Overcoming Phobias: How Systematic Desensitization Works

What Is Systematic Desensitization?

Please be advised, the below article might mention trauma-related topics that could be triggering to the reader. If you’re experiencing a mental health emergency, please contact a crisis hotline or emergency services immediately.

If you experience an intense fear of something, you may have heard of the process of systematic desensitization as a treatment. Millions of people live with phobias of all kinds, from spiders (arachnophobia) and ophidiophobia (snakes) to heights (acrophobia) and confinement in small spaces (claustrophobia), or even the fear of flying (aerophobia).

No matter what you are afraid of and no matter how drastically your phobias affect you, there are treatments available to help you overcome them and live without fears that affect your daily life.

What is systematic desensitization?

Systematic desensitization is a behavior therapy that aims to remove the fear response to a severe phobia and replace it with a relaxation response. Our licensed clinical social workers at ReachLink use a counter-conditioning process and gradual exposure to a stimulus to help clients feel less fearful during telehealth sessions.

How does systematic desensitization work?

An example of systematic desensitization in practice would be a ReachLink therapist treating a client experiencing arachnophobia (fear of spiders). During video sessions, the therapist may begin by asking the client to look at images of a small spider at first.

As the client begins to show less anxiety related to the spider images, the therapist may increase the size of the spider being presented or suggest more realistic images until the fear response diminishes. Eventually, the client might be guided to practice exposure in their own environment with therapist support via our secure telehealth platform.

How many sessions are typically required?

The number of systematic desensitization sessions needed may depend on the severity of the phobia and can range between four and 12 sessions. At ReachLink, our subscription-based model allows for consistent support throughout this process with your dedicated licensed clinical social worker.

Types of exposure

There are two ways our therapists might expose clients to the stimuli:

• In vitro, meaning the client imagines being exposed to the stimuli (an imagined spider)
• In vivo, meaning the client is exposed to the actual stimuli (a real spider)

One study found that in vivo techniques are generally more successful than in vitro techniques when looking at childhood water phobia and using vicarious exposure as a comparison.

Virtual reality exposure therapy

A specific form of in vitro desensitization is called virtual reality exposure therapy, or VRET, which involves using virtual reality experiences to slowly expose a person to their phobia or cause of anxiety. Through ReachLink’s telehealth platform, we can guide clients through digital resources that simulate exposure in a controlled environment when in vivo methods aren’t immediately feasible.

Systematic desensitization and muscle relaxation techniques

In systematic desensitization therapy work, relaxation can be a part of systematic desensitization, but the more significant component is repeated exposure to the feared object or situation. One of the premises behind systematic desensitization is that abnormal behavior is learned and is not innate. ReachLink’s licensed clinical social workers are trained to teach effective relaxation techniques that complement the exposure process.

Origins of systematic desensitization

In the 1950s, a South African psychiatrist, Joseph Wolpe, developed a type of behavioral therapy called systematic desensitization to help people manage their most anxiety-producing phobias. Desensitization is a type of behavior therapy that has its roots in classical conditioning.

One of Wolpe’s clients provides an example of the power of systematic desensitization. In Wolpe’s experimental desensitization practice, he encountered a young adult who had a severe handwashing compulsion. The young man was intensely fearful of contaminating others with his urine.

In treating the young man, Wolpe put him in a state of relaxation and asked him to imagine scenes that would incite a low amount of anxiety, such as imagining someone touching a large container of water with one drop of urine in it.

As his client was able to tolerate this image, Wolpe continued asking him to imagine scenes where the concentration of imaginary urine increased, creating a fear hierarchy or anxiety hierarchy.

In time, the young man was able to tolerate a real bottle of urine in front of him. Ultimately, the client was able to tolerate having a few drops of diluted urine being applied to the back of his hand without feeling any anxiety. Wolpe followed up with the patient four years later to find that he was in complete remission from his compulsive behaviors. Wolpe attributed this to reciprocal inhibition or the ability to voluntarily relax anxiety symptoms in response to stimuli over time.

While this may seem like an extreme case, other studies have shown the effectiveness of systematic desensitization and how this form of therapy helps individuals move past their phobias through gradual exposure.

What is the theory behind systematic desensitization?

Joseph Wolpe based systematic desensitization on the theory of reciprocal inhibition, which involves the automatic antagonist alpha motor neuron inhibition evoked by agonist muscle contraction. This biological process is suspected to play a major role in controlling voluntary movements in the human body.

Is systematic desensitization supported by research?

In clinical psychology, systematic desensitization has proven to be highly effective in treating anxiety disorders caused by a learned situation as well as specific phobias. However, this type of therapy is not usually effective for treating mental health disorders like depression or schizophrenia, which may require different therapeutic approaches available through ReachLink’s comprehensive care model.

Treating phobia symptoms through exposure therapy

Systematic desensitization is effective at treating the symptoms rather than the cause of the phobia. Within abnormal and social psychology, systematic desensitization only treats the observable and measurable symptoms of a phobia, it doesn’t necessarily account for potential underlying causes.

Thoughts and emotions often motivate behavior, especially with social phobias and agoraphobia. With these phobias, treatment through systematic desensitization has not been as effective.

For example, a fear of public speaking could stem from a phobia or poor social skills. In these situations, the proper treatment may be treating the underlying cause, systematic desensitization, or both. ReachLink’s licensed clinical social workers are trained to assess which approach might work best for your specific situation.

While cognitive behavioral therapy (CBT) is effective for many with mental disorders including panic disorders, for people experiencing panic disorders, behavior research suggests that systematic desensitization may also have a positive impact. At ReachLink, our therapists are skilled in multiple evidence-based approaches to ensure you receive the most appropriate care.

Understanding the phases of systematic desensitization

There are several components of systematic desensitization treatment that our ReachLink therapists implement through our telehealth platform:

1. Client learns muscle relaxation techniques to manage fear and anxiety

In the first phase, your ReachLink therapist will teach you deep muscle relaxation techniques, also known as progressive muscle relaxation (PMR), as well as breathing exercises. Through video sessions, our therapists guide clients on how to meditate, control their breathing, or lower muscle tension in a specific muscle group. When you experience fears or phobias, they can make you tense, and tension can interfere with the abovementioned relaxation techniques.

2. Client undergoes gradual exposure to triggering stimuli

The second phase of systematic desensitization usually starts with the client being gradually introduced to anxiety-provoking stimuli, beginning with those that elicit the least amount of fear and progressively moving toward more challenging exposures. This hierarchical exposure allows clients to build tolerance and reduce their anxiety response over time, using the muscle relaxation techniques learned in the first phase to remain calm throughout the process.

Throughout treatment, this methodical approach helps reinforce new learning, as the brain replaces the old fear response with relaxation, ultimately diminishing the power that the phobia holds over daily functioning. The gradual and controlled exposure ensures that clients do not feel overwhelmed, promoting steady progress and increased confidence in managing their fears independently.

In conclusion, systematic desensitization is a well-established, evidence-based behavioral therapy designed to help individuals overcome phobias by using a combination of muscle relaxation and incremental exposure to feared stimuli. Whether through imagery, in vivo exposure, or the use of virtual reality technologies, this method aims to break the cycle of fear and avoidance, enabling clients to regain control and improve their quality of life. At ReachLink, our licensed clinical social workers are dedicated to guiding you through this process with compassionate, personalized care tailored to your unique needs.

If you are struggling with a phobia or anxiety disorder, know that effective treatments like systematic desensitization are available to help you move toward healing and freedom from fear—take the first step by reaching out for support today.