What is Systematic Desensitization?

Systematic Desensitization

Systematic desensitization is a type of behavioural therapy that utilizes exposure therapy to treat anxiety and phobias. South African psychiatrist Joseph Wolpe first developed this approach in the 1950s.

It has since become a popular technique for treating various anxiety disorders, post-traumatic stress disorder (PTSD), and specific phobias, such as the fear of snakes or fear of spiders. The primary goal of systematic desensitization is to help individuals gradually confront their fears in a controlled manner, ultimately replacing fear responses with relaxation responses.

One of the critical components of systematic desensitization is the concept of counter-conditioning. The therapy process involves the creation of a fear hierarchy, which is a list of situations or stimuli that provoke varying levels of fear or anxiety.

While working with a therapist, the individual is gradually exposed to each item on the hierarchy, starting with the least fear-provoking situation and progressively moving to more anxiety-inducing scenarios. During the exposure sessions, the individual learns and practices relaxation techniques to counter their fear response, ultimately helping reduce anxiety and increase their self-control.

Systematic Desensitization Overview

As a part of cognitive behavioural therapy (CBT), systematic desensitization seeks to reduce anxiety, stress, and avoidance behaviours by carefully planning exposure to the source of discomfort. Throughout the therapy, patients can tackle their fears in a safe environment under the guidance of a mental health professional who helps them develop relaxation and coping strategies.

Systematic desensitization usually occurs in three main stages:

Anxiety Hierarchy

One of the main components of systematic desensitization is the creation of an anxiety hierarchy. This involves listing the feared situations or stimuli related to the phobia or anxiety disorder in a graded order from the least to the most anxiety-provoking scenarios. This hierarchy is a roadmap for individuals to face and overcome their fears gradually.

Relaxation Techniques

Before beginning the process of exposure to anxiety-provoking stimuli, the individual must learn and practice different relaxation techniques to help them cope with the anxiety. Some standard relaxation techniques include deep breathing exercises, progressive muscle relaxation, and meditation.

These techniques aim to induce a state of calm and relaxation in the individual and facilitate the process of reciprocal inhibition, which prevents anxiety from coexisting with relaxation.

Graded Exposure

Once the anxiety hierarchy is established, and the individual has learned and practiced relaxation techniques, the process of graded exposure begins. This step involves gradually confronting the feared situations or stimuli, starting at the lowest level of the hierarchy while simultaneously using the relaxation techniques to manage anxiety.

The individual moves up the hierarchy only when they can successfully handle the current level of exposure without experiencing significant anxiety.

History and Development

Systematic desensitization is a form of exposure therapy first developed by Joseph Wolpe. It is based on the concept of reciprocal inhibition, which suggests that an individual cannot experience anxiety and relaxation simultaneously.

Wolpe conducted several studies on the artificial induction of neurotic disturbance in cats in 1958. He discovered that the best way to treat the neurotic animals’ symptoms was to gradually decondition them.

By providing the neurotic cats with various feeding conditions, Wolpe deconditioned them. Wolpe substituted relaxation as a treatment to alleviate the symptoms of anxiety because he was aware that this feeding treatment would not generalize to humans.

Wolpe’s approach aimed to help patients facing phobias and anxiety by gradually exposing them to their fears while utilizing relaxation techniques. He found, however, that when he presented the actual anxiety-inducing stimulus objects to a client, the relaxation techniques did not work.

Bringing all of the objects into his office was difficult because not all anxiety-inducing stimuli are physical objects, but rather concepts. Wolpe instead started having his clients imagine the anxiety-inducing stimulus or look at pictures of the anxiety-inducing stimulus, which is still done today.

The therapy is also based on the principles of classical conditioning, a learning process discovered by psychologist Ivan Pavlov. In systematic desensitization, the goal is to remove the fear response associated with a phobia and replace it with a relaxation response through a process called counter-conditioning.

Applications and Effectiveness

Phobias and Anxiety Disorders

Systematic desensitization is an effective strategy for treating phobias and anxiety disorders rooted in learned situations. This type of exposure therapy aims to reduce anxiety, stress, and avoidance by slowly exposing the person to the thing that makes them uncomfortable in a well-planned way.

Patients can learn how to relax and deal with their fears and worries by working with a mental health professional in a safe environment.

Post-Traumatic Stress Disorder

Systematic desensitization therapy has also benefited individuals with post-traumatic stress disorder (PTSD). This approach helps patients confront and cope with traumatic memories or triggers by teaching them relaxation techniques and gradually exposing them to anxiety-provoking stimuli related to their trauma. The process can be tailored to each individual’s specific needs and situations, allowing for a personalized approach to address their PTSD symptoms.

It is important to note that systematic desensitization may not be an effective treatment solution for disorders like depression or schizophrenia. However, for those struggling with anxiety disorders, phobias, and PTSD, this therapy has proven to be a valuable tool in reducing anxiety and helping individuals regain control over their lives.


The evidence for systematic desensitization’s effectiveness is mixed. R. W. Willis and J. A. Edwards found in a 1969 randomized control trial that systematic desensitization was more effective than implosive therapy in reducing avoidant behaviour associated with mice, and Rynae Butler, and colleagues in 2011 found that systematic desensitization was effective in treating separation-related problem behaviours in dogs.

However, according to a 1982 study by R. Warren and R. McLellarn, the evidence for the effectiveness of systematic desensitization as a treatment for maladaptive anger and aggression is inconclusive due to methodological flaws and contradictory results.

Systematic Desensitization vs Other Treatments

Exposure therapy is another form of treatment for anxiety disorders, which involves directly confronting the feared objects, activities, or situations. Unlike systematic desensitization, exposure therapy does not always require a gradual approach or relaxation training. Instead, it may involve “flooding” – intense and prolonged exposure to the feared stimulus – to extinguish the fear response.

Virtual Reality Exposure Therapy (VRET) is a newer form of exposure therapy that uses virtual environments to replicate anxiety-provoking situations safely. This technology-driven approach has been found effective in treating various anxiety disorders, such as phobias, post-traumatic stress disorder, and social anxiety disorder.

While VRET and systematic desensitization aim to reduce anxiety through exposure, VRET offers a unique advantage by allowing customizable virtual settings and controlled exposure to specific feared stimuli.

  1. Butler, R., Sargisson, R.J., & Elliffe, D. (2011). The efficacy of systematic desensitization for treating the separation-related problem behaviour of domestic dogs. Applied Animal Behaviour Science, 129, 136-145.
  2. Joseph Wolpe and Arnold Lazarus. Behavior Therapy Techniques. Oxford: Pergamon Press Ltd., 1996
  3. Powers MB, Emmelkamp PM. Virtual reality exposure therapy for anxiety disorders: a meta-analysis. 2008. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.
  4. Warren, R., & McLellarn, R.W. (1982). Systematic Desensitization as a Treatment for Maladaptive Anger and Aggression: A Review. Psychological Reports, 50, 1095 – 1102.
  5. Willis, R.W., & Edwards, J.A. (1969). A study of the comparative effectiveness of systematic desensitization and implosive therapy. Behaviour research and therapy, 7 4, 387-95
  6. Wolpe, Joseph (1 August 1954). Reciprocal inhibition as the main basis of psychotherapeutic effects. Archives of Neurology and Psychiatry. 72 (2): 205–226. doi:10.1001/archneurpsyc.1954.02330020073007

Last Updated on September 26, 2023