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Differences between systematic desensitization and exposure

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There are a large number of psychological treatments developed in order to respond to the problems and psychological disorders that exist. Some of them have shown proven efficacy in improving symptoms or even getting rid of the problem, such as This occurs with two of the most widely used treatments in therapy to treat phobias: systematic desensitization and exposure.

These are highly effective techniques and very similar to each other, to the point that they are often confused with each other. However, the truth is that there are differences between systematic desensitization and exposure, as we will see throughout this article.

  • Related article: "Types of psychological therapies"

Two methods used in psychotherapy

Exposure therapy and systematic desensitization are two of the great treatments that are used in a wide variety of disorders.

Yes ok They are especially known for their success in treating phobias., there are several variations of these techniques that are used in problems such as

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post traumatic stress disorder (exposure to interoceptive sensations, for example, or reprocessing desensitization by eye movements). Even techniques such as behavioral experiments that are used in behavior problems or to combat beliefs (as in obsessive-compulsive disorder or major depression) are largely based on the same beginning. Let's see a brief definition of each of the terms.


Exposure is a basic but very powerful technique, which bases its operation on place the subject or patient face to face with the stimuli that he fears. It is about making the subject remain in the frightening situation long enough for his anxiety to decrease naturally, to the point of becoming imperceptible. Thus, a habituation to stimuli occurs.

Said exposure can and usually is graduated in such a way that the process is not excessive for the patient, creating an exposure hierarchy from which the subject will be exposed to the different stimuli until the level of anxiety is reduced until it becomes imperceptible.

There are multiple variants of exposure (in fact, under a certain perspective, systematic desensitization could considered as such), and can be applied both live and in imagination or even in recent years through reality virtual.

  • You may be interested in: "Intervention in phobias: the exposure technique"

systematic desensitization

This is a technique similar to exposure, aimed at achieving the reduction of anxious and aversive emotional responses for the patient at the same time that they limit themselves and avoid avoidance of situations.

On this occasion, part of the idea that if fear is learned, it can also be learned to eliminate it: the efforts Therapeutic treatments are going to focus on the subject being able to eliminate the anxiety generated by the stimulation in a active. It is sought that he actively perform contrary responses and totally incompatible with the anxious ones, in such a way that he learns to eliminate the association between stimulus and fear to generate another between stimulus and relaxation, indifference or another alternative. In other words, it is based on counterconditioning.

In this case, too, the subject will have to expose himself to the stimuli that generate anxiety, being essential the hierarchization of the stimuli in such a way that the counterconditioning process can be carried out little by little and with increasingly anxious stimuli. Traditionally and habitually, this technique tends to be performed in imagination, although it is possible to perform it with live stimulation or in virtual reality.

  • Related article: "What is systematic desensitization and how does it work?"

5 major differences between both techniques

Although a superficial observation can show that there is a great similarity between desensitization and exposure and even cause us to confuse them, a deeper analysis of their operation reveals that they have some differences remarkable. Among them, the following five stand out.

1. slightly different goals

One of the main differences between exposure and systematic desensitization is the fact that they have objectives that, although similar, are different: while in exposure the objective is for the subject to reduce their anxiety levels by remaining in the aversive situation itself, systematic desensitization seeks that it generates responses that do not leave room for the appearance of anxiety.

2. Different operating mechanisms

Deeply linked to the previous point, in addition to the objectives they also differ in the methods. Although in both cases the patient has to face the stimulus that causes anxiety, while the exposure is based on habituation to stimulation as a method to reduce the anxiety it generates, desensitization employs counterconditioning, looking for the subject to carry out a response incompatible with anxiety that replaces his previous response.

3. Structuring and gradualness in the exhibition

Another element that can mean a difference between both techniques is the obligatory nature of the graduation. Systematic desensitization is always carried out in a highly structured manner, requiring a clear exposure hierarchy. However, while exposure can also be (and is indeed recommended) graduated, it also it is possible to find variants such as implosion and flood in which the exposure to the most feared stimulus is very immediate. The rhythm will also depend on the preferences and possibilities of the patient and how he reacts to the exposure.

4. Different use of relaxation

Relaxation techniques such as diaphragmatic breathing and Jacobson's progressive relaxation are elements of very useful and frequently used to reduce the level of anxiety, being frequently incorporated into both techniques.

However, the use made of them is different: while in systematic desensitization they are used as mechanism for counterconditioning, using them as a response incompatible with anxiety, in exposing his use it is limited to lowering the level of tension before exposure to the phobic stimulus in those cases where anxiety is excessive for the patient.

5. Different levels of generalization

Although both techniques are very effective for the treatment of phobias when they are correctly applied by trained professionals and taking into account the needs and particularities of each patient and situation, the truth is that another difference can be found in regards to their level of generalization.

The exposure allows to reduce the level of anxiety towards the phobic stimuli agreed between therapist and patient in a very efficient way, but although the habituation to said stimuli can be generalized towards other similar ones, the effect of the technique can be slightly restricted. However, by allowing systematic desensitization to generate an alternative response, it is possible that in this second there may be a greater generalization towards other situations and stimulations that generate anxiety, applying the same incompatible response.

Bibliographic references

  • Labrador, J. (2004). Behavior modification techniques. Spain: Pyramid Editions.

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