Systematic Desensitization for Childhood Phobias

Systematic desensitization addresses childhood phobias by associating feared situations with a pleasant sensation that's incompatible with anxiety.
Systematic Desensitization for Childhood Phobias

Last update: 29 January, 2021

Children go through a variety of developmental fears as they grow up. These fears, appropriate to their developmental level, don’t necessarily pose a problem nor do they require intervention. However, on occasion, the fear becomes excessive, inadequate, or interferes with their daily life. In these cases, we may be looking at a phobia. One of the most effective treatments for this type of disorder is systematic desensitization (SD), which we’ll discuss in this article.

The most effective technique to date in the treatment of phobias is exposure. This consists of patients gradually facing the situations they fear. SD shares this essential component with exposure, however, it adds some elements that make it easier for children to accept.

What’s systematic desensitization?

South African psychiatrist Joseph Wolpe first proposed this behavior modification technique in the 1950s. It’s based on classical conditioning and uses its principles to eliminate anxiety and avoidance behaviors. This is based on the understanding that, in phobias, a certain neutral stimulus remains conditioned (by association with another) and begins to produce an anxiety response.

Systematic Desensitization for Childhood Phobias

For example, let’s imagine a child who begins to feel a phobia of dogs after one dog bite. Before this, the dog didn’t produce any negative emotion in the child. However, after associating it with the pain of the bite, dogs begin to produce a heightened fear in the child. In addition, because of this fear, the child will avoid coming into contact with dogs from now on at all cost.

Systematic desensitization proposes counter-conditioning in order for the dog to lose this negative association that it’s obtained. To achieve this, a professional attempts to associate this stimulus (the dog, in this case) with a response that’s incompatible with fear and anxiety.

In other words, the idea is to make the child associate the dog with a pleasant emotion. That way, they’ll no longer be able to continue associating it with fear.

Systematic desensitization step by step

1. Choosing the incompatible response

The first step is selecting the response that’s incompatible with the anxiety that we’re going to use. Generally, we usually work with relaxation, although it’s possible to use any emotion or response that fulfills the same function. To achieve this state of relaxation, it’s common to employ Jacobson’s progressive muscle relaxation technique.

In this technique, the person learns to differentiate the sensations of tension/distention in their different muscle groups. What’s more, they train to be able to detect muscle tension and dissolve it. This requires a certain amount of practice until kids can properly mange the technique, so this will be the priority task.

2. Development of a stimuli hierarchy

The next step is to make a list of the situations that cause anxiety in the child and to organize them hierarchically. In other words, it involves giving a value to each one according to the fear it produces in the child. And then, putting their fears in order from least to greatest.

Continuing with the previous example, the hierarchy could go from seeing a small dog on TV to petting a big dog on the street.

Systematic Desensitization for Childhood Phobias

3. Desensitization process

Finally, the desensitization sessions themselves begin. The professional asks the child to use the Jacobson technique until they feel completely relaxed. Then, the professional invites the child to imagine the scene of least value on the scale (the one that produces the least amount of fear) and to keep that image in their mind.

The child’s current state of relaxation will prevent the appearance of anxiety. And, once the child has managed to imagine the stimulus or situation three consecutive times without experiencing anxiety, they can move on to the next stimulus/situation on the list.

Considerations regarding systematic desensitization

Children are better able to tolerate this procedure than exposure, since the situation they fear may exist only in their imagination. This is also because they’re provided with a tool (relaxation) to deal with their anxiety.

However, it’s important to take into account that SD can only be applied to older children, who are able to correctly visualize the images and are capable of following the relaxation procedure. In younger children, emotional imagery is preferable.

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  • Schwarz, A., & Schwarz, A. (2017). Relajación muscular progresiva de Jacobson. Editorial HISPANO EUROPEA.
  • Pastor, J. F. S. (1987). La desensibilización sistemática treinta años después (Doctoral dissertation, Universitat de València).