Comprehensive reflection of a discussion

Write a one page response/feedback showing curiosity and highliting parts of the following post discussion. Build logical arguments based empirical evidence and theory.

Systematic Desensitization with Imaginal Exposure

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As Wright and colleagues (2017) described, systematic desensitization utilizes graded exposure with a hierarchy of stimuli, typically as a treatment for phobias or anxiety. With this approach, the individual is also taught relaxation techniques that they can use in each step of exposure. In imaginal exposure, also known as in vitro exposure, the exposure is imagined, such that the therapist gives the client various cues and paints the picture of a scene as detailed as possible, and the client is asked to imagine being immersed in the scene. Wright and colleagues (2017) clarified that the success of systematic desensitization depends on the quality of the hierarchy of anxiety-evoking situations. Developing the hierarchy for graded exposure is a collaborative effort in which the therapist helps the client create steps that are highly specific in nature. The client then rates each step/activity on a scale of 0 to 100 based on anxiety level. The ideal hierarchy has 8 to 12 steps relating to the same theme, with a good range of anxiety-evoking steps, from a low rating of 5 to 20 to a high rating of 80 to 100. Creating a thorough list will facilitate the process of stepwise exposure as opposed to jumping from a scene of low anxiety to one of high anxiety (Wright et al., 2017).

Spiegler (2016) added that the relaxation techniques such as progressive muscle relaxation are successful because they compete with the client’s anxiety which they would otherwise experience while imagining these scenes. Each session starts with a neutral scene that does not evoke anxiety, and the overall duration of the exercise is relatively short, as it need not take the entirety of the session. The client is also encouraged to signal when they are feeling discomfort so that they can stop the visualization to continue relaxing, and then carry on when comfortable so that the scenes are only associated with relaxation. Over time, the client becomes desensitized to specific situations and can progress down the hierarchy to imagining more anxiety-provoking situations. Spiegler (2016) stated that the first step of systematic desensitization with imaginal exposure is learning the response, followed by creating the hierarchy, and then finally, repeatedly visualizing the events while engaging in the competing relaxation techniques. It is also important to note that the three essential components for success of this treatment are repeated safe exposure, the gradual manner of exposure, and the use of a competing response during exposure (Spiegler, 2016).

Spiegler (2016) cautioned that though systematic desensitization is widely practiced and considered highly effective for the treatment of anxiety, is may not be equally appropriate for all populations. For example, some young children may struggle with progressive muscle relaxation. For those children and some adults who have difficulty with this, it may be helpful to use emotive imagery, or other competing responses such as listening to music or laughing. Additionally, if the root of the anxiety is a skills deficit, systematic desensitization would not be appropriate because it would not resolve the deficit as would skills training. Otherwise, systematic desensitization is efficient because it is not as time consuming as in vivo desensitization, and it is more acceptable because it involves less discomfort for the client. Clients are also able to maintain a sense of control by determining how fast they progress through the hierarchy. Though systematic desensitization is most commonly used for treating anxiety, it can be used for a wide array of diagnoses and concerns, such as OCD, anger, insomnia, and complicated grief to name a few (Spiegler, 2016). According to McLeod (2015), treatment with systematic desensitization is typically 4 to 6 sessions, but depending on the severity of the phobia, it may take up to 12 sessions (McLeod, 2015). Systematic desensitization certainly stands the test of time and is still considered effective in the treatment of various anxiety-related disorders in diverse populations more than 50 years since its inception.


McLeod, S. A. (2015). Systematic desensitization. Simply Psychology.

Spiegler, M. D. (2016). Contemporary Behavior Therapy (6th ed.). Wadsworth/Centage: Belmont, CA.

Wright, J. H., Basco, M. R., & Thase, M. E. (2nd Ed.) (2017) Learning cognitive-behavior therapy. Washington, DC: American Psychiatric Publishing, Inc.

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