How does Systematic Desensitization Work?

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  • Last Modified Date: 25 November 2018
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Systematic desensitization is a method to reverse learned fear behaviors in a patient. It is a behavior-based approach to phobia treatment and is often very successful, relying on a classical conditioning method to slowly break the cycle of escalating fear in a patient with a phobia. Many psychotherapists offer this treatment to their patients or can refer them to someone who specializes in phobias.

The first step in systematic desensitization involves providing the patient with some relaxation techniques. The therapist teaches the patient to use meditation, breathing exercises, and other tools to remain calm. These will be useful over the course of treatment, and are usually customized to the needs of the patient. Not all patients, for example, find meditation beneficial.

Next, the patient and therapist will work together to create a hierarchy, from the least traumatic exposure to the object of a phobia to the most traumatic one. For someone with a fear of flying, this might start with low level activities like reading about planes in the newspaper or thinking about going on a trip, and would escalate all the way to actually riding on a plane. With this list in hand, the therapist can start working with the patient on a systematic desensitization program.


The program starts with exposure to the least frightening form of the phobia. A patient who is afraid of dogs might look at dog pictures, for example. As the patient starts to experience the early symptoms of fear, the therapist works with him on relaxing and staying calm in response to the exposure. Eventually, the patient will reach a point where he is desensitized, and reacts neutrally to pictures of dogs. Then, the therapist can try escalating the exposure with a dog video, asking the patient to imagine dogs, and so forth, until the patient is comfortable enough for the final stage, exposure to an actual live dog.

This process can take varying lengths of time. Some patients do very well with systematic desensitization and may quickly progress through the steps of the hierarchy. Others may experience plateaus, where they struggle for a full session or even longer with a given exposure. It is important to avoid pushing patients, as this can traumatize them and may cause them to relearn their fear response. Knowing that someone is in therapy to overcome a fear of snakes, for example, friends and family should refrain from snake-related pranks.


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Post 9

@Esther11 - I'm not a therapist, but I have some ideas on how to get over the fear of public speaking. I think an underlying problem is lack of confidence and concern about making mistakes or looking like a fool. Some talk therapy and activities that increase confidence could be a first step.

Then getting down to systematic desensitization,it might be helpful to practice with a series of interviews - both interviewing and being interviewed.

This step might be followed by giving a presentation to young children using prompts to take your thoughts off of yourself.

Another idea might be to join a small group of adults with common interests and try to make just short comments.

Unless your job demands a lot of speaking, some people may not need to go so far as to get over the fear of speaking to a large group.

Post 8

Data has shown that fear of public speaking is one of the most common fears or phobias that people have. It quite often starts in middle school or high school, or even sometimes in elementary school.

I remember the nervousness and anxiety just waiting for my turn to speak in front of the class in high school. And then during the speech,I would blush, my voice would get hoarse and my brain would turn to mush.

I finally got past the phobia after I began teaching adult classes.

Does anyone know of a hierarchy of actions that could be taken to get over the fear of public speaking?

Post 7

@speechie - I have not heard about guides to create activities to go along with a patients hierarchy, but I have seen examples of the hierarchies and there are two things I noticed:

1) The hierarchies themselves are created by the patient, as the fears can be irrational so they may not go in a sequential order.

2) They try to give as much exposure to steps in the actual fear. For example one hierarchy I have seen was for someone who was afraid of going to give blood.

After going through a few steps with gentle exposure of the idea of giving blood (seeing someone on a movie give blood, talking with friends about giving blood); the

steps involved the actual process of giving blood for example calling the doctor to make an appointment, driving to and then parking their car at the doctor's office, sitting in the doctor's office and seeing a nurse with a needle.

It looks to me as though this method is extremely systematic and detailed! I can see why it works.

Post 6

I follow the general logic that goes into the systematic desensitization hierarchy of going from pictures of planes to eventually going on a plane, but it seems like there would be a lot of steps in between those two things that might be difficult to figure out.

Are there guides which help to aid a therapist out in creating this hierarchy?

Post 5

I love this method as it has done absolute wonders for my sister! My sister actually has obsessive compulsive disorder (OCD) and this method of systematic desensitization created a dramatic improvement.

We are talking having days where it was difficult for her to leave her room because her compulsions were that debilitating to a maybe an hour or so per week where she experiences the same type feeling as she previously that led her to have difficulty leaving her room.

The thing that surprised me though, is we had to find her a therapist that specialized in obsessive compulsive disorder. At first, she was going to a general therapist and this therapist did 'talk therapy.' As it

turns out this is a great therapy I'm sure for some, but for those who suffer from obsessive compulsive disorder, the research points to systematic desensitization over talk therapy!

Please note that we had to find her a new therapist, the therapist who was providing talk therapy did not refer my sister once she realized my sister had OCD rather she continued to perform talk therapy.

Because of this experience I think it is important to be advocates for our friends and family members that are receiving treatment!

Post 4

I wonder if we can think of systematic desensitization in non therapeutic terms. For instance, a lot of critics talk about life long exposure to violent films, TV and video games leading to a desensitization towards violence in the culture.

Similarly, a person who is addicted to pornography will become desensitized to sex. They may not experience as much pleasure when they are with a real partner and they may develop unrealistic notions about sex.

I think people can be desensitized out of fears that are an obstacle in their lives. But they can also be desensitized out of fears which might be worth keeping.

Post 3

I have a friend who is a therapist and has worked with patients with phobias for a number of years. he told me once that the success of systematic desensitization depends largely on the phobia that is being treated. In some phobias this type of treatment is very effective and in others it rarely works.

According to my friend, the success depends a lot on the tangibility of the phobia. If a person is scared of a thing or a place than they are much easier to work with than patients who have abstract or sometimes completely irrational fears. These patients are harder to work with because there is not an easy way for them to engage with their fear. A patient who is scared of spiders will be easier to work with than a patient who has a fear of nuclear war. I always thought that was an interesting distinction.

Post 2

@Moldova - For years I suffered from a debilitating fear of heights. I couldn't go in airplanes, I couldn't go on amusement park rides and in some cases I couldn't go anywhere near the windows in a building if I was above the second story. If had a huge effect on my life

I was put in touch with a therapist in my area who specializes in treating phobias. Over the course of 6 months I went through a therapy of systematic desensitization which effectively cured me of my fear of heights.

The therapy was a combination of talking therapy, practiced relaxation and then a series of field trips to places of height. We started slowly at the window

of a second story building and my therapist was there to talk me through every step of the way.

Last year I took the first plane ride of my life. A few months ago I went on a roller coaster for the first time with my husband. I will not say that I am completely cured but my quality of life is so much better than it was before. This therapy really works.

Post 1

I was watching a program in which the therapist was using systematic desensitization in order to help her client overcome her fear of spiders. She gradually exposed her by showing pictures of the spiders and then the lady was exposed to a spider in a tank.

At the end of the program, the lady was eventually able to hold the spider in her hands which cured her of the anxiety that she felt whenever she saw a spider. She realized that nothing was going to happen to her if she held a spider, and I think that some irrational fears that we develop can really keep us from enjoying life because of the constant level of anxiety that we


I know that I have a fear of heights and just getting in line in an amusement park for a ride that simulates flying used to scare me. I had to ride this ride a few times before my fear of heights subsided.

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