Systematic desensitization (SD) is a technique developed by Joseph Wolpe in 1958 that aims to end both anxiety responses and avoidance behaviors characteristic of anxiety disorders.
Since these behaviors are especially important in the maintenance of phobic disorders, this is a technique widely used in their treatment.
The DS, as proposed by Joseph Wolpe, is based on classical conditioning. The principle is that the intensity of a response such as anxiety can be reduced through the emission of an incompatible response, such as relaxation. The appearance of certain phobic stimuli produces anxiety responses. Certain stimuli automatically produce anxiety responses. Together, the aim is to provoke an automatic relaxation response that interferes with the discomfort of the aversive stimulus .
How does systematic desensitization work?
The standardized procedure of systematic desensitization includes four steps . Training in relaxation, a construction of the hierarchies, evaluation and practice in imagination and the systematic desensitization itself. Before moving on to relaxation training, it is necessary to explain the technique to the client, to motivate him/her and make him/her understand the basic strategy and principles of technical effectiveness.
You have to explain what are incompatible responses and why if one appears, the other cannot appear (such as relaxation and tension), what is a hierarchy of stimuli, what is counter conditioning and generalization in terms you can understand.
The relaxation response that the patient will use to combat anxiety will preferably be one that he/she already knows . It is possible to use any procedure, but if possible it is better to use some kind of relaxation that the patient can put into practice quickly and effectively.
Otherwise, techniques such as progressive relaxation or breath control can be taught, which are easy to learn techniques. The fundamental thing is that in the face of the anxious situation, these incompatible relaxation responses can be applied easily, quickly, and reduce anxiety effectively.
When we want to apply desensitization we have to do an arrangement of the feared situations . This is what we call an anxiety hierarchy, where we list all the potentially anxious situations related to the topic to be dealt with and order them according to the degree of anxiety they generate. To quantify the anxiety it generates, a scale from 0 to 100 is used, where the situation with a 0 score does not generate anxiety at all and the one with a 100 score is the one that generates the most anxiety of all.
To elaborate the hierarchy we do it through a brainstorming where the patient generates situations that cause him/her anxiety. These situations are written down, specified and given a number on the scale from 0 to 100. Many times it can be difficult to start assigning numbers. A good way to start is to use anchors. First generate the items that generate the least and most anxiety, which will be 0 and 100 respectively, and an intermediate item which will be 50.
Practice in imagination
As we will use the exposition in imagination, we will have to evaluate the capacity of the patient to imagine scenes . The patient will be asked to imagine a scene, and then the details of the scene will be asked to see how vivid the imaginative display is.
Once this is assured, the presentation of the situations that cause anxiety will proceed . This presentation can be in imagination or live. You will start with the situation that causes zero anxiety and gradually work your way up the anxiety hierarchy. The first presentations will be brief, but the time of exposure will be increased. At the same time as the anxiety-causing item is presented, the relaxation strategies that have been previously learned are put into action to interfere with the anxiety and unlearn the anxious response.
Naturally, the longer the patient is exposed, the greater the desensitization. Moreover, when the anxiety produced by a situation is reduced, it is generalized to situations that are above it. Items are considered to be overcome when they produce zero anxiety. That is, until a situation generates absolutely no anxiety, it is not possible to move on to the next one.
Applications of systematic desensitization
Systematic desensitization is an appropriate treatment when the therapist directs his efforts to the elimination of phobias and anxieties provided a number of conditions are met. In order for a conditioned response to be susceptible to modification through systematic desensitization, it must be a response to a specific situation or stimulus, not due to irrational beliefs or overrated ideas, that it is an irrational fear and that there is an adequate response incompatible with that of anxiety.
In addition to its use in phobias and anxiety disorders, it may also be appropriate for treating anxiety to specific stimuli without being phobic. For example in sexual dysfunction, alcoholism, other addictions, paraphilias or insomnia.