Systematic desensitization, developed by Wolpe, is a cornerstone of treatment for panic disorder and agoraphobia. Desensitization involves the patient exposing him or herself to the feared situation, in a non-threatening way, that is totally controlled by the patient. It is a way of "un-learning" a phobia.
What is In Vivo Desensitization?
In vivo desensitization is the process of doing systematic desensitization in real life. For example, if the phobic person fears being in the supermarket, the supermarket is the place where the person will go to practice in vivo desensitization. Some therapists will accompany clients in vivo, meaning they will go outside of their offices and into the supermarket. Others will train the clients how to do desensitization while at the office, and the clients will practice in vivo on their own or with other clients, in the case of group treatment.
Cognitive Treatment as Preparation for Systematic Desensitization
In preparation for desensitization, the client learns and practices relaxing body and mind. The client is taught to use proper breathing and muscle relaxation to relax the body at will.
Clients with panic disorder and agoraphobia are taught to recognize the thoughts that are panic attack triggers. Clients learn to recognize they are having these thoughts, and argue with them. An example would be, "If you go in the supermarket you will have a panic attack and everyone will laugh at you." The argument would be, "You might not have a panic attack at all, and if you did, no one would even notice."
Example of a Desensitization Hierarchy in Agoraphobia Treatment
The client and therapist prepare a list of tasks that would allow gradual exposure to the supermarket. They are arranged in a hierarchy, from least threatening to most scary. The hierarchy may look something like this:
- Drive to the supermarket;
- Get out of the car in the supermarket parking lot;
- Go in the entrance to the supermarket and then leave;
- Go further into the supermarket and then leave;
- Go to the back of the supermarket and then leave;
- Pick up one item in the supermarket, then replace it and leave;
- Purchase one item in the supermarket, and so on.
The Process of Systematic Desensitization
The client will start with a step that causes very little, minor anxiety. For some this will be step one, for others it might be step 7. The client exposes herself to the step and then leaves, uses relaxation techniques and cognitive training to recover, and then returns and repeats this same step over and over until the anxiety goes away entirely. Then, the person will try the next step.
Important steps in doing systematic desensitization can be found here. It is important to do this under the advice and care of a specialist in desensitization because if done improperly, it could make the phobia worse.
This article is for information purposes only. Anyone experiencing troubling symptoms should consult their medical or mental health care professional in person.
Lisa C. DeLuca - Lisa C. DeLuca is a psychotherapist/social worker who works with families and teens. She also treats panic and anxiety disorders.
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