Systematic Desensitization: Definition, History, Research

A spider is placed on a woman's hand; the woman makes a frightened facial expression
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Desensitization, commonly referred to as systematic desensitization, is a type of behavioral therapy technique in which patients gradually become exposed to certain fear stimuli in order to overcome the fear. Desensitization is a part of cognitive therapy treatment, or conditioning, that targets a specific phobia without addressing the causes of that phobia. Since its first practice in the mid-20th century, systematic desensitization has routinized the treatment and management of many phobias.

History and Origins

The first clinical use of systematic desensitization was described by the pioneer behavioralist Mary Cover Jones (1924), who found that both direct conditioning and social imitation were effective methods for eliminating children's fears. She concluded that the best way to break down maladaptive responses was to introduce the feared object while the child was enjoying him or herself.

Jones' colleague and friend Joseph Wolpe is credited with the operationalization of the method in 1958. He based his research on the simple idea that if a person could reach some state of relaxation that is antagonistic to anxiety or fear, and then experience that fear in some way, the overall impact of that fear would be reduced. Wolpe found that relaxation in the face of situations that had previously evoked anxiety tended to reduce the fear attached to the stimuli. In other words, Wolpe was able to substitute a relaxation response to a maladaptive neurotic habit.

Important Studies

Jones' study focused on a three-year-old boy named Peter who had developed a pathological fear of a white rabbit. Jones engaged him in eating—an enjoyable practice for him—and over time slowly moved the bunny closer to him, although always at a sufficient distance so as not to interfere with his eating. Eventually, Peter was able to stroke the rabbit.

Wolpe based his study on psychologist Jules Masserman's conditioned reflex experiments, which he produced experimental neuroses in cats and then cured them using desensitization. What Wolpe did was to devise other methods for treating the cats, in a manner he called "reciprocal inhibition." Like Jones, he offered the cats food when presenting the conditioned fear stimulus. He then applied those theories to clinical patients. He concluded that forcing people to face their fears often resulted in frustration, whereas combining relaxation with stepwise exposure to different levels of their fears (called a "hierarchy of anxiety") successfully weaned them from their phobias.

Wolpe reported a whopping 90 percent rate of cure or much improvement in a series of 210 cases. He also reported that his cases did not relapse and did not develop new kinds of neurotic symptoms.

Key Theories

Systematic desensitization is based on three hypotheses that underlie much of behavioral therapy:

  • It is not necessary to find out why or how a subject learned a phobia.
  • The methodology of stepwise exposure to increasing levels of a given fear does not lead to a replacement of learned behaviors.
  • It is not necessary to change the person as a whole; desensitization targets specific responses to phobias.

The existing response or neurotic behavior, said Wolpe, is the result of learning a maladaptive response to a stimulus situation, a conditioned fear. Systematic desensitization defines that fear as a true conditioned emotional reaction, and so a successful treatment involves the patient "unlearning" the response.

Usefulness of Systematic Desensitization

Desensitization works best on people with specifically definable fear responses. Successful studies have been conducted on people with fears such as stage fright, test anxiety, storms, closed places (claustrophobia), flying, and insect, snake, and animal phobias. These phobias can be truly debilitating; for example, storm phobias could make life intolerable to the patient for several months out of the year and bird phobias could trap a person indoors.

The rate of success seems to be related to the degree of sickness shown by the patient. As with all psychology, the least ill patients are the easiest to cure. Those things which do not respond well to the treatment are nonspecific or widely generalized states of fear or anxiety. For example, agoraphobia ("fear of the marketplace" in Greek, referring to a generalized anxiety around being in public), has proven to be comparatively more resistant to desensitization.

Systematic Desensitization vs. Psychoanalytic Treatment

Results since the 1950s have generally supported the effectiveness of systematic desensitization in modifying phobic behaviors and have demonstrated its short-term as well as long-term superiority over traditional psycho-dynamic treatment options. The success rate is often quite high. Benson (1968) cites a study by Hain, Butcher, and Stevenson of 26 cases of psychoneuroses. In that study, 78 percent of patients showed systematic improvement after an average of 19 sessions—one exhibited success after a one single hour and a half session. Follow up studies of a year later reported that 20 percent of the participants saw even more improvement, while only 13 percent saw relapses.

Compared to traditional psychoanalytical treatment, systematic desensitization sessions do not require a drawn-out process. Wolpe's average of success was only ten 45-minute sessions, depending on the client's ability to learn relaxation techniques. Others have found an average of about that found by Hain, Butcher, and Stevenson, 19 or 20 sessions. In contrast, psychoanalysis to identify and treat the underlying causes of a particular fear or sets of fears, as well as study the entire personality, can take hundreds if not thousands of sessions.

Unlike psychoanalysis, desensitization can successfully be done in small groups (6–12 people, for example). No elaborate equipment is required, just a quiet room, and the techniques are easily learned by school counselors and others in counseling roles.

In addition, desensitization is applicable to a wide variety of people, anyone who has good powers of visual imagery. They don't have to be able to verbalize and conceptualize their performance: Three-year-old Peter was able to learn to pet the bunny.

Criticism

There is clearly a high success rate—although more recent studies suggest the long-term success rate is likely around 60 percent rather than Wolpe's 90 percent. But some scholars, such as psychologist Joseph B. Furst, see systematic desensitization as a method that oversimplifies the complexities of neuroses, fear, and anxiety. It ignores the social surroundings and practices of the patient which likely both originally caused and presently maintain the neurotic behaviors.

Desensitization has little effect on symptoms of depression, obsession, and depersonalization. However, as the treatment progresses, some patients report improved social adjustment. As they experience decreased fear, they report that they work better, enjoy their leisure more, and get along better with others.

Desensitization Key Takeaways

  • Desensitization, or systematic desensitization, is a behavioral therapy that helps people overcome irrational fears through gradual exposure to the fear stimuli.
  • Desensitization does not take into account the underlying causes of the fears it treats.
  • The technique has been used successfully on people experiencing stage fright or test anxiety, as well as fears of storms, closed places, flying, and insects, snakes, and more.
  • Compared to regular psychoanalytic therapy, desensitization takes a shorter period of time to achieve results, can be conducted in groups, and requires limited training of counselors.

Sources

  • Benson, Steven L. "Systematic Desensitization in the Treatment of Phobic Reactions." The Journal of General Education 20.2 (1968): 119–30. Print.
  • Bernard, H. Russell. "The Science in Social Science." Proceedings of the National Academy of Sciences of the United States of America 109.51 (2012): 20796–99. Print.
  • Deffenbacher, Jerry L., and Calvin C. Kemper. "Systematic Desensitization of Test Anxiety in Junior High Students." The School Counselor 21.3 (1974): 216–22. Print.
  • Furst, Joseph B. "The Relation of Form to Content in Psychiatric Thought." Science & Society 32.4 (1968): 353–70. Print.
  • Gelder, Michael. "Practical Psychiatry: Behaviour Therapy for Anxiety States." The British Medical Journal 1.5645 (1969): 691–94. Print.
  • Jones, Mary Cover. "A Laboratory Study of Fear: The Case of Peter." Pedagogical Seminary 31 (1924): 308–15. Print.
  • Kahn, Jonathan. "Musician's Stage Fright: Analysis and Remedy." The Choral Journal 24.2 (1983): 5–12. Print.
  • Morrow, William R., and Harvey L. Gochros. "Misconceptions Regarding Behavior Modification." Social Service Review 44.3 (1970): 293–307. Print.
  • Rutherford, Alexandra. "Introduction to 'a Laboratory Study of Fear: The Case of Peter' Mary Cover Jones (1924)." Classics in the History of Psychology. 2001. Web.
  • Wolpe, Joseph. Psychotherapy by Reciprocal Inhibition. Stanford, California: Stanford University Press, 1958. Print.
  • Wolpe, Joseph, and Arnold Lazarus. Behavior Therapy-Techniques. New York: Pergamon Press, 1969. Print.