Practical Considerations and Critiques of Systematic Desensitization

While systematic desensitization therapy offers many benefits, there are several practical considerations and critiques to keep in mind:

1. Time investment: Systematic desensitization is a slow process, typically requiring 6-8 sessions. However, research suggests that longer treatment durations may lead to more effective outcomes.

2. Accessibility: Some individuals may face barriers to engaging in systematic desensitization, such as:

   • Unwillingness to participate
   • Inability to engage due to severe anxiety or other factors
   • Financial constraints limiting access to therapy

3. Focus on symptoms: A significant critique of systematic desensitization is that it primarily treats observable and measurable symptoms rather than addressing the underlying causes of phobias or anxiety disorders.

Highlight: Systematic desensitization may not fully address the cognitive and emotional aspects that often motivate anxious behaviors.

4. Variability in effectiveness: While systematic desensitization has shown success in treating specific phobias, its effectiveness may vary for different types of anxiety disorders or more complex psychological issues.

5. Need for personalization: The systematic desensitization steps must be tailored to each individual's specific fears and anxiety levels, requiring skilled therapists to implement effectively.

Definition: In vivo desensitization refers to exposure to feared stimuli in real-life situations, while systematic desensitization can include both real and imagined exposures.

6. Maintenance of results: Long-term follow-up studies are needed to assess the durability of treatment effects and determine if additional "booster" sessions may be necessary for some individuals.

Vocabulary: Symptom substitution - The phenomenon where treating one symptom may lead to the emergence of other psychological symptoms.

Despite these considerations, systematic desensitization remains a valuable tool in the treatment of phobias and anxiety disorders, particularly when combined with other therapeutic approaches that address underlying cognitive and emotional factors.

Effectiveness and Limitations of Systematic Desensitization

Systematic desensitization has shown considerable success in treating learned fears and specific phobias. Research indicates that this approach can significantly reduce both physiological and self-reported fear levels.

Example: Capafons et al. (1998) found that clients with a fear of flying exhibited fewer physiological signs of fear and reported lower fear levels after a 12-15 week treatment period using both in vivo and in vitro techniques.

Key points on effectiveness:

• Success rates for systematic desensitization and exposure therapies range from 75-80% (McGrath et al., 1990; Marks, 1990).
• In vivo procedures tend to be more effective than in vitro desensitization.
• The approach is particularly successful for overcoming learned problems and specific phobias.

However, systematic desensitization vs exposure therapy has some limitations:

• It may not be appropriate for all types of phobias, especially those rooted in ancient fears or involving intangible stimuli (e.g., ghosts).
• There is a risk of symptom substitution, where eliminating one symptom may lead to the appearance of others.
• High dropout rates have been observed in some studies.

Highlight: While systematic desensitization can effectively treat symptoms, it may not address the underlying causes of phobias or anxiety disorders.

Ethical considerations make systematic desensitization preferable to more intense methods like flooding:

• The gradual approach allows clients to progress at their own pace.
• Anxiety is controlled throughout the process, making it more ethical.
• Clients can provide informed consent and have the freedom to withdraw at any point.

Quote: "The progressive structure of SD allows the patient to control the steps they must make until fear is overcome."