Clearly, before therapy Nancy was extremely fearful about speaking in class. We might say that Nancy had a public speaking phobia. A phobia is “a fear in which the level of anxiety or escape and avoidance behavior is severe enough to disrupt the individual’s life” (Miltenberger, 1997, p. 490). While many people may feel anxious at the thought of giving a presentation in front of a class, Nancy’s initial reaction appears to be disproportionate to that situation. Dropping out of graduate school in order to avoid speaking in class is certain to have an adverse affect on her life.
(Consistent with Spiegler & Guevremont [1998], we will use the terms anxiety and fear equivalently to refer to reactions “that are characterized by uneasiness, dread about future events, a variety of physical responses [such as muscle tension, increased heart rate, and sweating], and avoidance of the feared objects” [p. 199].)
To help Nancy overcome her fear, her therapist used a procedure known as systematic desensitization, developed by Joseph Wolpe. In this procedure,
“…the client imagines successively more anxiety-arousing situations while engaging in a behavior that competes with anxiety (such as relaxing). The client gradually (systematically) becomes less sensitive (desensitized) to the situations.” (Spiegler & Guevremont, 1998, p. 200).
There are a few noteworthy features of Nancy’s therapy. First, she was taught a response to compete with her anxiety, in this case, relaxation. Competing responses are thought to inhibit or prevent the occurrence of the fear response, a process referred to as reciprocal inhibition. Neurophysiology may play a role:
“Our physical emotional responses (for example, increased heart rate and sweating) are largely controlled by the autonomic nervous system, which is divided into two branches: sympathetic and parasympathetic. The physical symptoms of anxiety are primarily sympathetic functions, while relaxation is associated with parasympathetic functions. At any given moment, either the sympathetic or the parasympathetic system predominates. Thus, during systematic desensitization, the client’s anxiety is inhibited by a reciprocal or opposite physiological response, relaxation.” (Spiegler & Guevremont, 1998, p. 216-218)
Wolpe (1976) contends that reciprocal inhibition is “a simple fact of life, a constant and inevitable condition of the central nervous system’s integration of its functions” and that it is “not only implicated in virtually every response, but probably participates in every instance of learning” (p. 16).
Another noteworthy feature of Nancy’s therapy was the fact that her therapist confronted her with the feared situation. Systematic desensitization is a type of exposure therapy, in which the client in some way makes contact with the situation that is causing the negative emotional reaction (under carefully controlled conditions). As Spiegler & Guevremont (1998) note: “In a sense, exposure therapies are refined applications of the common wisdom that you should get back on the horse that has just thrown you” (p. 199). Systematic desensitization is distinguished from other exposure therapies in two ways. First, the confrontation is incremental, starting with a distant approximation to the fear-provoking situation and working through a series of progressively closer approximations. Nancy’s therapy would not have been incremental if, from the start, she had imagined giving a presentation to her classmates and professor. Second, the confrontation occurs in Nancy’s imagination, not in the fear-provoking situation itself. With the guidance of her therapist, Nancy eventually visualizes her worst fear, but at no point during therapy sessions is she ever confronted with actually having to experience it firsthand.
Systematic desensitization is a therapeutic procedure employed to help persons overcome debilitating fears or phobias. Wolpe (1982) suggests that systematic desensitization is most appropriate for situations in which the client is a “passive responder to the stimulus” (p. 140). In other words, the situation triggers a negative emotional reaction. (As we will describe later, respondent behavior is likely involved in these situations.) Nancy may be able to perform a wonderful presentation, so long as no one else is around. When they are, she can’t help feeling extremely fearful. There is nothing the therapist can teach her to do in the classroom (e.g., how to deal with an unfair comment by a classmate or her professor) that would result in her feeling any less fearful. We might say that her problem does not lend itself to “being handled” (Wolpe, 1990).
When is systematic desensitization contraindicated? Systematic desensitization is not sufficient, when the problem is maintained by a skill deficit (Spiegler & Guevermont, 1998). Suppose Nancy is unable to perform a good presentation due to lack of knowledge and practice. In this case, teaching Nancy some of the basic skills involved in giving a good presentation may be the treatment of choice, or at least a supplement to systematic desensitization. Systematic desensitization is also typically not used with young children because of the troubles they have in implementing the procedures (Spiegler & Guevermont, 1998).