Systematic Desensitization for Anxiety

The last post was a general overview of exposure therapy for anxiety. In this post we’ll look at a very structured approach to exposure therapy known as systematic desensitization, or graduated or graded exposure exposure.

In systematic desensitization, we very gradually expose ourselves to things that cause us anxiety through a series of small, manageable steps. Systematic desensitization is the most common and effective treatment for phobias, including social phobia, but we can use systematic desensitization for any type of anxiety.

Systematic Desensitization and Graded Exposure

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

In the last video we learned how exposure decreases anxiety. But rather than plunging ourselves right into the middle of what’s making us anxious, we want to expose ourselves gradually through a process called graded exposure or systematic desensitization. Now we’re going to look at systematic desensitization in more detail.

The key to graded exposure or systematic desensitization is to break your exposure down into a series of small steps that will gradually lead you to your goal. So you start with a list of about 8 to 12 steps, and then you rate each of these steps on a scale from 1 to 10 in terms of how much anxiety they cause you. And so they form a sort of ladder with the least anxiety provoking on the bottom and the one that causes you the most anxiety at the top.

And then you work your way up through these steps, starting by exposing yourself to the ones that cause you the least amount of anxiety, and then going step by step until you make your way up to the top of the ladder. And so if you have a fear of spiders your ladder might look something like this. And notice at the bottom of the ladder we’ve started with just imagining a spider because perhaps anything involving an actual real life spider would be too anxiety provoking for you to be able to even start. And so you need to make sure that the first rungs on your ladder are manageable.

Or if you have social anxiety your ladder might look something like this.

And then once you’ve come up with your exposure ladder you start by exposing yourself to whatever’s on the bottom step of the ladder. And when you’re exposing yourself you want to feel a little bit of anxiety, up to about a three, but anything higher than that can be too much to start with now when you first expose yourself to something.

Your anxiety might spike a bit, so you want to be prepared for this initial surge of anxiety, and then if you do experience an increase in anxiety try some anxiety reduction techniques and then see if your anxiety starts to come back down to a 3 out of 10 or less.

But if your anxiety stays at a level of four or above then you don’t want to continue with the exposure because it’s causing you too much anxiety right now and it’s going to be a negative experience is going to increase the amount of anxiety that you associate with this step, rather than be a habituating experience that makes you more comfortable with this step.

So if your anxiety stays elevated then it’s time to do the three r’s: retreat, recover and repeat.

So first you retreat. And what this means is simply that you stop doing the exposure for now.

And then you recover and give yourself a chance to calm down until you’re not feeling anxious anymore.

And then you repeat and you start the exposure again.

And you continue with these steps of retreat, recovery and repeat as often as you need until your anxiety no longer rises above a three. And continue with your exposure to this step until you become habituated to it and your level of anxiety drops to below a three and then you’re ready to move on to the next step, which may have been a four out of ten before. But now as you’ve started to climb that ladder it’s now only a three out of ten which is low enough for you to expose yourself to that.

And you keep working your way up the ladder until you’ve habituated to each of these steps.

And eventually you become comfortable even with that step at the top of the ladder which may have caused you a 10 out of 10 on the anxiety scale before and now it’s down to a much more manageable level of about a three.

And so by gradually exposing ourselves to what’s making us anxious we can conquer even our biggest fears without ever getting too far out of our comfort zone.

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