What is systematic desensitization and how does it work?

Systematic desensitization (DS) is a technique developed by Joseph Wolpe in 1958 which aims to end both with the responses of anxiety as with the avoidance behaviors typical of anxiety disorders.

Since these behaviors are especially important in the maintenance of phobic disorders, it is a technique widely used in their treatment. In this article we will see what it consists of, and the type of psychological disorders in which it is useful in therapy.

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What is systematic desensitization?

What is known as systematic desensitization is a form of psychotherapeutic intervention used in the treatment of anxiety disorders and associated psychological disorders. It proposes a kind of training in which patients learn to manage the emotions produced by experiences anxiogenes, following a curve of ascending difficulty, from the easy to the more complicated, adapting to the progress of the person.

Thus, systematic desensitization starts from the idea that to overcome an anxiety disorder it is necessary to learn to face that discomfort, instead of trying to block or escape from it. Thus comes habituation, with which little by little the intense reaction to anxiogenic stimuli fades.

As proposed Joseph wolpe, is based on classical conditioning. The principle is that the intensity of a response such as anxiety can be reduced through the emission of an incompatible response, such as relaxation. The appearance of certain phobic stimuli produces anxiety responses. certain stimuli automatically produce anxiety responses. Jointly, it is intended to elicit an automatic relaxation response that interferes with the discomfort of the aversive stimulus.

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How does systematic desensitization work?

The standardized routine desensitization procedure includes four steps. Relaxation training, a construction of hierarchies, evaluation and practice in imagination, and systematic desensitization itself. Before moving on to relaxation training, it is necessary to explain the technique to the client, to motivate him and make him understand the basic strategy and the principles of technical effectiveness.

Explain what incompatible responses are and why if one appears, the other cannot appear (such as relaxation and stress), what is a hierarchy of stimuli, what is counterconditioning and generalization in terms that can understand.

1. Relaxation training

The relaxation response that the patient will use to combat anxiety will preferably be one that they already know.. It is possible to use any procedure, but if possible it is better to use some type of relaxation that the patient himself can implement quickly and effectively.

Otherwise, techniques such as progressive relaxation or breath control can be taught, which are easy to learn techniques. The fundamental thing is that in the face of the anxious situation, these incompatible relaxation responses can be applied easily, quickly, and reduce anxiety effectively.

2. Anxiety hierarchy

When we want to apply desensitization we have to do an ordering of the feared situations. This is what we call an anxiety hierarchy, where we list all situations potentially anxiogenic related to the topic to be treated and we order them according to the degree of anxiety they generate. To quantify the anxiety it generates, a scale from 0 to 100 is used, where the situation with A score of 0 does not generate anxiety at all and the score with 100 is the one that generates the most anxiety of all.

To elaborate the hierarchy we do it through a brainstorming where the patient generates situations that cause anxiety. These situations are noted, specified and given a number on the scale from 0 to 100. Many times it can be difficult to start assigning numbers. A good way to start is to use anchors. First generate the items that generate the least and most anxiety, which will be 0 and 100 respectively, and an intermediate item that will be 50. From here the items are easier to order.

3. Practice in imagination

As we will use the exposure in imagination, we will have to evaluate the patient's ability to imagine scenes. The patient will be asked to imagine a scene and then the details of the scene will be asked to see how vivid the visualization is in imagination.

4. The desensitization itself

Once this is assured, the presentation of the situations that cause anxiety will proceed. This presentation can be in imagination or live. You will start with the situation that causes zero anxiety and work your way up the anxiety hierarchy gradually. The first presentations are made short, but the exposure time will be increased more and more. At the same time that the anxiety item is presented, the relaxation strategies that have been previously learned to interfere with anxiety and unlearn the anxiety response are put in place.

Naturally, the longer the patient spends in exposure, the greater desensitization. In addition, when it is possible to reduce the anxiety that a situation produces, it is generalized to the situations that are above it. Items are considered passed when they produce zero anxiety. That is, until one situation generates absolutely no anxiety, you cannot move on to the next.

Applications of systematic desensitization

Systematic desensitization is an appropriate treatment when the therapist directs his efforts to the elimination of phobias and anxieties as long as a series of conditions are met. For a conditioned response to be susceptible to being modified through systematic desensitization, it must be a response to a situation or a stimulus. specific, that they are not due to irrational beliefs or overvalued ideas, that it is an irrational fear and that there is an adequate response incompatible with that of anxiety.

In addition to its use in phobias and anxiety disorders, it can also be suitable to treat anxiety to specific stimuli without being phobic. For example in sexual dysfunctions, alcoholism, other addictions, paraphilias or insomnia.

Bibliographic references:

• Bados, A. and Grau, E. G. (2011). Exposure techniques. Dipòsit Digital of the University of Barcelona: Barcelona.
• Labrador, J. (2004). Behavior modification techniques. Spain: Pyramid Editions.
• Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Stanford: Stanford University Press.