Systematic desensitization is an effective method of treating panic attacks, phobias, and avoidance behavior, first used by Dr. Joseph Wolpe in the 1950s. Wolpe found that people could overcome their avoidance behavior by learning how to relax deeply while facing their fears in stages. Two types of desensitization are used:
Fantasy Desensitization: you “imagine or visualize” yourself with the feared thing, or in the feared situation, etc., while deeply relaxing your body. You practice in fantasy desensitization until the feared thing, place, person, etc., does not provoke an anxious reaction. In essence, you rehearse facing your fears in a safe place, and learn how to relax while doing so. When you feel ready, you move to reality desensitization.
Reality Desensitization: now you face your fears up close and personal, but you do so with tools that will help you cope and handle the situation. By breaking down “big fears” into small pieces, and having rehearsed using fantasy desensitization, you likely will find that your anxiety level is manageable, and may have decreased.
Systematic desensitization is a method of treatment based on Pavlov's classical conditioning, also called associative learning. In classical conditioning two things, events, people, etc., are paired that causes you to associate one thing with the other. As an example, think of going to your dentist, and while sitting in the waiting room you hear the whine of the drill. If you have had painful experiences having your teeth filled, just hearing the sound of the drill might cause you to have an anxiety attack. Or if you have experienced panic attacks while shopping in a mall—then stepping into a mall, or even thinking about doing so may set off feelings of panic. In both cases you have been conditioned or sensitized to respond with anxiety.
Systematic desensitization is also called counter conditioning because it reverses the conditioning by reducing the level of anxiety to the feared stimulus, either the dentist or the mall. The reasons why counter conditioning works are: it is physiologically impossible to be anxious and relaxed at the same time, and you go at your own pace, one small step at a time allowing you to face your fears. The following are three necessary components to setting up your own desensitization program:
You must be able to relax yourself deeply and quickly with diaphragmatic breathing and other techniques.
You have created a hierarchy of your fears.
You are able to visualize in detail your feared situations, event, people, etc.
A hierarchy of fears is created by breaking down your fears into the smallest steps possible (at least ten steps per hierarchy), and rating the steps from easiest to hardest. As you face and accomplish each small step, your confidence will grow and your anxiety will decrease. Create one hierarchy for each fear. Below is a sample hierarchy for someone who has panic attacks in a shopping mall:
Think about going to the mall.
Drive to mall, do not park, turn around and go home.
Drive to a mall, park, sit in car for five minutes, return home.
Drive to mall, park, get out, and walk to the front entrance of the mall. Do not enter the mall; return to your car and go home.
Go into the entrance of the mall and stand for a few minutes. Return to your car and go home.
Go into the mall and walk as far from the entrance as possible, then return home.
Go into the mall and go into one store. Stay for at least five minutes, then return home.
Go into two to three stores and buy something.
Go into as many stores as possible and buy a few items.
Walk the entire mall and go into as many stores as possible.
Shop and then get something to eat.
This hierarchy can be worked through in fantasy desensitization first. You would imagine each step, and reduce your anxiety about it by breathing. You could also go right into reality desensitization either alone, or have a “buddy” go with you until your anxiety is decreased enough for you to work alone.
Guidelines for systematic desensitization are as follows:
Sometimes a step on the hierarchy may elicit no anxiety. For example, if you are working the fantasy desensitization program and imagining driving to the mall does not cause a flutter, then either remove it from the hierarchy, or try to make the details of the scene more intense. On the other hand, if you have worked a step on your hierarchy many times and you still experience high anxiety, then either break the step down into smaller pieces, or rewrite your hierarchy so that the step comes later in the hierarchy.