ASSESSMENTS OF PERSONALITY AND INTERVENTIONS IN CLINICAL
PSYCHOLOGY
SYSTEMATIC DESENSITIZATION
Demonstration: 02
Date:
INTRODUCTION:
Systematic desensitization was developed by South African psychologist Joseph Wolpe.
Systematic desensitization is an evidence-based therapy approach that combines relaxation
techniques with gradual exposure to help you slowly overcome a phobia. (Legg, 2019). It is
based on the principle of classical conditioning and was developed in the 1950s (McLeod,
2023)
During systematic desensitization, also called graduated exposure therapy, you work your
way up through levels of fear, starting with the least fearful exposure. This approach also
involves the use of relaxation techniques.(Legg, 2019).
Systematic Desensitization was shown to help decrease avoidance behavior in female
students by pairing graded aversive stimuli and relaxation techniques using counter-
conditioning process (Davison, 1968). A study also demonstrated how using humor in
systematic desensitization reduced fear just as effectively as traditional desensitization in a
sample of participants who had arachnophobia (Ventis [Link], 2000). A study also showed that
a short-term group method of administering systematic desensitization shows to be an
effective treatment for anxiety in college males (Paul, Shannon, 1966). A similar study of
administering group therapy of systematic desensitization with insight in groups who had
symptoms of phobia and anxiety also proved to be effective.(Lazarus, 1961)
Exposure therapy is a psychological treatment that was developed to help people confront
their fears. When people are fearful of something, they tend to avoid the feared objects,
activities or situations. Although this avoidance might help reduce feelings of fear in the short
term, over the long term it can make the fear become even worse. In such situations, a
psychologist might recommend a program of exposure therapy in order to help break the
pattern of avoidance and fear. In this form of therapy, psychologists create a safe
environment in which to “expose” individuals to the things they fear and avoid. The exposure
to the feared objects, activities or situations in a safe environment helps reduce fear and
decrease avoidance. (APA, 2017)
CONTENT:
Joseph Wolpe (1958; 1964) developed this approach based on his theory of reciprocal
inhibition, which found that two polarized emotional responses cannot coexist
simultaneously.
In other words, nobody can experience anxiety and be relaxed at the same time. Wolpe
developed his approach when working with World War veterans suffering from PTSD after.
During systematic desensitization, also called graduated exposure therapy, one works their
way up through levels of fear, starting with the least fearful exposure. This approach also
involves the use of relaxation techniques.
Systemic desensitization involves three main steps. First, you’ll learn muscle relaxation
techniques. Then, you’ll create a list of your fears, ranking them in terms of intensity. Finally,
you’ll begin exposing yourself to what you fear. As you work your way through your list of
fears, you’ll continue to focus on relaxation when facing each new situation until it no longer
causes discomfort.
Systematic desensitization can be used in conjunction with others treatment forms too and
can be used for population with mental health conditions like specific phobias like fear of
heights, flying, close spaces, public speaking etc, panic disorders, social anxiety disorder or
social phobia, obsessive compulsive disorder, post-traumatic stress disorder, generalized
anxiety disorder. it can also assist with uncomfortable aspects of life that do not meet the
threshold for a diagnosis. A professional who worries about speaking in public or a student
that experiences some test-taking anxiety can utilize the principles of systematic
desensitization to improve their skills and master challenging obstacles.
PROCESS:
The process of systematic desensitization involves the following steps:
1. Learn Relaxation Skills: This may include techniques like deep breathing techniques,
muscle relaxation, visualization, mindfulness techniques or meditation etc.
2. You would then create a hierarchy of fears for the phobia or feared situation.
Typically it involves 10 levels of fear, starting by what is least frightening at 1 and
most frightening at 10.
3. After ranking your fears you would slowly start getting exposed to them in a gradual
basis starting small. If there’s anxiety or discomfort in starting with exposure, one
would use the relaxation therapy and go back trying again until one can comfortably
address the fear at that level
In the current case, systematic desensitization was administered upon 22 year old Master’s
student PR, based in Bengaluru. She presented with the concern of having trouble with public
speaking (Glossophobia) and public performance. The client stated that she starkly
remembers feeling this anxiety clearly when she was running a 800m race, where she says
she had a panic attack. “I was forced to participate in that race. I was sick and so was afraid I
wouldn’t perform well” Client explains that due to this fear she fainted in the last round and
was unable to regain consciousness. When she did, people who were worried were
surrounding her and panicking about her state so much that the client remembers that she was
scared she would die then.
When asked to recall any other similar incident, she mentions a time she we had to go for a
singing performance. She recalls constantly have thoughts and worries about being judged,
evaluated, “what if I do a bad job?” and not being good enough. She continues that over time,
this spilled over to other aspects in her life and became generalized to anywhere in life where
she had to “perform”: Giving presentations, exams, group projects. She notes that she
constantly thinks “whatever I/ I will do will never be good enough and I know nothing in
skills and knowledge”
When asked if she’s ever noticed a pattern as to when she seems to get these anxious feelings,
she noted some triggering situations like crowded places, a stage, a presentation, any activity
that would involve me showing and proving my talent. When asked to rate this anxious
feeling on a scale of 1-10, with 1 being very less anxious and 10 being very high anxious –
she rated her anxious feelings being at a 7 saying that her heart starts to beat faster even at the
thought of asking a question in class.
Asking and thinking about how life would be without this anxious feeling as a concern and
how it would be – client said that it would be amazing, she would be able to convey her
thoughts and opinions in a much better way and would participate.
In regards to what she feels whens she gets these anxious feelings – PR notes that she feels
suffocated, her heart beats fast, that she feels disorganized and overwhelming.
In hopes of arriving at a solution and trying to see if and how the client has dealt with these
situations so far successfully, she notes that her panicked and anxious feelings seem to have
reduced when she is praised for her work even though it may be in public. She also noted that
with time and practice she notably felt less anxious about it.
Based on the triggers the client mentioned which included public and crowded spaces, having
to give a presentation, a stage, having to prove herself, a fear hierarchy was mutually
constructed.
Client may also practice some grounding techniques like the 5-senses and deep breathing
techniques to help curb any feeling of anxiety that may come up when working their way
through the hierarchy. Having a small prepared list of reassuring statements to recall or look
at may help reassure clients and return their focus to the task at hand and not spiral into
thinking of the consequences.
Perfor
m ing
som et
hing
prepa
ed to
a
Perform ing
genersom ething
preparedal to your
classm
crowates
d
.
Perform ing w ith only 1-2 close people present
Perform ing/speaking som ething prepared in an em pty room
Think about self-perform ing/speaking in front of a crow d
Looking at another person perform /speak in front of a crow d
Client was encouraged and suggested to take their time with each step of the hierarchy and to
revert back to relaxation techniques if she feels comfortable until she can comfortably reach
the top of the hierarchy. Since this was not a case in clinical setting, it was not followed up
for the progress.
OUTCOME:
The outcome expected from this was for the client to identify their triggers and anxieties and
over the fear of public performance and do the fear-inducing action in a more comfortable
state. Starting small with simply observing how other people perform in front of public and
slowly working their way up by making use of their protective factors and support systems,
like doing the fear inducing action in front of friends and close others; might provide a safe
space for PR to explore herself and have a mental cushion to fall back on and relax.
This fear hierarchy would be effective in tackling the behavioral side of things by getting the
client to gradually engage with the fear producing stimuli. This can be have more effect if
done in tandem with CBT techniques of trying to identify the core belief and fear of judgment
and messing up. Solution Focused Behavioral Therapy techniques to help client themselves
think about the ideal scenario and identifying the factors that would bridge the gap may be an
effective short-term technique that client may be more motivated to do.
CRITICISMS:
One criticism is that systematic desensitization is slow, and that it is often necessary to
eventually implement some form of real-life exposure in order to fully reduce the fears
(Taylor, 2002). Research has also shown that the relaxation techniques may give the illusion
of reduction in anxiety but it’s only momentary and hence may be misinterpreted as
desensitization (Rachman, 2015). This technique may also not be effective with all
populations as various factors like the intensity of the fear or phobia, individual’s cognitive
abilities may play a bigger role in how effective it would be in reducing anxiety.
Concerns of ethics have also been raised in a study by Marks in 2018 since it involved
exposing the client to stimuli that are known to cause then distress and discomfort. Because
of this, it may also not be appropriate for all people who may be more sensitive to their
traumatic experiences
Systematic desensitization also fails to address the emotional and cognitive processes that
makes a person anxious but rather aims to have the individual achieve doing the task even
though the anxiety and its cause isn’t fully explored (Kilpatrick, 2017)
CONCLUSION:
Systematic Desensitization is a therapeutic technique based on conditioning process that if
often used in behavior therapy to help client identify their triggers, anxieties and have them
become comfortable and reduce distress related to the fear inducing stimuli or situation. It is
often done by creating a hierarchy of fears and pairing it with relaxation techniques. The
client in the above case dealing with a fear of performing in public was given a hierarchy to
work through gradually based on their rating of their anxieties and relaxation techniques
paired with it, to help ground them to reality and focus on tasks at hand. Systematic
desensitization is often used with phobias and anxiety related disorders.
REFERENCES:
1. Raypole, C. (2019, February 25). How Systematic Desensitization Can Help You Overcome Fear.
Healthline. [Link]
2. 1. Wolpe J. Psychotherapy by reciprocal inhibition. Palo Alto, CA: Stanford University; 1958.
3. What Is Exposure Therapy? (2017, July 31). [Link] [Link]
guideline/patients-and-families/exposure-therapy#:~:text=In%20this%20form%20of
%20therapy,reduce%20fear%20and%20decrease%20avoidance.
4. Nash, J., PhD. (2022). Systematic Desensitization Steps: 13 Techniques & Worksheets.
[Link].
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%20desensitization%20is%20used%20to,overcome%20common%20fears%20or%20phobias.
5. APA PsycNet. (n.d.). [Link]
6. Ventis, W. L., Higbee, G., & Murdock, S. A. (2001). Using Humor in Systematic Desensitization
to Reduce Fear. Journal of General Psychology, 128(2), 241–253.
[Link]
7. Paul, G. L., & Shannon, D. T. (1966). Treatment of anxiety through systematic desensitization in
therapy groups. Journal of Abnormal Psychology, 71(2), 124–
135. [Link]
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