SYSTEMATIC DESENSITIZATION

Introduction

Exposure Therapy is a form of Behavioural Therapy that aims to reduce anxiety, fear, and guilt
by gradually exposing individuals to their fears. This therapy works by exposing the person to
their fear in a safe environment where there is no real danger, allowing them to learn how to
manage their stressors. By intentionally confronting their anxiety-inducing stimuli, the person
gains insight into their disorder and can effectively reduce their reactions to similar stimuli in the
future. Exposure Therapy is commonly used to treat anxiety disorders, such as Post-traumatic
Stress Disorder and Obsessive-Compulsive Disorder.

Content

Systematic Desensitization is a widely used technique in many settings that has proved to reduce
fear and anxious responses when confronted with a fear-inducing stimuli. Phobic and aversive
responses to certain specific stimuli are usually learnt after experiencing negative outcomes in its
presence. People learn to associate fear with certain stimuli after a negative encounter with it and
exhibit the same behavioural patterns whenever they confront it again. They are conditioned to
associate the stimulus with fear and anxiety. This is an evolutionary mechanism developed to
protect the species and improve their understanding of their threatening and harmful
environment. However, this can be extremely counterproductive when people develop aversive
feelings towards certain stimuli that is causing significant impairment in their everyday lives.

Systematic desensitization is a behavioural therapy technique that aims to help individuals

overcome their irrational fears or phobias. It involves gradually exposing the individual to the
feared object or situation while teaching relaxation techniques to counter the fear response. By
pairing the feared object or situation with relaxation, the individual learns to associate the fear-
inducing stimulus with relaxation rather than fear, which helps to reduce or eliminate the fear
response over time. Systematic desensitization has been found to be an effective treatment for a
variety of phobias, including fear of flying, fear of public speaking, and fear of spiders, among
others.
The conduction of Systematic Desensitization also involving the usage of the SUDS scale
developed by Wolpe. The Subjective Units of Distress, of SUDS, are a rating mechanism (from
0-10 or 0-100) for the client to rate their fear of the stimuli at a given point in time. They use this
scale throughout the exposure therapy to rate their current level of fear, both for the therapist’s
understanding as well as their own. This can greatly benefit in tracking the progress of the client
and can also let the therapist know if they must slow down and revisit rapport building or
mindfulness-based relaxation techniques before moving forward.

Process

Systematic Desensitization is conducted in a safe and protected environment in which an

individual who has a severe aversion to any sort of stimuli is introduced to their fear inducing
stimuli in a gradually increasing manner, easing them into the feeling of being confronted with
their fear-inducing stimuli in varying levels. It works on the premise of replacing anxious
feelings with relaxation (Wolpe, 1958) so that they learn that the stimuli no longer pose a threat
to them. It is a prolonged process and we allow the client to spend and much time as they need to
get comfortable with a certain level of exposure. It is a step-by-step process and we repeat the
steps as many times as necessary for the client to reap its full benefits. We also do not encourage
any safety behaviours such as use of substances to get rid of anxiety. Instead, we only focus on
the anxiety of the client and aim at reducing it by encouraging positive responses.

Systematic desensitization is behavioural, but it’s also the therapist’s duty to encourage
cognitive change towards the stimuli by resolving the concerns of the client as far as the fear-
inducing stimuli is concerned.

The initial procedure would be to conduct a trigger analysis of all the triggers that affect the
client with respect to the fear-inducing stimuli and to grade and understand each one of them.
We analyse the triads - Cognitive, Affective or Behavioural, and Physiological symptoms that
arise when confronted with the trigger and decide which aspect requires immediate intervention
and which can wait for later, as per the client’s needs and preferences.

For example, if client A has a fear of travelling in car, we analyse the triads in the following
way:
1. Cognitive: Thoughts and images of getting into accidents, replaying images of gruesome
accidents and their outcomes in their minds, thoughts of death, overthinking while in a car, etc.
2. Affective: Refusing to drive the car fast, avoidance of traveling when its late at night.

3. Physiological: Palpitations when sitting on the ship, shortness of breath and shaking of hands,
tunnelling vision, sweating profusely.

Post the trigger analysis, we also thoroughly take the past history of the client and understand
what are the social situations that trigger them. A triggering social situation for would be an
accident when her family was traveling back from a function and the feeling of losing control
when they didn’t sleep sufficiently.

We further analyse the triggers and understand where they start and rate them based on which is
causing the most impairment, which would the client predict as causing most impairment, which
is a trigger that is the easiest and most difficult to deal with, etc. After thorough understanding of
all these factors, the systematic desensitization begins in the following order:

1. Step 1: Picking a trigger to work on A want to reduce the shaking of her hands when she has
to sit on the car because this delay her work every time.

2. Step 2: Creating a fear hierarchy A list a number of ways in which she can purposely induce
this anxiety so that she can work on them, such as: - Imagining sitting in the car, imagining
driving very fastly, and being calm when the car is moving slowly.

● Seeing the picture of an accident in a car.

● Watching videos or news of accidents.

● Sitting in a car without safety precautions.

● Sitting in the car seat with the car moving fastly.

● Sitting on the car seat during late nights.

● Sitting on the car seat without sufficient sleep.

3 Step 3: Rating the hierarchy A rate the items in her list using a SUDS scale
4. Step 4: Starting the exposure

● A pick an item she rates 4 and sits in a car seat with the car on the road. She follows the rules
of exposure and tracks her progress on SUDS.

5. Step 5: Middle sessions of exposure

● A learns to sit in the car seat by increasing the speed a little.

6. Step 6: Final exposure

● A learns to sit in the car seat during traveling a long distance fastly.

The items on the list are triangulated wherein the most difficult item comes at the top of the
triangle and the easiest item comes at the bottom. A’s triangulated list is as follows:

Sitting in the car seat without sufficient sleep.

Sitting in the car seat with the car moving fastly on the road.

Sitting in a car seat with the safety precautions.

Watching good videos of traveling by car.

Seeing the picture of an accident car.

Outcome

Anxiety and fear are natural bodily responses when an individual is faced with threats. Our
physical responses to these threats help us either from confronting or escaping the threat. But,
when the threat is psychological, the body still exhibits the same responses as when the threat is
physical and these responses end up causing more harm than not. Phobias, anxiety, traumatic
memories, and many other triggers cause severe impairment in people’s lives, so much so that
daily functioning can sometimes be hindered. Relaxation techniques help immensely in changing
the way we approach things.

When faced with an anxiety or fear-inducing stimulus, we usually avoid it because we don’t
want to deal with the psychological pain that it gives us. Avoidance of a trigger can only provide
us with a temporary solution, but only confronting our fears can resolve our fear and anxiety in
the long run. Confrontation of our fears helps us in understanding our own potential is dealing
with stressors while putting things in perspective such as how exaggerated our fear was.

Fear and relaxation cannot co-exist. When one is present, the other cannot be. The fruition of
systematic desensitization lies in this truth. When we convert or replace the feelings of fear with
those of relaxation, the individual sees the stimulus in a completely different light, which in turn
helps with their coping.

References

1. Kazdin, A. E., & Wilcoxon, L. A. (1976). Systematic desensitization and nonspecific

treatment effects: a methodological evaluation. Psychological Bulletin, 83(5), 729.

2. Davison, G. C. (1968). Systematic desensitization as a counterconditioning process. Journal of

Abnormal Psychology, 73(2), 91.

3. Foa, E. B. (2011). Prolonged exposure therapy: past, present, and future. Depression and
Anxiety, 28(12), 1043–1047. doi:10.1002/da.20907

4. Ventis, W. L., Higbee, G., & Murdock, S. A. (2001). Using humor in systematic
desensitization to reduce fear. The Journal of general psychology, 128(2), 241-253.

5. Rajiah, K., & Saravanan, C. (2014). The effectiveness of psychoeducation and systematic
desensitization to reduce test anxiety among first-year pharmacy students. American journal of
pharmaceutical education, 78(9).

6. Obler, M., & Terwilliger, R. F. (1970). Pilot study on the effectiveness of systematic
desensitization with neurologically impaired children with phobic disorders. Journal of
Consulting and Clinical Psychology, 34(3), 314.

7. Willis, R. W., & Edwards, J. A. (1969). A study of the comparative effectiveness of

systematic