Systematic desensitization is used in order to. Dpdg alone. eye movement desensitization and processing - a method of psychotherapy for the treatment of post-traumatic stress disorders

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 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 working with clients experiencing fears and phobias, combining the state 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 systematic gradual reduction of 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 a test or a “failure” at a matinee in kindergarten a kid who learned a poem, but failed to recite it at the right time. In 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, trying to avoid surveys and tests 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 getting 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. Various methods can be used here: autogenic training, indirect and direct suggestion, and in exceptional cases - hypnotic influence. 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 according to physical properties and subject matter. 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 the 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 causing 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 in 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 himself 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 - group members.

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 assistance in the development of children.

Wolpe proposed ( Wolpe J., 1952), c systematic desensitization is historically one of the first methods that initiated the widespread use 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 the 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 that cause 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 compiling this list is the patient's real experience of fear in such a situation, i.e., it should not be imaginary.

Actually desensitization. The feedback technique is discussed - 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.

At present, the indications for using the method of systematic desensitization in neuroses are, as a rule, monophobias, which cannot be desensitized in real life due to the difficulty or impossibility of finding a real stimulus, for example, fear of flying on 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 less effective when the anxiety is reinforced by the 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.

Desensitization in vivo (in real life) includes only two stages: drawing up a hierarchy of situations that cause fear, and actually desensitization (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 doctor or 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 inducing the patient to bodily contact with the object that causes fear, the psychotherapist also joins modeling (performing by another patient who does not experience this fear, actions according to the compiled 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. A technique similar to emotive imagination can also be used in vivo .

Eye movement desensitization and processing (EMDR).

Psychotherapy of emotional trauma with the help of eye movements was proposed by the American psychotherapist Shapiro ( Shapiro F .) in 1987. This method was originally called the "eye movement desensitization" technique. However, technique eye movements is only one of the possible external stimuli used to activate the patient's information processing system and achieve a psychotherapeutic effect. Already the first experience with this technique showed that it should include both desensitization and cognitive restructuring of memories and personal relationships. This circumstance led to a new, real name for this psychotherapeutic method - "Desensitization and processing by eye movements" (EMDG).

Adhering mainly to a behaviorist orientation, the author proposed a general theoretical model for the accelerated processing of information, on the basis of which the psychotherapeutic technique of EMDH operates. This model considers most pathological conditions as a consequence of previous life experience that creates a stable pattern of affect, behavior, self-representation and the corresponding structure of personal identity. pathological structure is rooted in static, insufficiently processed information deposited in memory during a traumatic event. The model is considered by the author as a neurophysiological hypothesis. According to the model of accelerated processing of information, there is a natural physiological system designed to transform disturbing impressions into an adaptive resolution, and this system is focused on achieving psychological integration and physical health. Emotional trauma can disrupt the information processing system, so information will be stored in a form determined by the traumatic experience, and may, for example, lead to the appearance severe symptoms post-traumatic syndrome. The author hypothesizes that eye movements (there may be other alternative stimuli) used in EMPD trigger a psychological process that activates the information processing system. During the EMDR procedure, when the patient is asked to evoke a traumatic memory, the therapist establishes a connection between consciousness and the area of ​​the brain that stores information about the trauma. Eye movements activate the information processing system and restore its balance. With each new series of eye movements, the traumatic information moves, moreover, in an accelerated manner, further along the corresponding neurophysiological pathways until a positive resolution of this information is achieved. One of the key assumptions in EMDR is that activating the processing of traumatic memories will naturally direct these memories to the adaptive information needed for positive resolution. Thus, the model of accelerated processing of information is characterized by the idea of ​​psychological self-healing. In general, the idea of ​​activating the adaptive information-processing mechanism is central to EMDR psychotherapy and is fundamentally important in applying this technique to a variety of mental disorders.

The patient's information-processing system can be activated by guided eye movements or by alternative stimuli such as hand tapping or auditory stimuli. The author proposes several types of eye movements that can be used in EMDH psychotherapy. The task of the psychotherapist is to determine the type of eye movements that best suits the needs of the patient. It is necessary to provide the patient with comfortable conditions when performing eye movements. The therapist should not continue to use these movements if the patient reports eye pain or restlessness during the procedure. The goal of the therapist is to cause the patient's eyes to move from one end of his visual field to the other. Such full bilateral eye movements should be performed as quickly as possible, while avoiding discomfort. Typically, the therapist holds two fingers vertically with the palm facing the patient, approximately at a distance of at least 30 cm. In this case, the therapist should assess the patient's ability to follow the movements of the fingers - slowly at first, and then faster and faster until reaching the speed that is perceived as most comfortable. The effectiveness of diagonal eye movements can then be tested by moving the hand along a line through the middle of the patient's face, to the right and below, up and to the left (or vice versa), i.e. from the level of the chin to the level of the opposite eyebrow. With other types of movements, the patient's eyes will move up and down, in a circle or in the shape of a figure eight. Vertical movements have a calming effect and can be especially helpful in reducing emotional restlessness or feelings of nausea.

The duration of the series of eye movements is also determined by feedback from the patient. The first series includes 24 two-way movements, where moving from right to left and then right again is one movement. The same number of movements can be used in the first series of movements. After an initial reprocessing series of eye movements, the therapist should ask the patient, "How are you feeling right now?" This question gives the patient the opportunity to communicate what he is experiencing in the form of images, insights, emotions, and physical sensations. The average patient needs a series of 24 movements to process cognitive material and achieve a new level of adaptation. Some patients need a series of 36 eye movements or even more to process the material.

Other patients may be almost unable to follow the movements of the hand, or may find these movements unpleasant; in this case, it is necessary to apply the method in which both hands are used. The therapist places his clenched hands on either side of the patient's visual field and then alternately raises and lowers the index fingers of both hands. The patient is instructed to move his eyes from one index finger to another.

EMDH psychotherapy consists of eight stages. The first stage, patient history and psychotherapy planning, includes an assessment of patient safety factors and is responsible for patient selection. The main criterion for determining whether patients are suitable for EMDH therapy is their ability to cope with the high level of anxiety that can arise when processing dysfunctional information. The therapist, in the course of studying the patient's history, identifies goals for processing.

The second stage - preparation - includes establishing a therapeutic relationship with the patient, explaining the essence of the process of DCD-psychotherapy and its effects, determining the patient's expectations, as well as introductory relaxation. It is important that the patient has mastered relaxation techniques and can use special audio recordings to help cope with problems that arise in the intervals between EMDR psychotherapy sessions. If at the end of the psychotherapy session the patient shows signs of anxiety or continues to react, the therapist should use hypnosis or guided visualization. The patient is also trained to create in his mind an image of a safe place where he feels comfortable.

The third stage - determining the object of influence - reflects the identification of the main forms of reaction in relation to traumatic memories, the identification of a negative self-image and the creation of a positive self-image.

The fourth stage - desensitization - the psychotherapist repeats a series of eye movements, making them, if necessary, changes in focus until the patient's level of anxiety drops to 0 or 1 on a scale of subjective units of anxiety. Between each series of eye movements, the therapist must listen very carefully to the patient in order to identify the next focus for processing. The author of the method emphasizes that in many cases a series of eye movements is not enough for complete processing.

The fifth stage, installations, is focused on establishing a positive self-image as defined by the patient and increasing its strength so that it can replace the negative self-image. While negative images, thoughts and emotions become more diffuse with each new series of eye movements, positive images, thoughts and emotions become more and more vivid.

The sixth stage - body scan - reveals areas of residual tension, manifesting itself in the form of sensations in the body. Such sensations are then selected as targets for successive eye movements. In this stage, the patient is asked to keep in mind both the targeted traumatic event and a positive self-image while scanning his entire body from top to bottom.

1) past experience, which is the basis of pathology;

2) current circumstances or factors that cause concern;

3) plans for future actions.

Before the completion of the course of psychotherapy, the material uncovered during the analysis of the patient's history and subsequent processing should be reassessed. All relevant memories, current stimuli, and foreseeable future actions should be targeted and processed, and the patient should be offered positive examples for future actions that promote the emergence of new, more adaptive behaviors and the processing of any cognitive distortions. A final reassessment is carried out to determine whether it is possible to complete the course of psychotherapy.

In her book Eye Movement Desensitization and Processing (translated into Russian as Eye Movement Psychotherapy for Emotional Trauma), Shapiro presented her experience of successfully applying EMDR psychotherapy, primarily to patients with post-traumatic stress disorder, as well as victims of crime and sexual abuse. violence, with a phobic syndrome and other patients. Despite numerous reports of experimental studies of the clinical effects of EMDH psychotherapy, the mechanism underlying the information processing process remains unclear. Various hypotheses explain the psychotherapeutic effect that occurs when using eye movements, the destruction of the stereotypical response, distraction, hypnosis, changes in synaptic potentials, relaxation response, activation of both hemispheres of the brain, causing integrative processing. Some elements of the main psychological approaches (psychodynamic, behavioral, cognitive, humanistic) are combined in a continuing development of the integrated approach of EMDH psychotherapy.

As the author of the method, Francine Shapiro, notes, “It is important that DXP users remember that before extensive comparative studies are conducted to test the effectiveness of DPDH, this method should be used as a new, not fully tested method of treatment and report on to the client in order to obtain their consent to use the new method.Although there is already promising evidence, the effectiveness of EMCG is not yet a generally accepted fact.This is another reason for limiting the circle of people receiving EMCG training to licensed professionals in the field mental health. In such a case, even if the EMDR technique proves to be ineffective in a particular situation, specialists have at their disposal a set of more traditional methods of psychotherapy that they can apply.

Here is another opinion about this method. Helena Savitskaya, NLP trainer, believes that "this technique is applicable both to current traumatic states and to states from the past. The use of the "fresh tracks" technique, immediately after a traumatic event (for example, after a catastrophe) enables clients to quickly come back to normal state and eliminate the influence psychological trauma for later life. When working with old states, it is necessary to achieve association with them, since such states are often encapsulated. For example, the client may completely forget the traumatic event and the first manifestation of the state caused by this event. Often this manifests itself as the disappearance of segments of memories. The client says: “I was told that there was an event, but I don’t remember anything.” And the fact that the old state is dissociated does not exclude its influence on the life of the client, on his key behavioral strategies. For example, when working with a tremor, as soon as the client was able to remember and associate with a negative state from his past, the state was destroyed using the described technique and the tremor passed. Another application of the technique is as an addition to any others, in cases where a negative state interferes with work or for crushing generalized negative states. This technique is also applicable to relieve unaccountable and constant anxiety caused by the expectation of a significant event or being in a dangerous, according to the client, situation.

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 the 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 that cause fear. That was the rationale behind this method. However, experiments based on a two-factor model of avoidance have shown that the mechanism of action of S. d. includes a collision with a situation that previously caused fear, its real testing, 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, various situations are presented 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 S. procedure itself, three stages can be distinguished: mastering the technique of 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 desensitization. The feedback technique is discussed - 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 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. 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 S. d. technique 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 on an airplane, traveling by train, fear of snakes and others. In the case of multiple phobias, desensitization is carried out in turn for each phobia.
S. d. is less effective when anxiety is reinforced by a secondary gain from the disease. 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, S.'s method is effective only when combined with personality-oriented types of psychotherapy, aimed, in particular, at the patient's awareness of the motives of his behavior.
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 inducing the patient to bodily contact with the object that causes fear, the psychotherapist also joins modeling (performing by another patient who does not experience this fear, actions according to the compiled 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 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.
A technique similar to emotive imagination can also be used in vivo.

Psychotherapeutic encyclopedia. - St. Petersburg: Peter. B. D. Karvasarsky. 2000 .

See what "SYSTEMATIC DESENSITIZATION" is in other dictionaries:

Systematic desensitization- A type of behavior therapy aimed at reducing the feeling of anxiety experienced by a person in the presence of a frightening object. In accordance with the procedure, the patient is first taught to relax (see Relaxation Techniques), and then gradually ... ... Great Psychological Encyclopedia

Systematic desensitization- - D. Wolf's term, denotes various forms of behavioral therapy. See Desensitization Procedure... encyclopedic Dictionary in psychology and pedagogy

SYSTEMATIC DESENSITIZATION- Joseph Wolf's term for a form of behavioral therapy described in the article The Desensitization Procedure... Dictionary in psychology

Systematic desensitization- (systematic desensitization). A technique for gradually reducing a person's anxiety about a particular object or situation, used in behavioral therapy... Psychology of development. Dictionary by book

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The method of systematic desensitization is deservedly ranked among the most commonly used methods of behavioral psychotherapy. According to M.E. Vengle, more than a third of publications on the topic of behavioral psychotherapy are somehow related to this method. 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, one way or another associated with classic phobias (fear of spiders, snakes, mice, confined spaces etc.) or social fears.

The essence of the method is that in the process of therapy, conditions are created under which the client 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, either the fear reaction is extinguished (as a result of reciprocal inhibition), or it is replaced by another reaction incompatible with fear (rage, anger, sexual arousal, relaxation). In the second case, the principle of counterconditioning, discovered by Wolpe, becomes the basis of desensitization.

There are basically two ways to achieve desensitization.

The first way is for the therapist to very carefully and cautiously change some of the characteristics of situations or objects that cause fear in the client, starting with such an intensity of stimuli that the client himself is able to control the reactions of fear. Simulation is often used in this case - i.e. the therapist or assistant demonstrates how he or she handles such situations without fear. The point here, then, is to compile a hierarchy of stimuli, differing in degree of danger, and subsequently systematically teach

the client to deal with these situations by progressively increasing the degree of danger.

Example. A woman seeks the help of a psychotherapist after she jumped out of a car at full speed in a panic after seeing a spider crawling on her leg. She was very afraid of spiders before, but after this incident she decided that something was wrong with her.

After a preliminary behavioral diagnosis, a therapy plan based on the method of systematic desensitization is drawn up and discussed in detail with the woman. The goal is defined as follows: the client must be able to let the spider crawl over her arm and forearm, remove it herself and release it into the wild.

During the analysis, the following hierarchy of incentives is built:

1. A. See how a small spider crawls at the other end of the room.

B. Seeing a large shaggy spider crawling across the room.

2. A. and B. Seeing a small (A) or large shaggy spider (B) crawling in my direction.

4. Cover the spider with a glass and slip a thick sheet of paper under the glass.

5. Raise a spider caught in a glass and vilify around the room.

6. Insert your finger into the glass and touch the spider.

7. Give the spider the opportunity to crawl along the hand.

8. Let the spider crawl along the hand, touch it with your finger.

9. Cover the spider with the palm of your hand.

10. Catch a spider in a fist and let it out into the street.

This plan is consistently carried out, with the therapist's assistant himself demonstrating with a smile how it can be done. When signs of panic reactions appear, the confrontation immediately stops and the degree of danger of the situation decreases.

The second way of desensitization is that a situation that previously caused fear is associated with a feeling that is incompatible with fear, for example, with a sense of calm. As a result, situations that previously caused fear of growing strength, after counterconditioning, begin to cause relaxation of growing strength.

Before confrontation with dangerous stimuli, the patient is somehow brought into a state that prevents the emergence of fear. For this, the state of relaxation is most often used. Of course, before using this state, the patient must be taught relaxation techniques (for example, using auto-training or Jacobson's progressive muscle relaxation). Sometimes (however, quite rarely, so as not to become accustomed to external therapeutic interventions), hypnosis or medications are used for the same purposes. In working with children as a suppressor

fear-inducing reactions often use feelings of joy, interest, pleasure from food. In adult therapy, a sense of self-confidence has been increasingly used in recent years.

Next, a simple sign is negotiated with the client by which he will inform the therapist that the state of relaxation has been achieved (for example, the client will raise the index finger of his right hand). After that, the client is located in a comfortable position for him, relaxes and raises forefinger. At this point, the therapist reads the first description of the (least scary) situation. The client achieves relaxation by imagining himself in this situation. When this succeeds, with the help of the agreed sign, the client indicates that it is possible to read the next, more terrible situation. If the client fails to relax, then they return to the step back. Sessions continue until the client manages to remain calm while repeatedly going through the entire chain of situations.

This standard form of desensitization uses the client's capacity for imagining - the ability to vividly imagine his involvement in a given situation. It is assumed that the imaginary situation and the client's actual participation in the situation are closely related to each other. If we manage to achieve calmness in an imaginary situation, then this calmness will be transferred to a real situation. “What we fear in real life is what we fear in our imagination. Therefore, what we have ceased to fear in imagination will not frighten us in reality either. However, sometimes this doesn't work. Imagination and real life for some clients mean slightly different realities, and desensitization must be carried out in real conditions.

Training "in vivo", i.e. in real life, often turns out to be quite a difficult task, but without it, sometimes the therapy process cannot be completed. Using the same principle as in imaginative desensitization, the client is confronted with some real events increasing complexity, instantly taking him out of a situation in which he cannot calm down, or reducing the intensity of variable situations.

Example. Fear of driving is eliminated by getting the client to calm down first when looking at the car or when planning a car trip, then asking him to just sit in a parked car, try to drive along a country highway at low speed, etc. With the client, they immediately return to the previous stage if he fails to calm down.

As the main method, systematic desensitization is used for any kind of fears and phobias, excessive

feelings of shame or guilt, sexual dysfunction, obsessions, depression and stuttering. Often, desensitization is combined with other behavioral therapies, such as social skills training, shyness, or uncontrolled aggressiveness.

After the end of therapy, a client who has gone through all the stages of desensitization is usually quite capable of independently planning and implementing desensitization in relation to newly emerging or residual fears. To do this, the client independently compiles a hierarchical list of events or situations in which he will train in relaxation. Further, he strives to relax either by imagining these situations, or by actually participating in them. When desensitization is done in the absence of a therapist, it is often referred to as self-desensitization.

Hierarchy

As can be seen from the preceding text, systematic desensitization is preceded by two procedures, which are sometimes used as independent methods in complex behavioral programs. This is the hierarchization and learning of arbitrary relaxation. The essence of hierarchization is that for therapeutic purposes, together with the client, successively more complex situations or chains of behavioral acts are sought. Starting with extremely simple skills or situations, the client, either by himself or with the help of the therapist, gradually introduces more and more complex and complex behaviors, more and more complex or dangerous situations, thus forming a certain hierarchy.

In the treatment of complex complex social fears, in the process of systematic desensitization, the client is asked to remember, select and arrange in order of their "difficulties" various social situations that cause fear or other behavioral difficulties.

Traditionally, two types of hierarchies are distinguished - thematic and spatio-temporal. In the case of thematic hierarchization, situations or events from different spheres of life united by one “theme” are subject to ranking. If we are talking, for example, about the fear of being in a situation that requires certain achievements (fear of error, fear of seeming inferior), then for

hierarchization, situations of an exam, a report at a workshop, delivery of work to a customer, attendance at a parent meeting at school can be selected.

Spatio-temporal hierarchization, on the contrary, refers to the same situation in which spatial or temporal characteristics change. With fear of seeming inferior, the same exam can be chosen, but the time after which it will take place will change (in six months, in a month, in a week, tomorrow, in an hour, now you will need to answer). For the treatment of fear of dogs, the distance separating the patient from the dog, or other spatial characteristics (for example, the dog may be locked in an apartment), can be changed.

Social skills training often uses hierarchization according to the socio-psychological parameters of partners. To do this, some characteristics of the partner, the style of interaction or the nature of interpersonal relationships are changed. In this case, you can change the place of action, the number of partners, the degree of authoritarianism, aggressiveness or goodwill of the partner, etc.

Regardless of the type of hierarchization, the resulting situations are ranked according to their degree of difficulty. The resulting hierarchy is then used for desensitization or can be included in other methods of therapy (modeling, successive behavior formation, social skills training, etc.).

The effect of hierarchization in this case is that the client has a clear perspective of successive actions, each of which will be supported by success.

Basic concepts

Phobia - irrational fear of non-dangerous objects or situations. Neurotic social fears (phobias) arise before situations of social interaction.

Hierarchy - the process of selection, analysis and ranking according to the degree of difficulty or danger of situations or skills with a change in their spatio-temporal, content or socio-psychological characteristics.

Systematic desensitization - therapeutic interventions in which the client sequentially confronts fear-producing and hierarchically organized events or stimuli in such a way that, during the confrontation, these events or stimuli do not cause fear. The method is often combined with methods hierarchization and counter-conditioning. This combination is often referred to as systematic desensitization.

Synonym: systematic desensitisation.

Counter-conditioning - method of behavioral psychotherapy, which consists in the fact that fear is consistently replaced by an emotion that is incompatible with fear (anger, sexual arousal; in modern

various forms - relaxation, pleasure from food, a sense of self-confidence). After a series of sessions, a conditional connection is formed between a situation that previously caused fear, with a new emotion that replaces fear.

Reciprocal inhibition - a decrease in the strength of one reaction under the influence of a simultaneously evoked alternative reaction. The principle of reciprocal inhibition underlies systematic desensitization and counterconditioning. Reciprocal inhibition in these methods consists in the fact that the fear reaction is inhibited by a simultaneously occurring emotional reaction, incompatible with fear. If this inhibition occurs systematically, then the conditional connection between the situation and the reaction of fear is weakened.

Pervin L, John O. Psychology of Personality: Theories and Research. - M., 2000. - S. 340 - 343 (Reinterpretation of the "case of little Hans" in the spirit of classical fear conditioning).

LazarusA. Mind's eye: Images as a means of psychotherapy. - M., 2000 (Description of the method of systematic desensitization by one of the most famous students of J. Wolpe. Use of images in desensitization).

Walp D.(Volpe D.). Psychotherapy through reciprocal inhibition // Techniques of counseling and psychotherapy: Texts / Ed. W. S. Sahakian (First-hand description of the method). - M., 2000. - S. 349-382.

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 behavioral psychotherapy 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. Wolpe 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 stressful situation as if he had actually hit her.

  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 high level anxiety in situations where there is no danger or threat to physical, personal security. 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.

  During the preparation phase, the therapist uses autogenic training, suggestion or hypnosis. To work with children, suggestion or game exercises are mainly used, which easily cause a state of relaxation. The construction of a hierarchy of stimuli is based on 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 in physical properties and subject meaning. As a result of construction, a sequence of objects or events is constructed that increase anxiety and are associated with one situation.

  At the last stage, the patient is sequentially presented with stimuli from the constructed hierarchy. 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 (that is, 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;
  • the third stage is the beginning of a role-playing game: 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.