Systematic desensitization is a form of exposure therapy used to treat phobias and anxiety disorders. Developed by psychiatrist Joseph Wolpe in the 1950s, it is based on the principle of reciprocal inhibition, which is the idea that anxiety and relaxation cannot coexist simultaneously. By repeatedly exposing a patient to an anxiety evoking stimulus while they experience a physiological state antagonistic to anxiety (such as relaxation), their fear-response to the stimulus should progressively decrease. The goal of the therapy is for the individual to learn how to cope with and overcome their fear in each level of an exposure hierarchy. The process of systematic desensitization occurs in three steps. The first step is to identify the hierarchy of fears. The second step is to learn relaxation or coping techniques. Finally, the individual uses these techniques to manage their fear during a situation from the hierarchy. The third step is repeated for each level of the hierarchy, starting from the least fear-inducing situation.
History Emerging during the mid-20th century, Wolpe's work aligned with the rise of behaviorism in psychology and represented a shift from psychoanalysis. Rather than seeking to uncover the unconscious and root causes of anxiety disorders, systematic desensitization proposed that treatment should be more measurable, tangible and based on evidence. In 1947, Wolpe discovered that the cats of Wits University could overcome their fears through gradual and systematic exposure. Wolpe studied Ivan Pavlov's work on artificial neuroses and the research done on elimination of children's fears by Watson and Jones. In 1958, Wolpe did a series of experiments on the artificial induction of neurotic disturbance in cats. He found that gradually deconditioning the neurotic animals was the best way to treat them of their neurotic disturbances. Wolpe deconditioned the neurotic cats through different feeding environments. Wolpe knew that this treatment of feeding would not generalize to humans and he instead substituted relaxation as a treatment to relieve the anxiety symptoms. Wolpe found that if he presented a client with the actual anxiety inducing stimulus, the relaxation techniques did not work. It was difficult to bring all of the objects into his office because not all anxiety inducing stimuli are physical objects, but instead are concepts. Wolpe instead began to have his clients imagine the anxiety inducing stimulus or look at pictures of the anxiety inducing stimulus, much like the process that is done today.
Applications and uses
Three steps of desensitization There are three main steps that Wolpe identified to successfully desensitize an individual.
Establish anxiety stimulus hierarchy. The individual should first identify the items that are causing the anxiety problems. Each item that causes anxiety is given a subjective ranking on the severity of induced anxiety. If the individual is experiencing great anxiety to many different triggers, each item is dealt with separately. For each trigger or stimulus, a list is created to rank the events from least anxiety-provoking to most anxiety-provoking. Learn the relaxation response. Relaxation training, such as meditation, is one type of best coping strategies. Wolpe taught his patients relaxation responses because it is not possible to be both relaxed and anxious at the same time. In this method, patients practice tensing and relaxing different parts of the body until the patient reaches a state of serenity. This is necessary because it provides the patient with a means of controlling their fear, rather than letting it increase to intolerable levels. Only a few sessions are needed for a patient to learn appropriate coping mechanisms. Additional coping strategies include anti-anxiety medicine and breathing exercises. Another example of relaxation is cognitive reappraisal of imagined outcomes. The therapist might encourage patients to examine what they imagine happening when exposed to the anxiety-inducing stimulus and then allowing for the client to replace the imagined catastrophic situation with any of the imagined positive outcomes. Connect stimulus to the incompatible response or coping method by counter conditioning. In this step the client completely relaxes and is then presented with the lowest item that was placed on their hierarchy of severity of anxiety phobias. When the patient has reached a state of serenity again after being presented with the first stimuli, the second stimuli that should present a higher level of anxiety is presented. This will help the patient overcome their phobia. This activity is repeated until all the items of the hierarchy of severity anxiety is completed without inducing any anxiety in the client at all. If at any time during the exercise the coping mechanisms fail or became a failure, or the patient fails to complete the coping mechanism due to the severe anxiety, the exercise is then stopped. When the individual is calm, the last stimuli that is presented without inducing anxiety is presented again and the exercise is then continued depending on the patient outcomes.
Example A client may approach a therapist due to their great phobia of snakes. This is how the therapist would help the client using the three steps of systematic desensitization:
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