Systematic Desensitization: Definition And Process
Updated August 27, 2020
Medically Reviewed By: Debra Halseth, LCSW
Phobias run the gamut from being afraid of spiders or bees to fear of heights (acrophobia) and fear of being confined in small spaces (claustrophobia). This list of phobias is a long one, and phobias have existed for centuries. No matter what you are afraid of and no matter how drastically your phobias affect you, there are treatments available to help you overcome them and help you to lead a healthy, normal life.
A South African psychiatrist by the name of Joseph Wolpe developed a type of therapy called systematic desensitization dating back to the 1950s to help people manage their phobias. Desensitization is a type of behavior therapy that has its roots in classical conditioning. Systematic desensitization is a therapy that works by removing the fear of a response to a phobia and replaces it with a relaxation response. Therapists use counter conditioning and gradual exposure to a stimulus to help their clients feel less fearful.
One of Wolpe’s clients provides an example of the power of systematic desensitization. In Wolpe’s practice, he encountered a young adult that had a severe handwashing compulsion. The young man was intensely fearful of contaminating others with his urine. After he urinated, he spent up to 45 minutes cleaning his genitalia, around two hours washing his hands, and about four hours in the shower. In treating the young man, Wolpe put him in a state of relaxation and asked him to imagine scenes that would incite a low amount of anxiety, such as imagining someone touching a large container of water with one drop of urine in it. As his client was able to tolerate this image, Wolpe continued asking him to imagine scenes where the concentration of imaginary urine increased.
In time, the young man was able to tolerate a real bottle of urine in front of him. Ultimately, the client was able to tolerate having a few drops of diluted urine being applied to the back of his hand without feeling any anxiety. Wolpe followed up with the patient four years later to find that he was in complete remission from his compulsive behaviors.
In learning about the successful outcome of this case, it should give you hope that treatment can be highly effective no matter what kind of phobia you may be struggling with.
What Is the Theory Behind Systematic Desensitization?
Systematic desensitization has proven to be highly effective in treating disorders where anxiety presents due to a learned situation and in treating specific phobias. Still, it’s not effective for treating serious mental health disorders like depression or schizophrenia. Relaxation can be a part of systematic desensitization, but the more significant component of it is simply repeated exposure to the feared object or situation.
The premise behind systematic desensitization is that abnormal behavior is learned. The biological approach to treating phobias supposes that people are born with certain behaviors and that they should be treated medically.
Desensitization involves treating the symptoms of the problem rather than the cause of the phobia. Since systematic desensitization only treats the observable and measurable symptoms of a phobia, it doesn’t account for the underlying causes of the problem. Thoughts and feelings often motivate behavior, especially in the area of social phobias and agoraphobia (fear of feeling trapped, helpless, or embarrassed), which don’t tend to show as much improvement when treating them with systematic desensitization.
For example, the fear of public speaking could either stem from a phobia or from having poor social skills. In these situations, the proper treatment may be treating the underlying cause, systematic desensitization, or both.
How Does Systematic Desensitization Work?
There are three phases in the process of systematic desensitization. In the first phase, the therapist teaches the client a deep muscle relaxation technique, along with breathing exercises. Therapists may teach their clients how to meditate, control their breathing, or how to de-tension their muscles. When you experience fears or phobias, they make you tense, and tension is incompatible with relaxation, so there’s no room for both.
The second phase of systematic desensitization starts with exposing the client to stimuli that create the least amount of anxiety and builds up stimuli that generate fear in stages until the client gets to the most fear-producing images. The gradual exposure to stimuli, along with practicing relaxation techniques, makes people less afraid as they move to each stage in the hierarchy. If moving to a new stage increases anxiety, the client can return to an earlier stage and a relaxed state.
Continual exposure to the situation helps desensitize the client until they don’t experience any anxiety at all, and this means the therapy was successful.
As an example of how it works, imagine that a person has arachnophobia (fear of spiders). The therapist might start by exposing the client to one small spider at a distance from the client. As the client shows less anxiety to the spider, the therapist would increase the size of the spider, or bring the spider closer to the client (or both) until the fear no longer appears when the client sees a spider.
The number of sessions of systematic desensitization that someone needs will depend on how severe their phobia is. Sessions may run between approximately four to twelve sessions. There are two ways to expose the client to the stimuli:
- In vitro-which means, the client simply imagines being exposed to the stimuli (an imagined spider).
- In vivo-which means, the client is exposed to the actual stimuli (a real spider).
Researchers have found that in vivo techniques are generally more successful than in vitro techniques.
What Is Eye Movement Desensitization and Reprocessing (EMDR)?
Systematic desensitization is based on classic conditioning, and it led to the development of eye movement desensitization. Eye movement desensitization and reprocessing is a type of psychotherapy that is used to help people deal with the symptoms and stress that stems from disturbing life experiences.
It’s often easier to understand physical trauma because we can physically see the effects of a wound. It’s more difficult to imagine that someone’s brain is bruised or damaged as a result of a traumatic event. Just as physical injuries can take some time to heal, emotional wounds can also take a long time to heal.
Our bodies have natural healing capabilities. If someone cuts their hand, the blood naturally clots and starts to build new tissue. In time, new skin forms over the tissue and heals the wound. If dirt or some other foreign body gets into the wound, it blocks the natural healing process.
In much the same way, if a person experiences some type of severe mental or emotional trauma that injures the brain, the body works to try to heal the brain from that trauma. Memories of the trauma and repeated flashbacks of the trauma can block the brain from trying to heal itself. The concept behind EMDR is to remove the block that’s interfering with the brain’s natural healing process.
People who have experienced mental or emotional trauma once took many years to begin to heal from their trauma, and many people were not able to heal from it at all.
Numerous studies have shown that EMDR therapy is an effective form of systematic desensitization for people that are dealing with mental or emotional trauma.
- Researchers have conducted over 30 studies that show the effectiveness of EMDR therapy.
- Some studies have indicated that 84% to 90% of victims of a single trauma were relieved of their symptoms of PTSD after receiving only three sessions of 90 minutes of EMDR therapy.
- HMO Kaiser Permanente funded a study on EMDR that demonstrated that 100% of the single -trauma victims and 77% of victims of multiple traumas no longer had symptoms of PTSD after only six EMDR sessions that were 50 minutes long.
- In a study of combat veterans, 77% of them were free of their symptoms of post-traumatic stress disorder after 12 EMDR sessions.
- The American Psychiatric Association, the World Health Organization, and the Department of Defense all recognize EMDR as an effective form of treatment for trauma and other disturbing experiences.
- Over 100,000 clinicians worldwide use EMDR therapy to help clients heal from mental and emotional trauma.
- Over the last 25 years, virtually millions of people have been successfully treated with EMDR therapy.
With the many studies that have been done regarding the effectiveness of EMDR therapy, it makes sense that it would be effective for people that are dealing with issues and memories that cause them to have low self-esteem, feelings of powerlessness, and the many different types of problems that cause people to seek the benefits of therapy.
If you’re dealing with some type of fear, phobia, stress, or serious mental or emotional trauma, you don’t have to continue living with it, and you don’t have to face it alone. A licensed clinician will take a history of your problem and set up a course off systematic desensitization, EMDR, or other appropriate treatment protocols for your condition. The sooner you begin treatment, the sooner you can start to relax and feel better.