Systematic sensitization. Method of systematic desensitization

Permissible, possible therapies to eliminate or reduce the severity of social fears in adolescents aged 16-18.

In order to correctly and approximately accurately identify the problem, it is often used helper method, identifying a specific social fear or phobia in a child - observation of behavior, structured in accordance with the problem of the child. Ideally, evaluation of problem behavior should take place in the natural environment where it tends to occur.

Accordingly, evaluative procedures for monitoring behavior have been developed to measure it. Procedures are used with children in the classroom or at home. Supervision can be trained by parents, teachers. Once they have learned to observe the adolescent's behavior, they can be taught to conduct a behavioral analysis of the problem and modify their own behavior to modify the adolescent's problem behavior.

Psychological surveys and tests can be used at the diagnostic stage. Same on this stage visual observation of the behavior of a teenager in various situations is used.

After identifying the problem, the use of methods to eliminate it or reduce the severity of social fears.

Description of acceptable, possible methods for eliminating or reducing the severity of social fears in adolescents aged 16-18.

Systematic desensitization.

Systematic desensitization psychotherapy - form behavioral psychotherapy, which serves the purpose of reducing emotional susceptibility in relation to certain situations. Developed by J. Wolpe based on the experiments of I.P. Pavlova on classical conditioning. [website: http://www.psychologos.ru/articles/view/sistematicheskaya_desensibilizaciya_po_volpe].

Since 1952, when (still in South Africa) the first publications of Joseph Wolpe devoted to this method appeared, systematic desensitization has been most often used in the treatment of behavioral disorders associated with classic phobias (fear of spiders, snakes, mice, closed space etc.) or social fears.[website: http://psyjournal.ru/psyjournal/articles/detail.php?ID=2096].

When using systematic desensitization, the psychologist, having identified specific events that trigger unjustified anxiety, builds their hierarchy, in which situations that cause fear are ordered from the least scary to the most frightening situation. [book of social fears and phobias].

The essence of the method is that in the process of therapy, conditions are created under which the adolescent thus confronts situations or stimuli that cause fear reactions in him, so that fear will not arise. With repeated repetition of this kind of confrontation, the fear reaction is extinguished, the client gets used to calmly perceive the stimuli that previously caused fear.

Desensitization is achieved by the fact that the psychologist very carefully and carefully changes some characteristics of situations or objects that cause fear in the client, starting with such an intensity of stimuli at which the client himself is able to control the reactions of fear. Often used in this modeling- i.e. the therapist or assistant demonstrates how he or she handles such situations without fear. [website: http://psyjournal.ru/psyjournal/articles/detail.php?ID=2096].

Desensitization ends when the strongest stimulus no longer causes fear. Sometimes, to fix the situation, it is recommended to repeat the procedure. [book of social fear and phobia].

After completing a course of desensitization, recovery occurs in 70-80% of those suffering from fears. [book of social fear and phobia].

Example. The psychologist identifies a specific aspect that causes unreasonable fear at a teenager. After that, he makes up a hierarchy of situations that cause fears in a teenager, i.e. ranks them in order from less "scary" that a teenager can handle on their own, to a more frightening situation. It is necessary to agree with the teenager, his consent, the developed program is necessary.

Desensitization is a psychotherapeutic method that consists in working with fears by reducing sensitivity to them. This direction is used when working with children and adults, the founder is F. Shapiro. Exists a large number of desensitization methods, each of which has its own characteristics in work and a different number of stages. Currently, this method is actively used in the behavioral psychotherapeutic direction and as an addition to any other method of psychotherapy.

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  Description

  Desensitization in psychology is a method of psychotherapy developed by F. Shapiro, a psychotherapist from America. This method allows individuals to be treated for situations where they experience strong emotional stress. As part of desensitization, work is carried out with fears, anxiety, anxiety and phobias.

  According to the scientist, after experiencing a psychotrauma, a person begins to misinterpret the meanings or signals that he associates with a traumatic situation. After suffering stress, a person has an automatic physical reaction to some stimuli (stimuli) that remind of the event. The essence of desensitization is that there is a release from muscle clamps that occur in the human body.

  The therapist needs to know where the clamps are located in the body so that they can be controlled. They are natural reaction body to a stressful situation.

  There are seven groups of clamps (blocks):

  1. 1. Eye.
  2. 2. Oral.
  3. 3. Neck.
  4. 4. Breast.
  5. 5. Diaphragmatic.
  6. 6. Abdominal.
  7. 7. Pelvic.

  The longer the traumatic event affects a person, the greater the muscle clamp becomes. The main task of desensitization is to eliminate blocks by relaxing them, especially at the moment of fear. The technique involves re-experiencing the frightening situation in which the person develops withdrawal skills. muscle spasms. The work is carried out under the supervision of a psychotherapist.

  In the process, the patient trains his body to relax in the frightening situation. Can be used breathing exercises, in which a person tries to maintain even breathing under the influence of a negative event. Some psychotherapists use eye movement desensitization.

  Method of systematic desensitization

  This technique was proposed by the psychotherapist D. Volpe in the late 50s to overcome states of increased anxiety and phobias and means a gradual decrease in sensitivity (sensitivity) to objects, events or people that cause stress. The scientist believed that all inadequate and uncontrollable human reactions occur against a background of fear or anxiety. A person experiences them just as vividly when imagining a stressful situation as if he actually got into it.

  This method is as follows: the patient relaxes, after that he imagines various frightening events. They appear in the mind in ascending order: from the easiest to the most frightening. At each stage, a person must remain calm and learn to relax. Last stage lies in the fact that the patient in the most terrible situation feels relaxed.

  This method is not effective if the patient has any secondary benefits from his fear.

  Systematic desensitization is indicated when a high level of anxiety occurs in situations where there is no danger or threat to physical, personal safety. The technique is effective in the event of psychophysiological and psychosomatic disorders, such as:

  • migraine;
  • headache;
  • skin diseases;
  • pathology of the gastrointestinal tract.

  Systematic desensitization is used for behavioral disorders due to phobias and anxiety. In this case, before starting the method, the patient should be protected from repeated exposure to stress and allowed to rest. Sometimes a person has avoidance reactions, that is, he seeks to prevent the appearance negative emotions avoiding any traumatic situations. Some people, when fear arises, become aggressive and quick-tempered, behave defiantly in order to pay attention to them. This method, in combination with other types of psychotherapeutic help, allows you to get rid of these symptoms.

  

  Stages

  Work in this direction is carried out in three stages.

  1. 1. At the first stage, the patient's ability to move into a state of relaxation is trained.
  2. 2. At the second stage, the psychotherapist, together with the client, builds a hierarchy of stimuli that cause anxiety in the latter.
  3. 3. At the third stage, work with fears takes place.

  At the preparation stage, the psychotherapist uses autogenic training, suggestion or hypnosis. To work with children, suggestion or game exercises which easily induce a state of relaxation. The hierarchy of stimuli is built on the basis of observation and conversation with the patient or the child's parents, which makes it possible to identify objects/events that cause fear in the patient.

  There are two kinds of hierarchies, each with a different way of representing elements:

  • hierarchy of space-time type;
  • thematic type.

  The first is characterized by the fact that it contains one stimulus, but with different intensity of anxiety. In the hierarchy of thematic type, the stimulus that causes anxiety varies according to physical properties and subject matter. As a result of construction, a sequence of objects or events is constructed that increase anxiety and are associated with one situation.

  On the last step there is a consistent presentation of stimuli from the constructed hierarchy to the patient. If anxiety arises on the weakest stimuli, then the presentation stops, and the patient again plunges into a state of relaxation. After that, the stimuli are presented again from the very beginning. This continues until the moment when the resting state of the client will be saved when presenting the highest element of the hierarchy.

  When working with adults and adolescents, stimuli are described and the client imagines the situation. Working with children consists in presenting objects and situations visually, in the form of a game (i.e., in real life). Systematic desensitization in imagination has several disadvantages. So, it causes less anxiety than immersion in an event in a real situation.

  

  Work with children

  When carrying out this technique, with the help of representation, it is possible to imagine situations that cannot be reproduced in real life. Some patients have difficulty creating imaginary events. That is why, in some cases, the method of systematic desensitization is used in reality.

  In children, fears and anxiety arise due to the lack of adequate ways to respond and behave in such situations. That is why learning techniques are used, i.e., socially desirable patterns of behavior are modeled with the help of social reinforcement. First, the patient observes the behavior of another person, which does not cause fear or fright. Then the child is included in joint work with him and his achievements are reinforced. Then he tries to imitate the behavior model himself under the supervision of a psychologist.

  For the therapy of children, such a type of desensitization as emotive imagination is used. It allows the child to identify with favorite characters and act out situations involving a fictional character. The doctor directs the game so that in the form of a loved one fairy tale character the child is constantly faced with situations that cause fear.

  The work includes 4 stages:

  • at the first stage, a hierarchy of fears is compiled;
  • at the second stage, the psychotherapist during the conversation determines the child's favorite hero;
  • third stage - beginning role play: the child imagines a situation that looks like an everyday problem, and gradually introduces his hero into it;
  • at the last stage, the specialist desensitizes the child.

  Specific desensitization

  Method specific desensitization studied by Edmund Jacobson. The therapist divided the session into three stages:

  1. 1. At the first stage, the methods of muscle relaxation are studied. First, the therapist teaches the client to relax the arms, then the head and face, neck and shoulders, back, abdomen, chest and lower extremities. This stage is given 6-7 meetings.
  2. 2. At the second stage, a hierarchy of events is built that cause fear in the patient.
  3. 3. On the third stage, desensitization is carried out under the supervision of a therapist.

  In one session, the therapist with the client can work out about 4 situations. A person imagines each of them for 10 seconds, and then proceeds to relaxation, which lasts a small amount of time (20 seconds). After the session, the client talks about whether he was able to relax or not.

  eye movements

  Studying the situation with the movement of the eyes allows you to turn to the parts of the brain that are inaccessible to human consciousness. This technique is carried out in 8 stages.

  • The first step is to assess the client's safety and ability to cope. The patient learns ways to relax, works through traumatic memories.
  • The second stage is characterized by the study of ways of behavior.
  • At the third, the psychotherapist and the client identify a negative belief (the one that formed and consolidated fear) and a positive one (which the person would like to have).
  • The fourth stage is desensitization. The work consists in the fact that the patient imagines a traumatic situation, and then makes eye movements in one direction and the other. It is necessary to do about 30 complete movements and try to forget about the traumatic event. This happens until the client realizes that the anxious experience has decreased.

Method of systematic desensitization

Model classical conditioning served as the basis for the development of such methods of behavior correction as aversive therapy, the method of systematic desensitization, implosive ("shock") therapy. Aversive therapy uses the mechanism of suppression (crowding out) of a behavioral response due to negative reinforcement of undesirable behavior. Method of systematic desensitization and implosive therapy are based on the mechanism of actualization (release) of the suppressed reaction. implosion therapy, based on "flooding" and shock caused by excessive negative stimuli and generalized inhibition of fear and anxiety reactions, looks unattractive to child psychologists who prefer to avoid any possibility of additional traumatization of the client in the course of therapy. The method of systematic desensitization is one of the most authoritative methods of behavioral therapy.

Method of systematic desensitization was developed in the late 1950s. D.Volpe to overcome states of increased anxiety and phobic reactions. Since then, the method has become famous and is widely used in psychological and psychotherapeutic practice. The method was developed in the context of a behavioral approach and became the first attempt to spread the ideas of behaviorism to the practice of psychotherapy and psychotherapy. corrective work.

On the basis of data obtained in experiments with animals, D. Wolpe showed that the origin and extinction of neurotic anxiety, which suppresses adaptive behavior, can be explained from the standpoint of the theory of classical conditioning. The emergence of inadequate anxiety and phobic reactions, according to D. Wolpe, is based on the mechanism of a conditioned reflex connection, and the extinction of anxiety is based on the mechanism of counter-conditioning in accordance with the principle of reciprocal suppression. The essence of this principle is that if the reaction opposite to anxiety can be elicited in the presence of stimuli that normally cause anxiety, then this will lead to complete or partial suppression of anxiety reactions. D. Volpe implemented the idea of ​​superconditioning in his work with clients experiencing fears and phobias, combining the states of deep relaxation of the client with the presentation of stimuli that in a normal situation cause fears. In this case, the order of presentation and selection of stimuli was of decisive importance. The stimuli were chosen according to their intensity so that the anxiety reaction was suppressed by the preceding relaxation. In other words, a hierarchy of stimuli causing anxiety was constructed, in sequence from stimuli of minimal intensity, causing only mild anxiety and anxiety in the client, to high-intensity stimuli, provoking severe fear and even horror. This principle - the principle of systematic grading of stimuli that cause anxiety - gave the name to the new psycho-corrective method: the method of systematic desensitization by analogy with the method of systematic desensitization of allergens used in medicine. The method of systematic desensitization is a method of systematically gradually reducing sensitivity, i.e. the sensitivity of a person to objects, events or people that cause anxiety. The decrease in sensitivity leads to a consistent systematic decrease in the level of anxiety in relation to these objects. The method of systematic desensitization can be useful for resolving developmental difficulties when inappropriate inappropriate anxiety is the main cause.

The method of systematic desensitization is indicated for use in the following cases.

1. When there is increased anxiety in situations where there is no objective danger or threat to the physical and personal safety of a person. Anxiety is characterized by high intensity and duration, severe affective experiences and subjective suffering.

2. In the event of psychophysiological and psychosomatic disorders due to high anxiety (migraines, headaches, dermatosis, gastrointestinal disorders, etc.). In these cases, which constitute a borderline area for child and clinical psychology, comprehensive assistance is needed for the child, including medical, psychological and psychotherapeutic assistance.

3. With disorganization and disintegration of complex forms of behavior due to high anxiety and fears. An example is the inability of a student who knows the subject well to cope with the control work or a "failure" at the matinee in kindergarten a kid who learned a poem, but failed to recite it at the right time. AT severe cases situational "breakdowns" in the child's behavior can become chronic and take the form of "learned helplessness". Here, before using the method of systematic desensitization, it is necessary to remove or reduce the impact of the stressor, giving the child a rest and protecting him from the repetition of problem situations that cause fear and anxiety.

4. When avoidance reactions occur, when the child, trying to avoid severe affective experiences associated with anxiety and fears, prefers to avoid any traumatic stimuli and situations. In these cases, avoidance is a defensive response to the stressor. For example, a student skips classes in an effort to avoid a survey and control works with an objectively high degree of assimilation of educational material; or the child constantly tells lies at home even when asked about his completely impeccable deeds, because he experiences fear and anxiety of losing the favor of his parents. Over time, the child begins to experience fear already before the very possibility of fear (“be afraid of fear”). Long-term persistence of this condition can lead to depression.

5. When replacing avoidance reactions with maladaptive forms of behavior. So, when fear and anxiety arise, the child becomes aggressive, there are outbursts of rage, unjustified anger. In primary school and adolescence, adolescents may turn to psychoactive substances (alcohol, drugs), run away from home. In a milder socially acceptable version, maladaptive reactions take the form of bizarre eccentric or defiantly hysterical behavior aimed at becoming the center of attention and receiving the necessary social support. Maladaptive behavior can act in the form of special rituals, "magical actions" that allow avoiding confrontation with situations that cause anxiety. In the event of maladaptive reactions, the method of systematic desensitization should be used in combination with other types of psychotherapy.

The classical procedure for systematic desensitization is carried out in three stages:

1) training the client's ability to move into a state of deep relaxation;

2) constructing a hierarchy of stimuli that cause anxiety;

3) the stage of actual desensitization.

The first - preparatory - stage sets the task of teaching the client how to regulate the states of tension and relaxation, rest. Here can be used various methods: autogenic training, indirect and direct suggestion, and in exceptional cases- hypnotic effect. When working with children, the methods of indirect and direct verbal suggestion are most often used. The use of games and game exercises can significantly increase the possibilities of effective influence on the child in order to induce a state of rest and relaxation in him. This is the choice of the plot of the game, and the distribution of roles, and the introduction of rules governing the transition from activity to relaxation. The use of a game form also allows organizing the mastery of individual elements of autogenic training in special exercises, even by children up to school age.

The task of the second stage is to construct a hierarchy of stimuli, ranked in accordance with the increase in the degree of anxiety they cause. The construction of such a hierarchy is carried out by a psychologist on the basis of a conversation with the child's parents, which makes it possible to identify objects and situations that cause anxiety and fear in the child, data from the psychological examination of the child, as well as observation of his behavior. There are two types of hierarchies, depending on how they represent elements - stimuli that cause anxiety: the spatio-temporal hierarchy and the thematic type hierarchy. In the spatio-temporal hierarchy, the same stimulus varies depending on the intensity of the evoked anxiety. Such a stimulus can be an object, a person or a situation. For example, an object or person (doctor, Baba Yaga, dog, darkness) and a situation (answer at the blackboard, parting with mother, performance at a matinee, etc.) are presented in different temporal and spatial dimensions, due to which they cause different levels of anxiety. intensity. The temporal dimension characterizes the remoteness of the event in time and the gradual approach of the time of the event. Spatial dimension - a decrease in distance and the approach of an event or object that causes fear. In other words, when constructing a spatio-temporal type hierarchy, a model of the child's gradual approach to the fear-causing event or object is created. In the hierarchy of thematic type, the stimulus that causes anxiety varies in physical properties and objective meaning. As a result, a sequence of various objects or events is constructed that progressively increase anxiety, related to one problem situation, one topic. Thus, a model is created for a fairly wide range of situations, united by the commonality of the child's experience of anxiety and fear when confronted with them. Hierarchies of thematic type contribute to the generalization of the child's ability to suppress excessive anxiety when faced with a fairly wide range of situations. In practical work, hierarchies of both types are usually used: spatiotemporal and thematic. By constructing stimulus hierarchies, a strict individualization of the correctional program is ensured in accordance with the specific problems of the client.

At the third stage - desensitization itself - a consistent presentation of stimuli from a previously constructed hierarchy is organized to the client, who is in a state of relaxation, starting from the lowest element, which practically does not cause anxiety, and moving on to stimuli that gradually increase anxiety. If even slight anxiety occurs, the presentation of stimuli stops, the client again plunges into a state of relaxation, and a weakened version of the same stimulus is presented to him. Note that an ideally constructed hierarchy should not cause anxiety when presented. The presentation of the sequence of elements of the hierarchy continues until the client remains in a state of rest and relaxation even when the highest element of the hierarchy is presented. When working with adult clients and adolescents, stimuli are presented verbally as a description of situations and events. The client is required to imagine this situation in the imagination. When working with children, operating with images and representations in the imagination turns out to be very difficult, therefore the method of systematic desensitization is used "in vivo", i.e., stimuli that cause anxiety are presented to the child in the form of real physical objects and situations. The optimal form of such presentation of stimuli to children of preschool and primary school age is a game. The game provides the necessary visualization of "frightening" terrible objects and situations, and at the same time, the freedom and arbitrariness of the child in relation to these objects and situations is preserved, since they are realized in an imaginary, "imaginary" situation, are completely subject to the child and do not pose the slightest real threat. The game creates an opportunity to maintain a positive emotional mood and, accordingly, relaxation due to the experience of pleasure from the game itself, which can be saved by the child even when faced with situations that cause fear and anxiety.

AT childhood anxiety and fears of certain situations and objects may be due to the child's lack of adequate ways of behaving in these situations. In such cases, the method of systematic desensitization is supplemented by learning techniques developed within the framework of the theory of social learning (A. Bandura) - the technique of modeling socially desirable patterns of behavior and the technique of social reinforcement. Thanks to the observation of models of adequate behavior of an adult or a peer in a situation that causes fear in a child, and the organization of social reinforcement of attempts to imitate the behavior of the model, it is possible not only to overcome phobias and excessive unreasonable anxiety, but also to expand the child's behavioral repertoire, increase his social competence. A certain sequence of inclusion of the child in a difficult situation for him is envisaged. At first, the child only observes the behavior of an adult or a peer who does not show the slightest sign of fear and fright. Then he joins in joint activities with an adult or a peer, in which all his even minor achievements are constantly reinforced, and, finally, he tries to independently imitate the model of "fearless" behavior with the emotional support of a psychologist and peers - members of the group.

The principle of systematic desensitization also finds expression in the gradual transition from one type of activity to another so as to ensure the consistent approach of the child from an imaginary "frightening" situation to a real situation that causes anxiety. For example, the following sequence of remedial work justifies itself quite well: writing fairy tales and stories about a fearless hero who overcomes all difficulties and trials, then thematic drawing, a dramatization game, playing first conditional, and then real situations that simulate adequate behavior in situations before causing fear in the child.

In conclusion, we emphasize that although the method of systematic desensitization is not used very often when working with children, the very principle of systematic desensitization and the most important elements of this method are organically included in psycho-correctional work with children - and the method of game correction, and in art therapy - occupying a worthy place in the arsenal means of providing psychological help in the development of children.

Proposed by Volpe (Wolpe J., 1952), is historically one of the first methods that marked the beginning of the widespread behavioral psychotherapy. In developing his method, the author proceeded from the following provisions.

Non-adaptive behavior of a person, including neurotic, including interpersonal behavior, is largely determined by anxiety and is supported by a decrease in its level. Actions performed in the imagination can be equated with actions performed by a person in reality. Imagination in a state of relaxation is no exception to this situation. Fear and anxiety can be suppressed if the stimuli causing fear and stimuli antagonistic to fear are combined in time. There will be counterconditioning - a stimulus that does not cause fear will extinguish the previous reflex. In animal experiments, this counter-conditioning stimulus is feeding. In humans, one of the effective stimuli that is opposite to fear is relaxation. Therefore, if a patient is taught deep relaxation and in this state is encouraged to conjure up stimuli that cause an increasing degree of anxiety, the patient will also be desensitized to real stimuli or situations, causing fear. That was the rationale behind this method. However, experiments based on a two-factor avoidance model have shown that the mechanism of action of systematic desensitization includes a collision with a situation that previously caused fear, real testing it, in addition to counterconditioning.

The technique itself is relatively simple: a person in a state of deep relaxation evokes ideas about situations that lead to the emergence of fear. Then, by deepening relaxation, the patient relieves the emerging anxiety. In the imagination appear various situations from the easiest to the most difficult, causing the greatest fear. The procedure ends when the strongest stimulus ceases to cause fear in the patient.

In the procedure of systematic desensitization itself, three stages can be distinguished: mastering the technique muscle relaxation, drawing up a hierarchy of situations that cause fear; proper desensitization (combining ideas about situations that cause fear with relaxation).

Muscle relaxation training according to Jacobson's progressive muscle relaxation method is carried out at an accelerated pace and takes about 8-9 sessions.

Drawing up a hierarchy of situations that cause fear. Due to the fact that the patient may have various phobias, all situations that cause fear are divided into thematic groups. For each group, the patient should make a list from the mildest situations to more severe ones that cause pronounced fear. It is advisable to rank situations according to the degree of fear experienced together with a psychotherapist. A prerequisite for compiling this list is the patient's real experience of fear in such a situation, that is, it should not be imaginary.

Actually systematic desensitization. Methodology discussed feedback- informing the psychotherapist by the patient about the presence or absence of fear in him at the moment of presenting the situation. For example, he indicates the absence of anxiety by raising his index finger. right hand, about its presence - by raising the finger of the left hand. Representations of situations are carried out according to the compiled list. The patient imagines the situation for 5-7 seconds, then eliminates the anxiety that has arisen by increasing relaxation; this period lasts up to 20 seconds. The presentation of the situation is repeated several times, and if the patient does not have anxiety, they move on to the next, more difficult situation. During one lesson, 3-4 situations from the list are worked out. In the event of a pronounced anxiety that does not fade with repeated presentation of the situation, they return to the previous situation.

With simple phobias, 4-5 sessions are performed, in complex cases - up to 12 or more.

Currently, the indications for using the method of systematic desensitization for neuroses are, as a rule, monophobias that cannot be desensitized in real life due to the difficulty or inability to find a real stimulus, for example, fear of flying in an airplane, traveling by train, fear of snakes, etc. In the case of multiple phobias, desensitization is carried out in turn for each phobia.

Systematic desensitization is less effective when the anxiety is reinforced by secondary gain from illness. For example, in a woman with agoraphobic syndrome, with a difficult home situation, the threat of her husband leaving home, fear is reinforced not only by his decrease when she stays at home, avoids situations in which he appears, but also by the fact that she keeps her husband at home with the help of her symptoms, gets the opportunity to see him more often, more easily controls his behavior. In this case, the method of systematic desensitization is effective only when combined with personality-oriented types of psychotherapy, aimed, in particular, at understanding the patient's motives for his behavior.

Systematic desensitization in vivo (in real life) includes only two stages: drawing up a hierarchy of situations that cause fear, and desensitization itself (training in real situations). The list of situations that cause fear includes only those that can be repeated many times in reality. In the second step, the physician nurse accompanies the patient, encourages him to increase fear according to the list. It should be noted that faith in the therapist, the sense of security experienced in his presence, are counter-conditioning factors, factors that increase motivation to face fear-inducing stimuli. Therefore, this technique is effective only if there is good contact between the psychotherapist and the patient.

A variant of the technique is contact desensitization, which is more often used when working with children, less often with adults. It also compiles a list of situations ranked according to the degree of fear experienced. However, at the second stage, in addition to encouraging the patient by the psychotherapist to make bodily contact with the object that causes fear, modeling is also added (another patient who does not experience this fear performs actions according to the list).

Another desensitization option for treating children is emotive imagination. This method uses the child's imagination to easily identify with favorite characters and act out situations in which they are involved. At the same time, the psychotherapist directs the child's play in such a way that he, in the role of this hero, gradually encounters situations that previously caused fear. The technique of emotive imagination includes 4 stages.

1. Drawing up a hierarchy of objects or situations that cause fear.
2. Identification of a favorite hero (or heroes) with whom the child would easily identify himself. Finding out the plot possible action, which he would like to accomplish in the image of this hero.
3. Start the role play. The child is asked to eyes closed imagine a situation similar to Everyday life, and gradually introduce his favorite hero into it.
4. Actually desensitization. After the child is sufficiently emotionally involved in the game, the first situation from the list is put into action. If at the same time the child does not have fear, they move on to the following situations, etc.

In 1958, the Austrian psychotherapist D. Wolpe published a book entitled Psychotherapy by Reciprocal Inhibition. In the theory of reciprocal inhibition Wolpe we are talking about the inhibition of anxiety reactions by simultaneously causing other reactions that, from a physiological point of view, are antagonistic in relation to anxiety, are not compatible with it. If a reaction incompatible with anxiety is evoked simultaneously with an impulse that has so far caused anxiety, then the conditioned connection between the impulse and anxiety is weakened. Such antagonistic responses to anxiety are food intake, self-affirmation responses, sexual responses, and a state of relaxation. The most effective stimulus in eliminating anxiety was muscle relaxation.

Experimenting with animals, Wolpe showed that the origin and extinction of neurotic anxiety, which suppresses the subject's useful adaptive reactions, can be explained from the standpoint of the theory of classical conditioning. The emergence of inadequate anxiety and phobic reactions, according to Wolpe, is based on the mechanism of conditioned reflex communication, and the extinction of anxiety is based on the mechanism of counterconditioning in accordance with the principle of reciprocal suppression: if a reaction opposite to anxiety can be evoked in the presence of stimuli that lead to anxiety , then this will lead to a complete or partial suppression of the anxiety reaction.

2 Wolpe defined neurotic behavior as a fixed habit of maladaptive behavior acquired as a result of learning. Of fundamental importance is given to anxiety, which is integral part situation in which neurotic learning takes place, as well as an integral part of neurotic syndrome. Anxiety, according to Wolpe, is "a persistent response of the autonomic nervous system acquired through a process of classical conditioning." Wolpe developed a special technique designed to extinguish these conditioned autonomic responses - systematic desensitization.

He believed that non-adaptive human behavior (including neurotic) is largely determined by anxiety and is supported by a decrease in its level. Fear and anxiety can be suppressed if the stimuli causing fear and stimuli antagonistic to fear are combined in time. There will be counterconditioning: a stimulus that does not cause fear will extinguish the previous reflex. Based on this assumption, Wolpe developed one of the most common methods of behavioral correction at present - the method of systematic desensitization.

In animal experiments, this counter-conditioning stimulus is feeding. In humans, one of the effective stimuli that is opposite to fear is relaxation. Therefore, if a client is trained in deep relaxation and in this state is encouraged to conjure up stimuli that cause an increasing degree of anxiety, the client will also be desensitized to real stimuli or situations that cause fear. That was the rationale behind this method.

The method of systematic desensitization, developed by Wolpe to overcome the state of increased anxiety and phobic reactions, has gained fame and is widely used in psychological practice. Wolpe implemented the idea of ​​superconditioning in working with clients experiencing fears and phobias, by combining a state of deep relaxation of the client and presenting him with a stimulus that in a normal situation causes fear, while selecting stimuli according to intensity so that the anxiety reaction was suppressed by the previous one.

relaxation. In this way, a hierarchy of stimuli causing anxiety was constructed - from stimuli of minimal intensity, causing clients only mild anxiety and

2 anxiety, up to stimuli that provoke strongly pronounced fear and even horror. This principle of systematic grading of stimuli that cause anxiety, and gave the name to the method of systematic desensitization.

The method of systematic desensitization is a method of systematically gradually reducing the sensitivity (i.e. sensitivity) of a person to objects, events or people that cause anxiety, and consequently, a systematic gradual decrease in the level of anxiety in relation to these objects. The method can be useful for resolving developmental difficulties when the main cause is inappropriate inadequate anxiety.

The technique itself is relatively simple: a person in a state of deep relaxation is evoked an idea of ​​situations that lead to the emergence of fear. Then, by deepening relaxation, the client removes the emerging anxiety. Various situations are imagined in the imagination: from the easiest to the most difficult, causing the greatest fear. The procedure ends when the strongest stimulus ceases to cause fear in the patient.

2 Indications for the application of the method of systematic desensitization

1. The client has monophobias that cannot be desensitized in real life due to the difficulty or impossibility of finding a real stimulus, for example, fear of flying in an airplane, traveling by train, fear of snakes, etc. In cases of multiple phobias, desensitization is carried out in turn, as applied for every phobia. The desensitization technique has been used with great success in the treatment of conditions such as animal phobia, fear of water, school phobia, and fear of food.

2. Increased anxiety that occurs in situations where there is no objective danger or threat to the physical and personal safety of the client, is characterized by sufficient duration or intensity so that it gives the client severe affective experiences and subjective suffering.

3. Reactions of increased anxiety acquire specificity, causing psychophysiological and psychosomatic disorders: migraine, headache, insomnia, gastrointestinal disorders etc.

2 4. High intensity anxiety and fears lead to disorganization and disintegration of complex forms of behavior. An example is the inability of a student who knows the subject well to cope with a test or a failure at a matinee in kindergarten for a kid who learned a poem, but failed to recite it at the right time.

Situational breakdowns in the child's behavior in more severe cases can become chronic and take the form of "learned helplessness". Therefore, even before using the method of systematic desensitization, it is necessary to remove or reduce the impact of the stressor and give the child a rest, protecting him from the repetition of problem situations.

5. Strong desire of the client to avoid severe affective experiences associated with increased anxiety and fears, leads to reactions of avoidance of traumatic situations as a kind of defense. For example, a student skips classes, trying to avoid surveys and tests with an objectively high degree of assimilation of educational material. Or, for example, in situations where a child constantly tells a lie, even answering a question about his completely impeccable deeds, because he is afraid and anxious to lose the favor of his parents. Here the child already begins to experience fear of the situation. possible occurrence fear. Long-term persistence of this condition can lead to depression.

6. The reaction of avoidance is replaced by maladaptive forms of behavior. So, when fear and anxiety arise, the child becomes aggressive, there are outbursts of rage, unjustified anger. In elementary school and adolescence adolescents may turn to alcohol, drugs, substance abuse, and run away from home. In a milder socially acceptable version, maladaptive reactions take the form of bizarrely eccentric behavior aimed at becoming the center of attention and getting the necessary social support.

2 Steps in the systematic desensitization procedure

Stage 1 - the client mastering the technique of muscle relaxation and training the client's ability to move into a state of deep relaxation.

Stage 2 - constructing a hierarchy of stimuli that cause anxiety and fear.

2 3rd stage. The stage of actual desensitization is the combination of ideas about situations that cause fear with relaxation.

1st stage. This stage is preparatory. Its main task is to teach the client how to regulate the states of tension and relaxation. For this, various methods can be used: autogenic training, indirect, direct suggestion, and in exceptional cases - hypnotic influence. When working with children, the methods of indirect and direct verbal suggestion are most often used.

2nd stage. The task is to construct a hierarchy of stimuli, ranked in accordance with the increase in the degree of anxiety they cause. Due to the fact that the client may have different fears, all situations that cause fear are divided into thematic groups. For each group, the client should make a list: from the easiest situations to the most severe, causing pronounced fear. It is advisable to rank situations according to the degree of fear experienced together with a psychologist. A prerequisite for compiling this list is that the patient actually experiences the fear of such a situation (i.e., it should not be imaginary).

There are two types of hierarchy. Depending on how the elements - stimuli that cause anxiety are presented, they distinguish between spatio-temporal and thematic hierarchies.

In the spatio-temporal hierarchy, the same stimulus, object or person (for example, a doctor, Baba Yaga, a dog, a policeman, etc.) or a situation (answer at the blackboard, parting with mother, etc.) is presented in various temporal (remoteness of events in time and gradual approach of the time of occurrence of the event) and spatial (decrease in distance in space) dimensions.

That is, when constructing a spatio-temporal type hierarchy, a model of the client's gradual approach to the fear-causing event or object is created.

In the thematic hierarchy, the stimulus that causes anxiety varies in physical properties and objective meaning in order to construct a sequence of different objects or events that progressively increase anxiety associated with one problem situation. Thus, a model of a sufficiently wide

2 circles of situations united by the commonality of the client's experiences of anxiety and fear when confronted with them. Hierarchies of the second type contribute to the generalization of the client's ability to suppress excessive anxiety when faced with a fairly wide range of situations. In practical work, hierarchies of both types are usually used: spatiotemporal and thematic. By constructing a stimulus hierarchy, a strict individualization of the correctional program is ensured in accordance with the specific problems of clients.

For example, a client has a fear of heights - gibsophobia. The psychologist makes a hierarchical scale - a list of situations and scenes that cause fear in the client, ranging from weak to very pronounced. The word “height” can be put in the first place, then the view open door to the high-rise balcony, then the balcony itself, a view of asphalt and cars under the balcony. For each of these scenes, smaller details relevant to the client can be developed.

As an example, 15 scenes from a hierarchy drawn up for a client with a fear of flying in an airplane:

1. You are reading a newspaper and notice an airline ad.

2. You are watching a TV program and you see a group of people boarding a plane.

3. Your boss says you need to take a business trip by plane.

4. There are two weeks left before your trip, and you ask the secretary to book a plane ticket.

5. You are in your bedroom packing your suitcase for the trip.

6. You take a shower in the morning before the trip.

7. You are in a taxi on your way to the airport.

8. You are checking in at the airport.

9. You are in the lounge and hear about boarding your flight.

10. You are standing in line in front of the plane.

11. You are sitting in your plane and you hear how the plane engine starts to work.

12. The plane starts to move, and you hear the voice of the stewardess: "Fasten your seat belts, please!"

13. You look out the window as the plane starts to take off down the runway.

14. You look out the window as the plane is about to take off.

15. You look out the window as the plane takes off from the ground.

2 The 3rd stage is actually desensitization. Before starting desensitization work, a feedback technique is discussed: the client informing the psychologist about the presence or absence of fear in him at the time of presenting the situation. For example, he reports the absence of anxiety by raising the index finger of his right hand, the presence of it - by raising the finger of his left hand. Then the client (who is in a state of relaxation) is presented sequentially with stimuli from the previously constructed hierarchy, starting with the lowest element (practically not causing anxiety) and gradually moving to higher ones. The presentation of stimuli can be carried out verbally, in vivo.

When working with adult clients, stimuli are presented verbally as a description of situations and events. The client is required to imagine this situation in the imagination. The presentation of the situation is carried out according to the compiled list. The client imagines the situation 5-7 s. Then it eliminates the anxiety that has arisen by increasing relaxation. This period lasts up to 20 s. The presentation of the situation is repeated several times. And if the patient does not have anxiety, then they move on to the next, more difficult situation.

If even slight anxiety occurs, the presentation of stimuli stops, the client again plunges into a state of relaxation, and a weakened version of the same stimulus is presented to him. Note that an ideally constructed hierarchy should not cause anxiety when presented. The presentation of the sequence of elements of the hierarchy continues until the state of calm and the absence of the slightest anxiety in the client persists even when the highest element of the hierarchy is presented. So, moving from situation to situation on a hierarchical scale, the client reaches the most exciting one and learns to stop it with relaxation. Through training, it is possible to achieve such a result when the idea of ​​\u200b\u200bheight in a patient with gibsophobia no longer causes fear. After that, the training is transferred from the laboratory to reality.

During one lesson, 3-4 situations from the list are worked out. In the event of a pronounced anxiety that does not fade with repeated presentation of situations, they return to the previous situation. With simple phobias, a total of 4-5 sessions are performed, in complex cases - up to 12 or more.

2 A variant of verbal desensitization in working with children is the technique of emotive imagination. This method uses the child's imagination to identify with favorite characters and act out situations in which they are involved. The psychologist directs the child's play in such a way that he, in the role of this hero, gradually encounters situations that previously caused fear.

The technique of emotive imagination includes four stages:

1. Drawing up a hierarchy of objects or situations that cause fear.

2. Identification of a favorite hero with whom the child would easily identify himself. Finding out the plot of a possible action that he would like to perform in the image of this hero.

3. Start the role play. The child (eyes closed) is asked to imagine a situation close to everyday life, and his favorite character is gradually introduced into it.

4. Actually desensitization. After the child is sufficiently emotionally involved in the game, the first situation from the list is put into action. If at the same time the child does not have fear, they move on to the next situation, etc.

In another variant, systematic desensitization is carried out not in the representation, but "in vivo", by real immersion in a phobic situation. The method of systematic desensitization "in vivo" is that the stimuli that cause anxiety are presented to the client in the form of real physical objects and situations. This variant presents great technical difficulties, but, according to some authors, it is more efficient, can be used for clients with poor ability to call presentations. There is a case in the literature where a claustrophobic person learned to tolerate increasing restriction to the point where he was comfortable in a zippered sleeping bag. In all cases stressful situation is associated in the patient with muscle relaxation rather than tension. Faced with disturbing circumstances in real life, a person should now respond to it not with fear, but with relaxation. Depending on the nature of the difficulties experienced by the client, real rather than imaginary situations may be experienced in this approach more often.

Desensitization "in vivo" in real life includes only two stages: drawing up a hierarchy of situations that cause fear, and desensitization itself (training in real situations). The list of situations that cause fear includes only those that can be repeated many times in reality.

At the second stage, the psychologist accompanies the client, encourages him to increase the fear according to the list. It should be noted that faith in a psychologist, a sense of security experienced in his presence, are counter-conditioning factors that increase motivation to face fear-inducing stimuli. Therefore, the technique is effective only if there is good contact between the psychologist and the client.

A variant of this technique is contact desensitization, which is more often used in working with children. A list of situations is also compiled, ranked according to the degree of fear experienced. However, at the second stage, in addition to encouraging the client's psychologist to make bodily contact with the object that causes fear, modeling is also added - the execution by another client who does not experience this fear of actions according to the list.

The method of sensitization is opposite in terms of the mechanism of action to the desensitization technique.

It consists of two stages.

At the 1st stage, the relationship between the client and the psychologist is established and the details of the interaction are discussed.

At the 2nd stage, the most stressful situation is created. Usually such a situation is created in the imagination when the client is asked to imagine that he is in a state of panic that seized him in the most terrible circumstances for him, and then he is given the opportunity to experience the same situation in real life.

In a sense, this technique is analogous to teaching a child to swim, when he is thrown into the water in the very deep place. Through direct encounter with the scary object, the client discovers that the object isn't really that scary after all. Sensitization is conceived as a method that involves creating a very high levels anxiety in an intense stressful situation, while desensitization is based on the avoidance of any factors that cause more than the minimum allowable anxiety.