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Systematic Desensitization: What is it and How Does it Work?

Written by Megan Hull

& Medically Reviewed by Dr. Sarah Dash, PHD

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Last Updated - 07/15/2020

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Updated 07/15/2020

Key Takeaways

  • Systematic desensitization breaks down a conditioned fear or anxiety response through the practice of relaxation techniques
  • Therapy includes three stages: learning relaxation techniques, creating an anxiety hierarchy and practicing relaxation strategies while visualizing situations in the anxiety hierarchy
  • Desensitization therapy aims to help people use relaxation techniques instead of substances to cope with underlying anxiety or phobias

Systematic desensitization can help clients address the anxiety and fear that often underlie addictive behaviors. Learn the process of desensitization and how it can help with substance use disorder recovery.

Fear and anxiety can be beneficial emotions when they help a person avoid threats to their health and safety. However, these feelings can sometimes develop in response to people or situations that aren’t truly threatening. The conditioned response of fear or panic is not helpful in these cases and can unnecessarily disrupt well-being and normal functioning.

Systematic desensitization — also called gradual exposure therapy — is a technique that can help people unlearn unhelpful fear or panic responses. Learning the treatment process and benefits of systematic desensitization can highlight the ways may help with recovery from drug or alcohol addiction.

What Is Systematic Desensitization?

Systematic desensitization is a behavior therapy technique that can be used to treat anxiety and fear-related disorders. The process of systematic desensitization can be defined as learning to stay relaxed while visualizing increasingly stressful situations. These skills can be transferred to real-life situations to help a patient cope with fear and anxiety in their daily lives. Systematic desensitization is based on psychological theories of learning and behavior.

History of Systematic Desensitization

Systematic desensitization was developed by South African psychologist Joseph Wolpe to treat anxiety and fear-related conditions. Wolpe initially conducted experiments on cats, noticing that the animals were able to overcome their fears through gradual exposure. The therapy was introduced in his 1958 book titled “Psychotherapy by Reciprocal Inhibition.” This therapy was soon after supported by another therapist, Arnold Lazurus, who also found the therapy to be effective with his patients.

Reports of the successes of systematic desensitization continued to emerge through the 1960s, and became a treatment of choice for phobias and anxiety disorders. Although it can be a time-consuming therapy, it is often extremely effective for treating anxiety and fear disorders.

How Systematic Desensitization Works

Systematic desensitization aims to break down the conditioned fear response associated with a particular object or situation. A conditioned response is an automatic reaction — like fear or panic — to stimuli that would not normally be considered threatening. Conditioned responses are established or learned over time, often without a person realizing it.

Systematic desensitization for anxiety can help break the cycle of worry by teaching relaxation strategies and exposing a person to the situation that they fear. This is done gradually so that a patient can slowly learn to cope with their fear. This process helps to break down the conditioned fear response slowly.

Treating Phobias to Improve Addiction Recovery

Fear and anxiety can make it difficult to recover from addiction. While phobias may seem exaggerated to those who don’t have them, they are very real to those who do experience them. People with phobias may avoid triggering situations or use substances to cope with fear and anxiety.

Both fear and anxiety are linked with addiction, and people may use substances to avoid or cope with these uncomfortable feelings. Seeking treatment for phobias, anxiety and addiction can improve the chances of recovery by addressing underlying causes. Although specialized addiction management is important, treatment should also address underlying mental health conditions.

Who Benefits Most from Systematic Desensitization?

People who have a conditioned fear or anxiety response to certain situations are likely to benefit from systematic desensitization. This treatment is designed to help change how people respond to situations that make them anxious or fearful. The treatment of phobias with systematic desensitization can help improve overall quality of life and functioning.

Systematic Desensitization Steps

There are 3 steps of systematic desensitization that can help a person break down an anxiety response. These steps introduce relaxation techniques and teach the patient how to use them when exposed to an anxiety-inducing situation. These systematic desensitization steps help clients slowly build skills and tolerance to manage fear and anxiety.

Relaxation Techniques

The first stage of therapy includes learning relaxation techniques for anxiety. Relaxation techniques usually involve “progressive relaxation,” which includes mindfully relaxing parts of the body bit by bit until all muscles are relaxed and the patient is able to feel the difference between tense and relaxed muscles.

Anxiety Hierarchy

A fear or anxiety hierarchy represents a series of increasingly anxiety-inducing situations as ranked by the patient. The patient and therapist establish a hierarchical list of situations that trigger fear or panic in the patient.

An anxiety hierarchy example includes a therapist introducing a situation that provokes anxiety.

Then, while practicing the relaxation techniques, the patient visualizes this situation. If the patient is able to maintain relaxed during this exposure, the therapist can progress to the next level in the hierarchy. This process continues gradually until the patient no longer feels anxiety when visualizing their fears.

Applying Relaxation to Anxiety Hierarchy

Several relaxation techniques can be used to manage uncomfortable feelings that may arise as a client works through their anxiety and fear hierarchy. These include:

  • Tension-relaxation cycles, where the therapist instructs the patient to tense a muscle group and then mindfully relax those same muscles
  • Progression of relaxation from head to toe (or in reverse)
  • Practicing relaxation at home with recordings and keeping track of practice sessions and feelings during the session

These relaxation techniques can also be used for anxiety attacks, and can help a patient if they encounter an anxiety-inducing situation in the real world.

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Systematic Desensitization Examples

An important part of systematic desensitization is completing an anxiety hierarchy. This hierarchy places the most distressing item at the bottom, and the least distressing at the top. Throughout therapy, the patient and therapist work their way down the hierarchy.

For someone with a social phobia, part of phobia treatment may include practicing relaxation techniques while visualizing situations included in their hierarchy, like attending a party with new people or giving a speech in front of a large crowd.

Desensitization Goals in Recovery

The goals of desensitization in recovery are to break down the relationship between certain triggers and an automatic response of anxiety or fear. Breaking down this relationship can help a person regain control of their reaction, and cope using strategies other than self-medication. Other goals of this treatment to help recovery include:

  • Using relaxation techniques — rather than substances — as a coping strategy
  • Developing new automatic responses to triggers
  • Feeling confident and capable of managing situations

These goals can help a person feel in control of their response and behavior in stressful situations. By addressing underlying the fear and anxiety that can cause someone to self-medicate with substances, the chances of recovery can be improved.

View Sources

Head, Lara S., & Gross, Alan M. “Systematic desensitization.” General principles and empirically supported techniques of cognitive behavior therapy, 2009. Accessed July 18, 2019.

Stevens, Tom G. “ Self-Desensitization Instructions.” You can choose to be happy, 2019. Accessed July 18, 2019.

Encyclopedia of Psychotherapy. “Systematic desensitization.” Elsevier Science, 2002. Accessed July 18, 2019.

Dubord, Greg. “Part 12. Systematic desensitization.” Canadian family physician Medecin de famille canadien, November 2011. Accessed July 18, 2019.