What is Systematic Desensitization?

Systematic desensitization is a form of behavior therapy. Based on the principles of classical

conditioning the systematic desensitization technique is proved to be excellent in dealing with

different phobias and anxiety disorder such as panic disorder. . It was developed by Wolpe

during the 1950s.According to systematic desensitization, a learned response, e.g. fear of spiders,

can be unlearned through classical conditioning and a new response, e.g. relax when seeing a

spider, can be induced. For example, if a person is afraid of spiders and whenever he sees a

spider, he feels anxious. His fear of spiders can be gradually “unlearned” by using the systematic

desensitization technique. For example, his anxiety could be replaced by relaxation.

History and Origins

The first clinical use of systematic desensitization was described by the pioneer behaviorist Mary

Cover Jones (1924), who found that both direct conditioning and social imitation were effective

methods for eliminating children's fears. She concluded that the best way to break down

maladaptive responses was to introduce the feared object while the child was enjoying him or

herself. Jone’s colleague and friend Joseph Wolpe is credited with the operationalization of the

method in 1958. He based his research on the simple idea that if a person could reach some state

of relaxation that is antagonistic to anxiety or fear, and then experience that fear in some way,

the overall impact of that fear would be reduced. Wolpe found that relaxation in the face of

situations that had previously evoked anxiety tended to reduce the fear attached to the stimuli. In

other words, Wolpe was able to substitute a relaxation response to a maladaptive neurotic habit.

Important Studies
Jones' study focused on a three year old boy named Peter who had developed a pathological fear

of a white rabbit. Jones engaged him in eating an enjoyable practice for him and over time

slowly moved the bunny closer to him, although always at a sufficient distance so as not to

interfere with his eating. Eventually, Peter was able to stroke the rabbit. Wolpe based his study

on psychologist Jules Masserman's conditioned reflex experiments, which he produced

experimental neuroses in cats and then cured them using desensitization. What Wolpe did was to

devise other methods for treating the cats, in a manner he called "reciprocal inhibition." Like

Jones, he offered the cats food when presenting the conditioned fear stimulus. He then applied

those theories to clinical patients. He concluded that forcing people to face their fears often

resulted in frustration, whereas combining relaxation with stepwise exposure to different levels

of their fears (called a "hierarchy of anxiety") successfully weaned them from their phobias.

Wolpe reported a whopping 90 percent rate of cure or much improvement in a series of 210

cases. He also reported that his cases did not relapse and did not develop new kinds of neurotic

symptoms.

Key Theories

Systematic desensitization is based on three hypotheses that underlie much of behavioral

therapy:

 It is not necessary to find out why or how a subject learned a phobia.

 The methodology of stepwise exposure to increasing levels of a given fear does not

lead to a replacement of learned behaviors.

 It is not necessary to change the person as a whole; desensitization targets specific

responses to phobias.
The existing response or neurotic behavior, said Wolpe, is the result of learning a maladaptive

response to a stimulus situation, a conditioned fear. Systematic desensitization defines that fear

as a true conditioned emotional reaction, and so a successful treatment involves the patient

"unlearning" the response.

Usefulness of Systematic Desensitization

Desensitization works best on people with specifically definable fear responses. Successful

studies have been conducted on people with fears such as stage fright, test anxiety, storms,

closed places (claustrophobia), flying, and insect, snake, and animal phobias. These phobias can

be truly debilitating; for example, storm phobias could make life intolerable to the patient for

several months out of the year and bird phobias could trap a person indoors. The rate of success

seems to be related to the degree of sickness shown by the patient. As with all psychology, the

least ill patients are the easiest to cure. Those things which do not respond well to the treatment

are nonspecific or widely generalized states of fear or anxiety. For example, agoraphobia ("fear

of the marketplace" in Greek, referring to a generalized anxiety around being in public), has

proven to be comparatively more resistant to desensitization.

Systematic Desensitization Steps

When applying the systematic desensitization technique to treat phobia, a therapist sometimes

follows the following steps:

1. Relaxation

2. Constructing an anxiety hierarchy

3. Pairing relaxation with the situations described in the anxiety hierarchy

Relaxation

The first step of systematic desensitization is learning to relax. If an individual is afraid of

something, e.g. spiders, he needs to learn to relax when he faces the object of his fear. A

common relaxation technique is deep breathing or chest breathing. Here’s how to do it:

1. Inhale through your nose. When you inhale, your stomach should expand.

2. Hold your breath for 3 seconds

3. Exhale through your mouth

The patient is advised to do the deep breathing exercise for at least 5 minutes. When someone is

exposed to a fearful situation, he might not realize that he is not doing chest breathing and this

will result in tightening of muscles, anxiety, dry throat, etc. By practicing deep breathing

regularly, it is easier for an individual to become more relaxed.

Another common relaxation exercise is progressive muscle relaxation. In this exercise, the

patient is asked to tighten his muscles and then loosen them gradually. This exercise can induce

deep muscle relaxation in the patient.

Construction of an Anxiety Hierarchy

In this step of systematic desensitization, the patient is asked to list 10-15 triggers of a specific

phobia or situation and rate each trigger from 0-10 where 0 represents no anxiety at all and 10

represents extreme anxiety. For example, if a patient is afraid of spiders, his list of triggers may

look like this:

1. Thinking about going into the room where there are spiders.

2. Standing near a sofa and moving toward the room.

 3. Reaching the door of the room.

4. Thinking about the spider that is in the room.

5. Unlocking the door of the room.

6. Opening the door to the room.

7. Entering the room.

8. Turning on the light of the room.

9. Walking inside the room.

10. Closing the room door.

11. Seeing a spider on the wall.

The patient will then rate each of the above steps from 0-10 according to the level of his anxiety.

Pairing Relaxation with the Anxiety Hierarchy

In this step of systematic desensitization, the patient is asked to imagine him being exposed to

his object of fear or a fearful situation. For the patient who is afraid of spiders, he is advised to

close his eyes and imagine himself in a room alone with a huge spider. When he feels anxious,

he is asked to practice the relaxation exercise. After each imagine exposure, the patient is asked

to rate his fear of spiders. When the patient’s rating for the fear drops to a specific value, the

therapist moves toward the next step of the anxiety hierarchy. For example, the patient is asked

to look at images of spiders or even a dead spider. The therapy continues until the patient feels

no fear when he is exposed to real spiders. The patient is advised to practice deep breathing and

other relaxation exercises whenever he is exposed to spiders so that his anxiety will gradually be

replaced with relaxation. Systematic desensitization can be self-administered but it is advisable

that the patient consults a therapist.

Application

Wolpe (1964) successfully used the method to treat an 18 year old male with a severe hand

washing compulsion. The disorder involved a fear of contaminating others with urine. After

urinating, the patient felt compelled to spend 45 minutes cleaning his genitalia, two hours

washing his hands, and four hours showering.

 Treatment involved placing the young man in a state of relaxation and then asking him to

imagine low anxiety scenes (such as an unknown man touching a trough of water

containing one drop of urine).

 As the patient’s anxiety gradually dissipated, Wolpe gradually increased the imaginary

concentration of urine. In addition, a real bottle of urine was presented at a distance and

moved closer to the patient in gradual steps.

 Finally Wolpe could apply drops of diluted urine to the back of the patient’s hand without

evoking anxiety. A follow-up 4 years later revealed complete remission of the

compulsive behaviors.

Systematic Desensitization vs. Psychoanalytic Treatment

Results since the 1950s have generally supported the effectiveness of systematic desensitization

in modifying phobic behaviors and have demonstrated its short-term as well as long-term

superiority over traditional psycho-dynamic treatment options. The success rate is often quite

high. Benson (1968) cites a study by Hain, Butcher, and Stevenson of 26 cases of

psychoneuroses. In that study, 78 percent of patients showed systematic improvement after an

average of 19 sessions one exhibited success after a one single hour and a half session. Follow up
studies of a year later reported that 20 percent of the participants saw even more improvement,

while only 13 percent saw relapses. Compared to traditional psychoanalytical treatment,

systematic desensitization sessions do not require a drawn-out process. Wolpe's average of

success was only ten 45-minute sessions, depending on the client's ability to learn relaxation

techniques. Others have found an average of about that found by Hain, Butcher, and Stevenson,

19 or 20 sessions. In contrast, psychoanalysis to identify and treat the underlying causes of a

particular fear or sets of fears, as well as study the entire personality, can take hundreds if not

thousands of sessions. Unlike psychoanalysis, desensitization can successfully be done in small

groups (6–12 people, for example). No elaborate equipment is required, just a quiet room, and

the techniques are easily learned by school counselors and others in counseling roles. In addition,

desensitization is applicable to a wide variety of people, anyone who has good powers of visual

imagery. They don't have to be able to verbalize and conceptualize their performance: Three-

year-old Peter was able to learn to pet the bunny.

Criticism

There is clearly a high success rate although more recent studies suggest the long-term success

rate is likely around 60 percent rather than Wolpe's 90 percent. But some scholars, such as

psychologist Joseph B,

 First, see systematic desensitization as a method that oversimplifies the complexities of

neuroses, fear, and anxiety. It ignores the social surroundings and practices of the patient

which likely both originally caused and presently maintains the neurotic behaviors.

 Desensitization has little effect on symptoms of depression, obsession, and

depersonalization. However, as the treatment progresses, some patients report improved

 social adjustment. As they experience decreased fear, they report that they work better,

enjoy their leisure more, and get along better with others

References
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Junior High Students." The School Counselor 21.3 (1974): 216–22. Print.

Furst, Joseph B. "The Relation of Form to Content in Psychiatric Thought." Science & Society

32.4 (1968): 353–70. Print.

Wolpe, Joseph. Psychotherapy by Reciprocal Inhibition. Stanford, California: Stanford

University Press, 1958. Print.

Wolpe, Joseph, and Arnold Lazarus. Behavior Therapy-Techniques. New York: Pergamon Press,

1969. Print.

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