Systematic desensitisation

The theory: counterconditioning

If a phobia is a conditioned fear response, it can be replaced by conditioning a new, incompatible response.

• Counterconditioning: the feared stimulus (CS) is paired with relaxation instead of fear.
• Reciprocal inhibition: you cannot be relaxed and anxious at the same time, so relaxation inhibits fear.

The three stages

1. Relaxation training: the client learns deep muscle relaxation and breathing techniques.

2. Anxiety hierarchy: client and therapist list feared situations from least to most frightening (often rated 0 to 100).

3. Gradual exposure: the client works up the hierarchy while relaxed, moving up only when anxiety has faded at each step, and dropping back if anxiety rises.

Exposure can be in vitro (imagined) or in vivo (real); in vivo is generally considered more effective. Virtual reality can also be used.

Evidence

• Capafons et al. (1998): 41 people with fear of flying (20 treated, 21 controls). The treated group improved significantly on most measures; only 10% of treated patients did not show a significant reduction in fear.
• Lang and Lazovik (1963): students with snake phobia still showed improvement six months after treatment.
• Rothbaum et al. (2000): 45 people with fear of flying were given virtual reality exposure, standard exposure (in a stationary aeroplane) or no treatment (15 in each group). Six months after treatment, 14 of the 15 people (93%) in each exposure group had flown.

Evaluation

• Strengths: good evidence for specific phobias; client is in control and moves at their own pace, so it is ethical and causes less distress than flooding; virtual and imagined exposure make it practical.
• Weaknesses: less effective for social phobia, agoraphobia, depression or schizophrenia; treats symptoms rather than underlying causes (a psychodynamic criticism); relaxation may not be necessary, as exposure alone may be what works; needs imagination for in vitro exposure.

Worked example

Write a five-step anxiety hierarchy for someone with a fear of dogs, from least to most feared.

1. 1. Looking at a cartoon of a dog.
2. 2. Watching a video of a dog.
3. 3. Seeing a dog on a lead across the street.
4. 4. Being in a room with a calm dog on a lead.
5. 5. Stroking a dog.

Answer: Steps rise gradually in fear; the client only moves up when relaxed at the current step.

Check yourself

1. Reciprocal inhibition means
   • fear spreads to similar stimuli
   • relaxation and anxiety cannot happen at the same time
   • the therapist mirrors the client's feelings
   • reinforcement is withheld
   Show answer

   relaxation and anxiety cannot happen at the same time. One response inhibits the other.

2. What is the first stage of SD?
   • In vivo exposure to the most feared situation
   • Free association
   • Writing a coding sheet
   • Relaxation training
   Show answer

   Relaxation training. Relaxation must be learned before exposure.

3. An anxiety hierarchy is
   • a list of rewards
   • a list of feared situations ranked from least to most frightening
   • a dream diary
   • a type of brain scan
   Show answer

   a list of feared situations ranked from least to most frightening. It structures gradual exposure.

4. Exposure to the real feared object is called
   • in vitro
   • flooding
   • in vivo
   • transference
   Show answer

   in vivo. In vivo means in real life.

5. In Capafons et al., 20 people were treated and 10% did not show a significant reduction in fear. How many people is that?
   Show answer

   2 people. 10% of 20 = 2 people.

6. Which is a weakness of systematic desensitisation?
   • It has no research support
   • It is based on Freud's theory
   • It is less effective for complex disorders such as social phobia
   • It always causes extreme distress
   Show answer

   It is less effective for complex disorders such as social phobia. Evidence is strongest for specific phobias.

7. Explain how systematic desensitisation reduces a phobia.
   Show answer

   The client learns relaxation and then is gradually exposed to feared situations from an anxiety hierarchy while relaxed; because relaxation and fear cannot occur together (reciprocal inhibition), the feared stimulus becomes associated with relaxation instead of fear.. Relaxation, hierarchy, new association.

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Sources

• Pearson Edexcel International Advanced Subsidiary/Advanced Level in Psychology specification, Issue 5 (February 2021)
• Pearson IAL Psychology component guide: WPS02 (Issue 2, November 2024)
• Simply Psychology: Systematic desensitization
• Pearson IAL Psychology summary of studies: WPS02
• American Psychological Association press release (August 2000): virtual reality therapy for fear of flying (Rothbaum et al., 2000)

Last updated 8 November 2026. Spotted a mistake? Tell us.