What to Know About Systematic Desensitization

Medically Reviewed by Smitha Bhandari, MD on July 17, 2023
3 min read

‌Systematic desensitization therapy is a type of behavioral therapy used to treat anxiety disorders, post-traumatic stress disorder (PTSD), phobias, and a fear of things like snakes or spiders. The aim of this therapy is to change the way you respond to objects, people, or situations that trigger feelings of fear and anxiety. You will learn coping tools to help you stay relaxed and calm‌.

‌Systematic desensitization therapy has three main steps. First, you’ll learn ways to relax your muscles. Next, you’ll make a list of your fears and rank them based on how intense your fears are. Last, you’ll start exposing yourself to your fear in stages so you get more and more comfortable dealing with it. ‌

Step 1: Deep muscle relaxation techniques. In the first stage of the treatment, people with anxiety and fears are taught breathing exercises and muscle relaxation techniques. Relaxation techniques are generally these types:

  • Autogenic relaxation. You repeat words, phrases, or suggestions in your mind that create a feeling of relaxation and calm. The repetition in the mind leads to the muscles of your body getting more and more relaxed.  
  • ‌Progressive muscle relaxation. You learn to slowly tense and relax each muscle group. You normally start from your toes and work your way up to your neck and head muscles.
  • ‌Visualization. You imagine a journey to a peaceful and calm situation, place, or setting, like a seashore or a garden. This aids muscle relaxation and feelings of relaxation.

Learning muscle relaxation techniques is important because of a principle called ‘reciprocal inhibition.’ The idea behind reciprocal inhibition is that you can’t be relaxed and fearful at the same time. When you're feeling relaxed, it’s hard to feel tense. Tension is what you feel when you’re experiencing a phobia. Relaxation techniques can help you learn a different way of responding to your phobias. 

Step 2: Creating a fear hierarchy. In the second stage, you create a list where you write out all your fears and rank them on a scale of 1 to 10. First you list your level-10 fear, which causes you the highest amount of anxiety that you can imagine. Next, you list your level-1 fear, which causes you the least amount of anxiety. After this, you brainstorm the remaining fears and list them in order from 2 to 9.     

Once your list is done, you discuss your fears with your therapist and work on exposing yourself to them. You start from the fear that is the least frightening and work yourself up to your level-10 fear. 

Step 3: Working up through the fear scale through exposure. The process of exposure can be done in two ways:

  • ‌In vitro – the patient imagines being exposed to the object of fear in the mind's eye.
  • ‌In vivo - the patient is actually exposed to the fear.

A third type of exposure therapy called virtual reality exposure therapy (VRET) has become popular in recent years. Virtual Reality (VR) technology mimics real-life situations in a computer-generated environment. Virtual reality exposure therapy helps you work through your fears in a safe and controlled place. 

‌The number of sessions needed to successfully treat your fears will depend on how severe your condition is. You and your therapist will decide the specific goal you want to meet before starting the therapy. It can take anywhere from 4 to 6 sessions to see results, but you may need up to 12 sessions for a severe phobia.  

Systematic desensitization therapy is an evidence-based therapy. When a treatment is evidence-based, it means it's gone through documented scientific testing and extensive research, and has been shown to be successful. Studies point to the effectiveness of systematic desensitization therapy for anxiety disorders, phobias, and post-traumatic stress disorder. For example:

  • ‌A combination of anxiety management training and standard exposure (SE) or virtual reality exposure (VRE) treatments was found to be successful in treating 93% of patients who experienced fear of flying. All the people who got successful treatment had flown within 6 months after their treatment.
  • ‌Prolonged exposure therapy has been shown to be an effective first-line treatment for veterans and military personnel with post-traumatic stress disorder. It also helps with other feelings people may be having such as anger, guilt, depression, and negative health perceptions.