Can Systematic Desensitization Help Your Anxiety?

Systematic desensitization is a type of behavioral treatment that uses exposure therapy to treat anxiety and phobias. It involves gradually exposing a person to something that causes extreme fear and panic, and teaches them to replace fear responses with relaxation responses.

This article explains systematic desensitization, techniques, benefits, and how to find a therapist. 

Young woman sitting with a therapist

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How It Works

Systematic desensitization is a type of therapy that focuses on teaching you how to relax in the midst of your fears. Essentially, you’ll learn the skills and tools you need to navigate situations that would have previously felt unmanageable.

Developing strategies to help you relax your body during moments of distress is the first step of systematic desensitization. Next, you create a fear hierarchy by identifying situations or objects that cause fear.

To do this, you can work with a therapist to determine what situations cause you the most fear and least fear. Extreme fear-inducing situations would be a "10," while situations provoking the least amount of fear are rated as a "1." It's important to identify levels in between as well.

Example of Fear Hierarchy

Someone with a fear of flying might rank taking a flight as a "10" with thinking about flying as a "1." Fear situations that might be ranked between 1 and 10 can include purchasing a plane ticket, arriving at the airport, or sitting in a seat on the plane.

Once you’ve completed your fear hierarchy, you’ll work with a therapist to figure out how to start exposing yourself to the fears and managing your distress along the way. Systematic desensitization starts by exposing you to your lower-level fears. So, starting with the “1” and working your way up to the “10.”

While you are exposing yourself to fearful situations, you can use relaxation techniques to manage thoughts, emotions, and sensations that come up. Over time, your body comes to realize that the anticipated danger it expects isn't going to occur and that you don't need to use avoidance to short-circuit the distressing feelings. You can use the strategies as many times as you need to reduce the anxiety.

Tactics

Relaxation techniques are helpful for calming physical sensations in the body. These strategies are versatile, in that you can use them on their own or combine them.

There are many different types of tactics that can help. Trying a variety of techniques can help you determine what works best for you.

It’s also important to note that what works best in one situation may not be as effective in another. Having multiple strategies in your toolbox gives you the ability to choose what you need at the moment. 

Deep Breathing

Deep breathing invites you to slow down your breathing and lengthen the exhale to relax the sympathetic nervous system. With this technique, you:

  • Breathe in slowly through your nose, letting your belly fill with air.
  • Hold the breath for a couple of seconds.
  • Slowly release it from your mouth with the exhale being longer than your inhale

This is also known as diaphragmatic breathing. 

Muscle Relaxation

Progressive muscle relaxation teaches you to spot tension in your muscles and relax it. By concentrating on one group at a time, you learn to tense and relax your muscles, feeling tension melt away as you release.

Visualization

Visualization is an exercise that transports you to a place that feels safe and relaxing.

To do this, choose an environment or scene that brings you peace. Paint the picture clearly in your mind, focusing on the details. Using your senses, you can draw yourself in further.

For example, you may visualize the beach with slow and steady waves, white sand, and sun. You might imagine that you can smell the saltwater and hear the movement of the water.

Meditation

Meditation encourages you to tap into the present moment by becoming aware of different aspects of your experience. The act of recognizing your anxious thoughts and emotions without judging yourself or making evaluations about your thoughts can help you reduce the intensity of your anxiety and distress.

Benefits

Systematic desensitization is a form of exposure therapy, which aids patients by breaking cycles of avoidance, fear, and anxiety. Through therapy, patients can tackle their fears in a safe environment with a mental health professional who can help them develop relaxation and coping strategies.

Exposure therapy is effective in treating a range of mental health conditions, including:

Systematic desensitization often gives patients a sense of empowerment when it comes to facing their fears. In working with a therapist, there's space to process thoughts, emotions, and beliefs related to the fear situation. This allows you to identify avoidance reactions and unhelpful thoughts.

Through this work, you can establish new associations and manage emotional discomfort when in contact with fear.

Efficacy

One study that examined virtual reality exposure strategies for anxiety treatment showed these interventions were effective in addressing a range of specific phobias. Some of these phobias included flying, fear of animals, heights, getting an injection, or the sight of blood.

Another study showed that a certain type of exposure therapy is effective for the treatment of post-traumatic stress disorder (PTSD). This method can also help individuals address concerns that occur with PTSD, such as depression, anger, guilt, and negative health perceptions.

How to Do It on Your Own

You can gradually expose yourself to fearful situations. But before starting that process, it’s important to make sure that you feel comfortable using relaxation techniques and have a few in your reserve that reduce your anxiety. 

Once you feel confident in using relaxation strategies, you can start exposing yourself to situations that bring up lower levels of fear. Take your time as you begin exposure. The goal is to learn to manage your fear when faced with frightening situations.

Exercises

To implement gradual exposure on your own, you might try the following steps:

  • Learn and practice several different relaxation techniques.
  • Make it manageable. Ten levels of fear hierarchy may be overwhelming. Instead, identify a small number of fear situations to include.
  • Expose yourself to the lowest level of your fear hierarchy for brief amounts of time.
  • Use your relaxation tools when you feel anxiety or fear. You can use more than one strategy or repeat one that is helping until the anxiety diminishes.

Tracking Your Progress

It may be helpful to keep a journal or track your mood, fear levels, and relaxation techniques used before, during, and after exposure. This can give you some insight into what is helping and how you are progressing. This information can also be useful to share with a therapist if you decide to seek professional support. 

Working With a Therapist

Because systematic desensitization involves exposure to fears, you may experience distressing emotions, anxiety, or even panic during the process. Working with a therapist to help you identify coping skills, list and rank your fears, and determine a plan for the best way to begin gradual exposure. 

Questions When Considering a Potential Therapist

When looking for a therapist, it may be worthwhile to consider: 

  • What are the concerns you're seeking help with?
  • What qualities are important in a therapist?
  • What is the education, background, and training of the therapist? Do they have training and experience using exposure therapy with patients?
  • What are your options for getting access to care?

Being able to communicate any problems, goals, and hopes for therapy is beneficial information for you and a potential therapist.

Additionally, you may want to consider what traits matter to you in a therapist. Asking questions about the therapist’s education, training, and experience treating your particular concerns can help you decide if they're a good fit. 

Therapy can be expensive, so it can be helpful to evaluate your options. That might mean going through health insurance, an Employee Assistance Program, or seeking a referral from your primary healthcare provider. In some cases, you may need to explore other community-based options.

Help Is Available

If you or a loved one are struggling with anxiety or phobias, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database.

Summary

Systematic desensitization is an effective and evidence-based treatment method to gradually expose yourself to phobias or situations that create extreme fear or anxiety. With the support of a therapist, you can learn relaxation strategies, pinpoint your fears, and begin exposing yourself to distressing situations while using techniques to cope with strong emotions. When seeking help, it's important to locate a therapist with specialized training to guide you through the process. 

A Word From Verywell

Depending on the trigger, intense anxiety, fear, or phobias can make it difficult to function in your daily life. Systematic desensitization can help you gain a sense of confidence in your ability to encounter situations that induce fear. With the support of an experienced therapist, you can learn to manage your thoughts and feelings when facing your fears.

Frequently Asked Questions

  • What is prolonged exposure therapy?

    Prolonged exposure therapy is an evidence-based approach used to treat post-traumatic stress disorder. In this type of therapy, therapists employ techniques like psychoeducation, in vivo exposure, imaginal exposure, and emotional processing to reduce symptoms of PTSD. Prolonged exposure can be used to treat different types of trauma, including those stemming from assault or violence, combat, or multiple traumas.

  • What is narrative exposure therapy?

    The American Psychological Association describes narrative exposure therapy as a treatment approach that helps patients develop a coherent life narrative in which to contextualize traumatic events. It is known for its use in helping refugees.

  • How long does exposure therapy take?

    Though patients may see progress after even a few sessions, the length of exposure therapy may be different for each patient. Typically, patients will begin to see changes after a few sessions, while more severe phobias can take around 12 sessions. The length of treatment may depend on factors such as the problem, severity of the issue, comfortability with relaxation and coping techniques, and how a patient responds to different levels of the fear hierarchy.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Dubord, Greg. Part 12. Systematic desensitizationCan Fam Physician. 2011;57(11):1299.

  2. American Psychological Association. What is exposure therapy?.

  3. Oing T, Prescott J. Implementations of virtual reality for anxiety-related disorders: systematic reviewJMIR Serious Games. 2018;6(4):e10965. doi:10.2196/10965

  4. Thng C, Lim-Ashworth N, Poh B, Lim CG. Recent developments in the intervention of specific phobia among adults: a rapid review. F1000Res. 2020;9:195. doi:10.12688/f1000research.20082.1

  5. Rauch SA, Eftekhari A, Ruzek JI. Review of exposure therapy: a gold standard for PTSD treatment.J Rehabil Res Dev. 2012;49(5):679-687. doi:10.1682/jrrd.2011.08.0152

  6. American Psychological Association. Narrative exposure therapy.

By Geralyn Dexter, LMHC
Geralyn is passionate about empathetic and evidence-based counseling and developing wellness-related content that empowers and equips others to live authentically and healthily.