The 5 differences between systematic desensitization and exposure

March 26, 2024

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

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

Related article: "Types of psychological therapies"

Two methods used in psychotherapy

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

While They are especially known for their success when it comes to 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 by reprocessing by eye movements). Even techniques such as behavioral experiments that are used in behavior problems or to combat beliefs (as in obsessive-compulsive disorder or major depression) are largely based on the same principles. Let's see a brief definition of each of the terms.

Exposition

The exhibition is a basic but very powerful technique, which bases its operation on place the subject or patient face to face with the stimuli that he fears . It is about making the subject stay in the frightening situation long enough for his anxiety to go down naturally, to the point of becoming imperceptible. Thus, there is a habituation to the stimuli.

This exhibition can and often graduates 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 to be imperceptible.

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

Maybe you're interested: "Intervention in phobias: the technique of the exhibition"

Systematic desensitization

It is a technique similar to exposure, aimed at achieving the reduction of aversive emotional and anxious responses for the patient at the same time that they limit themselves and avoid the avoidance of situations.

On this occasion, part of the idea that if fear is learned can also be learned to eliminate it: the therapeutic efforts will focus on the subject getting rid of the anxiety that stimulation generates actively. It is sought to actively perform contrary and totally incompatible with anxious responses, in such a way that we learn to eliminate the association between stimulus and fear to generate another between stimulation and relaxation, indifference or other alternative. In other words, it is based on counterconditioning.

In this case, also, the subject will have to expose himself to the stimuli that generate anxiety, being essential the hierarchy of the stimuli in such a way that the counterconditioning process can be carried out little by little and with increasingly anxious stimuli. Traditionally and habitually this technique tends to be performed in imagination, although it is possible to perform it with live stimulation or virtual reality.

Related article: "What is systematic desensitization and how does it work?"

5 big differences between both techniques

While a superficial observation can show that there is a great similarity between desensitization and exposure and even generate that we confuse them, a deeper analysis of their functioning shows that they have some remarkable differences. Among them are the five that follow.

1. 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 the exhibition the objective is for the subject to reduce their levels of anxiety by remaining in the aversive situation in yes, systematic desensitization seeks that it generates answers 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 also differ in methods. Although in both cases the patient has to face the stimulus that causes anxiety, while the exposure is based on the habituation to stimulation as a method to reduce the anxiety it generates, in the desensitization contracondicionamiento is used , looking for the subject to carry out a response incompatible with the anxiety that replaces his previous response.

3. Structuring and graduality in the exhibition

Another element that can mean a difference between both techniques is the obligatory nature of the graduation. Systematic desensitization is always carried out in a very structured way, demanding a clear hierarchy of exposure. However, although exposure can also be (and in fact is recommended) graduated, too it is possible to find variants such as implosion and flood in which the 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 will react to the exhibition.

4. Different use of relaxation

Relaxation techniques such as diaphragmatic breathing and Jacobson's progressive relaxation are very useful and frequently used to reduce the level of anxiety, frequently incorporating both techniques.

However, the use made of them is different: while in systematic desensitization they are used as a mechanism for counterconditioning, using them as a response incompatible with anxiety, in the exhibition their use limits itself to lowering the level of tension when exposed to the phobic stimulus in those cases in which anxiety is excessive for the patient.

5. Different levels of generalization

While both techniques are very effective for the treatment of phobias when they are correctly applied 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 regard to their level of generalization.

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