Systematic Desensitization

Systematic desensitisation works for specific phobias such as:

• fear of flying
• fear of spiders or snakes

However, it is found to have little success when treating phobias which have a more general set of fears such as a social phobia – agoraphobia is a fear of going out and so is a general phobia rather than being simply one stimulus which provokes the fear response. 

It was first developed by Wolpe (1958) and is used in the treatment of phobias.

AIM: This therapy aims to extinguish an undesirable behaviour fear by replacing it with a more desirable one: relaxation.

Systematic desensitisation works through RECIPROCAL INHIBITION. Two contrasting emotions cannot co-exist i.e., you cannot feel fear and relaxation at the same time.

1. The subject is given training in deep muscle relaxation techniques.
2. A hierarchy of fear is formed, with the most frightening stimulus at one end and the least at the other
3. The subject is made to relax at each stage of the hierarchy, starting with the least fearful situation, and only progresses to the next stage when they feel sufficiently relaxed to do so. 

Example: fear of spiders

• 1: Think about spider
• 2: See picture of spider
• 3: Be in same room as spider in glass tank
• 4: Sit next to glass tank with  the lid closed
• 5: Sit next to glass tank with  the lid open
• 6: Put hand in tank
• 7: Hold spider in hands

Rachman (1965) investigated the separate effects of desensitisation and relaxation in Wolpe's technique of “systematic desensitisation”.

Four small groups of spider-phobic participants were allocated to the following treatments:

• desensitisation with relaxation
• desensitisation without relaxation
• relaxation only
• no-treatment controls. 

The effects of treatment were assessed by subjective reports, avoidance tests and fear estimates.

Marked reductions in fear were obtained only in the desensitisation-with-relaxation group and it was concluded that the combined effects of relaxation and desensitisation are greater than their separate effects.

Capafons et al (1998) found that systematic desensitisation was successful in overcoming a fear of flying. The programme had 3 phases: 

• First phase: training in relaxation and imagination
• Second phase: focus on setting up hierarchy and stopping negative thoughts
• Third phase: presentation of hierarchy along with the focus on stopping negative thoughts. 

Key points:

• 20 patients took part alongside a control group of 21.
• Success was measured by self-report, interview and recording biological factors when patients in the simulator.
• Programme was found to work.

Similar results were found by Rothbaum et al (2000) so increasing reliability of Capafons’ results.

Wolpe (1988) claims that 80-90% of patients are either apparently:

• cured
• much improved

This is after an average of 25-30 sessions.

However, systematic desensitisation is not effective with disorders such as schizophrenia. 

• Evidence suggests that it is quite effective for certain phobias such as animals or objects.
• The positive effects seem to last longer than other therapies for phobias
• It is less stressful than other therapies such as flooding. 
• It is considered ethical because the patient has a lot of control over the treatment: progression up the hierarchy only occurs when they feel confident enough

• It does not work for all phobias, particularly social phobias.
• It does not work for psychoses such as schizophrenia as the individual needs to be able to relax and has to be involved in the whole process, not everyone can do this.
• It is not 100% effective. It does not work for every person.
• It can still be quite stressful for the patient
• It can be time consuming and expensive
• The hierarchy and relaxation may not be necessary. Exposure to the feared stimulus alone may be enough to cure the phobia. 
• If a phobia is a result of an unconscious or underlying issue, systematic desensitisation will not remove the cause. 

Overall, the use of systematic desensitisation can be considered a useful contribution to society as it is a non-invasive treatment that has been shown to be successful for disorders such as phobias. This was supported by evidence from Rachmn and Capafons, who found that marked reductions in fear were obtained only in the desensitisation-with-relaxation group and it was concluded that the combined effects of relaxation and desensitisation are greater than their separate effects.

It allows the patient to take some control over their treatment and progress. However it does not work for all disorders.