Systematic Desensitization

The Principle of Counterconditioning: Relaxation

Systematic Desensitization (SD) is a technique designed to reduce anxiety associated with specific stimuli (phobias, stressful situations).

The first mandatory step is relaxation training, commonly using progressive muscle relaxation.

The objective is to teach the patient to identify tension in his or her body and voluntarily induce a state of muscle relaxation.

The underlying logic is physiological: it is impossible to be deeply relaxed and anxious at the same time.

Therefore, relaxation will serve as an incompatible response that will compete with anxiety when the feared stimulus is presented.

Construction of the Anxiety Hierarchy (USA)

The second component is the elaboration of a hierarchy of anxiogenic situations, graded by means of Subjective Anxiety Units (SAU).

The patient, with the help of the therapist, lists situations related to his fear (e.g. fear of dogs) and ranks them from 1 to 10 or from 0 to 100.

The lowest level could be "hearing a distant bark" or "seeing a picture of a dog", while the highest level would be "touching a large barking dog".

It is vital that the order is established by the patient, not the therapist, as the perception of threat is entirely subjective. This scale will be the road map for graded exposure.

The Graded Exposure Process

Once relaxation has been mastered and the hierarchy established, the actual desensitization process begins. Initially, work is usually done on imagery.

The patient is asked to vividly visualize the situation of least anxiety (Item 1 of the hierarchy) while applying the relaxation technique.

If anxiety appears, he/she should "freeze" the image and relax the muscles until the anxiety disappears.

Only when the patient can imagine the scene without discomfort, he/she advances to the next step.

The ultimate goal is to transfer this learning to live exposure, allowing the patient to face the actual stimulus without the conditioned fear response, having extinguished the connection between the stimulus and the anxiety.

Summary

This technique reduces anxiety associated with specific stimuli through the principle of counterconditioning. Deep muscle relaxation is taught, since physiologically it is impossible to be relaxed and anxious at the same time in front of the stimulus.

A hierarchy of anxiogenic situations subjectively ordered by the patient is constructed. Fears are classified from the lowest to the highest level, creating a graded roadmap for intervention.

The process involves visualizing the scenes of the hierarchy while maintaining a state of relaxation. Progressive progress is made until the fear response is extinguished, finally transferring this learning to live exposure.