said to be afraid of flying are actually afraid of crashing. On advantage of the technique is the use of imagination for purposes of exposure to stimuli that would be impossible or unethical to expose the client to in reality, such as past traumatic accidents, sexual or physical abuse, or possible future catastrophic events.

One of the only studies of the hypothesized fears aspect (Prochaska, 1971) showed a trend toward superiority of the implosive technique, but lacked the statistical power to find a significant difference. Later, Donald J. Levis, one of the originators of the theory, further modified the technique so that it was essentailly client guided rather than directed by the therapist. Associations to past traumatic events were thought to be central, and this was often traced to historical trauma, for which imaginal exposure has been shown to be a superior technique (Foa et al., 2013).  Arguably, the most recent research on prolonged exposure has validated the later model of Implosive Therapy, although there are some elements that remain to be empirically validated. At this point in time, research on the method has stalled, except for a couple of case studies demonstrating the potential usefulness of the newer form of the therapy for psychosis (Saper, Blank & Chapman, 1995) and Panic Disorder and combined with Posttraumatic Stress Disorder with maladaptive personality features (Saper & Brasfield, 1998). Evidence for the effectiveness of prolonged exposure for trauma continues to mount, sugesting that an arguably stripped down version of the therapy has shown itself to be effective. Further research on this technique might yet yield evidence of its efficacy, especially in view of the case studies suggesting possible usefulness for more complex clinical presentations.

Foa E.B., McLean C.P., Capaldi S., Rosenfield D. (2013). Prolonged Exposure vs Supportive Counseling for Sexual Abuse–Related PTSD in Adolescent Girls: A Randomized Clinical Trial. Journal of the American Medical Association, 310(24), 2650–2657. doi:10.1001/jama.2013.282829

Prochaska, J. O. (1971). Symptom and dynamic cues in the implosive treatment of test anxiety. Journal of Abnormal Psychology, 77(2), 133–142.

Saper Z., Blank M.K., Chapman L. (1995). Implosive therapy as an adjunctive treatment in a psychotic disorder: a case report. J Behav Ther Exp Psychiatry. 1995;26(2):157‐160. doi:10.1016/0005-7916(95)00008-n

Saper, Z. & Brasfield, C. (1998). Two-phase treatment of Panic Disorder and Posttraumatic Stress Disorder with associated personality features resulting from childhood abuse: Case study. Journal of Behavior Therapy and Experimental Psychiatry. 29. 171-8. 10.1016/S0005-7916(98)00008-1.

Stampfl, T. & Levis, D. J. (1968). Implosive Therapy-A behavioural therapy? Behaviour Research and Therapy, 6(1). 31-36. 

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