What is systematic desensitization and how does it work?
Systematic desensitization (DS) is a technique developed by Joseph Wolpe in 1958, which aims to finish both the anxiety responses and avoidance behaviors typical of anxious disorders.
Since these behaviors are especially important in the maintenance of phobic disorders, it 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, it is intended 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 hierarchies, evaluation and practice in imagination and the systematic desensitization itself. Before going on to training in relaxation, it is necessary to explain the technique to the client, to motivate him and make him understand the basic strategy and the principles of technical efficiency.
You have to explain what incompatible answers are and why if one appears, the other can not appear (like relaxation and tension), what is a hierarchy of stimuli, what is counterconditioning and generalization in terms you can understand.
Relaxation training
The relaxation response that the patient will use to combat anxiety will preferably be one that he or 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 control of breathing, which are easy techniques to learn, can be taught. The fundamental thing is that in the anxious situation, these incompatible responses of relaxation can be applied easily, quickly, and reduce anxiety effectively.
Anxiety hierarchy
When we want to apply desensitization we have to make an order of the feared situations . This is what we call a hierarchy of anxiety, where we list all the potentially anxious situations related to the topic to be treated and order them according to the degree of anxiety they generate. To quantify the anxiety generated, a scale of 0 to 100 is used, where the situation with a score of 0 does not generate anxiety at all, and the situation with a score of 100 is the one that generates the most anxiety.
To develop the hierarchy we do it through a storm of ideas (brainstorming) where the patient generates situations that cause anxiety. These situations are recorded, specified and given a number on the scale from 0 to 100. It can often be difficult to start assigning numbers. A good way to start is to use anchors. Generate first the items that generate less and more anxiety, which will be 0 and 100 respectively, and an intermediate item that will be 50. From here the items are easier to sort.
Practice in imagination
As we will use the exhibition in imagination, we must evaluate the patient's ability to imagine scenes . The patient will be asked to imagine a scene and then ask the details of it to see how vivid the visualization is in imagination.
Desensitization properly
Once this is assured, the situation that causes anxiety will be presented . This presentation can be in imagination or live. It will begin with the situation that causes zero anxiety and will gradually go up the hierarchy of anxiety. The first presentations are made briefly, but the time of exposure will increase more and more. At the same time that the anxiogenic item is presented, the relaxation strategies that have been previously learned to interfere with anxiety and unlearn the anxious response are set in motion.
Naturally, the longer the patient is on exposure, the greater desensitization. In addition, when it is possible to reduce the anxiety produced by a situation, it is generalized to situations that are above it. Items are considered outdated when they produce zero anxiety.That is, until a situation generates absolutely no anxiety, you can not 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 whenever a series of conditions are met. 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 overvalued ideas, that is an irrational fear and that there is an adequate response incompatible with anxiety.
In addition to its use in phobias and anxiety disorders, it may also be adequate to treat anxiety to specific stimuli without being phobic. For example in sexual dysfunctions, alcoholism, other addictions, paraphilias or insomnia.
