Systematic Desensitization: How To Get Rid Of Your Phobias

Medically reviewed by Julie Dodson, MA
Updated April 24, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention trauma-related topics that could be triggering to the reader. Please see our Get Help Now page for more immediate resources.

If you experience an intense fear of something, you may have heard of the process of systematic desensitization as a treatment. Millions of people live with phobias of all kinds, from spiders (arachnophobia) and ophidiophobia (snakes) to heights (acrophobia) and confinement in small spaces (claustrophobia), or even the fear of flying (aerophobia). 

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 live without fears that affect your daily life.

Joseph Wolpe and systematic desensitization

In the 1950s, a South African psychiatrist, Joseph Wolpe, developed a type of behavioral therapy called systematic desensitization to help people manage their most anxiety producing phobias. Desensitization is a type of behavior therapy that has its roots in classical conditioning. 

Systematic desensitization is a behavior therapy that aims to remove the fear of a response to a severe phobia and replace it with a relaxation response. Therapists tend to use a counter-conditioning process 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 experimental desensitization practice, he encountered a young adult who had a severe handwashing compulsion. The young man was intensely fearful of contaminating others with his urine.

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, creating a fear hierarchy or anxiety heirarchy.

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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. Wolpe attributed this to reciprocal inhibition or the ability to voluntarily relax anxiety symptoms in response to stimuli over time. 

While this may seem like an extreme case, other studies have shown the effectiveness of systematic desensitization and how this form of therapy helps individuals move past their phobias through gradual exposure.

What is the theory behind systematic desensitization?

Joseph Wolpe based systematic desensitization on the theory of reciprocal inhibition, which involves the automatic antagonist alpha motor neuron inhibition evoked by agonist muscle contraction. This biological process is suspected to play a major role in controlling voluntary movements in the human body.

In clinical psychology, systematic desensitization has proven to be highly effective in treating anxiety disorders caused by a learned situation as well as specific phobias. However, this type of therapy is not usually effective for treating mental health disorders like depression or schizophrenia.

In systematic desensitization therapy work, relaxation can be a part of systematic desensitization, but the more significant component of it is repeated exposure to the feared object or situation. One of the premises behind systematic desensitization is that abnormal behavior is learned and is not innate.

Treating phobia symptoms through desensitization

Systematic desensitization is effective at treating the symptoms rather than the cause of the phobia. Within abnormal and social psychology, systematic desensitization only treats the observable and measurable symptoms of a phobia, it doesn’t necessarily account for potential underlying causes.

Thoughts and emotions often motivate behavior, especially with social phobias and agoraphobia. With these phobias, treatment through systematic desensitization has not been as effective.

For example, a fear of public speaking could stem from a phobia or poor social skills. In these situations, the proper treatment may be treating the underlying cause, systematic desensitization, or both.

While cognitive behavioral therapy (CBT) is effective for many with mental disorders including panic disorders. For people experiencing panic disorders, behavior research suggests that systematic desensitization may have a positive impact.

Systematic desensitization phases

There are several components of systematic desensitization treatment. In the first phase, the therapist usually teaches the client deep muscle relaxation techniques, also known as progressive muscle relaxation (PMR), as well as breathing exercises. Therapists may teach their clients how to meditate, control their breathing, or lower muscle tension in a specific muscle group.

When you experience fears or phobias, they can make you tense, and tension can interfere with the abovementioned relaxation techniques.

The second phase of systematic desensitization usually starts with exposing the client to stimuli that create the least amount of anxiety and then building up the stimuli in stages until the most fear-producing images are reached.

The gradual exposure to stimuli, along with practicing PMR, tends to make people feel less afraid as they move to each stage in the hierarchy. If moving to a new stage increases anxiety, the client can return to a relaxed state at an earlier stage.

Successful treatment involves continual exposure to the phobia in order to desensitize the client until they no longer experience anxiety.


How does systematic desensitization work?

An example of systematic desensitization in practice would be a therapist treating a client experiencing arachnophobia (fear of spiders). The therapist may begin by exposing the client to one small spider at a far distance. 

As the client begins to show less anxiety related to the spider, the therapist may increase the size of the spider being presented or bring the spider closer to the client (or both) until the fear response no longer appears in the presence of a spider.

The number of sessions of systematic desensitization that someone needs may depend on the severity of the phobia and can range between four and 12 sessions. There are two ways to expose the client to the stimuli:

  • In vitro, meaning the client imagines being exposed to the stimuli (an imagined spider)
  • In vivo, meaning the client is exposed to the actual stimuli (a real spider)

One study found that in vivo techniques are generally more successful than in vitro techniques when looking at childhood water phobia and using vicarious exposure as a comparison. 

A specific form of in vitro desensitization is called virtual reality exposure therapy, or VRET, which involves using virtual reality experiences to slowly expose a person to their phobia or cause of anxiety. Using VRET is effective in managing anxiety where in vivo methods are not feasible.

What is eye movement desensitization and reprocessing (EMDR)?

Eye movement desensitization and reprocessing (EMDR) is defined as a psychotherapy treatment created to address the distress that stems from trauma. Dr. Francine Shapiro, the psychologist behind EMDR, hypothesized that EMDR therapy helps reach the traumatic memory network in a way that allows for enhanced information processing and newly formed associations between traumatic memories and adaptive memories and information.

Our bodies have natural healing capabilities. If we accidentally cut our hand, blood will clot and begin to build new tissue. In time, new skin will form over the tissue and heal the wound. If dirt or some other foreign body gets into the wound, it can block the 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.

During an EMDR session, a client typically revisits emotionally difficult memories in brief sequential doses while simultaneously focusing on an external stimulus. A therapist usually uses directed lateral eye movements as the external stimulus.

Previously, it took many years for individuals who experienced trauma to heal, and some were not able to heal at all. Numerous studies have shown that EMDR therapy is an effective form of systematic desensitization for individuals experiencing mental or emotional trauma, including as a posttraumatic stress disorder, or PTSD, treatment.

BetterHelp and systematic desensitization therapies

If you’re considering therapy for a phobia or other mental disorders, but are nervous about going to a therapy practice, you might try online therapy, which research has shown to be just as effective as in-person therapy for several mental health conditions. At BetterHelp, a therapist who specializes in systematic desensitization can work to help you overcome experiences such as past traumatic events or phobias. BetterHelp has over 30,000 therapists, many of whom are trained in desensitization therapies. 

In addition to the wide range of therapists available at BetterHelp, online therapy allows you to connect with them from the comfort and safety of your home. This may provide you with the confidence to get the help you want while being in a safe space with which you’re familiar.

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If you’re living with fears, phobias, stress, or other mental or emotional trauma, you don’t have to face it alone. A licensed clinician can take a history of your experience and set up an customized action plan using systematic desensitization therapy or another appropriate treatment. Take the first step toward healing and contact BetterHelp today.

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