Systematic desensitisation

Domain II · Behavioural & cognitive · Joseph Wolpe · 1958

What it is

Systematic desensitisation (SD) treats conditioned fears. The client is taught a response that is physiologically incompatible with anxiety, usually deep muscle relaxation. Then, while in that state, the client is shown the feared stimuli in small graded steps, usually in imagination. Wolpe's…

Format

• Phase 0: Behaviour analysis (assessment), sessions 1 to 2 or more. Goal: identify exactly which stimuli trigger anxiety and through what learning history. Separate fears that are classically conditioned (good fit for SD) from fears that rest on misinformation. Misinformation fears need correction…
• Phase 3: Desensitisation proper. Goal: every item, up to the top one, can be imagined at SUD 0. Format: the desensitisation part is about 15–30 min of a session. Early sessions use 8–10 scene presentations and later ones 30–50. Up to four hierarchies can be worked in one session. A scene is usually…

Who practises it, and how they are trained or regulated

• Phase 1: Relaxation training, about 6 lessons. Goal: the client can reach deep relaxation quickly from a brief cue. Format: each lesson takes about the first third of a session. Home practice is twice a day, 10–15 min. This is an abbreviated version of Jacobson's progressive relaxation, which used 50–200 sessions. Hierarchy work runs alongside in the rest of each session. Move on when: the client reliably relaxes to…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• skipping ahead. Check SUD logs, and keep in-session checks.
• the client depending on the therapist's presence. Fade it on purpose.
• pressure from the partner, and relationship conflict that needs couples work first.
• members who don't signal so as not to hold the group back. Check SUDs privately on paper.
• using the cue to escape or avoid situations. Its purpose is to lower tension, not to avoid.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.