Are you or a loved one suffering from addiction and a co-occurring mental health condition? Learn more about systematic desensitization therapy to treat addiction.

Systematic desensitization is a type of behavioral therapy that was developed in the 1950s by the South African psychiatrist, Dr. Joseph Wolpe. The goal of systematic desensitization is to gradually expose a person to an anxiety-provoking stimulus over time, similar to exposure therapy. The idea is that an individual will eventually become comfortable enough around the stimulus to function normally.

Traditionally, systematic desensitization therapy was designed to treat patients with severe phobias or irrational fears. However, this therapy is also useful for treating addiction and co-occurring mental health conditions.

What Is Systematic Desensitization?

Dr. Joseph Wolpe determined that systematic desensitization might be of practical utility by watching cat behavior on the campus where he worked. He found that over time, the cats overcame their fears through systematic exposure to them. Similarly, individuals with specific phobiasgeneral anxiety or even those struggling with addiction may find this therapy helpful for their recovery. The definition of systematic desensitization is the repeated, gradual and increasing exposure to an anxiety-triggering stimulus.

Some examples of anxiety-producing stimuli include:

  • Spiders
  • Animals
  • Airplanes
  • Heights
  • Small spaces
  • Large spaces
  • Clowns
  • Sobriety, especially in anxiety-provoking situations
  • In cases of physical addiction, withdrawal symptoms

Systematic desensitization slowly exposes a person to their anxiety-provoking stimulus. Over time, they will become more comfortable in the presence of that stimulus.

How Systematic Desensitization Works

Systematic desensitization is generally carried out under the supervision of a licensed mental health professional. A person who has an anxiety-ridden response to specific stimuli can consult therapists that specialize in systematic desensitization, or any therapist they feel comfortable with. Before the systematic desensitization process begins, a therapist and the individual will discuss each step of treatment. Systematic desensitization involves multiple therapy sessions to be effective, with at least five sessions with a therapist being recommended for optimal results. Therapy is deemed successful if a patient no longer has a negative reaction to the stimulus.

3 Steps of Desensitization

Each step in systematic desensitization is important for a person’s recovery. In the first step, relaxation techniques are learned and practiced. In the second step, the therapist and client work together to create an anxiety hierarchy that establishes a system for exposure. In the third step, the individual is gradually introduced to the stimulus that provokes their anxiety.

1. Learn Relaxation Skills

People undergoing systematic desensitization benefit from learning different relaxation techniques or coping strategies. Inevitably, individuals will be uncomfortable with some parts of the systematic desensitization process. Relaxation techniques are designed as a healthy and productive way to channel negative energy and tension. Relaxation techniques that may be helpful in the systematic desensitization process include:

  • Meditation techniques
  • Deep breathing exercises
  • Practicing tensing and releasing muscles
  • Focusing on how each part of the body feels
  • Stretching

2. Create an Anxiety Hierarchy

One of the most challenging aspects of systematic desensitization involves creating an anxiety hierarchy. In other words, a patient must work in conjunction with their therapist to design a unique desensitization plan. This plan may be written down or discussed during therapy sessions. The goal of creating an anxiety hierarchy is to assign different exposure levels to a stimulus, ranging from 0 (not very affected) to 10 (intensely affected). Some tips for designing an anxiety hierarchy include:

  • Develop a personal checklist of why it is important to an individual to get over their fears, anxiety, phobias or addictions
  • Create a reward system for each exposure level reached during therapy
  • Create an anxiety hierarchy that has at least 15 items, or at least three exposure items per therapy session/exposure level
  • Prepare for unpredictability during therapy depending on the stimulus; for example, a snake or rodent’s behavior may be unpredictable
  • Do not practice self-exposure unless anxiety has been decreased by 50%

3. Gradual Exposure to Fears

Gradual exposure to fears is directly based on the anxiety hierarchy designed by the patient and therapist. Generally speaking, two different types of exposure can be explored. The first is in vitro exposure. In vitro exposure involves an individual imagining their anxiety-provoking stimulus. For example, an individual with a fear of spiders would start their exposure by thinking about spiders. In contrast, in vivo exposure involves physical exposure to a stimulus under the supervision of a therapist. For example, a person with a fear of spiders would be introduced to the spider directly.

A study conducted in 1993 found that in vivo exposure was more effective at decreasing anxiety than in vitro exposure. In either case, a patient progresses through therapy when their anxiety of the stimulus lessens or disappears entirely.

Examples of Systematic Desensitization

Systematic desensitization has widespread implications. Some of the earliest experiments testing this therapy were conducted on an individual basis, but its experimental validity became apparent over time. In a study conducted in 2000, 49 individuals with a fear of flying were assigned to an in vitro exposure group (virtual reality simulation of flying), or a standard in vivo exposure group (actual flying), versus a control group. Both the in vitro and in vivo exposures were found to be superior for lessening the fear of flight relative to the control group. At six months past either in vitro or in vivo exposures, 93% of study participants successfully flew on airplanes, despite their initial phobias.

Another example of systematic desensitization involves its use as an addiction treatment since the 1960s. In a study conducted in 2000, individuals that had used heroin received methadone maintenance treatment simultaneously with systematic desensitization. In this case, systematic desensitization did not prevent the use of heroin but rather reduced the individual’s fears of withdrawal.

Goals of Systematic Desensitization

Overall, the goal of systematic desensitization is to alleviate stress or anxiety associated with a stimulus, whether that stimulus is a substance, fear, addiction or phobia. It is important to note that a stimulus may still be anxiety-provoking for an individual even after systematic desensitization therapy. Nevertheless, the goals of therapy should be discussed ahead of time between a person and their therapist. An individual may consider treatment successful even if their anxiety is decreased by a small percentage rather than completely alleviated. With more severe phobias, it may be necessary to repeat treatment.

Systematic Desensitization for Treating Phobias

Although systematic desensitization developed as a way to treat severe anxiety, it became a popular treatment for phobias as well. When treating phobias, the principles are the same — gradual exposure to a person’s irrational fear until the fear is lessened or ceases to exist. Since phobias are unique to each individual, systematic desensitization is also an individual process in this case. People struggling with the same or similar phobias may have completely different anxiety hierarchies based on their specific comfort levels.

If you or someone you love is struggling with an addiction and a co-occurring mental health condition, The Recovery Village can help. Call The Recovery Village today to learn about treatment options, including systematic desensitization, and other resources.

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Editor – Megan Hull
Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more
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Medically Reviewed By – Dr. Bonnie Bullock, PHD
Bonnie is a medical communications specialist at Boston Strategic Partners, a global health industry consulting firm. Her recent work in mental health includes developing conference materials for clinical studies in mood disorders and copy-editing clinical manuscripts. Read more

Corliss, Julie. “Six relaxation techniques to reduce stress.” Harvard Medical School, September 2016. Accessed May 23, 2019.

Dubord, G. “Part 12. Systematic desensitization.” PubMed Central, November 2011. Accessed May 16, 2019.

Menzies, RG and Clarke JC. “A comparison of in vivo and vicarious ex[…]ldhood water phobia.” PubMed Central, January 1993. Accessed May 23, 2019.

Rothbaum, B. O., Hodges, L., et al. “A controlled study of virtual reality ex[…]r the fear of flying”. Journal of consulting and clinical psychology, December 2000. Accessed May 23, 2019.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.