Interaction of OCD Severity with choice of graduated exposure vs. flooding

Hi. I'm a 4th year clinical psychology grad student working at a university clinic that specializes in the treatment of anxiety disorders and I have a specific question for any professionals out there who can help. I was wondering if there is any empirical or anecdotal evidence bearing on the issue of whether or not the level of severity of an anxiety disorder (say, OCD) would indicate that exposure would be more effective if it is conducted hierarchically (building up to the most feared items/situations) versus immediately "flooding" with the most feared items. It is my understanding that the evidence to date (at least in the case of OCD) indicates that (as long as the client stays in treatment and participates) both approaches will work but that the graduated approach will, of course, take longer. I realize that this is a difficult question to answer for "all clients" since the choice of treatment strategy is best determined on a case by case basis with reference to the case formulation while attending to the effects a choice of treatment may have on the therapeutic relationship. Nonetheless, I thought that I'd post my question so that I could get some feedback regarding the experiences of clinicians who have some expertise and experience with the application of behavior therapy (specifically, ERP) to the anxiety disorders (specifically, OCD). Thanks in advance for any help that you are able to provide.

• OCD Exposure by Barbara Fleming, Ph.D., 2/1/98