Introduction

In psychology, desensitization (also called inurement) is defined as the diminished emotional responsiveness to a negative or aversive stimulus after repeated exposure to it. It also occurs when an emotional response is repeatedly evoked in situations in which the action tendency that is associated with the emotion proves irrelevant or unnecessary. Desensitization is processes primarily used to assist individuals unlearn phobias and anxieties. Systematic desensitization (sometimes called graduated exposure therapy) is a type of behavioural therapy used in the field of psychology to help effectively overcome phobias and other anxiety disorders. More specifically, it is a type of Pavlovian therapy / classical conditioning therapy developed by a South African psychiatrist, Joseph Wolpe who developed a method of a hierarchal list of anxiety evoking stimuli in order of intensity, which allows individuals to undergo adaption. This therapy aims to remove the fear response of a phobia or anxiety, and substitute a relaxation response to the conditional stimulus gradually using counter conditioning. To begin the process of systematic desensitization, one must first be taught relaxation skills in order to extinguish fear and anxiety responses to specific phobias. Once the individual has been taught these skills, he or she must use them to react towards and overcome situations in an established hierarchy of fears. The goal of this process is that an individual will learn to cope and overcome the fear in each step of the hierarchy, which will lead to overcoming the last step of the fear in the hierarchy.

Overview
Phobia
A phobia is an excessive, enduring fear of clearly defined objects or situations that interferes with a persons normal functioning. Although they know their fear is irrational, people with phobias always try to avoid the source of their fear. Common phobias include fear of heights (acrophobia), fear of enclosed places (claustrophobia), fear of insects, snakes, or other animals, and fear of air travel. Social phobias involve a fear of performing, of critical evaluation, or of being embarrassed in front of other people. Phobic anxiety is distinguishable from other forms of anxiety only in that it occurs specifically in relation to a certain object or situation. This anxiety is characterized by physiological symptoms such as a rapid, pounding heartbeat, stomach disorders, nausea, diarrhoea, frequent urination, choking feelings, flushing of the face, perspiration, tremulousness, and faintness. Some phobic people are able to confront
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their fears. More commonly, however, they avoid the situation or object that causes the fearan avoidance that impairs the sufferer's freedom. Psychiatrists recognize three major types of phobias. Simple phobias are fears of specific objects or situations such as animals, closed spaces, and heights. The second type, agoraphobia, is fear of open, public places and situations (such as public vehicles and crowded shopping centres) from which escape is difficult; agoraphobics tend increasingly to avoid more situations until eventually they become housebound. Social phobias, the third type, are fears of appearing stupid or shameful in social situations. The simple phobias, especially the fear of animals, may begin in childhood and persist into adulthood. Agoraphobia characteristically begins in late adolescence or early adulthood, and social phobia is also associated with adolescence.

Anxiety Disorders
Anxiety disorders involve excessive apprehension, worry, and fear. People with generalized anxiety disorder experience constant anxiety about routine events in their lives. Persons with anxiety disorder feel anxious most of the time. They worry excessively about routine events or circumstances in their lives. Their worries often relate to finances, family, personal health, and relationships with others. Although they recognize their anxiety as irrational or out of proportion to actual events, they feel unable to control their worrying. For example, they may worry uncontrollably and intensely about money despite evidence that their financial situation is stable. Children with this disorder typically worry about their performance at school or about catastrophic events, such as tornadoes, earthquakes, and nuclear war. People with anxiety disorder often find that their worries interfere with their ability to function at work or concentrate on tasks. Physical symptoms, such as disturbed sleep, irritability, muscle aches, and tension, may accompany the anxiety. To receive a diagnosis of this disorder, individuals must have experienced its symptoms for at least six months.

Background
Russian physiologist Ivan P. Pavlovs classical conditioning therapy involved the use of dogs in studying the concept of behaviour modification. Pavlov knew for a fact that dogsindeed all animalssalivates when eating. In his experimentation, Pavlov began to present a neutral stimulus, such as signal light or bell, before feeding the dogs. Obviously, the signal had no noticeable effect on the dogs salivation. But Pavlov kept the signal on when the dogs were being fed (and actively salivating), and, over the course of time, Pavlov found that the signal alone, even without his offering food, gradually caused the dogs to salivate.
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In a nutshell, classical conditioning involves; given that an unconditioned stimulus (food) leads to an unconditioned response (salivation), a conditioned stimulus (light or bell), when paired consistently with the unconditioned stimulus (food) leads to a conditioned response (salivation) similar to the unconditioned response (salivation). Interestingly enough, theres a reverse side to classical conditioning, and its called counter conditioning. This amounts to reducing the intensity of a conditioned response (anxiety, for example) by establishing an incompatible response (relaxation) to the conditioned stimulus (a snake, for example). Through Joseph Wolpes experience in the late 1950s in extinguishing laboratoryinduced neuroses in cats, Wolpe developed a treatment program for phobia and anxiety disorders that was based on the principles of counter conditioning an off-shot of classical conditioning. Wolpe found that phobias and anxiety symptoms could be reduced (or inhibited) when the stimuli to the anxiety were presented in a graded order and systematically paired with a relaxation response. Hence this process of reciprocal inhibition came to be called systematic desensitization. Although the theoretical assumptions about the role of the sympathetic and parasympathetic nervous systems in extinguishing anxiety were actually erroneous, however, Wolpe Systematic Desensitization program, as a practical application of his theories, proved to be highly successful. In fact, it revolutionized the treatment of neurotic anxiety.

Systematic Desensitization Procedure

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. Thus, for example, 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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The situations or scenes in your hierarchy should represent a fairly well-spaced progression of anxiety. The best way to achieve this goal is to first grade the anxiety of each item by assigning it a number on a scale from 0 to 100, where 100 is the highest level of anxiety imaginable and 0 is no anxiety (complete relaxation).

Relaxation Techniques
Before beginning systematic desensitization, one need to have mastered relaxation training after developed a hierarchy (from least feared to most feared) list of your feared situations. If you have difficulty getting to a state of relaxation or identifying your anxiety hierarchy, the subject should consult with a professional who will be able to provide guidance. The patient is also given training in relaxation techniques like control over breathing and muscle de-tensioning.

Exposure to Stimulus
Systematic desensitization begins with imaginary exposure to feared situations. Use your anxiety hierarchy to break down the feared situation into manageable components. For example, the client imagines exposure to the phobic stimulus in vitro then proceeds to the patient been actually exposed to the phobic stimulus in vivo. 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 persons fears have been completely removed). 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.

Critical Evaluation of Systematic Desensitization

Research has shown that systematic desensitization can be effective for any phobia, with the following considerations: Systematic desensitization is more effective for Specific Phobias than for disorders involving free-floating anxiety, such as Social Phobia or Agoraphobia. Successful outcome of systematic desensitization is more likely when skill deficits are not causing the anxiety. That is, if you develop anxiety about taking exams in school, and if you have a tendency not to study or do your homework, your anxiety is probably the result of not knowing the material; systematic desensitization may

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not be of much help in such a case. But if you know the material backwards and forwards and develop anxiety, then systematic desensitization might be used to desensitize a patient to performance fears. The effectiveness of systematic desensitization does not appear to depend on the intensity of your anxiety, the duration of your anxiety, or on whether the anxiety was acquired suddenly or gradually. Some evidence suggests that systematic desensitization may not be as effective in treating anxieties that could have an underlying survival componentsuch as fear of the dark, fear of heights, or fear of dangerous animalsas in treating phobias that have been acquired from personal experience.

Conclusion
Systematic Desensitization is highly effective where the problem is a learned anxiety of specific objects/situations (e.g. phobias) however it is a slow process although research suggests that the longer the technique takes the more effective it is. Systematic Desensitization is not effective in treating serious mental disorders like depression and schizophrenia. However, it only treats the symptoms of the disorder, not the underlying cause. Academic research into systematic desensitization has declined in recent decades, replaced by studies of flooding, implosion therapy, participant modelling, exposure technology, and cognitive behavioural therapy.

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References
Arnold S. Chamove (2005): Spider Phobic Therapy Toy. The Behaviour Analyst Today, 6(2), 10913. Breaking Free From Anxiety Disorders Self-Care Handbook. (1998). Deerfield, MA: Channing L. Bete Co. Corey, Gerald. (2009). Theory and practice of counselling and psychotherapy. Belmont, CA: Thomson Brooks/Cole. McGlynn, F., Smitherman, T., Gothard, K. (2004). Comment on the status of systematic desensitization. Behaviour Modification, 28(2), 194-205. McLeod, S. A. (2008). Systematic Desensitization. Retrieved from http://www.simplypsychology.org/Systematic-Desensitisation.html Stolerman, Ian (2010). Encyclopaedia of Psychopharmacology. Berlin Heidelberg: Springer.

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