How does Systematic Desensitization work?
Building on the foundation of understanding the exposure hierarchy of classical conditioning and relaxation techniques, let's explore the step-by-step process of Systematic Desensitization:
Collaboration and assessment
The therapist collaborates with the patient to identify the specific phobia or anxiety-provoking situation. They work together to create a detailed exposure hierarchy, ranking situations or stimuli based on the level of anxiety they elicit.
Here's what this step might look like in practice:
- Identifying the fear: The therapist might ask the patient about the specific object or situation that triggers their anxiety. For example, a patient who fears heights might report experiencing significant anxiety when on airplanes or tall buildings.
- Building the hierarchy: Together, they brainstorm and rank various situations related to heights, starting with the least anxiety-provoking (e.g., looking at pictures of tall buildings) and progressing to more fear-inducing scenarios (e.g., standing on a stepladder, riding in an elevator).
Through this collaborative process, the therapist ensures the exposure hierarchy is tailored to the patient's fears and allows for gradual progression.
Learning relaxation techniques
The therapist equips the patient with relaxation techniques to manage their anxiety during exposure. These techniques may include:
- Deep breathing: Slow, controlled breathing exercises can help activate the body's relaxation response and counteract the physiological effects of anxiety, such as rapid heart rate or shallow breathing.
- Progressive muscle relaxation: Deep muscle relaxation techniques involve tensing and relaxing different muscle groups throughout the body, promoting a sense of overall calmness.
- Guided imagery: The therapist guides the patient through creating calming mental images of peaceful settings or situations, offering a temporary escape from anxiety-provoking thoughts.
By practicing these coping techniques more regularly, the patient develops a toolbox to manage their anxiety in various situations.
Gradual exposure and response prevention
Then, the actual exposure therapy begins. The therapist starts with the lowest item on the graduated exposure therapy hierarchy. Here's how gradual and systematic exposure may unfold:
- Imaginal exposure: In the initial stages, exposure might involve imagining the least fear-provoking scenario while practicing relaxation techniques. For example, a patient with a fear of heights might visualize themselves calmly looking at a picture of a skyscraper.
- In vivo exposure (real-life exposure): Once patients feel comfortable with imagined exposure, they can progress to real-life situations. This might involve visiting a park with a gradually increasing elevation or taking a low-floor elevator ride.
An essential aspect of this step is preventing the avoidance behaviors that typically reinforce anxiety. The therapist encourages the same relaxation, training the patient to tolerate some level of anxiety during exposure without resorting to escape or avoidance strategies. This allows them to learn that the anxiety will eventually subside without negative consequences.
Reinforcement and progress monitoring
The therapist provides positive reinforcement and encouragement throughout the exposure process. As the patient successfully manage their anxiety at each level of the anxiety hierarchy above, they experience a sense of accomplishment and increased confidence.
