What type of therapy is systematic desensitization?

Joseph Wolpe, a pioneer of behavioral therapy, developed a technique called systematic desensitization for the treatment of anxiety-related disorders and phobias. This technique is based on the principles of classical conditioning and the premise that what has been learned (conditioned) can be unlearned. Ample research shows that systematic desensitization is effective in reducing anxiety and panic attacks associated with fearful situations.

Systematic desensitization usually starts with imagining yourself in a progression of fearful situations and using relaxation strategies that compete with anxiety. Once you can successfully manage your anxiety while imagining fearful events, you can use the technique in real-life situations.

The goal of systematic desensitization is to become gradually desensitized to the triggers that are causing your distress.

Before you can begin gradually exposing yourself to your feared situations, you must first learn and practice some relaxation techniques. Some techniques commonly used in relaxation training include:

When people are anxious, they tend to take rapid, shallow breaths that come directly from the chest. This type of breathing is called thoracic or chest breathing. When you’re feeling anxious, you may not even be aware that you’re breathing this way. Chest breathing disturbs the oxygen and carbon dioxide levels in the body, resulting in increased heart rate, dizziness, muscle tension, and other physical sensations. This may signal your body to produce a stress response that contributes to anxiety and panic attacks.

If you have panic disorder, agoraphobia or another type of anxiety disorder, you may experience frequent muscle tension. In fact, chronic muscle tension may be so automatic that it seems normal, and you may have forgotten what it feels like when your muscles are completely relaxed. By employing the progressive muscle relaxation technique, you will be able to quickly rediscover the distinctions between relaxation and tension of various muscle groups.

By imagining yourself in a peaceful, stress-free setting, you can reach a state of mental and physical relaxation. For example, imagine yourself sitting near a beautiful, peaceful lake. Focus on the scene for a period. Feel the soft sand on the bottom of your feet. As a gentle breeze sweeps across the water, imagine the warm air on your face as you watch a magnificent sunset on the horizon.

Before beginning systematic desensitization, you need to have mastered relaxation training and developed a hierarchy (from least feared to most feared) list of your feared situations. If you have difficulty getting to a state of relaxation or identifying your anxiety hierarchy, you should consult with a professional who will be able to provide you with guidance.

Systematic desensitization begins with imaginary exposure to feared situations. Use your anxiety hierarchy to break down the feared situation into manageable components.

For example, let’s say you fear to go into large stores. You may have the least anxiety walking into the store and your anxiety likely intensifies as you get further from the exit doors. Standing in the checkout line represents your highest fear response. In this case, you would start the process by focusing on the action that causes the least amount of distress and then work your way up. The result is that you will gradually, or systematically, become desensitized to shopping in large stores.

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• Breaking Free From Anxiety Disorders – Self-Care Handbook. (1998). Deerfield, MA: Channing L. Bete Co.
• Corey, Gerald. (2009). Theory and practice of counseling and psychotherapy. Belmont, CA: Thomson Brooks/Cole.

Systematic desensitization is a type of behavioral treatment that uses exposure therapy to treat anxiety and phobias. It involves gradually exposing a person to something that causes extreme fear and panic, and teaches them to replace fear responses with relaxation responses.

This article explains systematic desensitization, techniques, benefits, and how to find a therapist. 

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Systematic desensitization is a type of therapy that focuses on teaching you how to relax in the midst of your fears. Essentially, you’ll learn the skills and tools you need to navigate situations that would have previously felt unmanageable.

Developing strategies to help you relax your body during moments of distress is the first step of systematic desensitization. Next, you create a fear hierarchy by identifying situations or objects that cause fear.

To do this, you can work with a therapist to determine what situations cause you the most fear and least fear. Extreme fear-inducing situations would be a "10," while situations provoking the least amount of fear are rated as a "1." It's important to identify levels in between as well.

Someone with a fear of flying might rank taking a flight as a "10" with thinking about flying as a "1." Fear situations that might be ranked between 1 and 10 can include purchasing a plane ticket, arriving at the airport, or sitting in a seat on the plane.

Once you’ve completed your fear hierarchy, you’ll work with a therapist to figure out how to start exposing yourself to the fears and managing your distress along the way. Systematic desensitization starts by exposing you to your lower-level fears. So, starting with the “1” and working your way up to the “10.”

While you are exposing yourself to fearful situations, you can use relaxation techniques to manage thoughts, emotions, and sensations that come up. Over time, your body comes to realize that the anticipated danger it expects isn't going to occur and that you don't need to use avoidance to short-circuit the distressing feelings. You can use the strategies as many times as you need to reduce the anxiety.

Relaxation techniques are helpful for calming physical sensations in the body. These strategies are versatile, in that you can use them on their own or combine them.

There are many different types of tactics that can help. Trying a variety of techniques can help you determine what works best for you.

It’s also important to note that what works best in one situation may not be as effective in another. Having multiple strategies in your toolbox gives you the ability to choose what you need at the moment. 

Deep breathing invites you to slow down your breathing and lengthen the exhale to relax the sympathetic nervous system. With this technique, you:

• Breathe in slowly through your nose, letting your belly fill with air.
• Hold the breath for a couple of seconds.
• Slowly release it from your mouth with the exhale being longer than your inhale

This is also known as diaphragmatic breathing. 

Progressive muscle relaxation teaches you to spot tension in your muscles and relax it. By concentrating on one group at a time, you learn to tense and relax your muscles, feeling tension melt away as you release.

Visualization is an exercise that transports you to a place that feels safe and relaxing.

To do this, choose an environment or scene that brings you peace. Paint the picture clearly in your mind, focusing on the details. Using your senses, you can draw yourself in further.

For example, you may visualize the beach with slow and steady waves, white sand, and sun. You might imagine that you can smell the saltwater and hear the movement of the water.

Meditation encourages you to tap into the present moment by becoming aware of different aspects of your experience. The act of recognizing your anxious thoughts and emotions without judging yourself or making evaluations about your thoughts can help you reduce the intensity of your anxiety and distress.

Systematic desensitization is a form of exposure therapy, which aids patients by breaking cycles of avoidance, fear, and anxiety. Through therapy, patients can tackle their fears in a safe environment with a mental health professional who can help them develop relaxation and coping strategies.

Exposure therapy is effective in treating a range of mental health conditions, including:

Systematic desensitization often gives patients a sense of empowerment when it comes to facing their fears. In working with a therapist, there's space to process thoughts, emotions, and beliefs related to the fear situation. This allows you to identify avoidance reactions and unhelpful thoughts.

Through this work, you can establish new associations and manage emotional discomfort when in contact with fear.

One study that examined virtual reality exposure strategies for anxiety treatment showed these interventions were effective in addressing a range of specific phobias. Some of these phobias included flying, fear of animals, heights, getting an injection, or the sight of blood.

Another study showed that a certain type of exposure therapy is effective for the treatment of post-traumatic stress disorder (PTSD). This method can also help individuals address concerns that occur with PTSD, such as depression, anger, guilt, and negative health perceptions.

You can gradually expose yourself to fearful situations. But before starting that process, it’s important to make sure that you feel comfortable using relaxation techniques and have a few in your reserve that reduce your anxiety. 

Once you feel confident in using relaxation strategies, you can start exposing yourself to situations that bring up lower levels of fear. Take your time as you begin exposure. The goal is to learn to manage your fear when faced with frightening situations.

To implement gradual exposure on your own, you might try the following steps:

• Learn and practice several different relaxation techniques.
• Make it manageable. Ten levels of fear hierarchy may be overwhelming. Instead, identify a small number of fear situations to include.
• Expose yourself to the lowest level of your fear hierarchy for brief amounts of time.
• Use your relaxation tools when you feel anxiety or fear. You can use more than one strategy or repeat one that is helping until the anxiety diminishes.
  

It may be helpful to keep a journal or track your mood, fear levels, and relaxation techniques used before, during, and after exposure. This can give you some insight into what is helping and how you are progressing. This information can also be useful to share with a therapist if you decide to seek professional support. 

Because systematic desensitization involves exposure to fears, you may experience distressing emotions, anxiety, or even panic during the process. Working with a therapist to help you identify coping skills, list and rank your fears, and determine a plan for the best way to begin gradual exposure. 

When looking for a therapist, it may be worthwhile to consider: 

• What are the concerns you're seeking help with?
• What qualities are important in a therapist?
• What is the education, background, and training of the therapist? Do they have training and experience using exposure therapy with patients?
• What are your options for getting access to care?
  

Being able to communicate any problems, goals, and hopes for therapy is beneficial information for you and a potential therapist.

Additionally, you may want to consider what traits matter to you in a therapist. Asking questions about the therapist’s education, training, and experience treating your particular concerns can help you decide if they're a good fit. 

Therapy can be expensive, so it can be helpful to evaluate your options. That might mean going through health insurance, an Employee Assistance Program, or seeking a referral from your primary healthcare provider. In some cases, you may need to explore other community-based options.

Systematic desensitization is an effective and evidence-based treatment method to gradually expose yourself to phobias or situations that create extreme fear or anxiety. With the support of a therapist, you can learn relaxation strategies, pinpoint your fears, and begin exposing yourself to distressing situations while using techniques to cope with strong emotions. When seeking help, it's important to locate a therapist with specialized training to guide you through the process. 

Depending on the trigger, intense anxiety, fear, or phobias can make it difficult to function in your daily life. Systematic desensitization can help you gain a sense of confidence in your ability to encounter situations that induce fear. With the support of an experienced therapist, you can learn to manage your thoughts and feelings when facing your fears.

Frequently Asked Questions

• What is prolonged exposure therapy?

  Prolonged exposure therapy is an evidence-based approach used to treat post-traumatic stress disorder. In this type of therapy, therapists employ techniques like psychoeducation, in vivo exposure, imaginal exposure, and emotional processing to reduce symptoms of PTSD. Prolonged exposure can be used to treat different types of trauma, including those stemming from assault or violence, combat, or multiple traumas.

• What is narrative exposure therapy?

  The American Psychological Association describes narrative exposure therapy as a treatment approach that helps patients develop a coherent life narrative in which to contextualize traumatic events. It is known for its use in helping refugees.

• How long does exposure therapy take?

  Though patients may see progress after even a few sessions, the length of exposure therapy may be different for each patient. Typically, patients will begin to see changes after a few sessions, while more severe phobias can take around 12 sessions. The length of treatment may depend on factors such as the problem, severity of the issue, comfortability with relaxation and coping techniques, and how a patient responds to different levels of the fear hierarchy.