Systematic desensitization is a technique used to treat phobias and other extreme or erroneous fears based on principles of behavior modification.
Systematic desensitization is used to help the client cope with phobias and other fears, and to induce relaxation. In progressive relaxation, one first tightens and then relaxes various muscle groups in the body. During the alternating clenching and relaxing, the client should be focusing on the contrast between the initial tension and the subsequent feelings of relaxation and softening that develop once the tightened muscles are released. After discovering how muscles feel when they are deeply relaxed, repeated practice enables a person to recreate the relaxed sensation intentionally in a variety of situations.
After learning relaxation skills, the client and therapist create an “anxiety hierarchy.” The hierarchy is a catalogue of anxiety-provoking situations or stimuli arranged in order from least to most distressing. For a person who is frightened by snakes, the anxiety hierarchy might start with seeing a picture of a snake, eventually move to viewing a caged snake from a distance, and culminate in actually handling a snake. With the therapist’s support and assistance, the client proceeds through the anxiety hierarchy, responding to the presentation of each fearful image or act by producing the state of relaxation. The person undergoing treatment stays with each step until a relaxed state is reliably produced when faced with each item. As tolerance develops for each identified item in the series, the client moves on to the next. In facing more menacing situations progressively, and developing a consistent pairing of relaxation with the feared object, relaxation rather than anxiety becomes associated with the source of their anxiety. Thus, a gradual desensitization occurs, with relaxation replacing alarm. Several means of confronting the feared situations can be used. In the pre-computer era, the exposure occurred either through imagination and visualization (imagining a plane flight) or through actual real-life—or so-called in vivo—encounters with the feared situation (going on an actual plane flight). More recently, during the 1990s, virtual reality or computer simulated exposure has come to be utilized in lieu of in vivo exposure. Research findings indicate that mental imagery is the least effective means of exposure; in
Behavior modification —An approach to therapy based on the principles of operant conditioning. Behavior modification seeks to replace undesirable behaviors with preferable behaviors through the use of positive or negative reinforcement.
Classical conditioning —In psychology, a process in which a previously neutral stimulus eventually produces a specific response by being paired repeatedly with another stimulus that produces that response. The best-known example of classical conditioning is Pavlov’s dogs, who were conditioned to salivate when they heard a bell ring (the previously neutral stimulus) because the sound had been paired repeatedly with their feeding time.
vivo and virtual reality exposure appear to be indistinguishable in terms of effectiveness.
Systematic desensitization is a therapeutic intervention which reduces the learned link between anxiety and objects or situations that are typically fear-producing. The aim of systematic desensitization is to reduce or eliminate fears or phobias that sufferers find are distressing or that impair their ability to manage daily life. By substituting a new response to a feared situation—a trained contradictory response of relaxation which is irreconcilable with an anxious response— phobic reactions are diminished or eradicated.
This behavior modification technique, which is founded on the principles of classical conditioning, was developed by Joseph Wolpe in the 1950s. Some of the most common fears treated with desensitization include fear of public speaking, fear of flying, stage fright, elevator phobias, driving phobias and animal phobias. Relaxation responses are trained to occur through progressive relaxation training, a technique initially perfected by Edmund Jacobson during the 1930s.
Because of the potential for extreme panic reactions to occur, which can increase the phobia, this technique should only be conducted by a well-qualified, trained professional. Also, the relaxation response should be thoroughly learned before confronting the anxiety-provoking hierarchy.
Desensitization is an effective form of therapy. Individuals who have a positive response are enabled to resume daily activities that were previously avoided. The majority of persons undergoing this treatment show symptom reduction.
Craighead, W. Edward. Behavior Modification: Principles, Issues, and Applications. New York: Houghton Mifflin, 1976.
Wolpe, Joseph. The Practice of Behavior Therapy. Tarry-town, NY: Pergamon Press, 1990.
North, M. M., S. M. North, and J. R. Coble. “Virtual reality therapy: An effective treatment for psychological disorders.” Student Health Technology and Information 44 (1997), 59–70.
Rothbaum, B., L. Hodges, S. Smith, J. H. Lee and L. Price. “A controlled study of virtual reality exposure therapy for the fear of flying.” Journal of Consulting and Clinical Psychology 68, number 6 (2000), 1020–1026.
Deborah Rosch Eifert, Ph.D.