Youtube Series “Coexisting With Agoraphobia, Anxiety and Panic Attacks” Video #4: Systematic Desensitization

Hello all….Below is the text from my 4th Youtube video in my series “Coexisting With Agoraphobia, Anxiety and Panic Attacks.” This video is about a subject called systematic desensitization… I expect there will be two more in this series. I hope some of this information is helpful to you!

Systematic Desensitization

Hello again my friends….Ellen here back for video #4 in my series “Coexisting with Agoraphobia, Anxiety and Panic Attacks”…
Today I’d like to talk about an important method used to help overcome anxiety reactions in certain situations that I have used in the past that was very helpful to me. This method is called “Systematic Desensitization.” Before I do that I’d like to briefly define what we mean here by “Sensitization”…at least in psychological terms.
Technically sensitization is the process of becoming highly sensitive to specific events or situations (especially emotional events or situations in our case). For most of us who are agoraphobic there can be a highly charged emotional reaction to many life events. Most, but not all, of these reactions pertain to trying to do things that are outside of our homes, safe place or comfort zone, such as going to the grocery store, or driving. We could call these types of situations “territorial.” These reactions however, can also happen in relation to situations that can happen WITHIN our safe place, or comfort zone. An example of such a situation might be having people enter our safe place or comfort zone. This might fall into the category of social phobia. Agoraphobia may encompass several different types of phobias. No matter what the trigger, however, systematically trying to desensitize to whatever the stimulus is can be very helpful.
A medical example that is similar and may be helpful in explaining desensitization is in reference to allergies. The first similarity is that a person can be allergic to something but not know what he is allergic to. The allergy specialist first determines, by testing, what is causing the sensitivity. Secondly, a person may be so overly sensitive that even the smallest amount of material will cause a severe reaction. The third similarity is that the treatment requires diluting the sensitizing material down to a level where it can be injected and only a mild reaction occurs. Then, by frequent injections the dosages are gradually increased, and by allowing the individual to recover fully before the next injection, desensitization takes place. By proceeding on a regular basis over a period of time, the person builds up a greater tolerance for the allergen or stimulus and finally arrives at a place whereby exposure to the full strength material produces no allergic reaction or very little reaction.
Now let’s translate this into phobias. We might say that the phobic person has become allergic [supersensitive] to certain emotional stimuli so that when exposed to that stimuli he overreacts both emotionally and physiologically. So if you have phobias, and the anxiety reactions that go with them, you first have to identify the specific stimuli that touch off the super reaction. Once you have identified a noxious or triggering stimulus, you can then expose yourself to that stimulus in small doses on a regular basis in gradually increasing amounts until a tolerance is developed to full strength exposure to that stimulus. It’s like taking baby steps out of your comfort zone and trying to accomplish doing a new or difficult task an inch at a time.
Now how do you discover what your triggering stimuli are? One way is to write down everything you can think of which causes you any problem at all. You can do this over a period of time …perhaps a week. During that week, you write down anything and everything that occurs to you at the time the reaction is occurring..
Next, arrange the list from the least troublesome fear to the most troublesome fear. This will be your hierarchy of fears.
The goal in desensitization is this: When there is a stimulus that triggers anxiety, you need to get to the point where that stimulus loses its capacity to cause you anxiety, so that in the presence of that stimulus, you can remain relaxed.
Basically, the desensitization process for phobias is composed of three parts: imaginal desensitization, visual desensitization, and in-vivo or “real life” desensitization. You must always start with imaginal desensitization, since our first area of avoidance is always in our minds.

Imaginal desensitization:
Start with your least bothersome fear.
1. Imagine that you are in the situation that causes anxiety and stay there in your imagination until you react to a point where you are just only slightly uncomfortable (we call this a #3 in the anxiety scale). Anxiety might be measured on a scale of 1-10 with #1 being no anxiety and #10 being full fledged panic. A #3 might have symptoms such as sweaty palms, some muscle tension and a strong or rapid heartbeat. Do not picture yourself anxious at all in this situation-instead picture yourself dealing with the situation the way you would like to feel.
2. Retreat in your mind from the subject and distract your mind and go to your safe place in your imagination.
3. Allow yourself to relax completely.
4. Wait, relaxed, until you are completely recovered. If feelings are stirred up, allow yourself to express them. Often strong feelings will begin to emerge as you go through this entire process ,but do NOT run from them, it’s a wonderful sign that you are making progress.
5. Then you repeat the process over again.
You keep repeating this process until the stimulus in the situation you have chosen to think about causes very little or no anxiety when you think about it.
These steps might be called the “five R’s” and they are very important:

Many people report that they cannot seem to arouse any anxiety when they are just thinking about a stimulus. That is fine!
But the tendency under this circumstance is to skip over this first step in the desensitization process. Do not fall into this trap! You do not have to feel any anxiety in order for imaginal desensitization to work. The key is in the frequency; the more frequently you practice imaginal desensitization, the better the transference to the real-life situation. The Imaginal desensitization process is vital to your recovery. Always start with it whether it arouses your anxiety or not.
Visual desensitization
Using the same stimulus (subject or situation), the next step is to use pictures or slides.
1. Look at the picture or slide until you react only to a #3 anxiety level.
2. Retreat- walk away from the picture or back off from it or turn it over, and distract your mind.
3. Relax
4. Allow yourself to recover completely. If feelings are stirred up, again, allow yourself to express them.
5. Repeat the process, going back and forth until looking at the picture or slide causes very little or no anxiety.
Now you are ready for the last step- approaching the situation in- vivo (real life). I want to stress here that you do not start this step until you have progressed through the first two steps in the desensitization process: imaginal and visual desensitization. After you have progressed through these two steps, using the same stimulus, then you are ready to try in- vivo desensitization.
In- vivo desensitization:
I’d like to mention here that it will be very helpful if you engage the help of a supportive person when you get to this step. Someone who can actually go out with you or actively participate with you in what you are trying to accomplish. The added support and encouragement is invaluable.
Using the same stimulus to use in the two previous steps, approach the situation with no intention of accomplishing anything specific. For example, your troublesome situation is a supermarket. Do not approach the market with the idea of buying anything. Your goal is desensitizing yourself, not buying groceries. It is very important that you make a clear distinction between practice and demand situations. Again the process entails the “FIVE R’s” of…

1. Approach the situation until you react only up to a #3 anxiety level.
2. Retreat-stop or back off, or turn around, or take a few steps toward the door, or walk away.
3. Distract your mind and allow yourself to relax.
4. Wait until you were completely recovered and allow yourself to express any feelings that have been stirred up.
5. Turn toward the situation and repeat the process.
There are a few points here that need to be emphasized:
1. Do not let your anxiety rise above a #3 before you retreat. If your anxiety gets.
2. Retreat is not cowardly-it is absolutely necessary. Retreat and regroup just as they do in the military-that’s how wars are won. Retreat does not mean that you have to leave the situation or run away-you may only need to stop where you are and back off a few paces, or go to another room or outside for a few minutes. If you can’t actually leave the situation, even for a few minutes, you can also retreat by going to a safe, calm scene/place in your mind until you get used to the situation. Remember, you are not retreating forever– just until you recover.
“RETREAT” seems to be a very difficult concept for people to think about, let alone do. Thoughts and comments such as “I’ll feel like a coward,” or “people will think it’s funny or something’s wrong with me,” etc., often keep people from practicing retreating. This is no time to worry about what other people will think. You want to recover, and in order to do so, you need to learn how to desensitize yourself-to practice this process. Retreat is a necessary and vital part of the desensitization process. Practice retreating as much as you can.
3. You must keep repeating the desensitization process (all three steps) in order for it to work. You’ll find as you keep repeating it, that you are able to approach closer and stay longer in the situation.
The desensitization process that I have just described is a natural process. If left to our own devices, and if we were not worried about what other people think, we would automatically use this process when we approached anything new. For instance, a small child goes to the beach for the first time and sees the ocean. He does not plunge into the water, but cautiously approaches it. He looks at it from a distance and then, as his courage grows, gets closer. Each time he gets closer, his courage grows and his fears diminish. Eventually he sticks his foot into the water, then his legs, then his body and arms, etc. Notice, however, that the child has been left to his own devices. If, on the other hand, the child is overly cautioned by his mother about the dangers of the water, it will start to worry about his mother’s approval, be frightened by the dangers his mother has suggested, become sensitized and will probably not approach the water. This could spread to all water, so that the child will become panicky at the thought of taking a bath. At this point, instead of the natural desensitization process, the child will have to begin to consciously practice desensitizing himself to the water.
Because you have become sensitized to some stimuli and situations, just as the child, you need to start practicing desensitizing yourself. I hope this method proves to be very helpful to many of you. It takes time and may require the cooperation of many of the people around you, but the payoff can be amazing!
‘Til next time, this is Ellen saying “Namaste!”


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