Which anxiety reduction technique involves creating a hierarchy of the clients fearful experiences?

Systematic desensitization is an evidence-based therapy approach that combines relaxation techniques with gradual exposure to help you slowly overcome a phobia.

During systematic desensitization, also called graduated exposure therapy, you work your way up through levels of fear, starting with the least fearful exposure. This approach also involves the use of relaxation techniques.

Both of these features make it different from other desensitization techniques, such as flooding.

Systemic desensitization involves three main steps. First, you’ll learn muscle relaxation techniques. Then, you’ll create a list of your fears, ranking them in terms of intensity. Finally, you’ll begin exposing yourself to what you fear.

Classical conditioning, sometimes associative learning principles, is the underlying theory behind this process. The goal is to overcome a phobia by replacing feelings of fear and anxiety with a state of calm.

As you work your way through your list of fears, you’ll continue to focus on relaxation when facing each new situation until it no longer causes discomfort.

Learning relaxation skills

You might learn a few different relaxation exercises in systematic desensitization. These exercises could be used on their own or in combination with each other.

Techniques you might learn include:

• Diaphragmatic breathing. With this technique, you’ll learn to regulate your breathing by breathing slowly and deeply through your nose, holding the breath for one to two seconds, then breathing out through your mouth.
• Visualization. You’ll focus on a relaxing scene, picturing it in your mind and concentrating on sensory details, such as sights or smells. This includes guided imagery, which involves someone describing a scene to you.
• Progressive muscle relaxation. You’ll learn to tense up and release muscles throughout your body. This technique can reduce muscle tension and help you recognize the difference between tense and relaxed muscles. That way, you’ll be able to better recognize when your muscles start tensing up in response to anxiety or fear.
• Meditation and mindfulness techniques. Learning meditation may help you become more aware of your thoughts and feelings as you face a fearful situation. Mindfulness helps you notice what you’re experiencing in the present moment, which can reduce anxious thoughts.

Creating a hierarchy of fears

After learning relaxation techniques, you’ll develop a fear hierarchy for the phobia or feared situation. This hierarchy typically involves 10 levels of fear.

You’ll likely go through the following steps to do this:

1. First, you’ll identify the most frightening level of your fear, or the “level 10” fear.
2. Next, you’ll identify the least frightening level of your fear, or the “level 1” fear.
3. Then, you’ll list the levels in between and rank them by the amount of fear they trigger. For example, seeing a photo of what you fear might be a level 3, but actually touching the thing you fear could be a level 8 or 9.
4. Next, you’ll develop ways to expose yourself to each level of fear. This is usually done with the help of a therapist.
5. Finally, you’ll begin exposing yourself to your fear, starting with the least frightening items on your list.

Slowly exposing yourself to fears

Once you have relaxation techniques and a hierarchy of fears, you can start gradually exposing yourself to your fears.

A typical first step is thinking about the thing you fear. Once you begin feeling afraid or anxious, use relaxation techniques to regain a sense of calm. Repeat the process until you no longer feel anxious.

When you can comfortably address a particular level of fear, move on to the next level.

You can work through your fear hierarchy in therapy, but you can also do it on your own.

The process of systematic desensitization differs for each person.

Some people move through low levels quickly and have a hard time overcoming higher levels. Others may take a long time to work through lower levels, but they find the fear easier to face once they’ve succeeded at the lower levels.

The most helpful relaxation technique can also vary. You might find visualization helps you relax the most, for example.

Regardless of your fear or the length of time you spend working through each level, the principles remain the same.

Here’s how systematic desensitization might look for different conditions.

Social anxiety

You’re a college student with social anxiety. When you think about giving the wrong answer in class or having to ask to use the restroom, you feel sick and your heart races. You avoid speaking in class or participating in college activities to avoid embarrassing situations.

When you decide to try systematic desensitization, you determine that talking to someone you don’t know is a level 1 fear. You begin imagining yourself vocally greeting people, practicing deep breathing when you feel anxious, until you can remain calm.

Next, you move on to greeting strangers in real life. After a week of doing this daily, you start to feel more at ease.

Then, you start working on the next fear — making eye contact during conversation. You work your way through the hierarchy, eventually introducing yourself and nodding along in class. You continue to use deep breathing and muscle relaxation to get through periods of discomfort.

The final level of your fear hierarchy involves sharing in class. It takes a few tries, but eventually you’re able to answer questions in class, though your heart still begins to race once you put your hand up. You take a deep breath, release the tension in your muscles, and begin to speak.

Dog phobia

When you see a dog coming toward you in the distance, your palms sweat, your heart races, and you have trouble breathing. Your phobia relates specifically to being bitten, but being around dogs also makes you feel afraid and anxious.

To get started on your hierarchy of fears, you begin by imagining you’re near a dog on a leash in a passing car. The next day, you drive by a dog park several times. It doesn’t seem to affect you much, so you park somewhere where you have a full view of the park.

You feel yourself tense up every time a dog starts barking. To combat this, you concentrate on relaxing your muscles and imagining yourself on a beautiful beach — one without dogs. You open your eyes and repeat this process for the next 30 minutes.

Next, you spend time with a friend who keeps her dog in a different room of her home while you’re visiting. You practice relaxation exercises each time you think about the dog getting out.

As you prepare to conquer your level 10 fear — walking through a dog park — you decide to spend some time in the puppy area of your local animal shelter.

Puppies are less frightening to you, but the thought of them being so close still makes you feel anxious. You have to step outside a few times to do some deep breathing and visualization exercises.

Finally, after months of work, you head back to the dog park. This time, you park your car and walk through the gates. You sit on a bench and practice deep breathing as you watch the dogs playing.

Even though you still feel somewhat frightened, you focus on the fact that you’re facing your fear.

It’s possible to try systematic desensitization on your own, but remember that slow, gradual exposure is a key component of this approach. If low-level exposure makes you feel anxious, keep practicing your relaxation techniques and working on that fear.

There’s no right pace for working through your hierarchy of fears. You might spend months on a single one, only to blast through the next two over the course of a few weeks.

Take as much time as you need. If you move too fast, you may put yourself through unnecessary discomfort.

If you’d like to try this approach on your own, the following tips can help:

• Familiarize yourself with relaxation techniques. If you’re already feeling tense and anxious, thinking about relaxing may be harder, so it’s important to learn these techniques first.
• List at least two items for each level of fear on your hierarchy. This allows for more exposure to your phobia.
• Practice exposing yourself to your fear each day. Even a few minutes every day can help.
• Remember to stop and use a relaxation exercise when you feel anxious. The goal is to replace the anxious feeling with a relaxed state. You might have to try each step multiple times, and that’s OK.
• Try to continue the exposure exercise until you feel about half the fear or anxiety you typically would. This can be hard to gauge, but you’ll likely become better able to track it as you become more familiar with exposure.

If you’re unsure about trying systematic desensitization on your own, a therapist can answer any questions you have and offer support. If the approach doesn’t work well for you, you can explore other approaches in therapy.

HOW TO FIND A THERAPIST

Finding a therapist can feel daunting, but it doesn’t have to be. Start by asking yourself a few basic questions:

• What issues do you want to address? These can be specific or vague.
• Are there any specific traits you’d like in a therapist? For example, are you more comfortable with someone who shares your gender?
• How much can you realistically afford to spend per session? Do you want someone who offers sliding-scale prices or payment plans?
• Where will therapy fit into your schedule? Do you need a therapist who can see you on a specific day of the week? Or someone who has nighttime sessions?

Next, start making a list of therapists in your area. If you live in the United States, head over to the American Psychological Association’s therapist locator.

If cost is an issue, check out our guide to affordable therapy.

It’s often difficult to face fears. It can be even harder if you have a mental health condition, such as a phobia, anxiety, or panic disorder. Systematic desensitization can help you overcome your fears at a pace that works for you.