Systematic desensitization (Wolpe, 1958; Lazarus; 1961; Kraft, 1969; Wachtel, 1977; Kraft & Kraft, 2004) is a method used in behaviour therapy and is an extremely helpful tool in the treatment of phobias. The principle of this technique is that, by pairing the anxiety with relaxation, the patient becomes desensitized to the phobic stimulus. Gradually, the psychotherapist introduces various scenarios from the easiest to more difficult ones. As the individual masters one or more potentially anxiety-provoking situations, he gradually becomes more confident with the phobic stimulus and, at the same time, feels more relaxed.
Hypothetical treatment programme of a phobia using systematic desensitization
Presenting condition: moth phobia
A) Provide the patient with ample opportunity to outline the characteristics of the phobia and possibly talk about the source of the problem.
B) Establish a ‘special place’ (Callow, 2003; Kraft , 2012) in which the patient feels comfortable, relaxed and in possession of his abilities.
C) Discuss together a list of potentially anxiety-provoking situations starting with the easiest situation and working towards more difficult ones*. The following is an example of an anxiety hierarchy which might be used in the treatment of an individual with moth phobia.
- Looking at pictures of moths in a biology book.
- Looking at a moth in the corner of a large room.
- Looking at a moth in the corner of a small room.
- Looking at a moth on the floor.
- Looking at a moth on the floor in close proximity.
- Being able to distinguish a moth in the bin.
D) Over an agreed period of time, the psychotherapist introduces the patient to each event systematically and gradually. This is done in the hypnotherapy. If the patient become distressed, he is immediately returned to the special place. From time to time, suggestions of relaxation are given in order to encourage the patient to master his anxiety. Ego strengthening is also given in order to boost the patient’s confidence.
E) Termination of therapy.
Systematic desensitization can be used in conjunction with psychoanalytic psychotherapy (Wachtel, 1977) and exposure therapy (in vivo desensitization). In addition, the therapy can also be enhanced by cognitive restructuring. Systematic desensitization is an effective technique for the full range of phobic anxieties.
David Kraft, PhD
UKCP Registered Psychotherapist
* This hierarchy has also been called a ‘Subjective Units of Discomfort Scale or SUDS (Wolpe, 1973). However, when this scale was originally invented, the therapist asked the client to give a percentage number of a series of anxiety-provoking situations, and then devised a short list of scenarios in order.
Pictures: Joseph Wolpe (above), David Kraft (below)