What is Systematic Desensitization?
If you experience an intense fear of something, you may have heard of the process of systematic desensitization as a treatment. Millions of people live with phobias of all kinds, from spiders (arachnophobia) and ophidiophobia (snakes) to heights (acrophobia) and confinement in small spaces (claustrophobia), or even the fear of flying (aerophobia).
No matter what you are afraid of and no matter how drastically your phobias affect you, there are treatments available to help you overcome them and help you live without fears that affect your daily life.
What is systematic desensitization?
How does systematic desensitization work?
An example of systematic desensitization in practice would be a therapist treating a client experiencing arachnophobia (fear of spiders). The therapist may begin by exposing the client to one small spider at a far distance.
As the client begins to show less anxiety related to the spider, the therapist may increase the size of the spider being presented or bring the spider closer to the client (or both) until the fear response no longer appears in the presence of a spider.
How many sessions are typically required?
The number of sessions of systematic desensitization that someone needs may depend on the severity of the phobia and can range between four and 12 sessions.
Types of exposure
There are two ways to expose the client to the stimuli:
In vitro, meaning the client imagines being exposed to the stimuli (an imagined spider)
In vivo, meaning the client is exposed to the actual stimuli (a real spider)
One study found that in vivo techniques are generally more successful than in vitro techniques when looking at childhood water phobia and using vicarious exposure as a comparison.
Virtual reality exposure therapy
A specific form of in vitro desensitization is called virtual reality exposure therapy, or VRET, which involves using virtual reality experiences to slowly expose a person to their phobia or cause of anxiety. Using VRET is effective in managing anxiety where in vivo methods are not feasible.
Systematic desensitization and muscle relaxation techniques
In systematic desensitization therapy work, relaxation can be a part of systematic desensitization, but the more significant component of it is repeated exposure to the feared object or situation. One of the premises behind systematic desensitization is that abnormal behavior is learned and is not innate.
Origins of systematic desensitization
In the 1950s, a South African psychiatrist, Joseph Wolpe, developed a type of behavioral therapy called systematic desensitization to help people manage their most anxiety producing phobias. Desensitization is a type of behavior therapy that has its roots in classical conditioning.
One of Wolpe’s clients provides an example of the power of systematic desensitization. In Wolpe’s experimental desensitization practice, he encountered a young adult who had a severe handwashing compulsion. The young man was intensely fearful of contaminating others with his urine.
In treating the young man, Wolpe put him in a state of relaxation and asked him to imagine scenes that would incite a low amount of anxiety, such as imagining someone touching a large container of water with one drop of urine in it.
As his client was able to tolerate this image, Wolpe continued asking him to imagine scenes where the concentration of imaginary urine increased, creating a fear hierarchy or anxiety hierarchy.
In time, the young man was able to tolerate a real bottle of urine in front of him. Ultimately, the client was able to tolerate having a few drops of diluted urine being applied to the back of his hand without feeling any anxiety. Wolpe followed up with the patient four years later to find that he was in complete remission from his compulsive behaviors. Wolpe attributed this to reciprocal inhibition or the ability to voluntarily relax anxiety symptoms in response to stimuli over time.
While this may seem like an extreme case, other studies have shown the effectiveness of systematic desensitization and how this form of therapy helps individuals move past their phobias through gradual exposure.
What is the theory behind systematic desensitization?
Joseph Wolpe based systematic desensitization on the theory of reciprocal inhibition, which involves the automatic antagonist alpha motor neuron inhibition evoked by agonist muscle contraction. This biological process is suspected to play a major role in controlling voluntary movements in the human body.
Is systematic desensitization supported by research?
In clinical psychology, systematic desensitization has proven to be highly effective in treating anxiety disorders caused by a learned situation as well as specific phobias. However, this type of therapy is not usually effective for treating mental health disorders like depression or schizophrenia.
Treating phobia symptoms through exposure therapy
Systematic desensitization is effective at treating the symptoms rather than the cause of the phobia. Within abnormal and social psychology, systematic desensitization only treats the observable and measurable symptoms of a phobia, it doesn’t necessarily account for potential underlying causes.
Thoughts and emotions often motivate behavior, especially with social phobias and agoraphobia. With these phobias, treatment through systematic desensitization has not been as effective.
For example, a fear of public speaking could stem from a phobia or poor social skills. In these situations, the proper treatment may be treating the underlying cause, systematic desensitization, or both.
While cognitive behavioral therapy (CBT) is effective for many with mental disorders including panic disorders. For people experiencing panic disorders, behavior research suggests that systematic desensitization may have a positive impact.
Understanding the phases of systematic desensitization
There are several components of systematic desensitization treatment.
Client learns muscle relaxation techniques to manage fear and anxiety
In the first phase, the therapist usually teaches the client deep muscle relaxation techniques, also known as progressive muscle relaxation (PMR), as well as breathing exercises. Therapists may teach their clients how to meditate, control their breathing, or lower muscle tension in a specific muscle group. When you experience fears or phobias, they can make you tense, and tension can interfere with the abovementioned relaxation techniques.
Client undergoes gradual exposure to triggering stimuli
The second phase of systematic desensitization usually starts with exposing the client to stimuli that create the least amount of anxiety and then building up the stimuli in stages until the most fear-producing images are reached.
The gradual exposure to stimuli, along with practicing PMR, tends to make people feel less afraid as they move to each stage in the hierarchy. If moving to a new stage increases anxiety, the client can return to a relaxed state at an earlier stage.
Client continues until the fear response is extinguished
Successful treatment involves continual exposure to the phobia in order to desensitize the client until they no longer experience anxiety.
What is eye movement desensitization and reprocessing (EMDR)?
Eye movement desensitization and reprocessing (EMDR) is defined as a psychotherapy treatment created to address the distress that stems from trauma. Dr. Francine Shapiro, the psychologist behind EMDR, hypothesized that EMDR therapy helps reach the traumatic memory network in a way that allows for enhanced information processing and newly formed associations between traumatic memories and adaptive memories and information.
How does EMDR work?
Our bodies have natural healing capabilities. If we accidentally cut our hand, blood will clot and begin to build new tissue. In time, new skin will form over the tissue and heal the wound. If dirt or some other foreign body gets into the wound, it can block the healing process.
In much the same way, if a person experiences some type of severe mental or emotional trauma that injures the brain, the body works to try to heal the brain from that trauma. Memories of the trauma and repeated flashbacks of the trauma can block the brain from trying to heal itself. The concept behind EMDR is to remove the block that’s interfering with the brain’s natural healing process.
What happens during an EMDR session?
During an EMDR session, a client typically revisits emotionally difficult memories in brief sequential doses while simultaneously focusing on an external stimulus. A therapist usually uses directed lateral eye movements as the external stimulus.
Is EMDR effective?
Previously, it took many years for individuals who experienced trauma to heal, and some were not able to heal at all. Numerous studies have shown that EMDR therapy is an effective form of systematic desensitization for individuals experiencing mental or emotional trauma, including as a posttraumatic stress disorder, or PTSD, treatment.
Online therapy for phobias and other anxiety disorders
If you’re considering therapy for a phobia or other mental disorders, but are nervous about going to a therapy practice, you might try online therapy, which research has shown to be just as effective as in-person therapy for several mental health conditions. At BetterHelp, a therapist who specializes in systematic desensitization can work to help you overcome experiences such as past traumatic events or phobias. BetterHelp has over 30,000 therapists, many of whom are trained in desensitization therapies.
In addition to the wide range of therapists available at BetterHelp, online therapy allows you to connect with them from the comfort and safety of your home. This may provide you with the confidence to get the help you want while being in a safe space with which you’re familiar.
Takeaway
What is systematic desensitization, for example?
Systematic desensitization is a form of exposure therapy where a person is exposed to increasingly anxiety-inducing stimuli. While the person is exposed to something that causes them anxiety, they also engage in behaviors incompatible with anxiety, such as relaxation techniques. It is a form of exposure therapy, and with new technology like virtual reality, exposure can often take place digitally or in real-life.
For example, consider a therapist working with a client who has a debilitating fear of spiders. The therapist teaches the client progressive muscle relaxation (PMR), a popular and highly effective technique for reducing feelings of stress, worry, and anxiety. Once the client has mastered PMR and can use it effectively, the therapist introduces anxiety-inducing stimuli, in this case related to spiders. The therapist may start with a photograph, move on to toys or models, and have the client interact with real (albeit harmless) spiders.
At each stage of exposure, the client identifies their feelings of fear and anxiety and uses PMR to reduce them. Reducing the feelings of anxiety also reduces the fear response the person feels when encountering a spider. As time goes on, the fear response becomes less pronounced, and the therapist can increase the degree of exposure. Ideally, the client will complete therapy with the tools necessary to prevent fear and anxiety when encountering spiders in their daily life.
What is the systematic desensitization technique?
The systematic desensitization technique is a psychotherapeutic method for treating anxiety disorders, including specific phobias. It was developed in the 1950s by Joseph Wolpe, a South African psychologist. His technique was published in his book Psychotherapy by Reciprocal Inhibition. Systematic desensitization is performed under the guidance of a qualified mental health professional and generally consists of three phases:
- The client is taught relaxation techniques designed to provide immediate relief from fear or anxiety. The client must master the relaxation techniques before moving on to stage two.
- The therapist and client work together to develop a fear/anxiety hierarchy. The hierarchy identifies which situations, events, or objects contribute to the client’s anxiety and ranks them from most anxiety-producing to least anxiety-provoking.
- The client is first exposed to the lowest anxiety-inducing situation. When they notice anxiety or fear appear, they use their newly learned relaxation skills to counter the negative feelings.
Over time, the client’s complex neurotic states caused by the least anxiety-inducing stimulus is reduced, meaning they no longer need to use relaxation techniques to feel calm around the stimulus. The client can then move on to the more anxiety-inducing situations in the hierarchy, gradually exposing themselves to more distressing situations until they are at the top of the hierarchy. At that point, the client likely has the skills and tools necessary to manage their fear or anxiety in daily life.
What is systematic desensitization, in simple words?
Systematic desensitisation is designed to lower feelings of fear and anxiety caused by a specific situation or object. It helps people feel less stressed when exposed to something that scares them. For example, someone who is deathly afraid of spiders might see a therapist for help managing their fear. Their therapist may use systematic desensitization to help them manage their fear.
The therapist will start by teaching their client how to relax when the thing that causes their fear isn’t near them. Once the client has mastered a few relaxation techniques, the therapist will slowly help them engage with their fear. They may start by having the client look at pictures of spiders, for example. The client then uses their relaxation strategies, which reduces their fear and makes it less likely their fear will be as strong in the future.
What is the aim of exposure therapies like systematic desensitization?
The primary goal of systematic is to help people manage fear and anxiety without causing additional harm. It is a relatively slow and gradual process, designed in such a way as to avoid worsening fear or anxiety, which is possible when the client is exposed to fear-inducing stimuli too quickly. If done properly, systematic desensitization achieves the goal of reducing or alleviating a source of fear or anxiety without putting the client through a difficult or traumatic process.
What is the main reason why systematic desensitization is used in stuttering therapy?
One of the challenges faced by those with a stutter is the anxiety associated with speaking to others. Many people who stutter are acutely aware of the negative personal reactions caused by their speech impediment, and the associated anxious feelings can significantly worsen stuttering symptoms. Systematic desensitization is an effective technique for reducing the anxiety associated with stuttering.
The process for treating a stutter using systematic desensitization often involves pseudostuttering. Pseudostuttering, or voluntary stuttering, is a technique wherein those who stutter intentionally produce speech that sounds like actual stuttering, but the person does it consciously and deliberately. Pseudostuttering allows a person to feel the anxiety associated with stuttering in public in a more controlled manner. They can then use relaxation techniques to counter the anxiety related to stuttering without needing to confront their anxiety around others.
How is systematic desensitization different from Counterconditioning?
Systematic desensitization is a technique that gradually reduces anxiety and fear by introducing a person to relaxation strategies they can use when progressively exposing themselves to frightening or anxiety-inducing stimuli. It is a form of counterconditioning, but not the only variety available from contemporary behavior research.
Counterconditioning, or stimulus substitution, refers to replacing unwanted behaviors or feelings with desired ones by associating the triggering stimulus with positive actions. For example, if someone is scared of dogs, their fear might be counterconditioned by associating dogs with more pleasant experiences or objects. The association of the stimulus that causes fear with the more pleasant stimulus will likely reduce the unwanted feeling of fear and anxiety.
What is the opposite of systematic desensitization?
The opposite of systematic desensitization is likely flooding. The underlying principle for both is the same: exposing someone to a fearful sitiuation or anxiety-inducing stimulus in a safe environment is likely to reduce the fear response associated with that stimulus. If someone is exposed to the object of their fear but experiences no harm, they will likely experience less fear the next time they are exposed to it.
The main difference between systematic desensitization and flooding is the time each process takes to complete. Systematic desensitization is designed to be a slow, gradual process that can take days or weeks. A person is first exposed to a stimulus that produces a small amount of fear before progressively increasing to stimuli that produce a large amount of fear. At each step, the person uses relaxation techniques to calm themselves before tackling higher fear or anxiety levels.
On the other hand, Flooding is a shorter process where a person experiences or imagines their most anxiety-inducing fear in a controlled setting. If the person is exposed to their greatest fear and the exposure continues without harm, their anxiety will likely abate. However, more than one controlled study has indicated that their fear may inadvertently be strengthened if the flooding process ends before their anxiety lowers. Because of this, systematic desensitization is thought to have lower risks than flooding and is used more frequently.
Why is desensitization important?
Systematic desensitization is important because it offers a reliable, low-risk method to help people overcome various fears and anxieties. Extensive research suggests that when fear is disproportionate or irrational, it can cause severe disruptions in a person’s daily life. Even if someone can complete daily tasks and make it through their day, they may be burdened more than others while doing so.
Even if a person is not impacted in their daily life, desensitization can help people master new skills or step out of their comfort zone. For example, college students might benefit from desensitization when trying to improve their public speaking abilities.
How does systematic desensitization treat phobias?
Systematic desensitization treats specific phobias by allowing a person to confront them gradually in a safe, controlled manner. A mental health professional guides the process. It begins with the therapist teaching the client evidence-based relaxation techniques that are known to reduce feelings of fear and anxiety.
Once the client has mastered one or more relaxation strategies, they and their therapist organize their phobia into a fear hierarchy. A fear hierarchy is a ranked list of how much fear a certain situation is likely to cause. For example, imagine a person is afraid of spiders; the lowest item on their fear hierarchy might be seeing a picture of a spider, while the highest item might be holding a live spider.
Once the fear hierarchy is established, the client begins exposing themselves to their phobic stimulus. In this case, that may mean starting with a picture of a spider or using more technologically advanced techniques, like virtual reality exposure therapy. As the client learns to manage their fear response, they are exposed to increasingly frightening stimuli.
At each step, the client uses relaxation techniques to reduce their feelings of fear. The relaxation strategies help the client stay calm when exposed to their fear. Over time, their fear response is reduced, and they experience much less fear or anxiety when confronted by their phobia.
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