The Development Of Systematic Desensitization Therapy
Fear is a real emotion and everyone has something they fear. In many cases this fear is logical and one can process through it on their own. However, there are cases, that fear is illogical and hinders one from living a full life. An approach to help lessen the anxiety that is caused by this stress is known as Systematic Desensitization. In the 1950’s Joseph Wople looked for ways to help lessen, or decondition a negative conditioned response (Murdock, 2017). Systematic Desensitization is a form of Exposure Therapy. It has been found that this method is effective with anxiety based fears because of the main components, teaching relaxation techniques, creating a fear hierarchy and using imagery. Individuals continue to work through the process with these tools until the fear lessens or abates. (Murdock, 2017, p. 254). For instance, a fear of worms is called scoleciphobia (Olesen, 2015).
According to Olesen (2015) “The old adage “Opening a can of worms” means to complicate existing matters or add to a problem. Thus, worms are directly/indirectly referred to as “unwanted/unpleasant or disgusting”” (paragraph 9). Asiannia, (Asi for short), is an intelligent, self-confident, 16-year-old sophomore at Moore High School. She does not take any regular oral medication, but does use a birth control patch to help minimize the growth of her endometriosis. Asi states that said she does suffer with anxiety and depression. Asi lives at home with her mother (Shawna), younger brother (Liam), and maternal grandparents. Asi’s father left when she was four. This when they moved in with their grandparents and Shawna went to nursing school. Asi said even though her grandparents were there she felt responsible for Liam, who was one at the time. When Asi was eight, her mother married her high school sweetheart, who was paralyzed. BJ moved in with them into the grandparents 1000 sq foot home.
This marriage lasted seven years and at the same time an aunt and two cousins also moved in for a two-year period. Asi said she loves her close family, but it became too much and she felt suffocated. About 2 years after the aunt and cousins left Shawna and BJ got a divorce. Asi said she felt like she could breathe again. Asi stated she has a fear of both cotton balls and worms. When the counselor asked her which she would most like to overcome, she stated, worms. She said that she probably didn’t really have a fear of worms, she just didn’t like the way they felt. The counselor asked her what her end goal was or what did she want to be able to do in regards to worms? Asi said, “nothing, but if I have to then I will be able to”. Over two months, Asi met with a School Counseling graduate student a total of 7 times to help her create strategies that will minimize the anxiety or fear reaction when confronting a situation that involves a worm.
The counselor started out by giving Asi the fear questionnaire. She rated her fear of worms at a 5, (definitely avoid it). At that same level, she rated “being watched or stared at” and “going alone far from home”. She rated “speaking or acting to an audience” at a 6, (markedly avoid it). In reviewing the questionnaire with her the counselor wanted to know why she chose worms, over the other three, especially speaking or acting to an audience, as she is in drama. Asi explained those were fears she was having to deal with on a daily basis, but there was not one helping her deal with worms. She also stated that she felt miserable or depressed at around a 4 (markedly), where her feelings of anger, irritability or panic were less because she felt it all goes with being a hormonal teenager.
After discussing her responses from the questionnaire, the counselor explained the process of relaxation. These are techniques where muscles are constricted and relaxed in a progressive manner (Murdock, 2017, p. 251). An example of this is to tighten your hand into a fist, hold for 7 seconds, relax your first for 7 seconds, then moving onto the next body part. It is important to have them focus on breathing in conjunction with the 7 seconds. Inhale with the tension and exhaling with the relaxation. This can be done with an image of being in a safe space. For Asi, this safe space is with her mother. After relaxation, the next approach is to create a fear hierarchy. The counselor and the client work together to discover 15-25 situations that would evoke the specific fear on a scale of 1-100. Ideally, looking for items that fall in increments of 10 degrees of anxiety. (Murdock, 2017, pg. 254). With Asi, the biggest fear of worms occurred at age 10 when her brother chased her and one put a worm in her shirt. She couldn’t get it out and started to imagine there were 100’s of worms, it was then she developed a phobia of worms, but not an individual worm, per say. Asi stated that putting her hand in a bucket of worms would be the worst, rated at 100. She felt that seeing a flowerbed before it rains does not make her think of worms, rated a zero but after a rain she might see one so this is rated 10. They continued to find15 interaction or fear encounters, in regards to worms.
The desensitization process began by exposing the Asi to each item in the fear hierarchy, starting with the lowest while used the relaxation techniques and visualized each item, until it no longer presented the anxiety. This was repeated progressively until she could experiencing each without any anxiety at all. This is usually done with a minimum of 10 to a maximum of 30 session. (Murdock, 2017, pg. 254) Because clients are taught the techniques for themselves, if the fears return, they have the tools work though the experience without guided help of a counselor. Asi, understood that she would never have to put her hand in a bucket of worms, but she will have to dissect one in Science. She decided that her highest anxiety was the dissection and that is what she was working on. Asi felt comfortable with the process of systematic desensitization. She felt like she could do the relaxation and breathing techniques anywhere, at any time, even if class, if needed. By using this type of behavior therapy the counselor was able to gently expose her to her fear at a pace Asi could control and learn from. When the counselor presented the idea of rewarding herself for overcoming the fear, Asi said “That will the A I get on the dissection”. Together the counselor and Asi developed a process that will help with future fears or obstacles.
