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What is Systematic Desensitization & How Does It Work?

Systematic desensitization is a type of therapy that combines relaxation techniques with gradual exposure to your fears. This form of therapy is a behavioral therapy that is often used in the treatment of post-traumatic stress disorder, anxiety disorders, phobias, as well as a fear of things like spiders, snakes, etc. The aim of systematic desensitization is to alter the way in which you respond to situations, people, or objects that trigger your feelings of anxiety and fear. Systematic desensitization teaches you coping tools to help you remain calm and relaxed under stressful situations. Here’s everything you need to know about systematic desensitization.

What is Systematic Desensitization?

Systematic desensitization is a type of behavioral therapy that is used to treat anxiety disorders, phobias, post-traumatic stress disorder, and any type of fear of things like spiders, snakes, heights, etc. This is an evidence-based therapy that combines relaxation techniques with a gradual exposure to things that trigger your anxiety or fear. Systematic desensitization is also known as graduated exposure therapy.(1, 2, 3, 4)

During systematic desensitization, you are taught how to work your way through your anxiety and fear in levels, starting with the least fearful trigger/exposure. This therapy approach involves the use of relaxation techniques, and it is quite different from other types of desensitization techniques like flooding.

The fundamental aim of systematic desensitization is to alter the manner in which you respond to certain situations, people, or objects that trigger your feelings of stress, anxiety, or fear. Systematic desensitization teaches you coping techniques to remain calm and relaxed even in triggering situations.(5)

How Does Systematic Desensitization Work?

There are three major steps to systematic desensitization. In the first step, you will learn about muscle relaxation techniques. The second step involves making a list of your fears and ranking them in terms of intensity. The third and final step involves exposing yourself gradually and in stages to your fears. This is done in stages so that you get more comfortable in dealing with your fears over a period of time.(6)

The underlying theory behind systematic desensitization is classical conditioning, along with associative learning principles. The goal of systematic desensitization is to overcome your fears or phobia by replacing the feelings of anxiety and fear with a state of calm and relaxation. And as you work upward through your list of fears, you will continue to remain focused on relaxation, especially when facing a new and stressful situation. You will continue to do this until it no longer triggers feelings of fear or anxiety in you.

Let us go through the steps of systematic desensitization.

Step 1: Learning Muscle Relaxation Techniques

There are many different relaxation exercises that you will get to learn in systematic desensitization therapy. These exercises can either be used on their own, or you can even combine them with one another to practice deep muscle relaxation. Usually, in the first stage of therapy, people with fears and anxiety are taught some basic breathing exercises and easy muscle relaxation techniques.

Some of the popular relaxation techniques you may learn to include:

  • Diaphragmatic Breathing: This is a fundamental breathing technique that helps you learn how to control your breathing. It focuses on breathing slowly and deeply through the nose, holding the breath for a second or two, and then exhaling through your mouth.(7)
  • Visualization Technique: This involves focusing on a relaxing scene, imagining it in your mind, and concentrating on certain sensory details such as the smells or sights. This can include guided imagery, which is a technique that involves someone describing a scenery to you, and you imagine it in your mind.(8)
  • Meditation and Mindfulness: You will find that learning meditation can help you become more aware of your feelings and thoughts, especially when you come face to face with a fearful situation. Mindfulness practice enables you to notice what is happening and what you are experiencing right then in the present moment, which helps decrease anxious thoughts in mind.(9)
  • Progressive Muscle Relaxation: During systematic desensitization, you will also learn to tense up and release the muscles throughout your body. This technique can help reduce tension in the muscles and also help you recognize the difference between relaxed and tense muscles. This will help you better recognize when your muscles begin to tense up or freeze as a response to fear or anxiety.(10, 11)

Learning how to relax your muscles is important because of a theory known as reciprocal inhibition. According to the idea of reciprocal inhibition, it is not possible to be relaxed and in a state of fear or anxiety at the same time. So when you feel relaxed, it is more challenging to feel tense. Tension is the state you are in when you are experiencing fear or phobia. Relaxation techniques, therefore, help you learn a different method of how to respond to your fear or anxiety.(12)

Step 2: Coming Up With a List of Fears or a Fear Hierarchy

Once you have learned the relaxation techniques, it is time to create a fear hierarchy or a list of your fears ranked according to their intensity. This fear hierarchy usually consists of ten levels of fear, and you are most likely to go through the below-mentioned steps to create this list:

  • Begin by identifying the most frightening level of fear you have. This will be your level 10 fear.
  • Identify the least frightening fear level and set it as your level 1 fear.
  • Now fill up the levels in between and rank them by the intensity of fear they trigger inside you. It is possible that seeing a photo of what you fear is ranked at a lower level, but actually coming face to face with that fear is at a level 8 or 9.
  • Now develops ways in which you will expose yourself to each level of fear. This is typically done with the help of your systematic desensitization therapist.
  • The final step is to start exposing yourself to your fears one by one, starting with your fear level 1 and moving up to fear level 10.

Step 3: Exposing Yourself to Your Fears

You have learned the relaxation techniques, and you have created a hierarchy of fears. Now it is time to slowly start exposing yourself to your fears. The first step is to think about what you fear and once you start feeling anxious or scared, use the relaxation techniques you have learned earlier to get back to a sense of calm. Keep repeating this process until you no longer feel scared or anxious when you think of the thing you fear. This mental visualization of your fear is known as in vitro exposure, where you imagine being exposed to your object of fear only in your mind’s eye. In vivo exposure is when you actually get exposed to the fear, and you once again use the relaxation techniques to get back your sense of calm.

Once you are comfortable addressing one level of fear, you can move to the next level. You can either work through your fear hierarchy with your therapist during therapy, or you can also do it on your own if you are comfortable doing so.

It is important to remember that the process of systematic desensitization is different for each person. Some people can move through the lower levels of their fear hierarchy quite quickly and have a challenging time getting through the higher levels. And others can take a long time to get past the lower levels themselves, but they find it easier to overcome their fears at the higher levels.

Regardless of the amount of time it takes for you to work through each fear level, the principles of the therapy remain the same.


It can be difficult to face and overcome one’s fears. It becomes especially harder if you also have a mental health condition such as anxiety or panic disorder, or phobia. Systematic desensitization is a form of therapy that helps you overcome your fears and anxiety at a pace that is comfortable for you. This is an evidence-based therapy, meaning it has gone through a lot of documented scientific research and has been found to be successful. Systematic desensitization has been found to be effective for anxiety disorders, post-traumatic stress disorder, and phobias.


  1. Rachman, S., 1967. Systematic desensitization. Psychological bulletin, 67(2), p.93.
  2. Davison, G.C., 1968. Systematic desensitization as a counterconditioning process. Journal of Abnormal Psychology, 73(2), p.91.
  3. McGlynn, F.D., Mealiea Jr, W.L. and Landau, D.L., 1981. The current status of systematic desensitization. Clinical Psychology Review, 1(2), pp.149-179.
  4. Kazdin, A.E. and Wilcoxon, L.A., 1976. Systematic desensitization and nonspecific treatment effects: a methodological evaluation. Psychological Bulletin, 83(5), p.729.
  5. Emmelkamp, P.M., 1975. Effects of expectancy on systematic desensitization and flooding. European Journal of Behavioural Analysis & Modification.
  6. Lazarus, A.A., 1961. Group therapy of phobic disorders by systematic desensitization. The Journal of Abnormal and Social Psychology, 63(3), p.504.
  7. Shiban, Y., Diemer, J., Müller, J., Brütting-Schick, J., Pauli, P. and Mühlberger, A., 2017. Diaphragmatic breathing during virtual reality exposure therapy for aviophobia: functional coping strategy or avoidance behavior? A pilot study. BMC psychiatry, 17(1), pp.1-10.
  8. Ayres, J. and Hopf, T.S., 1987. Visualization, systematic desensitization, and rational emotive therapy: A comparative evaluation. Communication Education, 36(3), pp.236-240.
  9. Delmonte, M.M., 1985. Meditation and anxiety reduction: A literature review. Clinical Psychology Review, 5(2), pp.91-102.
  10. Lomont, J.F. and Edwards, J.E., 1967. The role of relaxation in systematic desensitization. Behaviour Research and Therapy, 5(1), pp.11-25.
  11. Sue, D., 1975. The effect of duration of exposure on systematic desensitization and extinction. Behaviour Research and Therapy, 13(1), pp.55-60.
  12. Wagner, M.K. and Cauthen, N.R., 1968. A comparison of reciprocal inhibition and operant conditioning in the systematic desensitization of a fear of snakes. Behaviour Research and Therapy, 6(2), pp.225-227.
Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:September 18, 2022

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