What is Systematic Desensitisation Therapy: Process & Techniques Used

Joseph Wolpe developed a kind of exposure therapy based on the principles of classical conditioning during the 1950s, termed systematic desensitisation. This therapy aims to change people's outlooks and reactions when specific objects or situations trigger their feelings. The therapists in this practice teach coping mechanisms to relax and stay calm.

Interested to know more about this therapeutic process? Continue reading!

Systematic desensitisation is a type of behavioural therapy which can treat psychological disorders like anxiety, PTSD, phobias and fear. This therapy substitutes a fright and an anxious reaction with conditional stimulus by counter-conditioning.

Typically, the process of systematic desensitisation consists of four basic steps. In the first step, you will learn ways to relax. Next, you make a list of your fears and rank them in descending order of intensity. This is then followed by exposing yourself to your fear in stages.

Let us get deeper and understand the steps of systematic desensitisation.

Step 1: Techniques to Relax Muscles

In this stage, patients learn techniques to relax their muscles before the process. Types of relaxation techniques that are commonly used in these cases are:

• Breathing Exercises: Patients try to calm themselves down with a guided breathing exercise session. This is an age-old process which is used to relax their muscles.
• Autogenic Relaxation: Patients repeat words or phrases in their minds during this process. The repetition in their mind creates a ripple effect on the muscles and makes them even more relaxed
• Progressive Muscle Relaxation: Each patient learns to mindfully tense and relaxes each muscle group, starting from the toes to the neck.
• ‌Visualisation: This is where patients are guided to imagine a peaceful setting to relax their muscles and feelings.

Knowing about these muscle relaxation techniques is essential in systematic desensitisation because of its principle of ‘reciprocal inhibition.’

Step 2: Ranking Every Fear

This step works in the following way:

• List of Fears: Patients are asked to make a list of all their fears and rank them on a scale depending on their trigger stimuli.
• Highlights of the List: This list should ideally begin with the scariest scenario and then shift to a situation that represents the least anxiety.
• Brainstorm Ideas: Once the hierarchy is made, discuss and brainstorm ideas to cover this vast spectrum of fear and anxiety.

However, it is better to have as many items on your list as possible because it helps in generating more exposure.

Step 3: Complete Level-1 Exposure

Systematic desensitisation is about completing the fear hierarchy, one step at a time.

• Work on Minimum Stress Levels: So a therapist starts with a scenario that causes very minimum stress levels or the least frightening situation.
• Increase Intensity: Then, as the clients get more comfortable discussing their fear, they increase the level of intensity.
• Perform Exposure Therapy: Therapists can perform exposure therapy at the in-office sessions or assign this as a task to their patients.
• Calm the Body: During the process of exposure, the patients are expected to have severe anxiety. This is when they utilise the first step, relaxation techniques, to calm their body while staying engaged in the process.

If the anxiety drops by half its peak value, this exposure process ends and is a success.

Step 4: Review and Continue

When a patient and therapist successfully attain their first exposure, they continue to meet and discuss the effects of this process. In addition, they track the symptoms of their psychological conditions and practise relaxation techniques.

Thus, developing a pattern; exposure, review and repeat. Completing the routine in this way makes each step equally challenging. Patients who break their set hierarchy of fear feel content after the end of each session.

The following are the techniques used:

• In Vitro: This is when the patients imagine exposure to the phobic stimulus.
• In Vivo: In this situation, clients are physically exposed to the phobic stimulus.
• Virtual Reality Exposure Therapy (VRET): With the help of VR technology, professionals mimic real-life situations. This helps patients work on their fears in a safe and controlled environment.

The duration of the treatment of systematic desensitisation depends on various factors:

• The severity of the symptoms
• Performance of each patient
• Goals each patient sets for themselves

However, generally, it ranges from 4 to 6 sessions. In cases of severe phobia, it can go up to 12 sessions.

Professionals can treat the following psychological conditions when using systematic desensitisation therapy as a separate treatment method or combining it with other forms of treatment. Such as:

• Any specific phobia
• Social anxiety disorder
• Generalised anxiety disorder
• Panic disorder
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)

As we have read so far, this process requires maintaining a progression. Nevertheless, the therapist and clients involved in this process keep trying unique perspectives to tailor this process as per individual requirements. 

To understand the stages of systematic desensitisation, let us move into some examples.

1. Example Specific to Fear of Heights

• A therapist will start the session by educating the patient about this process and guiding them with relaxation techniques.
• Then they would create a fear hierarchy for their height phobia. The list should look something like this, the most powerful trigger at the top and the lowest possible trigger at the bottom.
• Then by using in vivo exposure, the therapist will help the patient with the progression of heights.
• Additionally, they would constantly remind the patients to try those relaxation techniques and cognitive thinking skills.
• Someone would note the anxious levels of the patient on a scale of 10 or 100 points. The process continues until the scale drops by at least 50% of the starting value. Hence, if someone is riding an escalator, their anxiety levels spike to 80 points out of 100 on the scale. The doctor would encourage them to keep riding the escalator until it drops to 40.

2. Example of Social Anxiety Disorder

By accurately following the systematic desensitisation steps, one can resolve social anxieties that include stress and fear:

• Beginning with educating clients about the process, relaxation and cognitive skills and helping prepare a fear hierarchy, professionals combine in vivo and in vitro exposures. In some cases, only imaginable exposure can work too.
• People with social anxiety may list situations they might not have to do in person. For example, a person with this condition would imagine scenarios like speaking in front of hundreds of people.
• Therapists encourage such imaginary situations because it increases their anxiety levels, eventually making them comfortable and increasing their self-efficacy.

3. Example of OCD With Fear of Contamination

• Those who have obsessive-compulsive disorder over cleanliness could respond well to systematic desensitisation. This is because they would find several things dirty or gross, and with more numbers of fears, the progression becomes more fruitful.
• The exposure can begin with touching a door knob or an elevator button, gradually progressing to a toilet seat and raw meat.
• Sometimes, the therapists can overshoot the exposure and take their clients to a sewage treatment plant or ask them to touch animal faeces.
• Exposure to these things triggers their anxiety, and they follow the rules of substituting their fear by reacting in a relaxed manner.
• Since those with OCD over cleanliness have an excessive habit of hand-washing, the therapists would make some arrangements to limit this condition.

According to studies on systematic desensitisation, these are some statistical findings on its effectiveness.

• 90% of people who have been through one session of in vivo exposure report less fear and a reduction in their impairment with the subject of fear. Moreover, it lasts for years.
• 65% of those experiencing exposure therapies for a specific kind of phobia report eliminating their phobic reactions after one session.
• 86% of people with OCD have fewer symptoms with exposure therapy. In contrast, only 48% report similar results with a treatment supported by medications only.

Therefore, it is proven that exposure therapy produces results that last longer if compared to a medication-only treatment method.

The risk factors of this therapy are associated with inexperienced therapists or patients who do not allow complete desensitisation to occur. Therefore, it is essential to let the anxious response reduce by at least 50% after being exposed to the triggers. Otherwise, it can sensitise the fear, causing stronger reactions in future.

For instance, PTSD patients expect the treatment of systematic desensitisation to reduce their trauma. However, if the process is not done accurately, it can have a re-traumatising effect.

It is possible to try and experience the process of systematic desensitisation on your own. Nonetheless, you must remember to be slow and gradual in the process. If you notice that you are unable to bear the lower levels of anxiety, you must practise relaxation skills.

As there is no right pace for handling the hierarchy of fears, it may take months on one and a few weeks on others. Since you are trying this process without any help, make sure to take as much time as you require. It is not a wise decision to rush towards uncomfortable levels.

You can follow these tips if you try this approach alone.

• Learn relaxation techniques, as it is the key tool of this process.
• On your fear hierarchy, your list should have two items for every level of fear.
• Practise exposing yourself to your fear every day, even for a few minutes.
• Your goal should be to replace the anxious mind with a relaxed one. Thus, remember when to stop and use relaxation techniques.
• Continue with the exposure exercise until you feel half of the fear or anxiety you naturally feel. Initially, it may feel difficult, but gradually you learn to track it.

Not everyone can undergo the pressure of fear and anxiety. Sometimes there are multiple breakdowns or outbursts when it becomes intolerable. To overcome such traumatising situations, you can try systematic desensitisation. If there is anyone you know who is struggling with psychological conditions, encourage them to check out this treatment method.