Sometimes things go much beyond just feeling uncomfortable while in a certain place or situation or with certain people. Perhaps all of that starts as a feeling of fear or being distressed.

But if you notice it repeating over and over again, and becoming stronger, then it is more than obvious that it’s something much more serious.

There have been many types of research on the topic of how to approach the whole thing.

Understanding systematic desensitization for fighting anxiety is a matter of our subject here. The goal is finding the safest and most effective way to help a person deal with the issue(s).

We shall go through as many aspects as possible to have a full grasp of what is it actually, how it works and what are the results.


Before we explain how any of the therapeutic methods work, we must give a brief definition of what anxiety disorders actually are.

When a person is worried about the future and the most common reaction to current events is fear, the feelings belong to the group of mental (aka anxiety) disorders.

There are several of them and it’s not a rare case that people often have more than one.

The list includes the following:

  1. Separation anxiety
  2. Social anxiety
  3. Panic disorder
  4. Specific phobia
  5. Generalized anxiety disorder
  6. Selective mutism
  7. Agoraphobia

Those uncomfortable feelings we mentioned, in the beginning, are actually the main responsible for physical symptoms which result in disorders.

Those, among many, often include shakiness and fast heart rate.

The set of feelings has the influence over the final outcome, or to be more precise- they result in certain disorder(s).

Disorders usually result in a combination of two major factors: environmental and genetical.

A significant contribution comes from risk factors such as the history of such disorders in the family, child abuse or poverty.

Anxiety-related usually comes in combination with some other mental disorders. Those are major depressive, substance use and personality disorder.

The symptoms need to be present consistently over a longer period of time, about 6 months in order to diagnose them.

In addition to this, to absolutely confirm the existence of disorder without any doubt, a person needs to feel that he/she doesn’t function properly and that those feelings go beyond the expected for a certain situation.

It is of vital importance to discover and treat any of the disorders as soon as possible.

They tend to remain, and only with an adequate approach, a person can learn to fight them and, in some ideal situation, cure those.

The treatment includes several aspects, such as the right medications, counselling and of course, changing the lifestyle.

The numbers behind the disorders are more than shocking and saddening, as about 12% of people yearly are affected by some of the disorders.

Up to 30% of them continue having the problem over a lifetime. Speaking in sexes, females are twice as often the “victims” compared to males.

As for the ages, the majority of problems start before the age of 25. Phobias are among the most common appearing.


Joseph Wolpe, a South African psychiatrist developed a behaviour therapy to help people deal with all kinds of anxiety disorders.

This method is known as graduated exposure therapy or systematic desensitization.

This treatment unifies the elements of applied behaviour analysis as well as cognitive-behavioural therapy. This means that depending on the application by analysts or psychologists, the approach would have different starting points and approaches.

Analysts will base it on mediation and breathing, whereas psychologists will use feelings and cognitions as a trigger to motor actions.

Desensitization occurs in three stages:

  1. Identification of anxiety
  2. Learning coping or relaxation techniques
  3. React and overcome the situations

To explain the process a bit more in detail, we shall go step by step through each of the stages here. So, the first step means identifying what triggers and causes anxiety problems.

If there are several items, each of them gets a subjective ranking based on the severity.

It’s important to mention that if there are multiple triggers which induce such reaction one has to deal with each of them separately.

Furthermore, for every single stimulus and trigger one has to make a list where the events will be ranked from the least to the greatest anxiety provoker.

This entire phase is familiar as establishing anxiety stimulus hierarchy.

The next step is learning the mechanism response, such as meditation, relaxation and similar methods.

Wolpe found the relaxation to be the most effective approach, as an individual cannot feel anxious and relaxed at the same time.

This looks like training, where one gets the instructions to practice tensing and relaxing different body parts. The ultimate goal is reaching the state of serenity.

A patient must find the means to control the fear and that’s why this exercise is necessary. One mustn’t allow it to reach levels where it becomes intolerable.

Besides learning useful mechanisms to cope with the triggers and situations, one also practices breathing and takes appropriate medicine as well.

In addition to this, an important part of this phase also includes cognitive reappraisal.

Therapists encourage patients to imagine what would happen if they are exposed to triggers along with imagining the possible outcomes.

Instead of thinking about catastrophic situations, a patient should replace them with some potentially positive outcomes.

The third, final stage is where the patient starts dealing with actual and real items that were initially listed, from the less to the most stressful stimuli. One needs to be fully relaxed before he/she is introduced to the first item from the list.

If a patent is in the state of serenity, a therapist may proceed to introduce him/her to the next item listed. The ultimate goal is having the patient be able to face the most stressful item from the list without having the panic response.

The whole procedure helps the patient overcome phobias. That’s why it is very important to go through the whole phase slowly and patiently, without pushing things.

The coping mechanism needs to strengthen, and that’s something you cannot reach overnight. If any issues occur, the therapy is immediately stopped, until the patient regains the feeling of calmness.


We could also name this part something like “from theory to practice”.

Having all the procedure explained in detail in the form of definitions and rules is one thing.

On the other hand, their application, in reality, is completely different, or to be precise, more challenging.

That’s why both patient and therapist need to find some common language where both will strive towards a similar goal, which in this case means anxiety-free life.

First of all, let us try to explain the above-described procedure using a practical example.

If you have a person having an enormous phobia of spiders (arachnophobia), the desensitization process would look like this:

  1. A patient should list as many as possible situations he/she can think of involving spiders. This should include all the potential unpleasantness caused by various levels of exposure to spiders. So, anything from looking at the picture of the spider to having this dreadful creature crawling on your arm counts. The first one would represent the lowest, whereas the latter would be ranked as the highest anxiety trigger.
  2. What comes next is learning the techniques to relax and cope with the stimulus. For the beginning, one must learn to be able to mediate as well as deeply relax the muscles. Perhaps we didn’t mention so far, but the whole thing with an anxious response includes not only panic, fear and similar feelings, but the body reacts as well. One freezes, so to say, making the muscles become tense. This is why one can often recognize a person with such disorders even by the facial expression. When untreated on time, these issues turn into serious problems which are harmful both to our body and our mind.
  3. The final stage is where the game begins. Remember the picture of the spider we listed in the previous paragraph? The first step towards fighting the phobia would be showing the patient this picture, as it is the least dangerous item on the list. The next would be gazing at the spider on the floor in the next room, followed by being with one in the same room. The final goal is letting the spider be in your hands without panicking. This is definitely the ultimate and the strongest stimuli. When a patient reaches this step, the anxiety starts fading out slowly.

As you can see, the whole process requires enormous amounts of professionalism and patience, as this is the thing that cannot be cured with a single session only.

Neither the patient nor the therapist should rush things here, as it can only become worse.

The goal is having one free from disorder(s) and having him/her ability to deal with the trigger even when there’s no therapist to direct him/her.

That feeling is something that comes as a result of several successful training sessions, not after a single one.


This is the kind of thing you cannot notice after a single situation, but it’s one of those that become visible when it is already a huge problem.

You will agree that this makes application of any method much difficult as the therapist has to deal with the occasion that is already a problem and a default condition.

It is very important that a person reacts and asks for help as soon as possible. It’s not a shame to seek advice from a professional before some occasional fears become real disorders.

For example, if a person notices that he/she has some strange and uncomfortable feelings when one needs to speak in public, or when near spiders, snakes, and such situations, it is more than obvious that this has a potential to become a disorder.

Therefore, reacting on time, after just a few occasion where one noticed that something wrong is going on is what increases the chances for a therapy to be successful.

We can freely say that these are more or less the right indications that one needs therapy.

It’s always an option that a person tries to deal with the fear of him/herself, which perhaps may turn to be successful if in the very initial phase.

On the other hand, trying to do so when a problem is already an obvious disorder will only make things worse. Many therapists like to include relaxation as an integral part of the therapy.

The method has good chances of success if a patient is able to relax completely and can willingly achieve this state.

As desensitization itself, this one requires patience as there’s no magical button that can switch the option on and off.

One has to learn this throughout several sessions, where a patient will slowly accept and learn to implement relaxation.

The fact that comes as one of the greatest ironies of contemporary times is that people are hard to relax these days.

Our everyday routine is stress-induced and the sad thing is that it doesn’t decrease as the time goes by, but only grows bigger and bigger.

Even those who are not dealing with disorders have multiple issues caused by this (obligatory) lifestyle.

But, that is definitely a subject of another matter to discuss in some other articles, as our main focus here is dealing with anxiety disorders.


Discussing the pros and cons is something that is an inevitable part of every field, even when things seem almost flawless. Like here, for example.

Still, having in mind that this technique actually includes multiple approaches and methods, not all of them will be equally corresponding and, consequently, effective in dealing with certain issues.

The first thing to compare here is in-vivo VS imaginal exposure. The first one refers to confronting a patient with the feared stimuli in the real world.

Sometimes this approach is simply not feasible. Take, for example, patients dealing with PTSD caused by combats. It is difficult to create such an exact environment to expose a patient to it.

This is a multi-layered situation which includes a plethora of various smells, sound, and sights that can be hazardous to deal with for someone with an upper-level anxiety disorder.

This is where the second option, imaginal exposure plays an important role.

A patient is asked to use as vivid as possible imagination and describe the problematic stimulus.

In addition to this, a patient should use present-tense language and talk about both external and internal cues.

This means describing every single condition to the tiniest possible detail, including not only sounds, smells, and sights but thoughts and emotions as well.

This type of exposure is useful for resolving worse-case scenarios related to fears, such as patients with OCD.

Application of this method significantly reduces the aversiveness of the thought.

Compared to in-vivo exposure, this imaginal technique eliminates potential practical disadvantages to the first one.

On the other hand, the only weakness of this method is that not all people are able to imagine and recreate the triggering occasions equally vivid.

This means that desensitization is not always equally effective, precisely due to these individual differences.

Another approach to discussing here is graded exposure VS flooding. The first approach refers to slowly and gradually implementing one by one stimulus, starting from the less intensive one.

If using this method, it is advisable to create an exposing hierarchy where all the triggers will be listed, from the mildest to the strongest.

It is necessary that a patient levels up according to accepting one by one stimulus without anxious reaction.

Contrary to this, flooding means implementing the strongest stimulus at the beginning of the therapy. This was formerly known as implosive therapy.

Each of the approaches has its own yes-es and no-s, but the truth is both are equally effective.

Which one the therapist will use depends entirely on personal comfort level and preference. However, the majority of therapists opt for the first one as it is less invasive and less stressful than flooding.

Regardless of the approach, the level of disorder and the patient and the therapists themselves, do know that desensitization is a slow process, which takes up to several sessions to be able to notice the progress.

The more you apply it, the more effective it will be, so do not expect a huge change overnight. The fact that this approach is progressive and free from potential disturbing elements increases the likelihood of patient sticking with it rather than abandoning the therapy.

Generally speaking, desensitization has multiple successes in dealing with phobias. Still, the method is not so effective for treating more serious mental disorders such as depression schizophrenia and similar.

With the idea to find some compromises and adequate ways to approach certain disorder, scientists are investigating all the possible options.

One method has slowly become popular, as it has great potential. What we are aiming at here is virtual reality.


Traditional techniques are more than successful in dealing with these issues, particularly if both patient and therapist show that they are willing to cooperate.

Above all, the approach is what means the most, as we pointed out several times.

Still, science never sleeps and the new methods appear in order to find a more effective and creative approach to the whole situation.

When it comes to fighting disorders, the latest trend in the field is VR therapy.

This technique represents a link between reality and the objective world.

However, the whole thing is rather new and there are no specific empirically based pieces of evidence which can provide more information on how this method actually works and what are the outcomes.

This innovative method definitely deserves special attention as it may simulate situations which are difficult to experience on some limited occasions.

To be more specific, the list of potential triggers a patient can be tested on definitely expands.

One of the fields regarding VR where some extensive researches started is the incorporation of this virtual method into an empty chair technique.

This can be applied when an individual has certain anxious responses related to inter-personal conflicts with identifiable individuals.

How does it look like?

A patient is asked to sit in front of a virtual empty chair imagining that the one causing the anxiety is sitting in that chair.

The therapist then motivates the patient to express the thoughts assertively directing the situation towards resolving the conflict.

The greatest advantage of this method is that this scene is quite simple to create. Moreover, the chair needn’t remain empty after all, as the avatar which would resemble an individual triggering the reaction is equally easy to create.

Incorporation of lighting and effective control over it in this scene, the avatar actually doesn’t have to be 100% matching the description the patient provides to the therapist.

Moreover, during the session, the avatar doesn’t have to communicate with the patient.

It’s the therapist that dictates the course and tasks a patient should perform during the session. However, if the situation requires so, a picture of the real person triggering anxiety can be used to create as resembling as a possible avatar.

Like we said in the beginning, the whole thing is still relatively new and the time will show how successful it will be in dealing with the disorders.

Nevertheless, one must admit that it certainly has great potential. Of course, like with any of the methods, the adequate approach is essential.


It would take many pages and discussions to give even more complex insight into the whole matter.

Yet we have tried to cover as many fields as possible hoping that one will get as precise as a possible insight into this multi-layered problem.

The whole logic of this technique could be described via three simple steps:

  1. Meet the disorder
  2. Build a fear ladder
  3. Climb the fear ladder

Although this is as simplified definition as possible, that doesn’t mean the whole process is as well. But it has quite positive chances if one knows what to do.

By “one” we mean both patient and therapist.

Our article here gave you valuable information on what disorders really are and how serious they are.

Moreover, you learned more about the desensitization including all the phases along with pros and cons.

Furthermore, you are now familiar with the possible indications for the therapy.

In addition to this, you are also knowledgeable about VR therapy, which is indeed the next big thing. By this, we mean in the majority of fields, such as problems with various addictions and similar.

All in all, if you have noticed any of these symptoms and situations that may imply there’s something going on, do not hesitate to look for a therapist and get down to eliminating fears.

Understanding systematic desensitization for fighting anxiety is the initial step to take in treating and curing the problem.

Be prepared that this road will be full of challenges and obstacles. But all the ways leading to success are like that, aren’t they?

Understanding Systematic Desensitization for Fighting Anxiety

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