broad spectrum behavior therapy. As specific techniques
are described in the following pages, the reader
should realize that each can serve a specific purpose
but that, in reality, they are complementary. For
example, a woman who has trouble coping with a
domineering husband may undergo assertiveness
training to learn specific behaviors. But when she
uses these behaviors, other sets of fears about their
relationship may begin to worry her. Therefore, she
may also require therapeutic sessions that will help
her restructure her beliefs about the marriage that
are illogical and tend to perpetuate her submissive
behavior. She might also participate in modeling or
observational learning to help her cope.
In addition, it is important to recall from Chap-
ter 9 that a comprehensive behavioral assessment is
conducted before behavioral treatments or tech-
niques are selected and implemented. For example,
a functional analysis of the presenting problem helps
to identify (a) the stimulus or antecedent conditions
that bring on the problematic behavior; (b) the
organismic variables (e.g., cognitive biases) that are
related to the problematic behavior; (c) the exact
description of the problem; and (d) the conse-
quences of the problematic behavior. By complet-
ing such a detailed analysis, behavior and cognitive-
behavioral therapists can prescribe appropriate
treatments.
Systematic Desensitization
This technique is typically applied when a patient
has the capacity to respond adequately to a particu-
lar situation (or class of situations), yet reacts with
anxiety, fear, or avoidance. Basically, systematic
desensitization is a technique to reduce anxiety.
Developed by Salter (1949) and Wolpe (1958), it
is based onreciprocal inhibition—the apparently sim-
ple principle that one cannot be relaxed and anx-
ious simultaneously. The idea is to teach patients to
relax and then, while they are in the relaxed state,
to introduce a gradually increasing series of anxiety-
producing stimuli. Eventually, the patient becomes
desensitized to the feared stimuli by virtue of having
experienced them in a relaxed state. Systematic
desensitization has been shown efficacious for ani-
mal phobias, public speaking anxiety, and social
anxiety (Chambless et al., 1998; Chambless &
Ollendick, 2001; Spiegler & Guevremont, 2010).Technique and Procedures. Systematic desensi-
tization begins with the collection of a history of
the patient’s problem. This includes information
both about specific precipitating conditions and
about developmental factors. Collecting a history
may require several interviews, and it often includes
the administration of questionnaires. The principal
reason for all of this is to pinpoint the locus of the
patient’s anxiety. It is also part of assessment to
determine whether systematic desensitization is the
proper treatment. In a patient with adequate coping
potential who nevertheless reacts to certain situa-
tions with severe anxiety, desensitization is often
appropriate. On the other hand, if a patient lacks
certain skills and then becomes anxious in situations
that require those skills, desensitization could be
inappropriate and counterproductive. For example,
if a man becomes seriously anxious in social situa-
tions that involve dancing, it would seem more
efficient to see that he learns to dance rather than
desensitize him to what is, in fact, a behavioral
deficit.
Next, the problem is explained to the patient.
This explanation is normally elaborated to include
examples from the patient’s life and to cover the
manner in which the patient acquired and main-
tains the anxieties. Following this, the rationale
for systematic desensitization is also explained.
The explanations and the illustrations should be in
language that the patient can understand—free
from scientific jargon. In a sense, the clinician uses
this phase to“sell”the patient on the efficacy of
systematic desensitization. It should be added that
the entire process of interviewing, assessment, and
explanation is conducted with warmth, acceptance,
and understanding.
The next two phases involve training inrelaxa-
tionand the establishment of ananxiety hierarchy.
While work is begun on the anxiety hierarchy,
training in relaxation is also started.PSYCHOTHERAPY: BEHAVIORAL AND COGNITIVE-BEHAVIORAL PERSPECTIVES 401