The National Institute of Mental Health tells us that the most common types of mental disorders in the United States are phobias, which affect about 10 percent of the adult population. For people suffering from phobias — which are defined as intense fears that pose no real risk but cause a disturbance in daily activities and well-being — as well as obsessive compulsions, one type of therapy that has been shown to improve coping skills is systematic desensitization.
The goal of this therapy is to help people learn how to remain calm when faced with a situation, object or place that he or she would normally avoid due to fear.
Not only can systematic desensitization reduce anxiety and symptoms associated with serious mental health conditions, but the principles of this approach can also be utilized by those of us dealing with more common fears, such as a fear of public speaking, flying, dogs or heights.
What Is Systematic Desensitization?
According to the American Psychological Association, the definition of systematic desensitization (SD) is “a form of behavior therapy in which counterconditioning is used to reduce anxiety associated with a particular stimulus.”
To make sense of this definition, it helps to understand what “counterconditioning” and “stimulus” actually mean.
Counterconditioning refers to changing someone’s mood through positive pairings and associations. It’s similar to response substitution, which refers to changing desired behaviors through positive reinforcement.
A stimulus is any anxiety-producing situation or object. When someone has a phobia, the stimulus is the thing that that person is scared of.
What’s types of issues is this technique used to help manage? Most often:
- Specific and “simple” phobias, which are fears about specific objects, animals, situations or activities. These include fear of death, snake phobias, fear of open spaces, fear of flying, etc.
- Fear of social functions or public speaking
- Fear of traveling, being in busy places or leaving home
- Compulsions, including those associated with obsessive compulsive disorder, such as repeated hand washing or checking
- Symptoms associated with generalized anxiety disorder
- Certain SD techniques may also be used by healthy individuals to improve their performance while under stress. For example, systematic desensitization is used in sports psychology and in military training (in fact it was developed to help treat soldiers during World War II). By learning muscle relaxation and breathing techniques, athletes and soldiers may be able to improve their self-confidence, concentration, arousal and self-regulation, leading to better outcomes.
How It’s Done
SD is a form of classical conditioning. It’s done in order to remove a fear response associated with a phobia by using the body’s natural relaxation response.
The intention is to replace a feeling of anxiety with feelings of calmness instead.
As the Simply Psychology website explains it:
deep muscle relaxation techniques and breathing exercises (e.g. control over breathing, muscle detensioning or meditation) are very important because of reciprocal inhibition, where once response is inhibited because it is incompatible with another. In the case of phobias, fears involves tension and tension is incompatible with relaxation.
A key component of SD is gradual exposure to a stimulus. Those who experience improvements with this treatment usually need to complete several sessions led by a trained therapist.
Depending on the severity of someone’s phobia, it may require four to 12 sessions in order to meet treatment goals.
Systematic Desensitization vs. Other Therapies
Therapies that utilize desensitization work by exposing someone to an animal, object, place or situation that causes fear. Someone can work toward becoming desensitized to his or her fears with help of a professional or by using self-help techniques.
A similar psychological technique to SD is called covert desensitization, which has the goal of helping someone overcome a fear or anxiety by learning to relax while imagining the anxiety-producing situation. This is different than aversion therapy, a type of behavior therapy designed to make a patient give up an undesirable habit by causing the patient to associate it with an unpleasant effect.
Is systematic desensitization the same as exposure therapy? In many ways, yes.
More accurately, SD is a form of graduated exposure therapy, since you begin by exposing yourself to the least scary aspects of the stimulus and then gradually progress to exposing yourself to the most feared aspects. SD also always uses relaxation techniques in order to create more positive associations with the stimulus, while other types of exposure therapies may not necessarily do this.
What about systematic desensitization vs. flooding? The main difference between these two approaches is the time requirement.
Flooding happens at a faster pace, as it usually involves two- to three-hour treatment sessions in which a patient is faced with his or her phobia/stimulus. With SD, exposure to the stimulus typically happens over the course of several days, weeks or sometimes longer.
While SD and exposure therapy can be used alone, they are often combined with other therapies when treating complex phobias. A patient with a severe or complex phobia is likely to get the best results when combining exposure with psychotherapy, such as cognitive behavioural therapy, and sometimes medication to control anxiety if needed.
How It Works (Steps and Benefits)
What are the steps in systematic desensitization? Here’s a basic overview of how this form of therapy works:
- The patient is trained in deep-muscle relaxation and breathing exercises, in order to be able to counteract physical effects of stress, such as a racing heartbeat and sweating.
- Anxiety-provoking situations related to the patient’s particular problem or phobia are identified. Fears are ranked from weakest to strongest, forming a hierarchy.
- A scary, unwanted situation is presented to the patient. This step is all about exposure and can happen through visualization (only in the patient’s imagination, called in vitro exposure) or in reality (called in vivo exposure).
- The first fears to be presented are typically the weakest, moving to those that are scariest and hardest to deal with. During the process the patient works on remaining calm through muscle relaxation, which helps keep symptoms of anxiety under control.
- While both approaches can be successful, most research shows that in vivo exposure techniques are more powerful.
What is systematic desensitization good for when it comes to improving one’s mental and physical health?
Studies suggest that this treatment approach can reduce anxiety symptoms and fear, as well as symptoms tied to chronic stress — such as trouble sleeping, headaches, changes in appetite and muscle tension/pain.
One study found that compared to a placebo group, a group of adults with phobias who took part in systematic desensitization treatments experienced more significant improvements in behavioral and attitudinal measures, including their levels of perceived fear. The treatment groups improved at both post-treatment interviews and at follow-up one month later.
There’s also evidence that various forms of exposure therapy are beneficial for those dealing with symptoms of PTSD.
How to Try It
In order to try desensitizing yourself to your fears, you first have to know exactly what you’re scared of. Begin by writing down your fears, starting with the least scary thoughts that you have, gradually working your way up to the scariest experience you can think of.
Next you’ll need to master relaxation techniques. You can do this on your own, such as with help from guided meditation apps, videos or books, or with the help of a professional therapist.
Attending meditation and yoga classes is another way to learn breathing and body relaxation exercises.
Here are some key ways to put yourself into a relaxed state:
- Try mindfulness meditation, in which you focus your attention on your breath, the sounds around you or other things that are happening right now in the present moment.
- Breath slowly and deeply. You may want to lay down or sit in a comfortable position. You can try diaphragmatic breathing, in which belly expands when you breath in but the chest does not rise.
- Imagine your muscles relaxing and letting go of tightness and tension. Doing a “body scan meditation” can help with this, as can progressive muscle relaxation, a process that involves tensing and relaxing each muscle group.
- Listen to soothing music that puts you in a relaxed state.
- Diffuse lavender essential oil in the room.
- Other ways to become more relaxed prior to a session include walking outdoors, exercising, doing yoga or journaling.
- You can also use neurofeedback therapy if you choose to work with a therapist. Neurofeedback (neuro means relating to the nerves and brain) involves tracking changes in your own brainwaves, a form of electrical activity of the nervous system, as you work on calming your body. It’s been shown in studies to help treat phobias, post-traumatic stress disorder (PTSD) and other forms of anxiety. While there’s ongoing research about how exactly it works, neurofeedback seems to allow patients to reduce activity in parts of their brains that play a meaningful role in causing their unwanted symptoms.
What is an example of the use of systematic desensitization? Here’s an example of how this treatment may play out if utilized to reduce a patient’s fear of flying:
- During the first treatment session the patient starts by reaching as deep of a state of relaxation as possible. He/she then starts to imagine low anxiety scenes in his/her mind, such as booking a flight online or entering an airport.
- While remaining as calm as possible, the patient gradually starts to imagine more feared situations. He/she may think of boarding an airplane and sitting down in a seat. This continues, with the patient imagining the plane starting to take off and then the actual flight or landing.
- These gradual steps may happen over the course of one session or several sessions (with an average of six to eight). This same approach can also be done in real life (in vivo exposure), if the patient is willing to practice going to the airport and boarding an airplane.
- Another option is to combine imagined scenarios and those in real life. Early sessions might involve looking at frightening photos, then later watching videos and then finally facing the fear in the real world.
- What is systematic desensitization psychology? It’s a form of behavior therapy in which counterconditioning is used to reduce anxiety associated with a particular phobia/fear (called a stimulus).
- Systematic desensitization involves these steps: a patient ranks fearful situations from least to most anxiety-producing; the individual then uses relaxation techniques while imagining or facing the feared stimulus/situation; while being exposed to the feared situation the patient works on relaxing their body so they can face the stimulus without feeling anxious.
- When someone becomes desensitized to previous fears, that person can benefit mentally and physically in many ways. This approach may help reduce general anxiety, fear of socializing, compulsions, and symptoms tied to stress like trouble sleeping or concentrating.