There are many psychological treatments developed to respond to the psychological problems and disorders that exist. Some of them have proven to be effective in improving the symptoms or even eliminating the problem, as is the case with two of the most commonly used treatments in therapy to treat phobias: systematic desensitization and exposure.

These are highly effective techniques and very similar to each other, to the point that they are often confused. However, the truth is that there are differences between systematic desensitization and exposure , as we will see throughout this article.

Two methods used in psychotherapy

Exposure therapy and systematic desensitization are two of the major treatments used for a wide range of disorders.

Although are particularly well known for their success in treating phobias , there are several variations of these techniques that are used in problems such as post-traumatic stress disorder (exposure to interoceptive sensations, for example, or desensitization through eye movement reprocessing). Even techniques such as behavioral experiments that are used in behavioral problems or to combat beliefs (such as in obsessive-compulsive disorder or major depression) are largely based on the same principles. Let’s look at a brief definition of each of the terms.

Exhibition

Exposure is a basic but very powerful technique, which bases its functioning on placing the subject or patient face to face with the stimuli he or she fears . The aim is to make the subject remain in the frightening situation long enough for his anxiety to subside naturally, to the point of becoming imperceptible. Thus, an habituation to the stimuli is produced.

This exposure can and usually is graduated in such a way that the process is not excessive for the patient , making a hierarchy of exposure from which the subject will be exposed to different stimuli until the level of anxiety is reduced until it becomes imperceptible.

There are many variations of the exhibition (in fact, under a certain perspective, systematic desensitization could be considered as such), and it can be applied both live and in imagination or even in recent years through virtual reality.

Systematic desensitization

This is a technique similar to exposure, aimed at achieving the reduction of aversive emotional and anxious responses for the patient while limiting and avoiding avoidance of situations.

On this occasion, it starts from the idea that if fear is learned, it can also be learned to eliminate it: the therapeutic efforts will be focused on the subject being able to eliminate the anxiety generated by the stimulation in an active way. The aim is for him to actively carry out responses that are contrary to and totally incompatible with the anxious ones, in such a way that he learns to eliminate the association between stimulus and fear in order to generate another between stimulus and relaxation, indifference or another alternative. In other words, it is based on counter-conditioning.

In this case, too, the subject will have to expose himself to the stimuli that generate anxiety, being essential the hierarchization of the stimuli in such a way that the process of counter-conditioning can be carried out little by little and with increasingly anxious stimuli. Traditionally and in a habitual way this technique tends to be carried out in imagination, although it is possible to carry it out with live stimulation or in virtual reality.

5 big differences between both techniques

While a superficial observation may show that there is a great similarity between desensitization and exposure and even cause us to confuse them, a deeper analysis of their functioning shows that they have some remarkable differences. Among them, the following five stand out.

Slightly different objectives

One of the main differences between exposure and systematic desensitization is the fact that they have objectives that, although similar, are different: while in exposure the objective is for the subject to reduce his anxiety levels by remaining in the aversive situation itself, systematic desensitization seeks for it to generate responses that do not leave room for the appearance of anxiety .

2. Different operating mechanisms

Deeply linked to the previous point, in addition to the objectives they also differ in the methods. Although in both cases the patient has to face the stimulus that causes anxiety, while the exposure is based on the habituation to the stimulation as a method to reduce the anxiety that it generates, in the desensitization the counter-conditioning is used , looking for the subject to carry out a response incompatible with the anxiety that substitutes its previous response.

3. Structuring and gradualness in the exhibition

Another element that can mean a difference between both techniques is the compulsory nature of the graduation. Systematic desensitization is always carried out in a very structured manner, requiring a clear hierarchy of exposure. However, although exposure can also be (and in fact is recommended) graduated, it is also possible to find variants such as implosion and flooding in which exposure to the most feared stimulus is very immediate. The rhythm will also depend on the preferences and possibilities of the patient and how he or she reacts to the exposure.

4. Different use of relaxation

Relaxation techniques such as diaphragmatic breathing and Jacobson’s progressive relaxation are very useful elements and are frequently used to reduce the level of anxiety, being frequently incorporated in both techniques.

However, the use made of them is different: while in systematic desensitization they are used as a mechanism for counter-conditioning, employing them as a response incompatible with anxiety, in exposure their use is limited to lowering the level of tension in the face of exposure to the phobic stimulus in those cases where the anxiety is excessive for the patient.

5. Different levels of generalization

Although both techniques are very effective in treating phobias when applied correctly by trained professionals and taking into account the needs and particularities of each patient and situation, the truth is that another difference can be found in terms of their level of generalization.

The exposure allows reducing the anxiety level towards the phobic stimuli agreed between therapist and patient in a very efficient way, but although the habituation to such stimuli can be generalized towards other similar ones, the effect of the technique can be slightly restricted. However, since systematic desensitization allows the generation of an alternative response, it is possible that in this second one there may be a greater generalization towards other situations and stimulations that generate anxiety, applying the same incompatible response.

Bibliographic references

  • Labrador, J. (2004). Behavior modification techniques. Spain: Ediciones Pirámide.