Journal of Traumatic Stress

, Volume 2, Issue 2, pp 137–152 | Cite as

Implosive therapy for the treatment of combat-related PTSD

  • Judith A. Lyons
  • Terence M. Keane


Implosive therapy for the treatment of post-traumatic stress disorder is based on the principle of exposing the patient to trauma-related cues until there is a reduction in the anxiety associated with the cues. It is a relatively specialized procedure regarding which few clinicians receive extensive supervised training, despite the numerous case studies that demonstrate its effectiveness. The present paper addresses a number of procedural issues and offers guidelines for conducting implosive therapy with traumatized combat veterans. Elements of controversy regarding the application of implosive therapy are discussed.

Key words

post-traumatic stress disorder traumatic stress 


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  1. Bernstein, D. A., and Borkovec, T. D. (1973).Progressive Muscle Relaxation Training, Research Press, Champaign, Ill.Google Scholar
  2. Black, J. L., and Keane, T. M. (1982). Implosive therapy in the treatment of combat related fears in a World War II veteran.Behav. Ther. Exp. Psychiat. 13: 163–165.Google Scholar
  3. Boudewyns, P. A., and Levis, D. J. (1975). Autonomic reactivity of high and low ego-strength subjects to repeated anxiety eliciting scenes.J. Abnorm. Psychol. 84: 682–692.PubMedGoogle Scholar
  4. Bowen, G. R., and Lambert, J. A. (1986). Systematic desensitization therapy with post-traumatic stress disorder cases. In Figley, C. R. (ed.),Trauma and Its Wake. Vol. II Brunner/Mazel, New York, pp. 264–279.Google Scholar
  5. Fairbank, J. A., Gross, R. T., and Keane, T. M. (1983). Treatment of post-traumatic stress disorder: Evaluating outcome with a behavioral code.Behav. Mod. 7: 557–568.Google Scholar
  6. Fairbank, J. A., and Keane, T. M. (1982). Flooding for combat-related stress disorders: Assessment of anxiety reduction across traumatic memories.Behav. Ther. 13: 499–510.Google Scholar
  7. Grigsby, J. P. (1987). The use of imagery in the treatment of post-traumatic stress disorder.J. Nerv. Ment. Dis. 175: 55–59.PubMedGoogle Scholar
  8. Keane, T. M., Fairbank, J. A., Caddell, J. M., and Zimering, R. T. (1988). Implosive (flooding) therapy reduces symptoms of PTSD in Vietnam combat veterans. Manuscript submitted for publication.Google Scholar
  9. Keane, T. M., and Kaloupek, D. G. (1982). Imaginal flooding in the treatment of post-traumatic stress disorder.J. Consult. Clin. Psychol. 50: 138–140.PubMedGoogle Scholar
  10. Keane, T. M., Zimering, R. T., and Caddell, J. M. (1985). A behavioral formulation of post-traumatic stress disorder in Vietnam veterans.The Behavior Therapist. 8: 9–12.Google Scholar
  11. Kipper, D. A. (1977). Behavior therapy for fears brought on by war experiences.J. Consult. Clin. Psychol. 45: 216–221.PubMedGoogle Scholar
  12. Kovacs, M., and Beck, A. T. (1978). Maladaptive cognitive structure in depression.Am. J. Psychiat. 135: 525–533.PubMedGoogle Scholar
  13. Lang, P. J. (1977). The psychophysiology of anxiety. In Akiskal, H. (ed.),Psychiatric Diagnosis: Exploration of Biological Criteria Spectrum, New York.Google Scholar
  14. Levis, D. J., and Boyd, T. L. (1985). The CS exposure approach of implosive (flooding) therapy. In Turner, R. M., and Ascher, L. M. (eds.),Evaluating Behavior Therapy Outcome Springer, New York.Google Scholar
  15. Levis, D. J., and Hare, N. A. (1977). A review of the theoretical rationale and empirical support for the extinction approach of implosive (flooding) therapy. In Hersen, M., Eisler, R. M., and Miller, P. M. (eds.),Progress in Behavior Modification. Vol. 4 Academic Press, New York.Google Scholar
  16. Lyons, J. A. (August 1988). Treatment matching for PTSD patients: Systematic desensitization vs. implosive therapy. Paper presented in Penk, W., and Robinowitz, R. (Chairs),Programmatic Treatment of Vietnam Combat-Related PTSD, Symposium presented at the American Psychological Association annual convention, Atlanta, Ga.Google Scholar
  17. Lyons, J. A., Gerardi, R. J., Wolfe, J., and Keane, T. M. (1988). Multidimensional assessment of combat-related PTSD: Phenomenological, psychometric, and psychophysiological considerations.J. Traum. Stress 1: 373–394.Google Scholar
  18. Marshall, W. (1988). Behavioral indices of habituation and sensitization during exposure to phobic stimuli.Behav. Res. Ther. 26: 67–77.PubMedGoogle Scholar
  19. Mowrer, O. H. (1974). On the dual nature of learning: A reinterpretation of “conditioning” and “problem-solving.”Harvard Ed. Rev. 17: 102–148.Google Scholar
  20. Mowrer, O. H. (1960).Learning Theory and Behavior Wiley, New York.Google Scholar
  21. Mueser, K. T., and Butler, R. W. (1987). Auditory hallucinations in combat-related chronic post-traumatic stress disorder.Am. J. Psychiat. 144: 299–302.PubMedGoogle Scholar
  22. Saigh, P. A. (1978). In vitro flooding of childhood post-traumatic stress disorders: A systematic replication.Prof. School Psychol. 2: 135–146.Google Scholar
  23. Saigh, P. A. (1987). In vitro flooding of an adolescent post-traumatic stress disorder.J. Clin. Child Psychol. 16: 147–150.Google Scholar
  24. Saigh, P. A. (1988). In vitro flooding of a childhood post-traumatic stress disorder.Social Psychol. Rev. In press.Google Scholar
  25. Schindler, F. E. (1980). Treatment by systematic desensitization of a recurring nightmare of a real life trauma.J. Behav. Ther. Exp. Psychiat. 11: 53–54.Google Scholar
  26. Shipley, R. H., and Boudewyns, P. A. (1980). Flooding and implosive therapy: Are they harmful?Behav. Ther. 11: 503–508.Google Scholar
  27. Solomon, R. L., Kamin, L. F. and Wynne, L. C. (1953). Traumatic avoidance learning: The outcomes of several extinction procedures with dogs.J. Abnorm. Social Psychol. 48: 219–302.Google Scholar
  28. Solomon, R. L., and Wynne, L. C. (1954). Traumatic avoidance learning: The principles of anxiety conservation and partial irreversibility.Psychol. Rev. 61: 353–385.PubMedGoogle Scholar
  29. Stampfl, T. G., and Levis, D. J. (1967). Essentials of implosive therapy: A learning-theory-based psychodynamic behavioral therapy.J. Abnorm. Psychol. 72: 157–163.PubMedGoogle Scholar
  30. Wald, L. R., and AuBuchon, P. G. (1987). Can flooding treatment be successfully administered with psychotic individuals? Unpublished manuscript, VA Medical Center, Charleston, SC.Google Scholar
  31. Wilmer, H. A. (1986). The healing nightmare: A study of the war dreams of Vietnam combat veterans.Quadrant 19: 47–62.Google Scholar

Copyright information

© Plenum Publishing Corporation 1989

Authors and Affiliations

  • Judith A. Lyons
    • 1
  • Terence M. Keane
    • 1
  1. 1.Boston VA Medical Center and Tufts University School of MedicineBoston

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