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).



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).

 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.

 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.

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