Systematic desensitization

Short description: Type of behavior therapy

Systematic desensitization, or graduated exposure therapy, is a behavior therapy developed by the psychiatrist Joseph Wolpe. It is used when a phobia or anxiety disorder is maintained by classical conditioning. It shares the same elements of both cognitive-behavioral therapy and applied behavior analysis.[clarification needed] When used in applied behavior analysis, it is based on radical behaviorism as it incorporates counterconditioning principles. These include meditation (a private behavior or covert conditioning) and breathing (a public behavior or overt conditioning). From the cognitive psychology perspective, cognitions and feelings precede behavior, so it initially uses cognitive restructuring.

The goal of the therapy is for the individual to learn how to cope with and overcome their fear in each level of an exposure hierarchy. The process of systematic desensitization occurs in three steps. The first step is to identify the hierarchy of fears. The second step is to learn relaxation or coping techniques. Finally, the individual uses these techniques to manage their fear during a situation from the hierarchy. The third step is repeated for each level of the hierarchy, starting from the least fear-inducing situation.

## Contents

* 1 Three steps of desensitization
* 1.1 Example
* 2 Uses
* 2.1 Specific phobias
* 2.2 Test anxiety
* 2.3 Recent use
* 3 History
* 4 See also
* 5 References
* 6 External links

## Three steps of desensitization

There are three main steps that Wolpe identified to successfully desensitize an individual.

1. Establish anxiety stimulus hierarchy. The individual should first identify the items that are causing the anxiety problems. Each item that causes anxiety is given a subjective ranking on the severity of induced anxiety. If the individual is experiencing great anxiety to many different triggers, each item is dealt with separately. For each trigger or stimulus, a list is created to rank the events from least anxiety-provoking to most anxiety-provoking.
2. Learn the mechanism response. Relaxation training, such as meditation, is one type of best coping strategies. Wolpe taught his patients relaxation responses because it is not possible to be both relaxed and anxious at the same time. In this method, patients practice tensing and relaxing different parts of the body until the patient reaches a state of serenity.[1] This is necessary because it provides the patient with a means of controlling their fear, rather than letting it increase to intolerable levels. Only a few sessions are needed for a patient to learn appropriate coping mechanisms. Additional coping strategies include anti-anxiety medicine and breathing exercises. Another example of relaxation is cognitive reappraisal of imagined outcomes. The therapist might encourage patients to examine what they imagine happening when exposed to the anxiety-inducing stimulus and then allowing for the client to replace the imagined catastrophic situation with any of the imagined positive outcomes.
3. Connect stimulus to the incompatible response or coping method by counter conditioning. In this step the client completely relaxes and is then presented with the lowest item that was placed on their hierarchy of severity of anxiety phobias. When the patient has reached a state of serenity again after being presented with the first stimuli, the second stimuli that should present a higher level of anxiety is presented. This will help the patient overcome their phobia. This activity is repeated until all the items of the hierarchy of severity anxiety is completed without inducing any anxiety in the client at all. If at any time during the exercise the coping mechanisms fail or became a failure, or the patient fails to complete the coping mechanism due to the severe anxiety, the exercise is then stopped. When the individual is calm, the last stimuli that is presented without inducing anxiety is presented again and the exercise is then continued depending on the patient outcomes.[2]

### Example

A client may approach a therapist due to their great phobia of snakes. This is how the therapist would help the client using the three steps of systematic desensitization:

1. Establish anxiety stimulus hierarchy. A therapist may begin by asking the patient to identify a fear hierarchy. This fear hierarchy would list the relative unpleasantness of various levels of exposure to a snake. For example, seeing a picture of a snake might elicit a low fear rating, compared to live snakes crawling on the individual—the latter scenario becoming highest on the fear hierarchy.
2. Learn coping mechanisms or incompatible responses. The therapist would work with the client to learn appropriate coping and relaxation techniques such as meditation and deep muscle relaxation responses.
3. Connect the stimulus to the incompatible response or coping method. The client would be presented with increasingly unpleasant levels of the feared stimuli, from lowest to highest—while utilizing the deep relaxation techniques (i.e. progressive muscle relaxation) previously learned. The imagined stimuli to help with a phobia of snakes may include: a picture of a snake; a small snake in a nearby room; a snake in full view; touching of the snake, etc. At each step in the imagined progression, the patient is desensitized to the phobia through exposure to the stimulus while in a state of relaxation. As the fear hierarchy is unlearned, anxiety gradually becomes extinguished.

## Uses

### Specific phobias

Specific phobias are one class of mental disorder often treated via systematic desensitization. When persons experience such phobias (for example fears of heights, dogs, snakes, closed spaces, etc.), they tend to avoid the feared stimuli; this avoidance, in turn, can temporarily reduce anxiety but is not necessarily an adaptive way of coping with it. In this regard, patients' avoidance behaviors can become reinforced – a concept defined by the tenets of operant conditioning. Thus, the goal of systematic desensitization is to overcome avoidance by gradually exposing patients to the phobic stimulus, until that stimulus can be tolerated.[3] Wolpe found that systematic desensitization was successful 90% of the time when treating phobias.[4]

### Test anxiety

Between 25 and 40 percent of students experience test anxiety.[5] Children can suffer from low self-esteem and stress-induced symptoms as a result of test anxiety.[6] The principles of systematic desensitization can be used by children to help reduce their test anxiety. Children can practice the muscle relaxation techniques by tensing and relaxing different muscle groups. With older children and college students, an explanation of desensitization can help to increase the effectiveness of the process. After these students learn the relaxation techniques, they can create an anxiety inducing hierarchy. For test anxiety these items could include not understanding directions, finishing on time, marking the answers properly, spending too little time on tasks, or underperforming. Teachers, school counselors or school psychologists could instruct children on the methods of systematic desensitization.[7]

### Recent use

Desensitization is widely known as one of the most effective therapy techniques. In recent decades, systematic desensitization has become less commonly used as a treatment of choice for anxiety disorders. Since 1970 academic research on systematic desensitization has declined, and the current focus has been on other therapies. In addition, the number of clinicians using systematic desensitization has also declined since 1980. Those clinicians that continue to regularly use systematic desensitization were trained before 1986. It is believed that the decrease of systematic desensitization by practicing psychologist is due to the increase in other techniques such as flooding, implosive therapy, and participant modeling.[8]

## History

In 1947, Wolpe discovered that the cats of Wits University could overcome their fears through gradual and systematic exposure.[9] Wolpe studied Ivan Pavlov's work on artificial neuroses and the research done on elimination of children's fears by Watson and Jones. In 1958, Wolpe did a series of experiments on the artificial induction of neurotic disturbance in cats. He found that gradually deconditioning the neurotic animals was the best way to treat them of their neurotic disturbances. Wolpe deconditioned the neurotic cats through different feeding environments. Wolpe knew that this treatment of feeding would not generalize to humans and he instead substituted relaxation as a treatment to relieve the anxiety symptoms.[10]

Wolpe found that if he presented a client with the actual anxiety inducing stimulus, the relaxation techniques did not work. It was difficult to bring all of the objects into his office because not all anxiety inducing stimuli are physical objects, but instead are concepts. Wolpe instead began to have his clients imagine the anxiety inducing stimulus or look at pictures of the anxiety inducing stimulus, much like the process that is done today.[10]

## See also

* Flooding (psychology)
* Immersion therapy
* Sensitization

## References

1. ↑ Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Stanford, CA: Stanford University Press.
2. ↑ Mischel, W., Shoda, Y. & Ayduk, O. Introduction to Personality. John Wiley & Sons, Inc., 2008.
3. ↑ Kazdin, A. E., & Wilson, G.T. (1978). Evaluation of behavior therapy: Issues, evidence and research strategies. Cambridge, MA: Ballinger.
4. ↑ Wolpe, J. The practice of behavior therapy. New York: Pergamon Press, 1969.
5. ↑ Cassady, J.C. (2010). Test anxiety: Contemporary theories and implications for learning. In J.C. Cassady (Ed.), Anxiety in schools: The causes, consequences, and solutions for academic anxieties (pp. 7–26). New York, NY: Peter Lang,
6. ↑ Deffenbacher, Jerry L.; Hazaleus, Susan L. (1985). "Cognitive, emotional, and physiological components of Test Anxiety". Cognitive Therapy and Research 9 (2): 169–180. doi:10.1007/BF01204848.
7. ↑ Austin, J. Sue; Partridge, Elizabeth; Bitner, Joe; Wadlington, Elizabeth (1995). "Prevent School Failure: Treat Test Anxiety". Preventing School Failure: Alternative Education for Children and Youth 40: 10–13. doi:10.1080/1045988X.1995.9944644.
8. ↑ McGlynn, F. D.; Smitherman, T. A.; Gothard, K. D. (2004). "Comment on the status of systematic desensitization". Behavior Modification 28 (2): 194–205. doi:10.1177/0145445503259414. PMID 14997948.
9. ↑ Dubord, Greg. "Part 12. Systematic desensitization." Canadian Family Physician 57 (2011): 1299+. Print.
10. ↑ 10.0 10.1 Rachman, S. (1967). "Systematic desensitization". Psychological Bulletin 67 (2): 93–103. doi:10.1037/h0024212. PMID 6045340.

## External links

* Self-administered Systematic Desensitization

* v
* t
* e

Cognitive behavioral therapy (list)

* Acceptance and commitment therapy
* Behavior therapy
* Behavioral activation
* Cognitive analytic therapy
* Cognitive therapy
* Compassion-focused therapy
* Contingency management
* Dialectical behavior therapy
* Direct therapeutic exposure
* Exposure and response prevention
* Functional analytic psychotherapy
* Habit reversal training
* Inference-based therapy
* Metacognitive therapy
* Method of levels
* Mindfulness-based cognitive therapy
* Multimodal therapy
* Prolonged exposure therapy
* Rational emotive behavior therapy
* Reality therapy
* Relapse prevention
* Schema therapy
* Self-control therapy
* Social skills training
* Systematic desensitization

* v
* t
* e

Psychotherapy (list)

Schools|

| Psychodynamic|

* Psychoanalysis
* Adlerian therapy
* Analytical therapy
* Mentalization-based treatment
* Transference focused psychotherapy

|

Cognitive and
behavioral|

* Clinical behavior analysis
* Acceptance and commitment therapy
* Functional analytic psychotherapy
* Cognitive behavioral therapy
* Cognitive therapy
* Dialectical behavior therapy
* Mindfulness-based cognitive therapy
* Rational emotive behavior therapy

Humanistic|

* Emotionally focused therapy
* Existential therapy
* Focusing
* Gestalt therapy
* Logotherapy
* Person-centered therapy

Other|

* Art therapy
* Dance therapy
* Feminist therapy
* Music therapy
* Narrative therapy
* Play therapy
* Reality therapy
* Systemic therapy
* Transactional analysis
* List

Integrative|

* Eclectic psychotherapy
* Integrative psychotherapy
* Multimodal therapy
* Transtheoretical model

Approaches|

* Brief psychotherapy
* Counseling
* Online counseling
* Residential treatment
* Self-help
* Support groups

Research|

* Clinical formulation
* Clinical pluralism
* Common factors theory
* Discontinuation
* History
* Practitioner–scholar model

Techniques|

| Behaviour therapy|

* Aversion therapy
* Chaining
* Contingency management
* Shaping
* Stimulus control
* Token economy
* Counterconditioning
* Desensitization/Exposure therapy
* Systematic desensitization

|

Other individual therapy|

* Autogenic training
* Biofeedback
* Cognitive restructuring
* Emotion regulation
* Free association
* Homework
* Hypnotherapy
* Modeling

Group psychotherapy|

* Co-therapy
* Couples therapy
* Family therapy
* Psychodrama
* Sensitivity training

People|

* Philippe Pinel (1745–1826)
* Josef Breuer (1842–1925)
* Sigmund Freud (1856–1939)
* Pierre Janet (1859–1947)
* Alfred Adler (1870–1937)
* Sándor Ferenczi (1873–1933)
* Carl Jung (1875–1961)
* Ludwig Binswanger (1881–1966)
* Melanie Klein (1882–1960)
* Otto Rank (1884–1939)
* Karen Horney (1885–1952)
* Harry Stack Sullivan (1892–1949)
* Fritz Perls (1893–1970)
* Anna Freud (1895–1982)
* Donald Winnicott (1896–1971)
* Wilhelm Reich (1897–1957)
* Milton H. Erickson (1901–1980)
* Jacques Lacan (1901–1981)
* Erik Erikson (1902–1994)
* Carl Rogers (1902–1987)
* Viktor Frankl (1905–1997)
* George Kelly (1905–1967)
* Rollo May (1909–1994)
* Virginia Axline (1911–1988)
* Carl Whitaker (1912–1995)
* Albert Ellis (1913–2007)
* James Bugental (1915–2008)
* Joseph Wolpe (1915–1997)
* Virginia Satir (1916–1988)
* Aaron T. Beck (b. 1921)
* Salvador Minuchin (1921–2017)
* Hans Herrman Strupp (1921–2006)
* Paul Watzlawick (1921–2007)
* Haim Ginott (1922–1973)
* Ogden Lindsley (1922–2004)
* Arthur Janov (1924–2017)
* Eugene Gendlin (1926–2017)
* R. D. Laing (1927–1989)
* Jean Baker Miller (1927–2006)
* Otto F. Kernberg (b. 1928)
* Nathan Azrin (1930–2013)
* Irvin D. Yalom (b. 1931)
* Arnold Lazarus (1932–2013)
* Lorna Smith Benjamin (b. 1934)
* Marsha M. Linehan (b. 1943)
* Vittorio Guidano (1944–1999)
* Les Greenberg (b. 1945)
* William R. Miller (b. 1947)
* Steven C. Hayes (b. 1948)
* Michael White (1948–2008)
* Jeffrey Young (b. 1950)
* Peter Fonagy (b. 1952)

Associations|

* Association for the Advancement of Psychotherapy
* Association for Applied Psychophysiology and Biofeedback
* Association for Behavioral and Cognitive Therapies
* Association for Behavior Analysis International
* European Association for Psychotherapy
* Society for Psychotherapy Research
* World Council for Psychotherapy

0.00

(0 votes)

Original source: https://en.wikipedia.org/wiki/Systematic desensitization. Read more

|

Retrieved from "https://handwiki.org/wiki/index.php?title=Philosophy:Systematic_desensitization&oldid=1029736"
*[v]: View this template
*[t]: Discuss this template
*[e]: Edit this template