Thursday, September 1, 2016

Systematic Desensitization

Systematic desensitization translates quite literally -- you develop a system to gradually desensitize yourself to a feared situation. The best written resource I've found is Chapter 6 in Thoughts & Feelings: The Art of Cognitive Stress Intervention, by McKay, Davis, & Fanning (New Harbinger Publications). 

"With Systematic Desensitization," the authors write, "you learn to relax while imagining scenes that are progressively more anxiety provoking." They provide a "Fear Inventory" and detailed instructions on how to develop a hierarchy of threatening scenes.

In The Anxiety & Phobia Workbook (also published by New Harbinger), Dr. Edmund J. Bourne outlines a hierarchy for a common phobia: giving presentations at work. Visualize:
  1. Preparing a talk you don't give.
  2. Preparing a talk and delivering it to a friend; when comfortable with that, visualize delivering it to 3 friends.
  3. Giving a brief presentation to 3-4 people at work you know well; when comfortable with that, visualize a longer presentation to them.
  4. Giving a brief presentation to 10-15 acquaintances; when comfortable, a longer presentation to them.
  5. Giving a brief presentation to 3-4 strangers; when comfortable with that, visualizing giving them a longer presentation.
  6. Giving a brief presentation to 10-15 strangers.
  7. Giving a brief presentation to 50 strangers.
Whatever the situation, visualization works best if you first learn a relaxation technique and visualize the scenes while practicing relaxation, moving up the hierarchy only when you feel comfortable.

  • Visualize a scene as if you're actually there -- emotions, colors, sounds, tastes, temperature, smells, other people/objects. First create a peaceful scene where you feel completely safe. As you move up the hierarchy, if you experience more than moderate anxiety after 30 seconds to a minute, go back to your peaceful scene for a few minutes until you feel relaxed enough to try again. 
  • The best way to gauge your change from anxiety to comfort is to create a 10-point scale, where level 2 or 3 is mild to moderate anxiety and 10 is blow-your-socks-off terror. When you feel low or no anxiety visualizing the least anxiety-provoking scene, move to scene #2 and repeat the process. You'll gradually develop comfort with the scene at the top of your hierarchy (#7 in the example above). Also, you can build up to 30 minutes of visualization/relaxation. Eventually, you'll find you can master 2-3 scenes in 30 minutes.
One of my most interesting consultations on this topic occurred almost as an aside. I reviewed personality styles with a client's team members before a team session, and one of them ("Ned") said "I really identify with the driving force of fear. My anxiety is not so bad at work, but I've developed a real phobia of snakes. I like to ride my motorcycle on country roads, but I haven't been able to do that for a couple of years."

"Well," I replied, "snakes can act as a metaphor for all the 'snakes' you have to deal with on the job. Let's work on it." I asked him to describe his worst possible imagined scene with snakes and the least scary scene. We then created seven or eight scenes between those two associated with increasing levels of anxiety. After we completed his hierarchy, I taught him deep relaxation and visualization techniques so he could mentally rehearse, moving up to the next most difficult step only when he felt relaxed at the step he'd just practiced. 

Apparently those few minutes motivated Ned to continue on his own. I didn't see him again until six months after the team session. As I was heading toward his boss' office, Ned stopped me in the hall and said with a grin, "I'm so glad to see you. I wanted to tell you my fear of snakes is gone!" 

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