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系统脱敏法 Systematic Desensitization

转载 2017-1-15

  phobia: 恐惧症
  systematic desensitization: 系统脱敏法
  classical conditioning: 经典条件反射
  counterconditioning: 对抗性条件作用
  neutral stimulus: 无关刺激
  unconditioned stimulus: 非条件刺激
  conditioned stimulus: 条件刺激
  unconditioned response: 非条件反应
  conditioned response: 条件反应
  motivational conflict: 动机冲突
  reciprocal inhibition: 交互抑制作用
  graduated exposure therapy: 渐进式暴露疗法
  negative reinforcement: 负强化,消极强化
  operant conditioning:操作性条件反射

Do you feel too uneasy about spiders or snakes or closed-in places to carry out daily life? I guess most of us would say "NO". Then, congratulation! However, some people would actually do. We call that symptom as phobia. A person with a phobia suffers from a persistent and irrational fear of a specific object, activity, or situation that is excessive and unreasonable given the reality of the threat. It causes tremendous anxiety and interfere with normal day-to-day life. Luckily, phobias can be managed and cured. Today we are going to introduce something about systematic desensitization which is a treatment for phobias and other anxiety, it also can help us to cope with fears and emotion issues in daily life. Let's start from its origin -- classical conditioning and counterconditioning.



Ivan Pavlov -- Classical Conditioning & Counterconditioning

In the early 1900's, Russian physiologist Ivan Pavlov used dogs in studying the concept of classical conditioning. Pavlov knew that a dog salivates when eating. In his experimentation, Pavlov began to present a neutral stimulus, such as signal light or bell, before feeding the dogs. Obviously, the signal had no noticeable effect on the dogs’ salivation. But Pavlov kept the signal on when the dogs were being fed (and actively salivating), and, over the course of time, Pavlov found that the signal alone, even without his offering food, gradually caused the dogs to salivate.


So, in classical conditioning, an unconditioned stimulus (food) leads to an unconditioned response (salivation), a conditioned stimulus (light or bell), when paired consistently with the unconditioned stimulus (food) leads to a conditioned response (salivation) similar to the unconditioned response (salivation). Interestingly enough, there’s a reverse side to classical conditioning, and it's called counterconditioning. This amounts to reducing the intensity of a conditioned response (anxiety, for example) by establishing an incompatible response (relaxation) to the conditioned stimulus (a snake, for example).

所以,在经典条件反射中,一个非条件刺激(食物)引起非条件反应(唾液分泌);一个与非条件刺激(食物)紧密结合的条件刺激(灯光或铃声)也会引起等同于非条件反应(唾液分泌)的条件反应(唾液分泌)。说也有趣,经典条件反射有其反面,我们称之为对抗性条件作用。通过建立一个不兼容的反应(放松)来应对条件刺激(比如蛇),对抗性条件作用相当于降低条件反应(比如焦虑)的强度。【不禁让人想起此类之言:用一个好习惯去代替一个坏习惯,从而逐渐消除坏习惯,不是同样的道理么?这就是系统脱敏法的基本原理的通俗表现哦。 】

Joseph Wolpe -- Counterconditioning & Systematic Desensitization

Why someone would think that counterconditioning could be used for helping human coping with fear? It's a long story. Let's just see how Wolpe did that. Wolpe's inspiration came from experiments by a researcher named Masserman . Masserman made cats "neurotic" by giving them electric shocks in a certain box. Soon the cats acted anxious whenever they were put in the box. Masserman observed that the cats lost their "neurosis" if they were fed in the box. He interpreted this in psychodynamic terms, as "breaking through the motivational conflict." Wolpe saw the same events in terms of conditioning. Wolpe replicated Masserman's work and showed that cats could be induced to show gradually less and less fear, by being fed first at a distance, then closer to the box where previously they were shocked.


Wolpe called this counter-conditioning, literally using one association (between the box and feeding) to run counter to another association (between the box and shocks). Wolpe also termed the process reciprocal inhibition because he felt the responses of anxiety and eating inhibited or prevented each other. By encouraging animals to have a response incompatible with anxiety, while exposing them to the stimulus that previously caused anxiety, he found that he could weaken and eliminate the conditional response of anxiety caused by being put in the box.


In the late 1950s, Joseph Wolpe developed a treatment program for anxiety that was based on the principles of counterconditioning. Wolpe found that anxiety symptoms could be reduced (or inhibited) when the stimuli to the anxiety were presented in a graded order and systematically paired with a relaxation response. Hence this process of reciprocal inhibition came to be called systematic desensitization.




Systematic Desensitization (SD or Desensitization) is defined by Wikipedia as a type of behavioral therapy used in the field of psychology to help effectively overcome fears, phobias, and other anxiety disorders. More specifically, it is a type of Pavlovian therapy developed by a South African psychiatrist, Joseph Wolpe.


Developed in the 1950s by behavior therapy pioneer Joseph Wolpe, systematic desensitization is based on the principles of “classical conditioning.” The idea is that when humans learn something, they are being ‘conditioned,’ so if someone with anxiety can be ‘unconditioned’ then the fears they have come to learn to be afraid of can therefore also be removed by reversing the learning…a kind of self brainwashing in a way.


Clinical Procedure 

Before we simply list the basic procedures of systematic desensitization, let's have a rough understanding about the reasons why they are important.


Specific phobias are one class of mental illness often treated through cognitive-behavioral therapy and the process of Systematic Desensitization (SD). When individuals possess irrational fears of an object, they tend to avoid it. Since escaping from the phobic object reduces their anxiety, patients’ behavior to reduce fear is reinforced through negative reinforcement, a concept defined in operant conditioning. The goal of Systematic Desensitization is to overcome this avoidance pattern by gradually exposing patients to the phobic object until it can be tolerated.


Prior to exposure, the therapist teaches the patient cognitive strategies to cope with anxiety. This is necessary because it provides the patient with a means of controlling their fear, rather than letting it build until it becomes unbearable. Relaxation training, such as meditation, is one type of coping strategy. Patients might be taught to focus on their breathing or to think about happy situations. Another means of relaxation is cognitive reappraisal of imagined outcomes. The psychotherapist might encourage subjects to examine what they imagine happening when exposed to the phobic object, allowing them to recognize their catastrophic visions and contrast them with the actual outcome. For example, a patient with a snake phobia might realize that they imagine any snake they encounter would coil itself around their neck and strangle them, when this would not actually occur.


The second component of systematic desensitization is gradual exposure to the feared object. Continuing with the snake example, the therapist would begin by asking their patient to develop a fear hierarchy, listing the relative unpleasantness of various types of exposure. For example, seeing a picture of a snake in a newspaper might be rated 5 of 100, while having several live snakes crawling on one’s neck would be the most fearful experience possible. Once the patient had practiced their relaxation technique, the therapist would then present them with the photograph, and help them calm down. They would then present increasingly unpleasant situations: a poster of a snake, a small snake in a box in the other room, a snake in a clear box in view, touching the snake, etc. At each step in the progression, the patient is desensitized to the phobia through the use of the coping technique. They realize that nothing bad happens to them, and the fear gradually extinguishes.


All in all, Joseph Wolpe(1958) described a three-part systematic desensitization procedure:


1. The client is trained in deep relaxation. Wolpe received the idea of relaxation from Jacobson who studied muscle relaxation. He modified Jacobson relaxation techniques so that they took less time. Wolpe’s rationale was that you cannot be both relaxed and anxious at the same time. Some techniques that may be helpful include deep breathing, progressive muscle relaxation, visualization and meditation.


Deep Breathing 腹式呼吸法

Progressive Muscle Relaxation 渐进式放松训练 & How to Practice Progressive Muscle Relaxation

Meditation 冥想


2. The client and therapist construct a list of anxiety-eliciting stimuli, the so-called fear hierarchy, ordered from least to most distressing. During this process, the client and therapist need to find out all the things that could trigger the client's fear or anxious, and then make correspondent fear hierarchy base on these things.

  3. Starting with the least anxiety-arousing image, the feared stimuli are paired with relaxation, until eventually the most feared stimulus is tolerated calmly.


In the years after Wolpe publicized his original procedure, researchers tried out dozens of variations, looking for more efficient procedures. For example, researchers found that drugs or carbon dioxide/oxygen mixtures could provide rapid relaxation, making time-consuming relaxation training unnecessary. No matter what, Wolpe's Systematic Desensitization program, as a practical application of his theories, proved to be highly successful in the treatment of neurotic anxiety.


点击查看大图案例---克服“考试怯场”的案例。将你每次应试的真实感受按时间顺序逐一记录下来。比如:开始复习时、复习期间、 考试前一天、临进考场时、进入考场时、未做试题前、开始做题时等等,记述当时的周围环境和内心体验,按紧张程度不同分成由弱到强的顺序。然后开始运用“脱敏”训练:在充分的自我放松后,读你的第一次记录上的描述,尽量详细逼真地想象当时的情景,感到有紧张反应时,可用言语暗示“停止紧张”和深呼吸、肌肉放松术等方法压制或减弱紧张,直至镇定自若;再接下去进行第二份记录,依次逐渐训练。最后达到在你回想起初最紧张的情景时也能够完全或接近完全般轻松自如。

Try Systematic Desensitization on Yourself



How To perform Systematic Desensitization on Yourself

•The most important step when starting to work on a program to cure your mind of fears is to gather data. So, make a list of all the situations and things that scare you. Once you have the list, start working with the point of least resistance: the situation you fear the LEAST. This way, you'll have a better chance of succeeding with minimal effort and a success is going to reinforce positive beliefs about your capabilities.


•Reserve an hour in the day for the exercise, preferably a quiet time in the day. I would suggest you avoid doing it at bedtime. The reason is that you don't want to do something radically proactive at night: it may interfere with sleep.


•Find and dedicate a quiet, peaceful corner for the practice.


•Sit or lay yourself down and relax as much as possible. Take a few deep breaths. Deep breathing takes you into a relaxed state so that you are more likely to focus your mind.


•Now imagine the least dreaded situation. Visualize it. Let's say, for instance, that you are scared of enclosed spaces. And you want to get over the fear of subways and tunnels and cars and elevators. Now out of these situations, pick the one which is relatively less frightening. And visualize yourself there.


•Out of the above situations in the example, let's suppose sitting in the car is the least bothersome. So what you do is visualize a calm, relaxed and normal "you" sitting in the car.


•Divide the situation into scenes for maximum benefit. Visualize yourself getting out into the garage, and imagine that you are totally relaxed doing that. Now try relaxing your muscles and calming yourself down while visualizing yourself in the garage.... Repeat the exercise till you are fairly in control and relaxed imagining the situation. Take your time. Remember it might take a few days of practice to get the hang of it.


•Now go to the next scene. Play it like a movie in your head. You now open the door of the car and climb in. Calmly. Visualize yourself totally relaxed and cool about the journey. Relax yourself with the vision. Relax your muscles. Keep your breathing steady. Now repeat this a few times.


•Keep visualizing each step of the situation and visualize a successful culmination of the task. Every time you do it, imagine that you are actually doing what you fear, without being fearful.


•Once you have learned the art of visualization and also practiced relaxing yourself for a couple of weeks, try doing the dreaded thing for real. You'll find that you are much less tense while actually doing it. The idea is rehearsal for the show. You teach yourself to face the fear by facing it in small increments over time and in your head.


•Keep working on your technique. Refine it. Modify it to suit your specific needs. Be creative. But... Don't quit it. Even if you stumble a bit on the way.


旧一篇:系统脱敏疗法(Systematic Desensitization)