What is systematic desensitization and how does it work?

A technique that is widely used in psychotherapy and is very useful for treating phobias.

Systematic desensitization (SD) is a technique developed by Joseph Wolpe in 1958 that aims to end both anxiety responses and avoidance behaviors characteristic of anxious 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.

What is systematic desensitization?

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

Thus, systematic desensitization is based on the idea that in order to overcome an anxiety disorder it is necessary to learn to confront this discomfort, instead of trying to block it or escape from it. This leads to habituation, with which the intense reaction to anxiogenic stimuli gradually fades away.

As proposed by 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 occurrence of certain phobic stimuli produces anxiety responses. certain stimuli automatically produce anxiety responses. In combination, the aim is to provoke an automatic relaxation response that interferes with the discomfort of the aversive stimulus..

How does systematic desensitization work?

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

It is necessary to explain to him what incompatible responses are and why if one appears, the other cannot appear (such as relaxation and tension), what a hierarchy of stimuli is, what counterconditioning and generalization are in terms he can understand.

1. Relaxation training

The relaxation response that the patient will use to combat anxiety will preferably be one that he/she already knows.. It is possible to use any procedure, but if possible it is better to use some type of relaxation that the patient himself can put into practice quickly and effectively.

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

2. Anxiety hierarchy

When we want to apply desensitization we have to make a ranking of the feared situations.. This is what we call a hierarchy of anxiety, where we list all the potentially anxiogenic situations related to the subject to be treated and we order them according to the degree of anxiety they generate. To quantify the anxiety generated we use a scale from 0 to 100, where the situation with a score of 0 does not generate any anxiety at all and the one with a score of 100 is the most anxious of all.

To elaborate the hierarchy we do it through brainstorming where the patient generates situations that provoke anxiety. These situations are noted down, specified and given a number on a scale from 0 to 100. A good way to start is to use anchors. Generate first the items that generate the least and the most anxiety, which will be 0 and 100 respectively, and an intermediate item, which will be 50.

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 imaginative visualization is.

4. The actual desensitization

Once this has been ensured, the presentation of the situations causing anxiety will proceed.. This presentation can be in imagination or live. We will start with the situation that causes zero anxiety and gradually move up the anxiety hierarchy. The first presentations are brief, but the time of exposure will be increased more and more. At the same time as the anxiogenic item is presented, previously learned relaxation strategies are put into action to interfere with the anxiety and unlearn the anxious response.

Naturally, the longer the patient spends in exposure, the greater the desensitization. In addition, when the anxiety produced by a situation is reduced, it generalizes to situations above it. The items are considered to be overcome when they produce zero anxiety. That is to say, until a situation generates absolutely no anxiety, it is not possible to move on to the next one.

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 modification through systematic desensitization, it must be a response to a specific situation or stimulus, it must not be due to irrational beliefs or overvalued ideas, it must be an irrational fear and there must be an adequate response incompatible with that of anxiety.

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