ASHIQ HUSAIN(AGS23MPSY025)

Systematic Desensitization

Introduction

Systematic desensitization (SD) is a behavioral therapy technique developed by Joseph

Wolpe to treat phobias and anxiety disorders. It is based on classical conditioning, where an

individual learns to associate a feared stimulus with a relaxation response instead of anxiety.

The process involves counter-conditioning, where the fear response is systematically replaced

by relaxation. The process combines relaxation techniques with a hierarchical exposure to the

anxiety-causing stimulus, allowing the individual to confront and reduce their fear without an

anxiety response gradually. The patient is counter conditioned, taught a new association that

is to counter the original behaviour learnt. The new response they learn is relaxation instead

of fear (being mindful) because fear and relaxation cannot coexist (reciprocal inhibition).

After the assessment and identification of the stimulus, SD occurs in three steps

1. Relaxation Training:

The individual learns deep muscle relaxation techniques and breathing exercises like

Deep breathing exercises, Progressive muscle relaxation (PMR), Visualization

techniques, Meditation and guided imagery to control anxiety and physical reactions

to stress.

2. Establishment of Anxiety Hierarchy:

The individual and therapist collaboratively create a list of fear-inducing situations

related to the specific phobia, ranking them from least anxiety-provoking to most

distressing. Each situation is ranked on a Subjective Units of Distress Scale (SUDS)

from 0 (minimum or no anxiety) to 100 (maximum anxiety).

3. Gradual Exposure:
 The client is gradually exposed to the feared situation in a controlled manner while

practicing relaxation techniques. Exposure progresses from the least anxiety-

provoking situation to the most distressing situation according to the hierarchy

created. The client moves to the next level only after successfully managing the

previous level without significant distress. Over time, the exposure in a relaxed state

reduces the anxiety response to the feared stimulus. The client repeatedly imagines or

is confronted by this situation until it fails to evoke any anxiety, indicating that the

therapy has succeeded.

Application

 Treatment of phobias

 Managing generalized anxiety disorder

 PTSD and trauma recovery

 Reduce exam anxiety in students

 Overcome social anxiety

Methodology

Aim

To apply Systematic Desensitization as a behavioral intervention to reduce the participant's

anxiety towards a specific feared stimulus.

The intervention was administered on the participant MK, female, aged 24, studying in

Bangalore.

Materials required

 Worksheet

 Stationery

 Stopwatch

Procedure

The participant was seated comfortably in a well-ventilated and bright room and rapport was

established. Demographic details are collected and informed consent is taken. And the

participant is briefed about the purpose of the intervention. Initial assessment is done to

identify the participant’s fear causing stimulus. After identifying the feared stimulus, fear

hierarchy is created by ranking anxiety- provoking situations from least to most distressing.

The participant was then taught relaxation techniques, such as deep breathing and progressive

muscle relaxation. Script was prepared for the first level in the hierarchy and by using the

prepared script, the first level of the hierarchy was introduced, guiding the participant to

visualize the least anxiety-inducing stimulus while maintaining relaxation. The participant

was asked about the anxiety level before and after relaxation. If the participant successfully

managed their anxiety at this level, they gradually progressed to the next stage. This process

continued until they could face the most feared situation with reduced distress.

Fear

Fear of Snake

Relaxation technique
Before beginning the fear hierarchy, the participant was taught the box breathing technique to

help maintain relaxation throughout the process. The technique involved inhaling for 4

seconds, holding the breath for 4 seconds, exhaling for 4 seconds, and holding the breath

again for 4 seconds. This cycle was repeated 10 times. This relaxation strategy was integrated

into the exposure process to ensure that the participant could remain relaxed and in control as

they faced more anxiety-provoking situations related to their fear of Snake in a progressive

manner.

Fear hierarchy

Hierarchy and ranking of the fear of playing with the Dog from least to most distressing were

as follows:

1. Hearing a story of snake

2. seeing photos or videos of snake

3. hearing hissing sound of snake

4. Seeing snake on road

5. Seeing dead snake

6. Seeing snake beside me while walking

7. Seeing a snake attacking another animal

8. Seeing group of snakes

9. Seeing snake in the house

10. Being attacked by snake

Script

“One day you are sitting with your friends in the classroom and they started telling an

incident about a snake saw nearby their home. They explained the situation which a snake

swallows a little lamp. At that moment your blood rushed and you felt your heart racing faster
than usual. You started ton remember the experience you had when you were young. You felt

an uneasiness in your body.”

Table

Table 1: Showing the hierarchy of the fear from least to most distressing, along with the

corresponding SUD rank and anxiety level before and after relaxation for level one in the

hierarchy.

Sl Situation SUD Anxiety before Anxiety after

no (0-1) relaxation relaxation

1 Hearing a story of snake 1 2 0.5

2 seeing photos or videos of snake 2

3 hearing hissing sound of snake 3

4 Seeing snake on road 4

5 Seeing dead snake 5

6 Seeing snake beside me while 6

walking

7 Seeing a snake attacking another 7

animal

8 Seeing group of snakes 8

9 Seeing snake in the house 9

10 Being attacked by snake 10

Result

Table one shows the hierarchy of the fear from least to most distressing, along with the

corresponding SUD rank and anxiety level before and after relaxation.
The SUD rank given by the participant for each level from 1-10 of the hierarchy were

1,2,3,4,5,6,7, 8,9 and 10 respectively.

In the first level of hierarchy, the participant’s Anxiety level before box breathing was 2 and

after box breathing the anxiety level reported was 0.5.

Discussion

The aim of the intervention was to apply Systematic Desensitization as a behavioral

intervention to reduce the participant's anxiety towards a specific feared stimulus. SD is a

behavioral technique that includes gradual exposure to a feared stimulus accompanied with

relaxation techniques to reduce anxiety over time.

The participant for the intervention was MK, female, aged 24, studying in Bangalore. And her

fear of snake was identified through initial assessments, and a fear hierarchy was developed,

starting with the least anxiety-provoking situation to the most distressing.

For the desensitization process, one provoking situation was selected—hearing a story of

snake. At the initial presentation of the story, MK reported elevated anxiety levels, including

physical manifestations such as increased heart rate and feelings of distress. This stage served

as the baseline measurement for her anxiety response.

To mitigate her anxiety, a relaxation technique was introduced immediately after the

exposure. MK was guided through progressive muscle relaxation, a method involving the

systematic tensing and relaxing of different muscle groups to promote physical and mental

calmness. During this exercise, MK was encouraged to focus on her breathing and to

visualize a peaceful scene. After practicing the relaxation technique, MK reported a

physical tension, slower breathing.

The contrast between MK’s anxiety before and after the relaxation technique highlights the

efficacy of systematic desensitization when combining exposure with relaxation. Initially, the

story of the snake elicited a strong fear response, but the application of relaxation strategies

successfully reduced her emotional distress

MK's case underscores the value of a controlled and focused approach to systematic

desensitization. By limiting the exposure to a single, specific anxiety-provoking stimulus and

pairing it with an effective relaxation strategy, significant reductions in fear were observed.

This individualized approach demonstrates that even brief, targeted interventions can yield

meaningful improvements in managing anxiety responses. Future applications of this method

could explore the long-term retention of reduced anxiety levels and whether repeated

exposures further strengthen emotional regulation.

Conclusion

The Systematic Desensitization intervention effectively helped the participant manage mild

anxiety related to snake through the relaxation technique, which significantly reduced the

discomfort. And the positive response in the hierarchy level 1 indicates readiness to continue

progressing through the fear hierarchy.

Reference

 Dubord, G. (2011), Part 12. Systematic Desensitization. Canadian Family Physician,

57(11),

1299.

Doi: https://pmc.ncbi.nlm.nih.gov/articles/PMC3215612/
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