Systematic desensitization is a behavior therapy technique designed to treat anxiety-related disorders through sensory adaptation. The technique helps an individual replace an anxiety response to specific stimuli with a relaxation response.
The technique emerges from both classical and operant conditioning schools of behavioral psychology, which holds that exposure to stimuli can alter our beliefs and actions.
Examples of systematic desensitization include overcoming fear of flying by spending time inside planes and watching calk plane flights in movies and overcoming arachnophobia by holding spiders regularly.
Systematic Desensitization Definition
The technique was invented by Joseph Wolpe (1958) in his studies on cats that had been conditioned to exhibit “neurotic disturbances.”
According to Rachman (1967), Wolpe:
“…began by feeding the neurotic cats in an environmental situation which was distinctly dissimilar from the original traumatic environment” (p. 93).
However, by gradually exposing the cats
“…to situations which approximated more and more to the original traumatic situation…he was able to overcome the animal’s neurotic reactions and restore them to apparent normality” (p. 93).
Systematic desensitization is sometimes referred to as “counterconditioning” because it teaches the individual to develop a new response to a previously conditioned stimulus.
The strategy is based on the principles of classical conditioning, which considers disorders such as phobias and post-traumatic disorder (PTSD) the result of traumatic conditioning.
Systematic Desensitization Examples
- Peter and the White Rabbit: In one of the most famous psychology experiments, Mary Cover Jones helped a child named Peter overcome his sensitized fear of white rabbits by exposing him to the animal while he ate meals, slowly bringing it closer in each session. She also exposed him to other children who were not so afraid of rabbits.
- Overcoming arachnophobia: Dr. Wilkes has taught her patient to breathe deeply when looking at a high-resolution color photo of an eerie-looking spider. At first, the photo is placed across the room. When the patient isn’t bothered by that, the photo is moved a little closer.
- Overcoming fear of flying: Emily has been working with her therapist for almost one year. Today, she will take a short commuter flight from Dalllas to an airport just 45-minutes away. Then she will stay the night. If all goes well, she won’t have to rent a car to return home the next morning.
- Overcoming social anxiety: A therapist might help a client gradually expose themselves to social situations that cause anxiety, such as attending a small gathering, then a larger event, and eventually speaking in public.
- Overcoming fear of heights: A therapist might start by having the client stand on a low platform and gradually work up to standing on a high platform or even walking across a narrow bridge.
- Overcoming obsessive-compulsive disorder (OCD): A therapist might work with a client to gradually reduce compulsive behaviors, such as washing hands or checking locks, by gradually increasing the time between each behavior.
- Overcoming fear of dogs: A therapist might start by showing the client pictures of dogs, then videos of dogs, and eventually introduce the client to a small, friendly dog and gradually work up to larger or more intimidating dogs
- Using VR to gain exposure to a fear: Clinical psychologist Dr. Martinez has VR equipment in his office. For a client that has a phobia, he uses the set-up to immerse them in a beach scene. They can listen to the soothing sounds of waves and watch the sunset. When the client is able to create that level of relaxation on their own (or close to it), he introduces them to the first step in their fear hierarchy.
- Using meditation to work through phobias: Lisa is practicing mediation at home so that when she goes to her next therapy session, she will be better able to relax herself independently. In her next session, her therapist will introduce her to the next level up in her fear ladder: holding a small spider in her hand.
- Slow transitions to ‘big school’: Mr. Hinato knows his children are very apprehensive about going to a new school. So, every day for a week he drives them by the school. He talks about how fun it will be and how nice the teachers are. In the weeks that follow, they take a walk around the campus, play on the playground, walk through the hallways, eat lunch in the cafeteria, and then attend just one hour of class while he sits in the back.
- Desensitization to public speaking: Dr. Simms is helping a client get over his fear of public speaking by gradually exposing him to increasingly anxiety-provoking situations. They began by watching videos of speeches; then progress to attending speeches; introducing themselves to different groups; and practicing a short speech with a podium in the office. Next week, the client will deliver a 10-minute speech to his family in their living room.
- Repeatedly tackling a fearful task: This is the 5th time that a client has attempted to get past this step in their fear hierarchy. The first four attempts went better each time. The client experienced a similar difficulty getting past the first 2 steps, so they are confident that eventually they will be able to overcome this obstacle as well.
How is Systematic Desensitization Applied to Phobias?
Systematic desensitization begins with the creation of a fear hierarchy. A therapist will ask the client to create a list of situations that make them anxious.
The client then orders them from least to most anxiety-provoking.
The therapist also teaches the client how to relax using one of the numerous techniques available: progressive relaxation, guided imagery, or biofeedback.
When the client can handle exposure to the least anxiety-provoking situation by practicing one of the relaxation techniques, then they can move up the fear hiearchy to the next level.
However, each step has to be mastered before moving forward. This empowers the client and builds their confidence.
Eventually, that last step in the hierarchy is reached, and conquered. Congratulations!
Approaches to Systematic Desensitization
1. The Graded Exposure Worksheet
The first step to overcoming a fear is to understand the exact stimuli and situations that activate that fear. This is why a therapist will ask their client to construct a fear hierarchy, sometimes called a fear ladder.
One version of a fear ladder can be seen in this Graded Exposure Worksheet.
There are 4 steps to completing the worksheet.
First, make a list of the different situations that create anxiety.
Next, rate each one on a scale from 0 to 100% (0 = not at all distressed and 100 = extremely distressed).
Then, place the items that evoke the strongest fear response at the top of the stairs on the worksheet.
Finally, now the staircase displays that person’s fear hierarchy. The therapist can then start training the client in one of the relaxation techniques while being exposed to the situation at the bottom of the hierarchy.
2. Biofeedback-Controlled Systematic Desensitization
Phobias contain both psychological and physiological components. Fear is a psychological state that also involves increased heart rate, deep and shallow breathing, and heightened cerebral activity in the emotional areas of the brain.
To help patients better control their physiological reactions, some therapists use biofeedback.
Electrodes are attached around the fingertips of the patient, which are then connected to a small machine that registers the patient’s physiological responses and displays them on a computer screen.
The patient can monitor what their body is doing in real-time, microsecond-by-microsecond.
As the therapists provides instructions on how to relax, the patient can observe their progress on the screen. This increases their awareness of their physiological state and helps them learn how to control those states.
The therapist will then begin systematic desensitization, starting at the bottom of the patient’s fear hierarchy. The patient will use the biofeedback equipment to help them control their anxiety at each step.
This biofeedback computer game helps improve concentration.
3. Using VR to Treat Phobias
At the upper levels of most people’s fear hierarchies are real-life situations like flying in a plane or walking across a very high bridge. Those situations can’t be simulated in a therapist’s office. That is, until the invention of VR.
Today there are a wide range of VR simulations that are specifically designed for treating phobias.
So, instead of the therapist and the client traveling to a nearby airport, buying two tickets, taking a short flight and then turning around, much of that can be accomplished with VR.
Take a look at this video to see how realistic the experience can be. It is truly immersive.
Don’t miss the part in the video that shows how the VR simulation can create an audience to treat the fear of public speaking. Believe it or not, the therapist can make the audience look uninterested, even upset (just like in real life).
4. Guided Imagery
The therapist can teach the client to relax in response to each stimulus in the fear hierarchy using a variety of techniques. One of those is guided imagery. Guided imagery involves imagining a place that is pleasant and peaceful.
When imagining being in this place, the patient will try to visualize the scene. This helps create a stronger mind-body connection and allows the patient to exert control over their physiological state.
The therapist might facilitate this process by describing the place in a calm tone of voice, play soft music in the background, or even use an essential oil diffuser to create an overall relaxing ambience.
There are a lot of resources available, such as already prepared scripts like The Beach, podcasts by the University of Michigan, and narrated nature videos (starts at 1:25).
By placing the client in a relaxed and calm state of mind, the presentation of one of the stimuli in the fear hierarchy will be easier to encounter.
5. Progressive Muscle Relaxation (PMR)
PMR is a relaxation technique frequently used in systematic desensitization. It basically involves tensing a muscle group for a few seconds, then relaxing that muscle group.
The therapist will train the client in how to do the procedure before introducing the first item on the fear hierarchy. When clients see themselves being able to control their heart rate and breathing, it can create a tremendous sense of self-control.
That is a sense of control they did not have previously. This builds their confidence and strengthens their resolve to overcome their phobia.
When the client can do PMR sufficiently well enough, the first stimulus on the fear hierarchy will be presented.
Most likely the client will feel tense at that moment. So, they engage the PMR process until their physiological state has returned to baseline.
Once that level has been mastered, the next stimulus in the hierarchy can be introduced.
Northwestern Medicine provides a very good demonstration of PMR. Although a lot of times clients will keep their eyes closed, the Northwestern video has some beautiful scenes.
Desensitization vs Habituation
Desensitization and habituation are overlapping concepts in psychology. Desensitization refers to the process of actively reducing an emotional response to a stimulus through techniques like controlled exposure and mediation. Habituation refers to the natural process of becoming less responsive to a repeated stimulus over time because the human brain becomes used to it. While desensitization is an active intervention to an emotional or irrational response, habituation is a passive change that occurs as the mind learns to phase out a stimulus it no longer deems relevant or urgent.
Systematic desensitization is a therapeutic technique to help individuals overcome phobias and other anxiety issues. It can help people overcome their fear of heights, flying, public speaking, and social anxieties, just to name a few applications.
The process involves the patient creating a fear hierarchy of stimuli that cause distress. The stimuli are arranged in order from least anxiety-provoking to most.
Next, the patient is trained in how to apply one of the relaxation techniques in response to each stimulus in the hierarchy.
Eventually the patient will progress through the entire hierarchy and overcome their phobia. This may take quite some time, but for many, it is well worth the time and effort.
Di Corrado, D., Guarnera, M., Guerrera, C. S., Maldonato, N. M., Di Nuovo, S., Castellano, S., & Coco, M. (2020). Mental imagery skills in competitive young athletes and non-athletes. Frontiers in Psychology, 11, 633. doi: https://doi.org/10.3389/fpsyg.2020.00633
Nguyen, J., & Brymer, E. (2018). Nature-based guided imagery as an intervention for state anxiety. Frontiers in Psychology, 9 doi: https://doi.org/10.3389/fpsyg.2018.01858
Rachman, S. (1967). Systematic desensitization. Psychological Bulletin, 67(2), 93–103. Doi: https://doi.org/10.1037/h0024212
Rothbaum, B. O., Hodges, L., Smith, S., Lee, J. H., & Price, L. (2000). A controlled study of virtual reality exposure therapy for the fear of flying. Journal of consulting and Clinical Psychology, 68(6), 1020. doi: https://psycnet.apa.org/doi/10.1037/0022-006X.68.6.1020
Skinner, B. F. (1963). Operant behavior. American Psychologist, 18(8), 503–515. doi: https://psycnet.apa.org/doi/10.1037/h0045185
Tyson, P. D. (1996). Biodesensitization: biofeedback-controlled systematic desensitization of the stress response to infant crying. Biofeedback and Self-regulation, 21, 273-290. doi: https://doi.org/10.1007/BF02214738
Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Stanford, CA: Stanford University Press.
Wolpe, J. (1964). Behavior therapy in complex neurotic states. The British Journal of Psychiatry, 110(464), 28-34. doi: https://psycnet.apa.org/doi/10.1037/10546-007