When Is Systematic Desensitization Used
Systematic desensitization is a therapeutic procedure employed to help persons overcome debilitating fears or phobias. Wolpe suggests that systematic desensitization is most appropriate for situations in which the client is a passive responder to the stimulus . In other words, the situation triggers a negative emotional reaction. Nancy may be able to perform a wonderful presentation, so long as no one else is around. When they are, she cant help feeling extremely fearful. There is nothing the therapist can teach her to do in the classroom that would result in her feeling any less fearful. We might say that her problem does not lend itself to being handled .
When is systematic desensitization contraindicated? Systematic desensitization is not sufficient, when the problem is maintained by a skill deficit . Suppose Nancy is unable to perform a good presentation due to lack of knowledge and practice. In this case, teaching Nancy some of the basic skills involved in giving a good presentation may be the treatment of choice, or at least a supplement to systematic desensitization. Systematic desensitization is also typically not used with young children because of the troubles they have in implementing the procedures .
Techniques Used In Systematic Desensitization
The techniques used in systematic desensitization are delineated based on the form of real or imagined exposures implemented to achieve results. Fortunately, there is good evidence to suggest the techniques all work well. Common techniques involved in systematic desensitization include in vivo, imagination, virtual reality, and interoceptive exposure.
Joseph Wolpe And His Work On Systematic Desensitization As A Treatment For Anxiety Disorders And Phobias
Introduction
Throughout the United States, an estimated 9.1% or about 19 million people are affected by a specific phobia . Phobias are an anxiety disorder that can be debilitating to the people they affect. Joseph Wolpe was a psychologist who helped create the method of systematic desensitization that deals with treating the symptoms of phobias however, his treatment plan is not always effective. Without the work of Joseph Wolpe, many advances in the behavioral health field would not have happened.
Who is Joseph Wolpe?
What did he do and why is he important?
What are phobias and why are they a problem?
What is systematic desensitization?
Systematic desensitization is a behavioral technique based on classical conditioning in which exposure to an anxiety-producing stimulus is paired with deep relaxation to extinguish the response of anxiety . It is used to treat a type of anxiety disorder known as a phobia. Anxiety disorders are the occurrence of anxiety without an obvious external cause that affects daily functioning . Phobias are different because they have an obvious external cause. This technique aims to remove the fear response of a phobia and replace it with a relaxation response. The goal is to gradually desensitize yourself to the triggers that are causing the anxiety to form. Linked below is a video from youtube.com that helps explain in-depth of what systematic desensitization is and how it works.
How does it work and what is it used for?
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Exposure Therapy Flooding And Systematic Desensitization
While systematic desensitization is based on counter conditioning using reciprocal inhibition, exposure therapy uses graded exposure to the stimulus while positively reinforcing tolerance of anxiety, until the anxiety is gradually extinguished .
Meanwhile, flooding exposes the client to the feared stimulus directly in one session, so that anxiety floods the nervous system, and then reduces until it becomes extinguished .
The problem with graded exposure is that rising anxiety may be experienced as intolerable, and the client may discontinue therapy. Also, flooding may be experienced as traumatic, lead to further psychological harm, and the termination of therapy .
How To Find A Therapist Who Practices Systematic Desensitization
Because systematic desensitization is a widely used treatment option, finding a therapist who is experienced with the practice should be relatively easy. While there may not be many practitioners who would claim they specialize in systematic desensitization, many are competent in the practice. To search for an expert clinician in a specific area, consider using an online directory.
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Questions When Considering A Potential Therapist
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 therapists 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.
Key Questions To Ask A Therapist When Considering Systematic Desensitization
Gaining as much information as possible from the treatment provider before initiating any therapy can serve as a guide to the coming sessions. This information can also establish expectations that are fair and realistic. Let answers to your questions either build trust and confidence in the therapist or provide a sign that another provider may be a better option.
Here are ten key questions to ask a therapist using systematic desensitization:
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History Of Systematic Desensitization
Psychology in the first half of the 20th century was ruled by psychoanalysts who believed unconscious thoughts and desires fueled a persons feelings and actions and building insight to these issues could create change. When Joseph Wolpe proposed a person could change their feelings by changing their behaviors in the 1950s, it seemed like a foreign concept to the psychological establishment.4
Certainly, the concept of facing your fears is nothing new, but Wolpe was the first mental health professional to discover and document how exposing oneself to the source of their fears in a gradual and progressive way can result in symptom relief. Today, it fits in perfectly with many concepts of CBT and psychology as a whole.
Over the years since Wolpes work in South Africa, many practitioners and researchers have explored ways to make exposure more effective. With advances linked to virtual reality, systematic desensitization is being used in ways Wolpe could have never imagined.
Who Developed Systematic Desensitization
Joseph Wolpe developed this approach based on his theory of reciprocal inhibition, which found that two polarized emotional responses cannot coexist simultaneously.
In other words, nobody can experience anxiety yet be relaxed at the same time. Wolpe developed his approach when working with veterans suffering from PTSD after the second World War.
He used Pavlovâs research on classical conditioning to develop counter conditioning during graded exposure to aversive stimuli that were preventing the veterans from re-entering normal civilian life. With PTSD, specific stimuli, such as sounds, smells, words, and places, had become associated with traumatic experiences.
Wolpe paired a graded exposure to these stimuli with relaxation exercises. Because of the process of reciprocal inhibition, he found the veterans could not feel afraid and relaxed at the same time. He used graded exposure to the stimuli to avoid overwhelming his patients and reinforcing their aversive responses.
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Behavior Therapy And Anxiety
CBT and exposure therapy, a type of behavior therapy, are the two most commonly used interventions in the treatment of anxiety disorders. Exposure therapy has its roots in classical conditioning. In exposure therapy, patients make contact with the feared stimuli and this contact is maintained until the anxiety associated with the contact subsides. This process is termed habituation and it can only occur if the patients are prevented from using their usual escape or avoidance behavior . Several versions of exposure exist. Systematic desensitization is on the gentler part of the spectrum. Systematic desensitization is based on the idea of reciprocal inhibition proposing that two opposite emotions can not co-exist . In systematic desensitization , relaxation training is followed by gradual exposure to the feared stimuli starting with the least feared stimulus. In contrast, flooding involves immediate exposure to the stimulus. Exposure therapy has been described as the most effective way to treat fear. Research indicates that the efficacy of exposure is optimal when it is graduated, repeated, and prolonged with practice tasks clearly specified.
Lets look at this case study with Jessica to see this type of therapy in practice.
Systematic Desensitization Vs Exposure Therapy
Systematic desensitization is not a treatment separate from exposure therapy. Instead, systematic desensitization is a form of exposure therapy. There are many ways to complete a course of exposure therapy, and anytime the focus is on gradual and methodical exposure with the incorporation of relaxation, the therapy is systematic desensitization.
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Establishing The Fear Hierarchy
A fear hierarchy is a list established between the therapist and client to describe and rate triggering stimuli. The list begins with the scariest, most challenging situation at the top to represent the level-ten item. Then, the discussion shifts to the lowest situation that would cause fear to represent the level-one stress.
Once the range is established, the therapist and client will brainstorm steps along the way that cover the entire spectrum of anxiety. Having many steps and exposures is necessary, so at least 15 separate items should be on the fear hierarchy. With too few, there are not enough opportunities for exposure.4
Risks Of Systematic Desensitization
The primary risk of systematic desensitization comes from inexperienced therapists or frightened clients who do not allow the full desensitization to occur. After exposure, if the anxious response is not allowed to reduce to less than 50%, the fear becomes sensitized, not desensitized, which means the person will have stronger reactions in the future.4
In people with PTSD, systematic desensitization risks creating a retraumatizing effect. This increase in symptoms could be short-term or long-term, so the therapist and client must plan and prepare for the chance of this occurring.8
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What Are The Steps Of Systematic Desensitization
The process of systematic desensitization occurs in three steps.Example
Why does systematic desensitization work?
The main goal of Systematic Desensitization is teaching the patient how they can force relaxation and calm down when their body normally reacts from fear or worry. It is a therapeutic intervention that will eliminate anxiety or situations that inflict fear within the patient.
What is desensitization process?
Systematic desensitization is an evidence-based therapy approach that combines relaxation techniques with gradual exposure to help you slowly overcome a phobia.
What Is Systematic Desensitization Therapy
Systematic desensitization therapy is a behavioral therapy intervention used to treat anxiety, phobias, OCD, and PTSD. It is predicated on the idea that the client has learned a conditioned aversive response to a specific stimulus , and that this association can be broken by counter-conditioning .
The stimulus may be a specific situation, such as meeting new people, in the case of social anxiety, or a specific thing like spiders, in the case of arachnophobia. It could also be places, sounds, sights, and events associated with a traumatic experience with PTSD.
Systematic desensitization uses counter conditioning to teach a client a new response to the stimulus using relaxation techniques during graded exposure to the stimulus. In this way, the original fight-or-flight response of the sympathetic nervous system is replaced by the relaxation response of the parasympathetic nervous system .
The technique is called systematic desensitization, as the counter conditioning graded exposure proceeds systematically through three phases.
These three phases are practiced over several sessions and homework may also be given to maintain the counter conditioning between sessions.
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How Does Systematic Desensitization Therapy Work
âSystematic desensitization therapy has three main steps. First, youâll learn ways to relax your muscles. Next, youâll make a list of your fears and rank them based on how intense your fears are. Last, youâll start exposing yourself to your fear in stages so you get more and more comfortable dealing with it. â
Step 1: Deep muscle relaxation techniques. In the first stage of the treatment, people with anxiety and fears are taught breathing exercises and muscle relaxation techniques. Relaxation techniques are generally these types:
- Autogenic relaxation. You repeat words, phrases, or suggestions in your mind that create a feeling of relaxation and calm. The repetition in the mind leads to the muscles of your body getting more and more relaxed.
- âProgressive muscle relaxation. You learn to slowly tense and relax each muscle group. You normally start from your toes and work your way up to your neck and head muscles.
- âVisualization. You imagine a journey to a peaceful and calm situation, place, or setting, like a seashore or a garden. This aids muscle relaxation and feelings of relaxation.
Once your list is done, you discuss your fears with your therapist and work on exposing yourself to them. You start from the fear that is the least frightening and work yourself up to your level-10 fear.
Step 3: Working up through the fear scale through exposure. The process of exposure can be done in two ways:
Treatment Of Anxiety Disorders
OCD can often involve a fear of contamination with germs or pathogens. In such cases, systematic desensitization can be a very useful intervention. Clients with OCD may experience severe anxiety and panic should they have to use a washroom outside the home, for example. They may manage this by indulging in compulsive hand washing until their skin is raw or even avoid using the washroom altogether, leading to additional health problems.
The principles for dealing with a fear of contamination are broadly similar to those used to overcome phobias, as in our arachnophobia example above. Instead of using a spider, use pictures of objects your client perceives as contaminated or dirty.
Clients with OCD fear contamination from different things, so first, identify the objects and situations they fear most and factor that into a systematic desensitization intervention using the relaxation techniques and worksheets provided below.
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Creating A Hierarchy Of Fears
After learning relaxation techniques, youll develop a fear hierarchy for the phobia or feared situation. This hierarchy typically involves 10 levels of fear.
Youll likely go through the following steps to do this:
Behavior Therapy In Action: How Does It Work
Meet Jessica. She is smart, ambitious, creative, and full of energy. She is studying at a university, majoring in business. After she graduates, she wants to live in interesting places and get solid training and experience with a good corporation. Her dream is to start her own company, to be her own boss, and to do things that she can take pride in. For her, financial success and doing something worthwhile must go hand-in-hand.
But Jessica has a secret. She is terrified of speaking in front of people who are not her close friends. She has fought these fears for a long time, but she has never been able to conquer them. She is also aware of the fact that she will need to be able to speak to strangers comfortably and convincingly if she is going to meet her goals in business.
Now that you and your client have agreed upon your goals, it is time to choose a particular technique for the therapy. As a behavioral therapist, you are looking for a method to allow Jessica to learn a new response to the thought of public speaking. Now the idea terrifies her. After therapy is over, she should no longer be terrified and she may even look forward to the opportunity to speak in front of other people.
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Three Steps Of Desensitization
There are three main steps that Wolpe identified to successfully desensitize an individual.