Systematic Self-Desensitization
Goal
To be able to counteract anxious feelings by engaging in systematic self-desensitization
Anxiety Hierarchy
Now that you have learned how to address thinking mistakes and to relax, it is time to complete systematic self-desensitization. Systematic self-desensitization is a process where you imagine that certain anxiety-provoking situations are occurring followed by counteracting your anxious feelings with relaxation. The interaction between exposure and relaxation trains your body to no longer respond to those situations in an anxious manner. The first step in this process of becoming desensitized to anxious situations is to create an anxiety hierarchy, which consists of 10 situations that would cause you to feel anxious if they were to occur in real life.
Anxiety Hierarchy Exercise Part I (adapted from Martin & Pear, 2002, p. 378)
Instructions: Using the table on the next page to create a hierarchy of 10 anxiety-provoking situations ranging from mildly anxious (1) to extremely anxious (10). In the situation column, write a brief phrase about the situation that causes you to feel anxious or afraid. In the stimuli column, list stimuli that will prompt you to realistically imagine yourself actually experiencing the accompanying situation.
Complete this process for all 10 levels with each level reflecting a slightly larger amount of anxiety or fear, as indicated by the initial rating column beginning with 1 and ending with 10. Make sure your situations are specific and concrete since you will need to imagine them in vivid detail in part II. The last three columns will be completed in part II of this exercise.
Example: If you are afraid of flying, your “situation” might be talking to the travel agent and making reservations. Your “stimuli” might be calling travel agent, giving agent specific details about the trip, and writing down flights numbers and times.
| Situation | Stimuli | Initial Rating | Post Rating | Date Completed | # of Exposures | Real Rating |
|---|---|---|---|---|---|---|
| 1 | ||||||
| 2 | ||||||
| 3 | ||||||
| 4 | ||||||
| 5 | ||||||
| 6 | ||||||
| 7 | ||||||
| 8 | ||||||
| 9 | ||||||
| 10 |
Anxiety Hierarchy Exercise Part II (adapted from Martin & Pear, 2002, pp. 384-387)
Instructions: Find a quiet, distraction free place to complete this exercise. It will likely require several 20 minute sessions to complete. Sessions might be conducted as frequently as twice per day and no less frequently than twice per week. Make sure your anxiety hierarchy and a timer are in front of you and complete the steps listed below-using this scale to rate your anxiety level when prompted:
| 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
| None | Mild | Moderate | Strong | Extreme | ||||||
- Take several minutes to relax completely by doing deep breathing and muscle relaxation.
- Read the item to yourself-starting with the first situation listed. Allow your stimuli to help you visualize the situation clearly and vividly.
For about 10 seconds with your eyes closed, try to imagine that you are actually in that situation.- For about 30 seconds, allow yourself to relax-completely forgetting about the scene that you just imagined. Think only about your muscles and how completely relaxed you feel while breathing deeply.
- Repeat steps 2-4.
- Rate the amount of anxiety you felt while imagining the scene the second time. If you were able to imagine it with your anxiety level being a 5 or less, proceed to step 7. If not, repeat the above steps once or twice more.
- Relax for 2 minutes.
Repeat steps 2-7 with the next situation. Continue repeating the steps through all 10 of the situations. Only progress if your anxiety level is five or less for a given situation.
If you have great difficulty in imagining a scene, in relaxing while imagining it, and/or if you feel extreme anxiety (9 or 10 on the scale above), follow these steps. Otherwise, proceed to step 14.
- Immediately stop imagining and induce deep muscle relaxation for a minute or two.
- Repeat the item for only 3-5 seconds rather than a full 10 seconds. If this does not work, proceed to the next step. Otherwise, continue progressing through your items following steps 2-7.
- Go back to the previous item and imagine that item for 20 seconds on two successive presentations of the item. Then, again try the item that caused the difficulty. If this does not work, proceed to the next step. Otherwise, continue progressing through your items following steps 2-7.
- Try to construct three new items with smaller steps between them to correct the difficulty encountered with that item. Proceed through the new items as instructed in steps 2-7.
If you are still having difficulties, you would likely benefit from seeking professional help.
In general, you should be able to proceed through 1 to 4 items in one sitting. However, it is all right to go as slow as one item per session, if necessary. On the other hand, if you do not feel anxiety, you should not hesitate to go through as many as 4 items per session, or perhaps more. Each session should begin with an item that was completed successfully in the previous session.
At the end of each session, follow these steps:
- Record your post-desensitization anxiety rating for the successfully completed items (should be 5 or less).
- Record the date to indicate when those items were successfully completed.
- Record the number of exposures you had to each successfully completed item during that session.
Next Step
If in real life you experience the actual situation that you successfully completed during this exercise, rate your anxiety in the real situation (recording it in the last column) and compare it with your post-desensitization rating. This will give you some indication of the success of your generalization to the natural environment.
