relaxation and 100 maximum tension.
Tell me approximately where you’d place
yourself on that scale....(Therapist is
advised to look for a rating that reflects consid-
erable calm and relaxation, often in the range of
15 to 25.)
Fine. Soon I shall ask you to imagine a
scene. After you hear the description of the
situation, please imagine it as vividly as you
can, through your own eyes, as if you were
actually there. Try to include all the details
in the scene. While you’re visualizing the
situation, you may continue feeling as
relaxed as you are now. If so, that’sgood.
After 5, 10, or 15 seconds, I’ll ask you to
stop imagining the scene and return to your
pleasant image and to just relax. But if you
begin to feel even the slightest increase in
anxiety or tension, please signal this to me
by raising your left forefinger. When you do
this, I’ll step in and ask you to stop imagin-
ing the situation and then will help you get
relaxed once more. It’s important that you
indicate tension to me in this way, as we
want to maximize your being exposed to
fearful situations without feeling anxious.
OK? Do you have any questions?...Fine,
we’ll have ample opportunity afterwards to
discuss things in full. (pp. 124–125)^1Rationale. Many explanations have been offered
for why systematic desensitization works (Spiegler
& Guevremont, 2010). Although Wolpe’s explana-
tion for the success of systematic desensitization is
based on the principle of counterconditioning (the
substitution of relaxation for anxiety), others are
not so sure (Davison & Wilson, 1973). Some have
argued that the operative process is reallyextinction.
That is, when the patient repeatedly visualizes
anxiety-generating situations but without ensuing
bad experiences, the anxiety responses are eventu-
ally extinguished (Wilson & Davison, 1971).
Alternatively, Mathews (1971) argues on behalf of
ahabituationhypothesis. Finally, some suggest that
cognitive factors may be responsible for the benefi-
cial effects of systematic desensitization (e.g., creat-
ing expectations that one will be less anxious in a
given situation).
The standard method of desensitization is to
present scenes in a graduated ascending fashion to
avoid premature arousal of anxiety that would dis-
rupt the procedure. Systematic desensitization
involves a number of components. The instruc-
tions to the procedure suggest that a positive
outcome is likely. Consequently, the patient’s
expectations for improvement may affect the
process. Another crucial element may be positive
reinforcement from the therapist following the
patient’s reports of reduced anxiety, improvement
outside the consulting room, or the successful
completion of anxiety hierarchies. For example,
Leitenberg, Agras, Barlow, and Oliveau (1969)
observed that, with snake phobias, the effects of
systematic desensitization are best when the thera-
pist uses reinforcing comments, such as“Good,”
“Excellent,”and“You’re doing fine,”when par-
ticipants (a) visualize a scene without reporting
anxiety, (b) complete a hierarchy item, and (c)
report progress in approaching a snake during
practice. Goldfried (1971) argues that systematic
desensitization is far from a passive process that is
appliedtopatientstoreducetheirfears.Rather,it
represents the acquisition of a skill that the patients
canusetoreducetheirownfear.Inthatsense,
Goldfried regards systematic desensitization as
training in self-control.
All of the foregoing suggests that systematic
desensitization is hardly the simple mechanical or
conditioning process that it was once thought to
be. A number of relationship variables seem impli-
cated as well as beliefs or expectations on the part
of the patient. In general, systematic desensitiza-
tionhasproventobeamoderatelyusefulform
of psychological intervention for a variety of- FromClinical Behavior Therapy(Expanded Edition) by M. P. Goldfried & G. C. Davison. Copyright © (1994) John Wiley
and Son, Inc. Reprinted by permission.
PSYCHOTHERAPY: BEHAVIORAL AND COGNITIVE-BEHAVIORAL PERSPECTIVES 405