Systematic desensitization or exposure?

Systematic desensitization and exposure are widely used techniques in psychology. Usually, they are postulated as useful for getting the person into contact with the stimulus that scares them or causes anxiety, so that it is reduced.

Therefore, they can be especially useful techniques for treating anxiety disorders (they work especially well in phobias), mood disorders or obsessive-compulsive disorders.

As anxiety is an almost constant emotion in any mental disorder, they are two very versatile techniques. However, the limitations that one presents can be covered by the other, such as the problem of abandonment or refusal to expose oneself through exposure with response prevention.

Thus, systematic desensitization and exposure are postulated as the great techniques to eliminate fear through fear itself.

What is a DS? What is an exhibition?

Systematic desensitization and exposure They aim to stop the person from fearing a stimulus. Whether it is public speaking, snakes or anxious expectations of the future, the aim is to ensure that this stimulus stops being dangerous for the person.

The systematic desensitization (DS) aims to carry out an association between stimuli that previously provoked an anxiety response; and responses on the part of the person that are incompatible with that anxiety. Therefore, we seek to achieve counterconditioning, breaking the link between stimulus.

The exhibition, or exposure with response prevention (EPR) seeks to prevent the person’s avoidance or escape from the phobic or anxiety-producing stimulus; so that behaviors that always function as safety behaviors disappear. Thus, they stop sustaining the anxiety that emanates from it, and it ends up disappearing.

How are DS and EPR different?

It is quite common to think that the big difference between systematic desensitization and exposure with response prevention is the way in which it is applied. There are certainly differences.

For example, in DS, as we have said before, a counterconditioning process is sought to take place including relaxation techniques. If the person shows anxiety when faced with a stimulus, we want the person to stop and relax, and then present the stimulus again. However, are the processes inherent to the techniques not the same? Is DS an exhibition with relaxation techniques?

The truth is that what differentiates both techniques is the learning process. In the case of the DS it takes place, as we have already mentioned, a counterconditioning process and in the case of EPR, an extinction process.

Van Egeren’s model has the solution

Van Egeren (1970) presents four phenomena based on two dimensions: reciprocal inhibition and short or long term.

In all four modalities, anxiety levels decrease when faced with an anxiety-producing stimulus, but the learning processes inherent to all four are different. In fact, in two there are learning processes (long term) while in the remaining two there are psychophysiological processes (short term).

Reciprocal inhibition refers to the use of some element that is incompatible with feeling anxiety. For example, a relaxation technique or controlled breathing. It appears in the DS, but not in the EPR.

Thus, Van Egeren argued that stimuli can stop being anxiety-producing or phobic through processes of:

Habituation: when there is no reciprocal inhibition, that is, when a relaxation strategy is not implemented, it may occur that in the short term The person becomes accustomed to the anxiety stimulus. This does not mean that, if that stimulus appears again, the anxiety response will not take place. Habituation happens in the short term, and that is why it is a psychophysiological process, not a learning one.Reciprocal inhibition: Likewise, in the short term, reciprocal inhibition can be used to reduce anxiety levels. However, like habituation, it does not mean that when that stimulus is presented again the person will not feel anxiety.Extinction: extinction takes place in the long term and when there is no reciprocal inhibition. In this case, the person is exposed to the anxiety stimulus without being able to carry out safety or reciprocal inhibition behaviors. This is the EPR learning process: expose until you extinguish.Counterconditioning: It also has long-term effects and, if it works, in the long term. It is the learning process of DS, as already mentioned.

Is DS Pavlovian and EPR operant?

Some people also try to differentiate systematic desensitization and exposure. arguing that the first is Pavlovian and the second is operant.

When we say that it is Pavlovian, we are talking about DS dealing with conditioned stimuli. An example of CS could be a car, the conditioned response (CR) being anxiety about a possible accident. In this case there are neither reinforcements nor punishments that maintain a behavior.

However, EPR can also take care of Pavlovian stimuli and not only operant ones. It is useful for operants because ERP is about avoiding any behavior on the part of the person that reinforces anxiety.

For example, when a person with a bus phobia avoids this method of transportation, they are reinforcing the anxiety that the bus generates. In EPR, broadly speaking, the aim would be to ensure that the person does not run away or avoid the bus; The aim is to increase it, and not to reinforce the opposite behavior.

The exhibition can also assume CE and CR. In the previous example, a person can be exposed to a car, without any type of reciprocal inhibition or relaxation, so that they can verify that this accident does not take place.

What technique do I use then?

ERP is used in various anxiety disorders. Currently, is the preferred behavioral intervention for the treatment of the obsessions and compulsions of obsessive-compulsive disorder. It has also been used in specific phobias, such as agoraphobia or social phobia.

DS, on the other hand, has evidently been advocated as valid for the treatment of phobias or disorders where anxiety is an important element, such as eating disorders, sexual dysfunctions, insomnia, alcoholism… It is also recommended to reduce fear and the tension experienced by some asthmatic patients in the face of their crisis.

The DS is also useful when live exposure or EPR is problematic: a man whose anxiety levels prevent him from carrying out the exposure (in which case relaxation techniques could be appropriate), or exposures that are difficult to apply, such as a phobia of flying.

Some authors, on the other hand, understand that systematic desensitization also presents a process of extinction and not counterconditioning. These suggest that any technique that causes subjects to be exposed to feared stimuli in the absence of aversive consequences would be as effective as a DS in eliminating fear responses.

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