Systematic desensitization

Concept and background

Systematic desensitization is a procedure developed by Joseph Wolpe (1958) in which the

person with a phobia practices relaxation while imagining scenes of the fear-producing
stimulus.The verb “desensitize” means to make someone less responsive or susceptible to
certain stimuli. A phobia is a fear in which the level of anxiety or escape and avoidance
behavior is severe enough to disrupt the person’s life. Wolpe used his concept of
counterconditioning as the basis for developing a technique to desensitize people’s fears,
which he described as proceeding in the following way:

A physiological state inhibitory of anxiety is induced in the patient by means of muscle

relaxation, and he is then exposed to a weak anxiety-arousing stimulus for a few seconds.

If the exposure is repeated several times, the stimulus progressively loses its ability to evoke
anxiety.

Then successively ‘‘stronger’’ stimuli are introduced and similarly treated.

Wolpe determined that a person could decrease fear responses by learning to relax while
imagining progressively greater anxiety-producing scenes described by the therapist.
Systematic desensitization, is designed to reduce a conditioned emotional response by
presenting conditioned stimuli that are successively more fear arousing while the individual
remains in a physiologically calm state, which is induced by having the person perform
relaxation exercises. Relaxation is a competing response to fear because people almost never
feel afraid and relaxed at the same time. The technique is called systematic because it is
carried out with a gradual, step-by-step procedure: Each conditioned stimulus is presented
briefly and is desensitized before advancing to a stronger one.
In systematic desensitization, exposure can be done in two ways:
In vitro – the client imagines exposure to the phobic stimulus.
In vivo – the client is actually exposed to the phobic stimulus.
The fact that the systematic desensitization technique can be applied in images means that
many of the practical disadvantages involved in in vivo exposition with this type of phobia
can be eliminated. One weakness of in vitro exposition is that it relies on the client’s
ability to be able to imagine the fearful situation. Some people cannot create a vivid image
and thus systematic desensitization is not always effective (there are individual differences).
Steps/Processes

A three step process is carried out in the desensitization process:

(1) Relaxation training

(2) Development of a graduated anxiety hierarchy, and

(3) Systematic desensitization through presentation of hierarchy items while the client is in a
deeply relaxed state.

Relaxation training

The first step is progressive muscle relaxation. The therapist uses a quiet, soft, and
pleasant voice to teach progressive muscular relaxation. The client is asked to create imagery
of relaxing situations, such as sitting by a lake or wandering through a beautiful field. It is
important that the client reach a state of calm and peacefulness. The client is instructed to
practice relaxation both as a part of the desensitizatio n procedure and also outside the session
on a daily basis.

Development of a graduated anxiety hierarchy

The therapist then works with the client to develop an anxiety hierarchy for each of
the identified areas. Stimuli that elicit anxiety in a particular area are analyzed, such as
rejection, jealousy, criticism, disapproval, or any phobia. The therapist constructs a ranked
list of situations that elicit increasing degrees of anxiety or avoidance. The hierarchy is
arranged in order from the most anxiety-provoking situation the client can imagine down to
the situation that evokes the least anxiety. If it has been determined that the client has anxiety
related to fear of rejection, for example, the highest anxiety-producing situation might be
rejection by the spouse, next, rejection by a close friend, and then rejection by a coworker.
The least disturbing situation might be a stranger’s indifference toward the client at a party.
Desensitization does not begin until several sessions after the initial interview has been
completed. Enough time is allowed for clients to learn relaxation in therapy sessions, to
practice it at home, and to construct their anxiety hierarchy.

Desensitization
 The desensitization process begins with the client reaching complete relaxation with
eyes closed. A neutral scene is presented, and the client is asked to imagine it. If the client
remains relaxed, he or she is asked to imagine the least anxiety-arousing scene on the
hierarchy of situations that has been developed. The therapist moves progressively up the
hierarchy until the client signals that he or she is experiencing anxiety, at which time the
scene is terminated. Relaxation is then induced again, and the scene is reintroduced again
until little anxiety is experienced to it. Treatment ends when the client is able to remain in a
relaxed state while imagining the scene that was formerly the most disturbing and anxiety-
producing.

The core of systematic desensitization is repeated exposure in the imagination to anxiety-

evoking situations without experiencing any negative consequences. Homework and follow-
up are essential components of successful desensitization. Clients are encouraged to practice
selected relaxation procedures daily, at which time they visualize scenes completed in the
previous session. Gradually, they can expose themselves to daily-life siIFttuations as a further
way to manage their anxieties. Clients tend to benefit the most when they have a variety of
ways to cope with anxiety-arousing situations that they can continue to use once therapy has
ended.

Recent studies

In 2001, a study was conducted to see the effectiveness of systematic desensitization

for fear reduction, using humorous hierarchy scenes without relaxation and the results
showed that humor in systematic desensitization reduced fear as effectively as more
traditional desensitization (Ventis & Murdock, 2001).

Another study was conducted to study the effectiveness of systematic desensitization and
self-regulating on students' internet addiction. The results showed that systematic
desensitization with behavioral changes, and self-regulation with cognitive changes, reduce
Internet dependence; therefore, these two educational approaches can be used to reduce
students' Internet dependence. (Majareh, Moghtader & Mousavi, 2021)

A study was conducted in Indonesia to examine the effectiveness of systematic

desensitization and thought-stopping counseling groups to reduce students’ social anxiety and
the results found that these were effective (Bulantika, Wibowo & Jafar, 2018)
Applications

Systematic desensitization is highly effective where the problem is a learned anxiety of

specific objects/situations, e.g. phobias. However, systematic desensitization is not effective
in treating serious mental disorders like depression and schizophrenia. Systematic
desensitization is based on the idea that abnormal behavior is learned. The biological
approach would disagree and say we are born with a behavior and therefore it must be treated
medically.
It also only treats the symptoms, not the cause(s) of the phobia. Systematic desensitization
only treats the observable and measurable symptoms of a phobia. This is a significant
weakness because cognitions and emotions are often the motivators of behavior and so the
treatment is only dealing with symptoms not the underlying causes.
Social phobias and agoraphobia do not seem to show as much improvement, most likely in a
case where the cause of phobia is something other than classical conditioning.
Systematic desensitization is a slow process, taking on average 6-8 sessions. Although,
research suggests that the longer the technique takes the more effective it is.