Systematic desensitization (DS) is a technique developed by Joseph Wolpe in 1958 which aims to put an end to both anxiety responses and avoidance behaviors inherent in anxiety disorders.
Since these behaviors are particularly important in maintaining phobic disorders, it is a technique widely used in their treatment. In this article we will look at what it is and what kind of psychological disorders it is useful in therapy for.
What is systematic desensitization?
What is called systematic desensitization is a form of psychotherapeutic intervention used in the treatment of anxiety disorders and the psychological alterations associated with these. It offers a kind of training in which patients learn to deal with the emotions produced by anxious experiences, following an ascending curve of difficulty, from the easiest to the most complicated, adapting to the progress of the person.
Thus, systematic desensitization is part of the idea that in order to overcome an anxiety disorder, one must learn to manage that discomfort, rather than trying to block it or escape from it. In this way comes the habit, with which little by little the intense reaction to anxious stimuli fades away.
As proposed by Joseph Wolpe, it is based on classic conditioning. The principle is that the intensity of a response such as anxiety can be reduced by issuing an incompatible response, such as relaxation. The appearance of certain phobic stimuli produces anxious responses. certain stimuli automatically produce anxiety responses. Together, it is intended to elicit an automatic relaxation response that interferes with the discomfort of the aversive stimulus.
How does systematic desensitization work?
The standardized routine desensitization procedure consists of four steps. Relaxation training, hierarchy building, assessment and practice in imagination and systematic desensitization itself. Before moving on to relaxation training, it is necessary to explain the technique to the client, motivate him and make him understand the basic strategy and principles of technical efficiency.
You need to explain 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 is counter-conditioning and generalization in terms you can understand.
1. Relaxation training
The relaxation response the patient will use to combat anxiety will preferably be something you already know.. It is possible to use any procedure, but if possible, it is better to use some type of relaxation that the patient himself can implement quickly and effectively.
Alternatively, techniques such as progressive relaxation or breathing control can be taught, which are easy to learn techniques. Ultimately, when faced with the anxiety situation, these incompatible relaxation responses can be applied easily, quickly, and effectively reduce anxiety.
2. Hierarchy of anxiety
When we want to apply desensitization, we have to make an arrangement of the feared situations. This is what we call an anxiety hierarchy, where we list all the potentially anxious situations related to the subject to be treated and classify them according to the degree of anxiety they generate. To quantify the anxiety it generates, we use a scale from 0 to 100, where the situation with a score of 0 does not generate anxiety at all and the one with a score of 100 is the one that generates the most. anxiety of all.
To establish the hierarchy, we do it through a storm of ideas (brainstorming) where the patient generates situations that cause anxiety. These situations are noted, necessary and placed on a scale of 0 to 100. It can often be difficult to start assigning numbers. A good way to start is to use anchors. First generate the elements that generate more and more anxiety, which will be 0 and 100 respectively, and an intermediate element which will be 50. From there, the elements are easier to sort.
3. Practice in imagination
As we will use the exposure in the imagination, we will need to assess the patient’s ability to imagine scenes. The patient will be asked to imagine a scene and then the details of it will be asked to see how vivid the visualization is in the imagination.
4. Desensitization proper
Once this is ensured, the situations that cause anxiety will be presented.. This presentation can be imaginative or live. It will start with the situation that causes no anxiety and gradually move up the anxiety hierarchy. The first presentations are made briefly, but the exposure time will be longer and longer. At the same time as the anxious item is presented, relaxation strategies that have been previously learned to interfere with anxiety and unlearn the anxious response are put in place.
Of course, the longer the patient is exposed, the greater the desensitization. In addition, when it is possible to reduce the anxiety produced by a situation, it generalizes in situations beyond it. The elements are neglected when they do not produce any anxiety. In other words, as long as a situation does not generate any anxiety at all, you cannot move on to the next.
Applications of systematic desensitization
Systematic desensitization is an appropriate treatment when the therapist directs his efforts towards eliminating phobias and anxieties as long as a number of conditions are met. For a conditioned response to be susceptible to modification by systematic desensitization, it must be a response to a specific situation or stimulus, not because of irrational beliefs or overestimated ideas, that it is about irrational fear and that there is an adequate response inconsistent with it. anxiety.
In addition to its use in phobias and anxiety disorders, it may also be suitable for treating anxiety about specific stimuli without being phobic. For example in sexual dysfunctions, alcoholism, other addictions, paraphilias or insomnia.
- Bados, A. and Grau, EG (2011). Exposure techniques. University of Barcelona digital repository: Barcelona.
- Pagès, J. (2004). Behavior modification techniques. Spain: Editions Pyramid.
- Wolpe, J. (1958). Psychotherapy for reciprocal inhibition. Stanford: Stanford University Press.