#3 Overcoming fear gradually

The Three Steps of Systematic Desensitization

1. Relaxation Training

Before confronting fears, individuals learn relaxation techniques to manage anxiety responses (Jacobson, 1938).

• Techniques Include:

  • Progressive muscle relaxation

  • Deep breathing exercises

  • Visualization and guided imagery

• Purpose: Equip individuals with tools to counteract anxiety during exposure.

2. Creating an Anxiety Hierarchy

An anxiety hierarchy is a ranked list of fear-inducing situations, ordered from least to most anxiety-provoking (Lang, 1969).

• Steps:

  • Identify the feared stimulus.

  • Break down the fear into specific situations.

  • Assign a subjective anxiety rating (e.g., 0–100) to each situation.

• Example: For someone afraid of dogs:

  • Seeing a picture of a dog (20/100)

  • Being in the same park as a dog on a leash (50/100)

  • Petting a dog (90/100)

3. Gradual Exposure

Individuals are gradually exposed to each level of the hierarchy while employing relaxation techniques (Marks, 1975).

• Process:

  • Start with the least anxiety-provoking situation.

  • Use relaxation to manage anxiety.

  • Move to the next level only when comfortable.

• Goal: Desensitize the individual to each stimulus, reducing overall fear.

How Does Systematic Desensitization Work?

Systematic Desensitization operates on the principles of classical conditioning and extinction learning.

• Classical Conditioning: Replaces the anxiety response with a relaxation response when exposed to the feared stimulus (Pavlov, 1927).

• Extinction Learning: Repeated exposure without negative consequences weakens the fear association (Bouton, 2004).

• Neural Mechanisms: Involves changes in the amygdala and prefrontal cortex, similar to other forms of Exposure Therapy (Quirk & Mueller, 2008).

Case Study: Overcoming a Phobia of Flying

Background: Sarah, a 35-year-old marketing executive, developed a severe fear of flying after experiencing turbulence during a flight.

Application of Systematic Desensitization

1. Relaxation Training: Sarah learned deep breathing and progressive muscle relaxation.

2. Anxiety Hierarchy:

   • Looking at pictures of airplanes (10/100)

   • Watching videos of flights (30/100)

   • Visiting an airport (50/100)

   • Sitting in a stationary airplane (70/100)

   • Taking a short flight (100/100)

3. Gradual Exposure:

   • Sarah started by viewing airplane images while practicing relaxation.

   • Progressed to watching flight videos, visiting the airport, and eventually boarding a stationary plane.

   • After several sessions, she successfully took a short flight with minimal anxiety.

Outcome

• Results: Significant reduction in anxiety levels associated with flying.

• Follow-Up: One year later, Sarah reported no recurrence of her phobia and even enjoyed a vacation abroad.

Effectiveness and Research Evidence

Meta-Analyses and Studies

• Efficacy for Phobias: Meta-analyses show that Systematic Desensitization is highly effective for treating specific phobias (Öst, 1987).

• Long-Term Benefits: Studies indicate sustained improvement years after treatment completion (Emmelkamp et al., 2002).

Comparative Effectiveness

• Versus Flooding: Systematic Desensitization is often better tolerated due to its gradual nature (Marks, 1975).

• Combined Approaches: Integrating cognitive techniques can enhance outcomes (Rachman, 1997).

Comparison with Other Exposure Techniques

Systematic Desensitization vs. Flooding

• Systematic Desensitization:

  • Gradual exposure

  • Emphasizes relaxation

  • Lower dropout rates

• Flooding:

  • Immediate exposure to the most feared stimulus

  • Can be more distressing

  • May yield quicker results but with higher discomfort (Chaplin & Levine, 1981)

Systematic Desensitization vs. Interoceptive Exposure

• Focus: Systematic Desensitization addresses external fears, while interoceptive exposure targets internal sensations.

• Application: Both can be combined for comprehensive treatment of complex anxiety disorders (Barlow, 2002).

Summary

Systematic Desensitization is a time-tested, effective technique for reducing anxiety and phobic reactions through gradual exposure paired with relaxation. By systematically confronting fears, individuals can reclaim control and significantly improve their quality of life.

Takeaway

Gradual and controlled exposure to feared situations, coupled with relaxation strategies, can effectively diminish anxiety responses and empower individuals to overcome their fears.

Further Reading

• Books:

  • Wolpe, J. (1958). Psychotherapy by Reciprocal Inhibition. Stanford University Press.

  • Barlow, D. H. (2002). Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic. Guilford Press.

• Articles:

  • Öst, L.-G. (1987). Age of onset in different phobias. Journal of Abnormal Psychology, 96(3), 223–229.

  • Quirk, G. J., & Mueller, D. (2008). Neural mechanisms of extinction learning and retrieval. Neuropsychopharmacology, 33(1), 56–72.

Activity

Create Your Own Anxiety Hierarchy

1. Identify a Fear: Choose a specific fear or phobia you wish to address.

2. List Situations: Write down situations related to this fear, ranking them from least to most anxiety-provoking.

3. Assign Anxiety Ratings: Use a scale of 0–100 to rate each situation.

4. Practice Relaxation: Learn a relaxation technique to employ during exposure.