Systematic Desensitization

Description of the Strategy

Systematic desensitization is a venerable behavior therapy approach developed by Joseph Wolpe for the treatment of fear and anxiety-based disorders. As is described below, treatment with systematic desensitization begins with careful assessment that seeks to describe in detail the objects and/or events that occasion fear. Treatment then continues so as to include three basic procedures. The therapist teaches the patient to relax the voluntary muscles. Concurrently, the therapist and patient develop detailed narrative descriptions of personal encounters with the objects/ events that provoke fear, and they arrange the descriptions in order of increasing fearsomeness. Finally, the therapist instructs the patient to visualize the encounters in increasingly fearsome order, while the patient remains fully relaxed. Ordinarily, the therapist also encourages the patient to confront the fearsome objects/events in such a way that the actual confrontations follow relaxed visualization of them.

Wolpe's theory of the effects of systematic desensitization combines concepts borrowed from the famous physiologists Ivan Pavlov, Charles Sherrington, and Edmund Jacobson and the psychologist Clark L. Hull. According to the theory, systematic desensitization reduces fear by causing the cues for fear activation to become cues for fear inhibition. Fear amounts to aversively conditioned sympathetic responsivity to the objects/events of interest and imagery related to them. The sympathetic activation that occurs during fearsome imaging is reciprocally inhibited by the parasympathetic correlates of concurrent muscular relaxation. When sympathetic activation during fearsome imaging is reciprocally inhibited, the act of imaging acquires its own fear-inhibitory capability. This occurs through the action of conditioned inhibition. Hence, Wolpe's explanation of the effects of [Page 575]systematic desensitization appeals to conditioned inhibition of fear activation based on reciprocal inhibition of fear activation. Fearsome images and their real-life referents become conditioned inhibitors of the sympathetic arousal they once excited. Muscular relaxation came to be the reciprocal inhibitor of choice in systematic desensitization, but in principle, reciprocal inhibition of sympathetic activation via assertive behaviors and sexual arousal would serve equally well.

By the late 1960s, systematic desensitization came to be commonly regarded as efficacious and as the treatment of choice for a variety of fear-and anxiety-related disorders. Therefore, psychological theorists were quick to provide post hoc explanations of Wolpe's results using the languages of their own theoretical orientations. By the end of the 1970s, a dozen or so theories of the effects of systematic desensitization had appeared. Some of the theories asserted simply that systematic desensitization was a special case of a more general principle such as habituation, respondent extinction, or counterconditioning. Others of the theories posited the action of change mechanisms such as expectations of therapeutic gain, the therapeutic relationship, and covert self-modeling of fearless behavior. Even psychodynamic explanations of the effects of systematic desensitization appeared. Problematically, the late 1960s and early 1970s saw the emergence of a research literature about systematic desensitization that was large, methodologically heterogeneous, and substantively contradictory. Theorists with diverse doctrinal leanings were able, therefore, to find empirical support for their assertions.

Also during the 1970s, Isaac Marks began popularizing the idea that systematic desensitization is simply a variant of exposure technology. Marks argued that successful fear therapies such as systematic desensitization, flooding, and participant modeling worked for the same reason; they all incorporated imaginal or actual exposure to the cue stimuli for fear. Descriptions of systematic desensitization as a variant of exposure technology are now commonplace, and such a characterization is not without intuitive appeal. However, categorizing systematic desensitization as a variety of exposure technology does little to explain how systematic desensitization works, because the beneficial effects of exposure themselves remain to be explained satisfactorily.

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