Systematic Desensitization

Systematic Desensitization

Systematic desensitization, also referred to as graduate exposure therapy, is a type of behavior therapy based on classical conditioning developed in the 1950s by South African psychiatrist Joseph Wolpe. The treatment combines relaxation techniques and gradual exposure to help individuals overcome their phobia using reciprocal inhibition as a fundamental intervention. 

Reciprocal inhibition posits that two competing emotions cannot be experienced at the same time. Desensitization occurs when the anxiety associated with the phobia is reduced or eliminated after being paired with a competing feeling, i.e., at one time called counter conditioning, but more accurately described as new information now competing with old fearful learning.

Systematic desensitization treatment

Systematic desensitization exposure can be ensured in one of two ways. The first is referred to as:

In vivo: This is where the client is physically exposed to their phobia. For example, if an individual were to be afraid of dogs, they would be placed into a safe room where a dog would sit. 

In vitro -The second treatment involves the patient imagining their phobia due to the inability to be physically exposed. This can include phobias such as being lost at sea or flying.  

Research has discovered that in vivo, where the patient is physically exposed to the phobia stimulus, is more successful than in virto. However, there are many practical and medical reasons why in vitro may be used over in vivo, with safety being a number one priority. 

The three steps of systematic desensitization therapy

Systemic desensitization involves three main stages. 

Firstly you will learn how to relax your muscles through guided techniques by your therapist. You will learn how to control your breathing, how to meditate, or muscle de-tensioning. 

Secondly, you will create a list of all your fears. With your therapist, you will rank them in terms of intensity. When writing this list, you must be open and honest as it provides a structure for the therapy session.

And third, you will be exposed to your phobia, either in vivo or in vitro. The individual will begin with the phobia that they least fear. In hierarchical order, the individual will be exposed to each fear written down; however, this will only commence why the individual is no longer afraid of the current phobia. 

The individual at hand will be repeatedly exposed either through imagination or physically confronted by the fear until the situation fails to provoke any form of anxiety. This is a solid indication for the therapist that the therapy treatment for that phobia has been successful. 

How long does treatment take?

The number of sessions an individual will need to treat their fears successfully depends on how severe their phobias are. Individuals will work with their therapist to ensure they are aligned on specific goals before starting any form of treatment. 

Therapy treatment can take anywhere between four to six weeks to twelve weeks plus. Setting yourself timeframes for the therapy to work will only create unnecessary stress and result in the complete opposite of what you are trying to achieve. 

The best way for you to allow treatment to work and complete in the quickest timeframe is to be open and honest with your therapist about your phobias, sit back and allow treatment to work at its natural pace for you. 

Mastering relaxation skills

You may be shown various relaxation exercises during systematic desensitization therapy; these can be used alone or with first relaxation skills. Techniques you may be taught can include:

Visualization: Individuals will be taught to focus solely on a relaxing scene of their choice, for example, the beach or a woodland area. Individuals will be asked to concentrate on the sounds they may hear in this location, how things may feel physically, or even smells around as they picture themselves in their relaxing, safe scene. 

Visualization will usually include guided imagery from the therapist, which can consist of someone describing a scene to you as you sit back and bring it to life in your mind. 

Meditation techniques: Individuals who master meditation may naturally become more aware of their feels and thoughts when facing an uncomfortable situation. 

Diaphragmatic breathing: Individuals will learn how to regulate their breathing by breathing deeply, and slowing in through the nose, holding it for 2-4 seconds, and breathing back out again through the mouth. 

Progressive muscle relaxation: You will be taught how to release your muscle when they become tense. Individuals will often be in a situation sitting with their entire body muscles tensed without even realizing it. Mastering how to tense and relax your muscles will quickly identify when your body is starting to feel uncomfortable and tense up. 

What can systematic desensitization help with

Whether systematic desensitization is used alone or in conjunction with other forms of treatment, it can effectively treat the following mental health conditions:

  • Panic disorder
  • Social anxiety disorder
  • Social phobias
  • Generalized anxiety disorder
  • Obsessive-compulsive disorder
  • Post-traumatic stress disorder
  • Specific phobias such as 
    • Spiders
    • Dogs
    • Flying
    • Small spaces
    • Flying
    • Bridges
    • Driving 

Systematic desensitization therapy does not stop there; additionally, it can further assist with uncomfortable aspects of life that an individual may be going through but does not meet the current threshold for a diagnosis. For example, a student who worries about presenting in class or public speaking can utilize their core principles of systematic desensitization to improve their skill sets and master challenging obstacles by themselves. 

Final thoughts 

Systematic desensitization therapy is an evidence-based therapy. When medical treatment is classed as evidence-based, the therapy has gone through extensive documented scientific testing and research, which has proven successful in the treatment outcome. 

Studies have further shown that systematic desensitization treatment is effective for phobias, anxiety, and post-traumatic stress disorders (PTSD). 


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