Self-Control Desensitization

Description of the Strategy

Self-control desensitization (SCD) is a variation of systematic desensitization (SD) that was developed by Marvin Goldfried in 1971. It is based on a somewhat [Page 509]different theoretical model than SD and provides for more procedural control to clients. Classical systematic desensitization as developed by Joseph Wolpe is based on a counterconditioning model and relies on a hierarchical procedure of gradual anxiety extinction. Two aspects are important. First, fear-producing situations must be arranged on a graduated hierarchy, from those involving the least anxiety to those involving the most. Second, the anxiety-producing scenes must be paired with relaxation such that the relaxation is stronger than the anxiety. It was considered important to immediately terminate the anxiety-producing scene should anxiety occur, so that anxiety did not overwhelm relaxation, rather than relaxation reducing anxiety. The therapist is in charge of this procedure, instructing the client and presenting the anxietyproducing scenes in ascending order and with the appropriate timing.

In self-control desensitization, however, the theoretical model of counterconditioning is replaced by a coping-skills model. Rather than an automatic weakening of a psychological bond taking place, a method of active coping is learned. The rationale provided to clients is that they have learned through past experience to react to certain situations with anxiety. They are told that the relaxation and breathing control techniques that they will learn will help them cope with these situations with less anxiety and avoidance. In addition, in accordance with a more mediational paradigm, clients are told it is not as important that a strict anxiety hierarchy be constructed and followed. The therapist works with clients to include items from a variety of different anxiety-producing situations. In presenting the anxiety-producing scenes, the therapist may encourage the client to stay with it until the anxiety diminishes, rather than terminating it as soon as anxiety appears. This practice is contrary to that considered optimal according to the counterconditioning model.

The treatment program is as follows. Clients are given the coping-skills rationale and are taught relaxation and deep-breathing skills. They are instructed to pay attention to their internal sensations as a way of acquiring information about their progress in coping and to use these skills to relax away anxiety and practice covert cognitive rehearsal for situations they may face. Anxiety-producing scenes from a variety of situations are constructed jointly by the therapist and client, and the client is asked to imagine them for 10 to 15 seconds if there is no anxiety response. If there is an anxiety response, however, the client is instructed to remain with the scene and gradually to relax the anxiety away or use other coping strategies to reduce the anxiety. Only if anxiety becomes unmanageable should the client terminate the scene. It is not necessary that the scenes be presented in a hierarchy, and scenes should be repeated until the client can handle the anxiety without difficulty or until it has been eliminated. Once clients have learned relaxation and other coping strategies, they can then use them in actual anxiety-producing situations. In fact, for ultimate success, it is important that clients practice these techniques outside of the therapy situation, in a sort of homework assignment. Research by Aaron Beck and his colleagues has shown that client completion of homework assignments in cognitive therapy correlates significantly with therapeutic outcome. It is likely the same would be true with other therapeutic interventions.

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