What Is Systematic Desensitization Therapy and How Does It Work?

Systematic desensitization is a type of behavioral treatment that uses exposure therapy to treat anxiety disorders, post-traumatic stress disorder (PTSD), and phobias. It involves gradually exposing a person to something that causes extreme fear and panic, and teaches them to replace fear responses with relaxation responses.

This article explains systematic desensitization, techniques, benefits, and how to find a therapist. 

How Does Systematic Desensitization Therapy Work?

Systematic desensitization is a type of therapy that focuses on teaching you how to relax in the midst of your fears. Essentially, you’ll learn the skills and tools you need to navigate situations that would have previously felt unmanageable.

Step 1: Relaxation Techniques

Developing strategies to help you relax your body during moments of distress is the first step of systematic desensitization.

Relaxation techniques are helpful for calming physical sensations in the body. These strategies are versatile, in that you can use them on their own or combine them.

Many different types of tactics can help. Trying a variety of techniques can help you determine what works best for you. It’s also important to note that what works best in one situation may not be as effective in another. Having multiple strategies in your toolbox gives you the ability to choose what you need at the moment. 

Deep breathing

Deep breathing invites you to slow down your breathing and lengthen the exhale to relax the sympathetic nervous system:

• Breathe in slowly through your nose, letting your belly fill with air.
• Hold the breath for a couple of seconds.
• Slowly release it from your mouth with the exhale longer than your inhale.

This is also known as diaphragmatic breathing. 

Muscle relaxation

Progressive muscle relaxation teaches you to spot tension in your muscles and relax it. By concentrating on one group at a time, you learn to tense and relax your muscles, feeling tension melt away as you release.

Visualization

Visualization is an exercise that transports you to a place that feels safe and relaxing.

To do this:

• Choose an environment or scene that brings you peace.
• Paint the picture clearly in your mind, focusing on the details.
• Using your senses, you can draw yourself in further.

For example, you may visualize the beach with slow and steady waves, white sand, and sun. You might imagine that you can smell the saltwater and hear the movement of the waves.

Meditation

Meditation involves focusing your attention and awareness to help you feel more calm and relaxed. There are many types, including mindfulness meditation, which encourages you to tap into the present moment by becoming aware of different aspects of your experience. The act of recognizing your anxious thoughts and emotions without judging yourself or making evaluations about your thoughts can help you reduce the intensity of your anxiety and distress.

Step 2: Creating a Fear Hierarchy

Once you've learned relaxation techniques that work best for you, you can create a fear hierarchy by identifying situations or objects that cause fear.

To do this, you can work with a therapist to determine what situations cause you the most fear and least fear. Extreme fear-inducing situations would be a "10," while situations provoking the least amount of fear are rated as a "1." It's important to identify levels in between as well.

Step 3: Gradually Expose Yourself to the Fears

After you’ve completed your fear hierarchy, you’ll work with a therapist to figure out how to start exposing yourself to the fears and managing your distress along the way. Systematic desensitization starts by exposing you to your lower-level fears. So, starting with the “1” and working your way up to the “10.”

While you are exposing yourself to fearful situations, you can use relaxation techniques to manage thoughts, emotions, and sensations that come up. Over time, your body comes to realize that the anticipated danger it expects isn't going to occur and that you don't need to use avoidance to short-circuit the distressing feelings. You can use the strategies as many times as you need to reduce the anxiety.

How Long Does Treatment Take?

Though patients may see progress after even a few sessions, the length of exposure therapy may be different for each patient. Typically, patients will begin to see changes after a few sessions, while more severe phobias can take around 12 sessions.

The length of treatment may depend on factors such as the problem, severity of the issue, comfortability with relaxation and coping techniques, and how a patient responds to different levels of the fear hierarchy.

Examples of Systematic Desensitization Therapy

The process of systematic desensitization can be different for everyone. For some people, different relaxation techniques may be more helpful than others. Additionally, a person's progress will depend on how quickly they are able to successfully move through each level of their fear hierarchy.

The following are examples of fear hierarchies that one may create and use to overcome a specific phobia.

Social Anxiety

People with social anxiety often fear a variety of social situations. For someone confronting a social phobia, their fear hierarchy may look something like this:

1. Making eye contact with a stranger
2. Asking a stranger for directions
3. Talking to a friend on the phone for 10 minutes
4. Ordering takeout
5. Asking a neighbor for a favor
6. Introducing oneself to a group
7. Eating lunch with colleagues
8. Asking a question in class or during a work meeting
9. Starting a conversation with a stranger in a coffee shop
10. Giving a presentation to a group of collogues

Dog Phobia

For persons with a dog phobia, a fear hierarchy may look like the following:

1. Looking at the word "dog"
2. Looking at pictures of dogs
3. Listening to a dog bark
4. Watching videos about dogs
5. Seeing a real dog from across the street
6. Standing beside a dog on a leash
7. Petting a dog
8. Feeding a dog a treat
9. Sitting in a dog park
10. Touching dogs at a dog park

What Are the Pros and Cons of Systematic Desensitization?

Systematic desensitization is a form of exposure therapy, which aids patients by breaking cycles of avoidance, fear, and anxiety. Through therapy, patients can tackle their fears in a safe environment with a mental health professional who can help them develop relaxation and coping strategies. However, there may be pros and cons to this type of therapy.

Pros

Exposure therapy is effective in treating a range of mental health conditions, including:

• Panic disorder
• Social anxiety disorder
• Obsessive-compulsive disorder
• Post-traumatic stress disorder
• Phobias

Systematic desensitization often gives patients a sense of empowerment when it comes to facing their fears. In working with a therapist, there's space to process thoughts, emotions, and beliefs related to the fear situation. This allows you to identify avoidance reactions and unhelpful thoughts.

Through this work, you can establish new associations and manage emotional discomfort when in contact with fear.

Cons

Although systematic desensitization can be very effective in treating a range of mental health conditions, it can take time to see results. Additionally, this therapy may trigger distressing emotions, like anxiety, during the process.

How to Do It on Your Own

You can gradually expose yourself to fearful situations. But before starting that process, it’s important to make sure that you feel comfortable using relaxation techniques and have a few in your reserve that reduce your anxiety. 

Once you feel confident in using relaxation strategies, you can start exposing yourself to situations that bring up lower levels of fear. Take your time as you begin exposure. The goal is to learn to manage your fear when faced with frightening situations.

Exercises

To implement gradual exposure on your own, you might try the following steps:

• Learn and practice several different relaxation techniques.
• Make it manageable. Ten levels of fear hierarchy may be overwhelming. Instead, identify a small number of fear situations to include.
• Expose yourself to the lowest level of your fear hierarchy for brief amounts of time.
• Use your relaxation tools when you feel anxiety or fear. You can use more than one strategy or repeat one that is helping until the anxiety diminishes.
  

Working With a Therapist

Because systematic desensitization involves exposure to fears, you may experience distressing emotions, anxiety, or even panic during the process. Working with a therapist to help you identify coping skills, list and rank your fears, and determine a plan for the best way to begin gradual exposure. 

Being able to communicate any problems, goals, and hopes for therapy is beneficial information for you and a potential therapist.

Additionally, you may want to consider what traits matter to you in a therapist. Asking questions about the therapist’s education, training, and experience treating your particular concerns can help you decide if they're a good fit. 

Therapy can be expensive, so it can be helpful to evaluate your options. That might mean going through health insurance, an Employee Assistance Program, or seeking a referral from your primary healthcare provider. In some cases, you may need to explore other community-based options.

Summary

Systematic desensitization is an effective and evidence-based treatment method to gradually expose yourself to phobias or situations that create extreme fear or anxiety. With the support of a therapist, you can learn relaxation strategies, pinpoint your fears, and begin exposing yourself to distressing situations while using techniques to cope with strong emotions. When seeking help, it's important to locate a therapist with specialized training to guide you through the process.