What is fear? In a simple sense, it is a connection between certain neutral stimuli and an inappropriate emotional reaction (identified as fear), such as a fear of heights or leaving home or public speaking etc. Desensitization is a treatment procedure designed to break that connection and replace the fear response to the situation with a stronger relaxed response. It is also called counter-conditioning. Fear is countered with calm relaxation, since you can't feel both fear and calm at the same time.
How is this done? Very gradually. You start with mildly scary situations where a strong relaxed response might over-ride the weak anxiety response. You imagine being in that slightly disturbing scene while remaining very relaxed. You do this over and over, breaking the connection with fear. Next, you do the same thing with a slightly more scary situation. You continue this process until you can imagine climbing a tower, leaving home, or speaking to a crowd without experiencing strong fear. Then you are ready to handle reality (not without some anxiety but without overwhelming fear).
- To relieve excessive, unreasonable or unneeded fears and traumatic memories, such as a fear of heights, violence, war, flying, the dark, bugs, public speaking, taking tests, meeting people, asserting one's self, being away from home and many other situations.
- To break the connection between any given situation and an unwanted emotional response, e.g. to extinguish depression or anger associated with a certain person or behavior or situation. For instance, several students have used this method to reduce their jealousy when a date or spouse attends to another person.
STEP ONE: Learn a method of relaxing
Deep-muscle relaxation is recommended, but any method that works well for you is fine. Some therapists use drugs; self-hypnosis (chapter 14) might be a good choice. You may find that a certain time or place relaxes you, e.g. right after awakening, after exercising, or in bed late at night. Thorough, strong relaxation is necessary because it must over-ride the fear reaction.
Recently, a new, rather strange sounding desensitization procedure has been developed for use by professionals (Shapiro, 1995). Instead of using relaxation, this method uses rapid eye movements (left and right), much like what occurs with the eyes closed during dreams. The therapist quickly moves his/her finger back and forth in front of the client and the client follows the finger with his/her eyes. While moving his/her eyes, the client also focuses his/her awareness on the traumatic memory or scary scene... and he/she should also focus on the physical bodily sensations associated with the fear or anxiety. Rapid reduction of the fearful reactions are reported. In addition, repressed traumas are sometimes uncovered and new positive feelings about him/herself are claimed by some clients after only an hour or two of this process. More research of this procedure is needed but it is an interesting finding (I expected it would go the way of Silva Mind Control, EST Seminars, NLP eye movements, etc. but it hasn't yet; it has strong supporters and critics.).
Dr. Richmond provides detailed instructions for Systematic Desensitization very similar to mine. At this page you can also find links to several other self-help methods, such as Progressive Muscle Relaxation, meditation, and prayer. We will use deep muscle relaxation in our example.
STEP TWO: Study your fear response (or other emotional response)
Every time you have the unwanted emotional response, record these five things: (a) the antecedents or situation prior to the emotional response, (b) the feelings you have, e.g. fear or anger, including the intensity on a scale of 0 to 99, (c) the thoughts you have, (d) how you behave while experiencing the emotion, and (e) the consequences of your response, i.e. how others react to you and what the outcome usually is. This information has many uses: (a) and (b) will be necessary in the next step when you rank order several scary scenes, (c) is needed to know if your thoughts--misinformation or misperceptions--might cause the emotions, (d) and (e) help you determine if your emotional reaction is being reinforced by others. If the emotional response doesn't occur very often, imagine what it is like and make these ratings.
Keep these records for a week or so, then try to answer these questions: Could I avoid these situations? If the emotion occurs in many situations, what do they have in common (e.g. a fear of criticism or losing control or looking dumb?) Could the emotions be based on misconceptions? (Is the probability of rejection that high? Is the teacher or boss that critical?) Could the emotions be yielding some payoff? (Do fears keep me dependent and cared for? Does anger get me my way?) These records provide some answers and a way of measuring your progress in overcoming the fear.
STEP THREE: Make a list of scary situations
Use the rating (a) and (b) above. For each fear, make a list (called a hierarchy) of 10 to 20 scary situations that you have faced or might. Start the list with a few very slightly disturbing situations or scenes. In very small steps, add more scenes that arouse more and more fear or anxiety (see samples below). Use a fear scale from 0 (not frightening at all) to 100 (terrorizing) to rate each scene. The increase in rated fear from one scene to the next in the hierarchy should be no greater than 10 scale score units. It's important to conquer the fear one small step at a time. It's also important to include realistic but scary scenes at the frightening end of the list. Do not include scenes that involve real dangers or consequences that would inevitably be disturbing, e.g. if you are afraid of flying, do not include a scene where you burn up in a fiery crash. If you are afraid of speaking to groups, do not imagine the crowd becomes unruly, throws tomatoes and boos you off the stage. Instead, include at the high end (rated about 75, not 99) scenes of things you'd like to do if you were not afraid, such as flying safely cross-country or successfully addressing a large audience.
Several sample hierarchies are given below (Rosen, 1976). They illustrate the kind of list you should develop for each specific fear but they probably do not fit your situation accurately enough to be used as they are. Example: suppose you are uncomfortable in social gatherings. It is crucial that you know why you are scared--is it the number of people? the type of people? the activities engaged in? the topics of conversation? the drinks and drugs being offered? the way you talk or act? the way you look? the way people look at you? what you think they are thinking about you? The relevant factors need to be included in your hierarchy (Rosen, 1976).
Problem: Speaking to a familiar class-- Item
Scary Scenes 1. 8 Signing up for a class that requires presentations. 2. 15 Hearing the instructor describe what is to be done in our presentations. 3. 20 Going to the library and preparing the talk--and thinking about what I will say. Wondering if the material I find will be of interest. 4. 25 Watching others give their talk. Seeing that they are nervous. 5. 30 Realizing the presentation is just a week away and planning when to finish preparing and when to practice. 6. 35 Rehearsing the talk in my room in front of a mirror. The notes are not well organized but I'm getting smoother. 7. 40 I invite a friend over to hear my talk. He/she listens intently and makes some suggestions. 8. 50 Final practice the night before it is due. Three or four friends come over and listen while I rehearse again. I am a little bothered by their being there but I know the speech pretty well. 9. 55 Going into class--wondering if I will be called on first, trying to keep my opening remarks in mind, and hoping a fantastic speaker doesn't go right before me. 10. 60 Sitting in class, waiting to be called on. Only partially listening to what is being said by other presenters, mostly thinking about what I will say. 11. 65 The teacher calls on me, I walk up to the rostrum, spread out my notes, make eye contact, see the teacher smiling at me, and feel ready to start my talk. 12. 70 I give the speech-I remember the opening lines, it is going pretty well, occasionally I don't use exactly the right words but it's OK. The class seems interested. I finish and there is a little round of applause. They smile and I sit down.
Naturally, one would want the ability to speak to groups to generalize to other settings. So you might select scary scenes that involve speaking up at social gatherings, handling a business meeting, making a point at an intellectual discussion, challenging some point made by a speaker, etc. If large audiences are a problem for you, imagine addressing a class of 40, then 80, 120, etc. until you are speaking to stadiums or to TV. If it is the nature of the audience that bothers you, imagine addressing people from your home town, a group of your teachers and professors, or a critical audience who asks you lots of questions.
Problem: Fear of flying Item
Scary Scene 1. 5 Realizing I will have to fly some place. 2. 10 Planning the flight, making reservations and asking for a big plane. 3. 15 Packing my bags on the morning of the flight. 4. 20 Saying "good bye" to my wife and kids. 5. 25 Playing down my concerns about flying to my wife but being really afraid of a crash. 6. 30 Driving to the airport and watching the planes come in to land. 7. 35 Going into the terminal and finding out the plane will be 15 minutes late. 8. 40 Waiting to board and seeing some questionable characters waiting for the same plane. 9. 45 Watching the plane taxi up to the boarding gate; looks huge. 10. 50 Getting on board and finding my seat near the front. 11. 55 Plane is backed away from terminal; it squeaks and there is noise. 12. 60 Plane starts on its own power; I know there is no turning back. 13. 65 Stewardess gives safety instructions; I try to find exits and think about how I could get to one if there were a crash. 14. 70 Plane waits for take off; there is a loud roar and a forward surge as it starts down the runway to take off. 15. 75 Plane gains speed going down the runway; I see the terminal out the window. 16. 80 I can see the ground rapidly moving away as we gain altitude. 17. 85 The plane enters some clouds; I know the pilot can't see anything. 18. 90 I have to get up to go to the bathroom; I have trouble walking straight and it seems bumpy in the bathroom. 19. 95 The pilot warns that there may be some turbulence ahead and asks people to put on their seat belts; it gets rough as we come in for a landing.
Problem: fear of social dating. Item
Scary Scene 1. 5 I overhear a friend call someone for a date. 2. 8 I ask this friend to describe what he/she did to prepare for the phone call and the date. He/she tells me the details. 3. 15 I am at a party with friends. Someone comes up and starts a conversation with us. I ask this person a question and he/she answers. I like his/her comment and say, "That's a good point." 4. 22 I am at a party with a group of friends. I get into an extended conversation with someone. I wonder if I will have anything to say; it turns out to be enjoyable. 5. 28 I am at another party and get into an conversation with someone attractive. At the end of the conversation I ask this person if he/she would like to go to a show with me. 6. 33 I am at home and phone someone for a date. The person says he/she is busy that evening but would like to do something at another time. 7. 40 same, but does not suggest getting together at another time. 8. 43 I call someone for a date and he/she asks me several questions about my interests and my work before agreeing to go out. I handled the questions all right. 9. 48 I go to a party alone and try to make conversation. I'm not trying to find a date, just making light social conversation. Sometimes I don't know what to say but they usually think of something when I can't. 10. 53 I see someone at a party I'd like to meet. I go over and introduce myself and find out about them. They have a boy (girl) friend. 11. 58 I call up a person I met in class and ask them to have a coke some afternoon after class. He/she says that would be nice. 12. 63 I have a coke with this person and we talk about school, home-town, interests, and so on. Then I ask him/her to go to a concert with me the next weekend. 13. 69 I have a whole evening with a date. We go out to eat, then to a show. Later, we stop for a drink and I take him/her home. The conversation goes OK.
Successful dating may not be just a matter of overcoming fears; it is likely to involve many skills--approaching people, conversing, self-disclosing, empathizing, knowing about current events, being able to tolerate silence, having stories to tell, having a sense of humor, being able to touch, etc. So, first identify the social skills needed, then imagine rehearsing these new skills over and over, and finally try them out in real life (see chapter 13). Usually, gaining skills reduces fears. Clearly, reducing our fears frees us to use the skills we have.
After you have constructed your hierarchy of increasingly scary scenes, write each one on a 3 x 5 card. This way you can easily add a scene if it is needed. Also, feel free to modify your scenes to make them more realistic or easier to imagine--and to make them more or less frightening.
STEP FOUR: Shift back and forth between imagining the scary scenes and relaxing
After learning to relax and making a hierarchy, you are ready to replace fear with relaxation. Follow this procedure:
Become deeply relaxed (using your preferred method). The task is to have a stronger relaxed response than fear response while imagining the scary scenes. So, if you start to feel tense anytime while imagining the scenes, turn off the scene and go back to relaxing, then continue. Place the 3 x 5 cards in order on your lap so you can easily refer to them without disrupting your relaxation.
The crux of the desensitization process is continuously (every 10-30 seconds) shifting back and forth between (a) briefly imagining a scary scene and (b) relaxing. The purpose is to stay thoroughly relaxed while imagining the scenes; thus, breaking the situation-fear connection. Example: visualize a scary scene for 10 to 30 seconds, whatever is comfortable for you. Then, go back to relaxing and giving yourself relaxation instructions for 10 to 30 seconds. Then, imagine the same scene again for 10 to 30 seconds, relax again, imagine, relax, etc. until the scene no longer arouses anxiety. You are ready to go on to the next scene.
If you become tense while imagining the scenes, you will be strengthening the situation-fear connection, so stop the fantasy and go back to relaxing. If a scene consistently arouses anxiety, it is probably too big a jump from the previous scenes or it is more scary than you judged it to be. There are three things to do: go back and work on the less-scary scenes more, add some less scary scenes that lead up to this one, or this scene may be out of order and needs to be moved to later in the hierarchy.
After you have imagined a scene three consecutive times (10 to 30 seconds each) without experiencing anxiety, you can go on to the next scene on the list. Imagine each scary scene as vividly as possible, include details and realistic action. Visualize the situation exactly as it is, picture the people involved, see clearly how you behave, etc. Hear, feel and smell everything that is going on too. There are perhaps thousands of stimuli associated with the unwanted fear response. Each of these connections has to be broken. The more life-like you make the imagined scene, the faster your fear of the real situation will be extinguished.
Do desensitization for 30 minutes to one hour every other day or 1/2 hour every day in a quiet, private place. Start each new session by repeating the most intense scene you imagined the last session and then work up the hierarchy from there. Continue the method until you can imagine all the scenes without feeling fear (or whatever feeling you are extinguishing).
STEP FIVE: Confront the real situation
What is important is how well you can handle the real life situation. So, after desensitizing all the scary scenes, test your reaction in reality. After imagining approaching people you find attractive, then be sure to approach people in real life--start a conversation with someone in your class, ask someone to go out, etc. Keep in mind, there is a lag, often, between what you have done with ease in fantasy and what you will be able to do easily in real life. But your anxiety should be reduced by desensitization sufficiently that you can now handle the real situations that previously frightened you away. Expose yourself to the scary real situations over and over while relaxing as much as possible. Soon you will have conquered your unreasonable fears. Keep practicing your new skills.
Keep in mind that fear is natural in many situations. You can't eliminate it entirely. It may even be beneficial. Almost everyone feels tense giving a speech (anxiety helps us prepare). Who doesn't feel a tinge of fear when 40 or 50 feet above the ground? Who doesn't feel a little jealous sometimes? The goal is not to remove all fears, just to make them tolerable and to avoid being controlled by unreasonable fears.