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systematic desensitization to treat phobias

Exposure can be done in two ways:

· In vitro – the client imagines exposure to the phobic stimulus

· In vivo – the client is actually exposed to the phobic stimulus

Also, systematic desensitization can be paired with modeling, an application suggested by social learning theorists. In modeling, the patient observes others (the "models") in the presence of the phobic stimulus who are responding with relaxation rather than fear. In this way, the patient is encouraged to imitate the model(s) and thereby relieve their phobia. Combining live modeling with personal imitation is sometimes called participant modeling (Bernstein, 1997).

Rothbaum et. al. (1995) reports using a virtual-reality helmet being worn by the patient which then displays a phobic situation which is controlled and monitored by the therapist. The scene might be one of driving a car over a high bridge, while pulse rate is being monitored by the therapist. When the pulse rate gets too high, the scene is either shut down or frozen in frame to allow the therapist to counter-condition relaxation to replace the fear and anxiety response.

Systematic desensitization in a variety of forms has been commonly used to treat specific phobias and, in some cases, can be achieved in a single therapeutic session (Ost, 1989; Zinbarg & others, 1992).

Systematic desensitization is a type of behavioral therapy based on the principle of classical conditioning. It was developed by Wolpe during the 1950s.

This therapy aims to remove the fear response of a phobia, and substitute a relaxation response to the conditional stimulus gradually using counter conditioning.

This is done by forming a hierarchy of fear, involving the conditioned stimulus (e.g. a spider), that are ranked from least fearful to most fearful. The patient works their way up starting at the least unpleasant and practicing their relaxation technique as they go. When they feel comfortable with this (they are no longer afraid) they move on to the next stage in the hierarchy.

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The patient is also given training in relaxation techniques. E.g. control over breathing, muscle detensioning. However, studies have shown that neither relaxation nor hierarchies are necessary, and that the important factor is just exposure to the feared object or situation.

The number of sessions required depends on the severity of the phobia. Usually 4-6 sessions, up to 12 for a severe phobia. The therapy is complete once the agreed therapeutic goals are met (not necessarily when the person’s fears have been completely removed).

a spider phobic might regard one small, stationary spider 5 meters away as only modestly threatening, but a large, rapidly moving spider 1 meter away as highly threatening. The client reaches a state of deep relaxation, and is then asked to imagine (or is confronted by) the least threatening situation in the anxiety hierarchy.

The client repeatedly imagines (or is confronted by) this situation until it fails to evoke any anxiety at all, indicating that the therapy has been successful. This process is repeated while working through all of the situations in the anxiety hierarchy until the most anxiety-provoking.

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