This is such a great plugin.
I have it set to only require approval on the first discussion, with a sql query that runs periodically to check for metrics (like if others liked their post), and if it does it sets their first_discussion_approval_count to 1.
This way the majority of my real users never require manual approval.
I was having a big spam problem and had moderators getting upset. I think the people posting spam get paid for simply having a spam discussion successfully be visible, so even taking them down and banning quickly didn't do much.
This completely disrupted that whole system. After a few weeks of a post never getting through, I think they gave up. ️