The 5 differences between systematic desensitization and exposure

There are a large number of psychological treatments designed to address existing psychological problems and disorders. Some of them have been shown to be effective in improving symptoms or even eliminating the problem, as is the case with two of the most widely used therapy treatments for phobias: systematic desensitization and exposure.

These are very 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.

    Two methods used in psychotherapy

    Exposure therapy and routine desensitization are two of the main treatments used in a wide variety of disorders.

    even if they are best known for their success in treating phobiasThere are several variations of these techniques which are employed in problems such as post-traumatic stress disorder (exposure to interoceptive sensations, for example, or desensitization by reprocessing by eye movements). Even techniques such as behavioral experiments used in behavior problems or to fight beliefs (such as in obsessive-compulsive disorder or major depression) are largely based on the same principles. Let’s look at a brief definition of each of the terms.


    The exhibition is a basic but very powerful technique, on which he bases his work place the subject or patient face to face with the stimuli he fears. It is about keeping the subject in the frightening situation long enough for his anxiety to naturally subside, to the point of becoming imperceptible. Thus, habituation to the stimuli occurs.

    This exhibition it can and usually is graduated so that the process is not excessive for the patient, Perform an exposure hierarchy from which the subject will be exposed to different stimuli until the level of anxiety is reduced to make it imperceptible.

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

      Systematic desensitization

      It is a technique similar to exposure, aimed at reducing anxious and aversive emotional reactions for the patient while limiting and avoiding the avoidance of situations.

      On this occasion, it is based on the idea that if fear is learned, we can also learn to eliminate it: the therapeutic efforts will focus on the subject being able to eliminate the anxiety generated by the active stimulation. We seek to actively perform opposite responses and totally incompatible with anxiety, in such a way that we learn to eliminate the association between stimulus and panic to generate another between stimulus and relaxation, indifference or another alternative. In other words, it is based on counter-conditioning.

      Also in this case, the subject will have to expose himself to stimuli that generate anxiety, being essential the hierarchy of stimuli in such a way that the process of counter-conditioning can be carried out slowly and with increasingly anxious stimuli. Traditionally and consistently, this technique tends to be performed in the imagination, although it is possible to perform it with live stimulation or virtual reality.

        5 big differences between the two techniques

        While a superficial observation can show that there is a great similarity between desensitization and exposure and even generate that they are confused, a more in-depth analysis of how they work shows that they have remarkable differences. Among them, the following five.

        1. Slightly different objectives

        One of the main differences between exposure and systematic desensitization is the fact that they have objectives which, although similar, are different: whereas in exposure, the objective is for the subject to reduce their level of d ‘anxiety by remaining in the aversive situation itself, systematic desensitization seeks that it generates responses that leave no room for the onset of anxiety.

        2. Different operating mechanisms

        Deeply related to the previous point, in addition to the objectives also differ in methods. While in both cases the patient has to deal with the stimulus that causes him anxiety, while the exposure is based on the habit of stimulation as a method of reducing the anxiety it generates, in desensitization, a counter-conditioning is used, Seeking that the subject achieves a response incompatible with the anxiety that replaces his previous response.

        3. Structuring and graduality of the exhibition

        Another element that can make the difference between the two techniques is the compulsory nature of obtaining the diploma. Systematic desensitization is always carried out in a very structured way, requiring a clear hierarchy of exposures. However, while the exposure can also be (and is in fact recommended) graduated, so too it is possible to find variants such as implosion and flood in which exposure to the most feared stimulus is very immediate. The pace will also depend on the patient’s preferences and possibilities and how the patient responds to exposure.

        4. Different use of relaxation

        Relaxation techniques such as diaphragmatic breathing and Jacobson’s progressive relaxation are very useful and frequently used elements in reducing anxiety levels, frequently integrating the two techniques.

        However, their use is different: whereas in systematic desensitization, they are used as a counter-conditioning mechanism, using them as an incompatible anxiety response, to expose their use. it is limited to lowering the level of stress in the face of exposure to the phobic stimulus in cases where the anxiety is excessive for the patient.

        5. Different levels of generalization

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

        Exposure very effectively reduces the level of anxiety towards phobic stimuli agreed upon between therapist and patient, but if habituation to these stimuli can generalize to other similar stimuli, the effect of the technique may be slightly. limit. However, by allowing systematic desensitization to generate an alternative response, it is possible that in this second there may be greater generalization to other situations and stimuli that generate anxiety, applying the same inconsistent response.

        bibliographical references

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

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