Systematic Desensitization: Why Facing Your Fears Reduces Anxiety

Also called graduated exposure therapy, systematic desensitization is a therapeutic intervention for anxiety disorders, particularly phobias.

The therapy involves being exposed to situations that typically cause you high levels of stress and fear. The therapy may begin with a situation that isn’t as fear-inducing to you but progressively moves to more intense situations.

“Desensitization” refers to becoming less reactive to a stimulus in this context. The process is done in a “systematic” way, following a methodical step-by-step plan.

Systematic desensitization avoids exposing you to your greatest fears in the beginning. Instead, you’ll work your way up, going from less stressful to more stressful stimuli, and learn new coping techniques.

The three main characteristics of systematic desensitization are:

• the creation of a fear hierarchy where you score your fears from 1 to 10, 10 being the scariest
• the gradual exposure to these stressors from 1 to 10
• relaxation techniques such as visualization, progressive muscle relaxation, and mindfulness

Because exposure is systematic and gradual, your body and mind become desensitized to the stressors. Because you learn relaxation techniques, you develop coping skills to face your fears.

Systematic desensitization differs from exposure response prevention therapy (ERP). Although both involve exposure to anxiety-inducing stimuli, ERP is typically used for obsessive-compulsive disorder (OCD).

ERP aims to expose you to events related to your obsessive thoughts and prevent you from engaging in compulsions every time exposure happens.

Is systematic desensitization a type of CBT?

Yes. Because systematic desensitization is a form of exposure therapy, it’s often considered cognitive behavioral therapy (CBT). As in CBT, systematic desensitization also addresses unhealthy thinking patterns and behaviors, thus helping you better cope with stressful situations.

Systemic desensitization is also similar to applied behavior analysis — both are forms of behavioral therapy. Applied behavior analysis (ABA) involves systematically encouraging particular behaviors and discouraging other behaviors.

Unlike systemic desensitization, ABA is controversial, especially in the autism community. It encourages autistic children to conform to other people’s ideas of “normal” behavior, often at the expense of their emotional wellness and individuality. For example, ABA can involve punishing the child for behaviors associated with autism.

Systematic desensitization aims to reduce the intensity of your fear and teach you to manage anxiety-inducing situations.

Typically, most people avoid the things they fear. By gradually exposing yourself to your fear, you might reduce avoidant behaviors and learn to face your stressors without experiencing intense symptoms.

There are three steps in systematic desensitization therapy:

• learning and practicing relaxation techniques such as deep breathing, meditation, or progressive muscle relaxation
• talking about your fears, listing them from least intense to most intense
• exposure to fears while you practice relaxation techniques

Your therapist will ensure that you are safe while being exposed to your fears when it comes to exposure.

One way to do this is to avoid facing the real stressor and instead use visual imagery. Your therapist might ask you to close your eyes while they guide you through a mental scenario where you face your stressor.

For example, if you’re scared of the ocean, they might ask you to visualize being at the beach while looking at the sea from a distance. Later on, they may ask you to imagine you’re swimming in a tidal pool.

After you’ve developed coping skills, your therapist may suggest you expose yourself to your fear in between sessions. Your homework might be to watch an ocean documentary or stand on the beach and watch the ocean.

More recently, therapy may also involve virtual reality (VR). VR can bridge the gap between imagining your fear and experiencing it in real life. For example, VR might allow you to swim in a tidal pool while eliminating any actual danger.

Suppose you’re afraid of birds. Your therapist might ask you to talk about birds in detail.

As you feel more at ease with the topic, they may ask you to look at photos of birds while you focus on breathing deeply or practicing another relaxation technique.

When you feel ready to move on, your therapist could ask you to watch a video of birds in different scenarios.

As you become less reactive to this exercise, your therapist may bring a real bird in a cage to the session while you watch at a distance.

Progressively, they may bring the bird closer while you continue to practice a relaxation technique to manage your anxiety.

Eventually, you may feel less anxious about seeing or being close to a bird.

Yes. Systematic desensitization is effective for anxiety in many scientific studies.

For example:

• A 2020 study suggested systematic desensitization does reduce anxiety in people living with specific phobias.
• A 2014 study showed the therapy effectively reduced symptoms of test anxiety among pharmacy students in Malaysia. A 2015 study saw similar findings in high school students from Nigeria’s urban areas.
• A 2017 clinical trial with female nurses suggested systematic desensitization is effective in reducing general anxiety symptoms.

In recent years, there has been less research on systematic desensitization. This might be because newer desensitization therapies, such as eye movement desensitization and reprocessing (EMDR) therapy and virtual reality exposure therapy (VRET), have been developed.

But many kinds of exposure therapy take their main principles from systematic desensitization, especially the creation of fear hierarchies.

Systematic desensitization is exposure therapy to help you face your main stressors without experiencing an intense mental and physical reaction. This is done by progressively exposing you to your fears in a safe setting.

The therapy can be helpful for people with phobias and other anxiety disorders.