The 5 differences between systematic desensitization and exposure

These two techniques are widely used to treat phobias.

There are a large number of psychological treatments developed in order to respond to the problems and psychological disorders that exist. Some of them have demonstrated a proven efficacy in improving the symptomatology or even eliminating the problem, as is the case with two of the most used treatments in the therapy to treat phobias: systematic desensitization and exposure.

These techniques are highly effective and very similar to each other, to the point that they are often confused with each other. However, the truth is that there are differences between systematic desensitization and exposure, as we will see in the following sections.as we are going to see throughout this article.

Two methods used in psychotherapy

Exposure therapy and systematic desensitization are two of the major treatments used for a Wide range of disorders.

While they are are particularly well known for their success in treating phobias, there are several variations of theseThere are several variations of these techniques that are used in problems such as post-traumatic stress disorder (exposure to interoceptive sensations, for example, or desensitization by eye movement reprocessing). Even techniques such as behavioral experiments used in behavioral problems or to combat beliefs (as in obsessive-compulsive disorder or major depression) are largely based on the same principles. Let's look at a brief definition of each of the terms.

Exposure

Exposure is a basic but very powerful technique, which bases its operation on placing the subject or patient face to face with the stimuli he or she fears.. It is a matter of making the subject remain in the frightening situation long enough for his anxiety to decrease naturally, to the point of becoming imperceptible. Thus, a habituation to the stimuli is produced.

Such exposure can and usually is graded in such a way that the process does not become excessive for the patient.This exposure can and usually is graded in such a way that the process is not excessive for the patient, with a hierarchy of exposure from which the subject will be exposed to the different stimuli until the level of anxiety is reduced until it becomes imperceptible.

There are multiple variants of exposure (in fact, under a certain perspective, systematic desensitization could be considered as such), and it can be applied both live and in imagination or even in recent years through virtual reality.

Systematic desensitization

It is a technique similar to exposure, oriented to achieve the reduction of anxious and emotional responses aversive to the patient while limiting and avoiding for the patient while limiting and avoiding the avoidance of situations.

On this occasion, it is based on the idea that if fear is learned, it can also be learned to eliminate it: the therapeutic efforts will be focused on the subject achieving the elimination of the anxiety generated by the stimulation in an active way. The aim is for the subject to actively perform responses that are totally incompatible with the anxious ones, in such a way that he/she learns to eliminate the association between stimulus and fear in order to generate another one between stimulus and relaxation, indifference or another alternative. In other words, it is based on counterconditioning.

In this case, too, the subject will have to expose himself to the stimuli that generate anxiety, being essential the hierarchization of the stimuli. in such a way that the counterconditioning process can be carried out little by little and with increasingly anxiogenic stimuli. Traditionally and habitually this technique tends to be performed in imagination, although it is possible to perform it with live stimulation or in virtual reality.

5 major differences between the two techniques

Although a superficial observation can show that there is a great similarity between desensitization and exposure and even cause us to confuse them, a deeper analysis of how they work reveals that they have some notable differences. Among them, the following five stand out.

1. Slightly different objectives

One of the main differences between exposure and systematic desensitization is the fact that they have objectives that, although similar, are different: while in exposure the objective is for the subject to reduce his or her anxiety levels by remaining in the aversive situation itself, systematic desensitization aims for the subject to generate responses that do not lead to the appearance of anxiety. that the subject generates responses that do not leave room for the appearance of anxiety..

2. Different mechanisms of functioning

Profoundly linked to the previous point, in addition to the objectives, they also differ in the methods. Although in both cases the patient has to face the stimulus that causes anxiety, while exposure is based on habituation to the stimulation as a method to reduce the anxiety it generates, in desensitization, counterconditioning is used.The aim is for the subject to carry out a response incompatible with the anxiety that replaces his or her previous response.

3. Structuring and gradualness in the exposure

Another element that can mean a difference between the two techniques is the obligatory nature of the gradualness. Systematic desensitization is always carried out in a very structured manner, requiring a clear hierarchy of exposure. However, although exposure can also be (and indeed is recommended to be) graded, it is also possible to find variants such as implants. variants such as implosion and flooding, in which exposure to the most in which exposure to the most feared stimulus is very immediate. The pace will also depend on the patient's preferences and possibilities and how the patient reacts to the exposure.

4. Different use of relaxation

Relaxation techniques such as diaphragmatic breathing and Jacobson's progressive relaxation are very useful and frequently used to reduce the level of anxiety, being frequently incorporated in both techniques.

However, the use made of them is different: while in systematic desensitization they are used as a mechanism for counterconditioning, employing them as a response incompatible with anxiety, in exposure their use is limited to lowering the level of anxiety. is limited to lowering the level of tension before the exposure to the phobic stimulus in those cases in which the anxiety is excessive for the patient.

5. Different levels of generalization

Although both techniques are very effective for the treatment of phobias when correctly applied by trained professionals and taking into account the needs and particularities of each patient and situation, the truth is that another difference can be found regarding their level of generalization.

Exposure allows to reduce the level of anxiety towards phobic stimuli agreed between therapist and patient in a very efficient way, but although habituation to such stimuli can be generalized towards other similar stimuli, the effect of the technique may be slightly restricted. However, as systematic desensitization allows the generation of an alternative response, it is possible that in this second one there may be generalization towards other situations and stimuli that generate anxiety, applying that generate anxiety, applying the same incompatible response.

Bibliographical references

• Labrador, J. (2004). Behavior modification techniques. Spain: Ediciones Pirámide.