Learning to relax may take two to five hours. Another one or two hours for making up your own unique hierarchy. Some people get results after only a few hours of desensitization; others require three hours a week for a couple months. If you don't get results in that time, see a professional. Don't expect instant cures; the professionals take months too. Most fears have occurred many times in the same situation, i.e. fear has been paired with a stimulus and/or reinforced perhaps thousands of times. It isn't unreasonable to expect 1/10th as many unlearning trials as were involved in the original learning, so if you have gotten a little anxious in class a thousand times while preparing to speak up (even if you didn't go through with it), it may take 100+ fantasies of speaking without fear to extinguish the fear.
It also takes time to "test out" the fears in real situations. Sometimes the test situation is hard to arrange. A plane trip in rough weather isn't easy to schedule. How often do you get to give a speech? You will just have to wait until the real occasion arises. When it does, prepare well and desensitize yourself again right before testing out your reactions. At other times, the opportunity to test oneself is readily available and can be done in a few minutes (like calling someone for a date).
Several problems have already been mentioned: some people can't relax, others have trouble fantasizing, some hierarchies have gaps between items, sometimes actually dangerous or harmful scenes are included at the end of the hierarchy. Some people are afraid of fear; they worry and fret when they think about having fears and would prefer to believe they have no concerns at all.
Sometimes what appears to be the major fear is not the real problem. Joseph Wolpe (1958) gave an example of a man who thought he was afraid of open places who was really afraid of dying (and being unable to get help). Another patient, who avoided all social interaction, was basically afraid of being trapped in her marriage. These are unusual cases, but it would be naive to assume that we are aware of the true sources of all our fears.
In step one, it was mentioned that some emotions are the result of our thinking and expectations and misunderstandings. In these cases, our thoughts and views need to be corrected (Burns, 1980, for depression). Other emotions yield payoffs; it is unlikely that desensitization will extinguish an emotional response that is being highly reinforced, such as one person's jealousy that keeps his/her partner from associating with any attractive competitors. You may have to give up the payoffs first.
Desensitization is not a fast cure. It takes hours spread over weeks or months. And in the end you have to do whatever you are afraid of--fly in a plane, ride in an elevator, give a speech, ask for a date, etc. That involves some stress, so why not just "bite the bullet" and immediately do what you are afraid of doing? For some people confronting the fear (method #6) would be more efficient but for many it seems impossible to do without the aid of a method like desensitization.
Lastly, there is some evidence that body chemistry is involved in some fears, especially agoraphobia (fear of being away from home) which is difficult to treat. Fortunately, tricyclic antidepressants are effective in preventing the panic reactions of some people with agoraphobia, so that 1/3 do not need psychotherapy or desensitization. Yet, even if biochemical factors are involved, desensitization claims an 85% cure rate with agoraphobia (Salholz, Namuth, Zabarsky, Junkin, & Jackson, 1984).
Effectiveness, advantages and dangers
Extensive research during the last 20 to 25 years has generally documented the effectiveness of desensitization. Wolpe originally reported 90% effectiveness but later results have not been quite so positive. Psychologists do not know exactly how it works. There is clearly a strong suggestion effect built into the method. And, some experiments have found powerful placebo effects (suggestion effects) to be as effective in reducing fears as desensitization.
Since it emphasizes relaxation, desensitization is excellent for people who hate pain and stress. It is painless. Another advantage is that the procedures are simple and easily understood. As mentioned in chapter 5, self-desensitization has been reported to be more effective than therapist administered desensitization. It is a lot cheaper. There are no known dangers.
Fensterheim, H.& Baer, J. (1978). Stop running scared. New York: Dell.
Forgione, A. G. & Bauer, F. M. (1980). Fearless flying: The complete program for relaxed air travel. New York: Houghton Mifflin.
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Sutherland, E. A., Amit, Z., & Weiner, A. (1978). Phobia free: How to fight your fears. New York: Jove.
Shapiro, F. (1995). Eye Movement Desensitization and Reprocessing: Basic principles, protocols and procedures. New York: Guilford Publications.
Watson, D. & Tharp, R. (1972). Self-directed behavior: Self-modification for personal adjustment. Monterey, CA: Brooks/Cole Publishing Co.
Wenrich, W. W., Dawley, H. & General, D. (1976). Self-directed systematic desensitization. Kalamazoo, MI: Behaviordelia.
Wolpe, J. (1974). The practice of behavior therapy. New York: Pergamon Press.
Zimbardo, P. G. & Radl, S. (1979). The shyness workbook. New York: A & W Publishers.
In the middle 1960's, I started giving my psychotherapy patients little lecturettes about how to help themselves with rewards, desensitization, etc. One of these clients was a graduate student in zoology who had a fear of heights. The fear was life-long and, indeed, it was a family trait. She was so bright and motivated that I explained the idea of desensitization (or counter-conditioning) to her in 10 minutes or so. She immediately understood the concept and thought she could use it on her own. Her fear had restricted her a lot: she couldn't walk up a fire escape or climb a ladder. It was stressful to look out of windows above the first floor, ride an elevator, and fly. Most difficult were climbing towers and walking on boat docks one can see through.
By the next session one week later, she had been relaxing and imagining climbing the fire escape in her dorm. As soon as she could imagine climbing half a flight of stairs without being tense, she immediately went out to the fire escape and did it! During that week she had climbed up one and a half flights. She felt fantastic about her accomplishment. By the end of the second week, she was climbing the fire escape to a friend's room on the fifth floor and looking out her window! These accomplishments were not easy for her but she became confident she could do it. She was delighted with herself--and with desensitization.
The third week was spring break and she was going to Florida. Before going, she imagined walking on docks while relaxing. She came back gleeful; she had walked on and looked through every dock she could find in Florida. She was also writing all her relatives about how to overcome their fears of heights. She hadn't done desensitization exactly like the textbooks say but she grabbed the idea and ran with it. She changed herself...and she changed me too (I became much more interested in self-help).
Self-desensitization in the real situation (in vivo)
Keep yourself calm and very gradually approach the stressful situation. Get a friend to provide support. Relax before the confrontation and during it as much as possible. The objective is to extinguish the unreasonable fear response by replacing it with a more relaxed response. To do this, you need a hierarchy of real situations involving increasing stresses. The rationale for in vivo is the same as systematic desensitization (method #4).
- To reduce the unwanted fears and stresses associated with many situations where the fear is excessive or unreasonable.
- To enable you to handle scary situations better and with less emotional stress.
The procedures are the same as in the last method, except that here you use real situations, not imagined scenes. Refer to the last method for detailed instructions.
STEP ONE: List the stressful situations in order of scariness
Describe several situations related to your fear on separate 3 x 5 cards. List only situations that are readily available to you, e.g. asking questions in class if you are a phonophobic student (whereas flying cross-country several times might be expensive treatment for an aerophobiac). Arrange 10 or 15 of the situations in order from least scary to most scary. For example, if you wanted to ask a special someone for a date, you might first (1) talk with a friend about asking this person out, (2) ask this friend to help you plan the date, (3) ask another friend to role-play the situation in which you practice approaching this special person, (4) talk to the special person without asking him/her out, and so on.
There are other ways to gradually approach a real situation: (1) look at a picture of a scary situation (or imagine it) instead of actually being there, (2) look at the scary situation, such as a tower or animal, from a distance and gradually approach it, (3) take a supportive friend along, (4) shorten the amount of time spent in the scary situation, and (5) approach smaller or less scary versions of the thing you fear (examples: approach less attractive males/females before the beautiful ones or buy a puppy if afraid of big dogs).
STEP TWO: Develop an emotion incompatible with fear
You need some emotion to counter the fear, usually relaxation but perhaps fatigue or anger or assertiveness. The relaxation techniques given earlier will do fine. Recently, it has been reported that fatigue, e.g. immediately after jogging your limit, is incompatible with fear, just as relaxation is. So the person with a fear of elevators might run three miles first and end up jogging into the elevator. An assertive attitude, such as "I won't let them push me around any more," can counter fear.
STEP THREE: Confront the scary situations starting with a very mildly stressful one
Place yourself in the least frightening situation on your 3 x 5 cards and remain as relaxed as possible. Stay in the situation or repeat it over and over until you are entirely unafraid. Work your way through the list until you can handle the most scary situation well. It might be helpful to record and reward your progress.
The time depends on availability of the situations. If actual circumstances seem impossible to arrange, you always have your imagination (method #4).
Many real life situations just aren't available at the right time. Sometimes it is hard to arrange actual situations close enough together in scariness that you can move on easily to the next situation. In these cases, use some of the suggestions in step one above or use imagined scenes instead of real situations to fill in the gaps.
Effectiveness, advantages and dangers
Watson and Tharp (1972) gave three reasons why in vivo desensitization may be better than fantasized scenes: (1) the actual behavior change is what is important--the real-life problems eventually have to be faced anyway, (2) imagined scenes are not as complete and realistic as the real thing, thus, it takes longer to extinguish the fear, and (3) often effective coping with the situation requires more than removal of fears. Watson and Tharp cite a case of a shy young woman who reduced her fear of men via desensitization but had not learned how to converse, how to handle their advances, or how to handle her other emotions besides fear. With in vivo desensitization the social skills are, hopefully, being learned as the fears are reduced.
There are no known scientific evaluations of in vivo self-desensitization. Of course, the method has been used many times in therapy and described in case studies. Throughout history, people have learned as much as possible about the things they fear as a way of conquering the phobias. A famous case is Johann Wolfgang Von Goethe, one of the world's greatest minds--a poet, author and philosopher. Goethe was born into wealth and became a good student but a restless, sexually active playboy in 1765-70. During this time, he became seriously ill and was treated at home for a year. Following this illness, he became obsessed with fears of having "diseased organs." He decided to study medicine as a means of overcoming his morbid fears. Goethe's greatest work, Faust, tells of a man striving for complete knowledge of life in all its forms. Faust is torn between the devil, who provides him with many life experiences, and God. Eventually, God saves Faust from the devil, partly because Faust continually sought self-improvement in the hopes of becoming perfect.
There are no known dangers except the stress you might feel if you proceed too rapidly. Of course, you should never do anything dangerous in an effort to overcome a fear. We are talking only about overcoming unreasonable fears, not realistic fears.
Watson, D. & Tharp, R. (1972). Self-directed behavior