Wednesday, September 5, 2007

Systematic Desensitization

By Sudipa Sarkar
Introduction

Systematic desensitization refers to the therapeutic procedure through which the learned link between anxiety and corresponding fear-producing objects or situations can be reduced by means of employing relaxation technique in a sequence of increasing fear-arousing steps. Systematic desensitization, as in contrast with flooding, can be performed in different fragmented but interlinked forms, leading to bring alteration in behavioral process, through the application of counter-conditioning – responsible for reducing the strength of a conditional response (anxiety) in substitution with an incompatible response (relaxation) over the conditional stimulus (fear-provoking objects or situations). This paper aims at designing and describing a systematic desensitization program for an individual (Pat) suffering from social phobia.
Systematic Desensitization

Systematic desensitization is used to help clients to cope with phobic experience by inducing the method of relaxation technique. During the phases of progressive relaxation, the client should be concentrating on the differences between the primary anxiety and consequent feeling of relaxation and comforting that develops throughout the progression of the treatment procedure along with the realization of muscle release (APA, 2000). As gradual understanding of muscle release at the time of deep relaxation, the client may repeat the practice enabling the individual to recreate the relaxed experience in a wide array of situations intentionally (Stewart and Berkowitz, 1999). As soon as the relaxation technique is learned, the aim of the therapist is to create an ‘anxiety hierarchy’, cataloging the fear-provoking stimuli from least to most distressing, along with the cooperation of the client in question.
Assumed Anxiety-Hierarchy of Situation

As given the case study of the client Pat in question, the ‘anxiety hierarchy’ can be introduced as soon as the relaxation skills being learned by Pat. The hierarchy refers to cataloging situations that include fear-triggering stimuli arranged in order from the least to most emotionally distressing. The hierarchy may include the followings –
Feeling embarrassed among fellow students
Feeling anxious while speaking in front of class
Feeling as being the center of other’s attention, especially in a group setting.
Feeling reluctant about participating in non-verbal classroom activities
Active avoidance from classroom setting
Treatment Approach through Systematic Desensitization Procedure
The treatment procedure – Systematic Desensitization – is, in particular, a psycho-cognitive procedure, which views children not being stubborn or incompatible rather having an acquired anxiety instead of an oppositional or defiant disorder. As a therapist, I prefer to suggest taking the child away in a secure, confidential as well as contented atmosphere in order to initiate the therapeutic intervention. While making Pat comfortable regarding the therapeutic session, the session may begin with the analysis of whether the condition for communicating in school is actually or not a frightening factor from the child’s perspective.

Next the session may be continued with an empathetic outlook and with my attempt in determining the setting and situation perceived as most difficult and easier by Pat. For example, Pat may be found to communicate in a setting where he is alone with the teacher in the hall and no other fellow students are around him. With this understanding, I should focus on slowly increasing my expectations by inducing more complex condition and making Pat realize his goal to pursue over the condition, for example, making him to resemble safe situation within the hall, closer to the classroom door. The process may move further by encouraging Pat in non-verbal classroom activities through whispering in teacher’s ear or in one particular classmate of his preference who may act sensibly as an active and understanding listener. Counter-conditioning relaxation technique (Taylor and Arnow, 1988) thus enables Pat to resolve successfully his fear-provoking stimulus in order as listed in the anxiety hierarchy.
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