Systematic Desensitization with Children and Adolescents

Description of the Strategy

Since the 1950s, systematic desensitization has been a primary behavioral intervention used for a variety of fearand anxiety-based difficulties experienced by children and adolescents. Developed by Joseph Wolpe, systematic desensitization is premised on the assumption that fear responses cannot simultaneously exist in the presence of a competing response. This basic principle is referred to as reciprocal inhibition. In essence, responses that are incompatible or inhibitory to anxiety (e.g., relaxation, a state of calm) are created and compete with the fear response. Because of their incompatibility, both responses cannot coexist, and the anxiety decreases. Through repeated pairings of the inhibitory response with the anxiety-provoking stimuli, the connection between the feared stimuli and the anxiety response is diminished, a process known as counterconditioning. Fear and anxiety are the most typical presenting problems for which systematic desensitization is utilized.

Systematic desensitization involves three separate components, including (1) relaxation training, (2) the creation of an anxiety or fear hierarchy, and (3) the systematic presentation of the fear hierarchy while the child is in a relaxed state. The implementation of systematic desensitization follows these three components and consists of two phases. In the first phase, the child is taught relaxation strategies. Most frequently, progressive muscle relaxation is utilized. This component of training can take anywhere from 3 to 10 sessions; the primary goal is for the child to attain a deep state of relaxation. Relaxation tapes are often created so that the child can practice on a regular basis in the home context. To facilitate the acquisition of skills, parents are often trained to coach their children in the relaxation procedures and to reinforce their children's efforts. For children who have difficulty learning and utilizing progressive muscular relaxation, alternative means of achieving a relaxed state can be introduced, such as diaphragmatic breathing exercises, imagery exercises, or autogenic training.

Simultaneous to the relaxation training, an anxiety or fear hierarchy is created. The construction of a fear hierarchy essentially involves the creation of a number of different fear-related scenarios that approximate the target fear or anxiety-provoking situation. Children are asked to help create descriptions of different situations that produce different levels of anxiety, fear, or tension. These scenes are then rank ordered from least anxiety provoking to most anxiety provoking. For example, a child with a fear of receiving shots may begin by first creating an imaginal scene that involves driving past the doctor's office. The next scene may involve walking into the doctor's office with the child's parent, but not having an appointment. A third scene might involve going to the doctor's office with the child's parent for an appointment that would not involve a shot. A fourth scene might involve seeing a needle and watching a friend or sibling receive a shot, and so on. A final scene in the hierarchy might involve actually receiving multiple shots at the doctor's office. In addition to the feared scenes, the child is also asked to identify one scene that is relaxing and nonanxiety provoking (e.g., playing computer games, reading a book).

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