Systematic desensitization psychotherapy is a form of behavioral psychotherapy that serves the purpose of reducing emotional receptivity to certain situations. Developed by J. Wolpe based on the experiments of I.P. Pavlov on classical conditioning (Wolpe J. Praxis der Verhaltentherapie, Bern, 1974). It is based on the assumption that during a phobia, affect is generalized, and the emotional experience of fear is associated with the initially neutral signs of those situations in which fear was born. Because of this, a psychotherapeutic goal is formulated — to achieve the extinction of a conditioned reflex, which is the experience of fear to objectively neutral stimuli, by linking these stimuli with a pleasant reinforcement.
According to Wolpe, the inhibition of fear reactions has three stages;
- compiling a list of frightening situations or stimuli with an indication of their significance or hierarchy;
- training in any method of muscle relaxation in order to form the skill to create a physical state opposite to the state with the emotion of fear, that is, the skill to inhibit the reaction of fear;
- gradual presentation of a frightening stimulus or situation in combination with the use of a muscle relaxation method. An example would be dealing with a traffic phobia. The patient is taught, for example, the method of autogenic training. Then the patient is taught to imagine himself in the subway, keeping even breathing and relaxed muscles. Then the instructor can go down with him to the subway, helping to control breathing and muscle condition. Then the instructor can drive with the patient together one stop. The next day, the patient is invited to go down the subway alone, controlling breathing and muscle condition, the next day — to drive one stop, and so on until the fear reaction disappears.
The procedure of systematic desensitization psychotherapy consists of several stages. At the first stage, the patient is trained in the method of deep relaxation (using hypnosis or anesthesia); at the second stage, the therapist and the patient draw up the so-called “Fear Hierarchy List”, at the beginning of which the situation (or object) that causes the least fear is indicated, at the end — the greatest, with intermediate 8-15 situations; at the third stage, the actual training of desensitization begins. At the same time, the patient, who is in a state of complete relaxation, is invited to mentally reproduce a situation that causes him minimal fear, and try to «get used» to it. In this way, all the positions of the «Fear Hierarchy Sheet» are worked out. When this method is applied to young children, it is not relaxation that is used as a positive reinforcement, but, for example, the opportunity to engage with other children, caress from an adult, treats; frightening situations are staged or presented in pictures. The method has the greatest effect when it is possible to accurately determine the situation (or object) in which fear (or shame) was fixed.
Literature: Svyadoshch A.M. Neurosis, M., 1982, p. 273–277; Wolpe J. Experimental neuroses as learned behavior, «British J. Psychol.», 1952, 43, p. 243–268.
Development of systematic desensitization technique
For a long time, systematic desensitization has been the queen of techniques for dealing with anxiety. However, at present, Wolpe’s ideas about the three stages of inhibition of fear reactions are used rather isolatedly, and the techniques for working with anxiety have somewhat changed. For example, the technique of confrontation with the suppression of an anxious reaction (exposure / response prevention) has become widespread. Confrontation means placing the client in a frightening situation. Usually, the client has a pronounced fear reaction, accompanied by avoidance behavior. According to learning theory, avoidance behavior was reinforced by negative reinforcement, as it led to a decrease in the fear response. The main purpose of this method is to prevent the avoidance reaction. The prohibition against avoidance can be, for example, in the form of a contract with the client to conduct an experiment, the purpose of which is to make sure that their own fears are unfounded.
For example, you can offer a client with social fears and the expectation of hostile reactions from others to ask passers-by walking towards the street what time it is. As such an experiment is carried out and the bulk of the responses are benevolent or calmly indifferent, the client becomes convinced of the groundlessness of his fears (the reaction of fear does not find reinforcement) and his tension on the street subsides, that is, as a result of a confrontation with a frightening situation, behavior changes: expectations and expectations change. learning takes place. See details →