Joseph Wolpe was a psychologist who, in 1958, refined the exposure therapy techniques pioneered by Mary Cover Jones. His work led to the development of systematic desensitization, a method for treating phobias and anxiety disorders.

Joseph Wolpe

A fear hierarchy is a list of situations or behaviors related to a phobia, ranked from least to most anxiety-inducing. This tool is used in graded exposure and systematic desensitization. For a person with arachnophobia (fear of spiders), a sample hierarchy with corresponding fear ratings could be:

*   **Look at a photo of a spider:** Fear Rating 15
*   **Look at a real spider through clear glass:** Fear Rating 35
*   **Hold a box that contains a spider:** Fear Rating 55
*   **Watch a spider crawl across the floor:** Fear Rating 65
*   **Watch a spider crawl across your desk:** Fear Rating 75
*   **Hold a spider with gloved hands:** Fear Rating 90
*   **Hold a spider with bare hands:** Fear Rating 100

The accompanying image of a person holding a large spider on their bare arm represents the final and most challenging step in this hierarchy.

Example of a Fear Hierarchy for Arachnophobia

This example illustrates the application of systematic desensitization for a person named Jayden with a severe phobia of elevators. A behavior therapist guides Jayden through the process, which begins with creating a fear hierarchy that ranks elevator-related situations from mildly anxiety-inducing to panic-provoking. The therapist then teaches Jayden progressive relaxation techniques to achieve a deep state of calm. The core of the therapy involves Jayden, while relaxed, imagining the least threatening situation from his hierarchy. If he feels anxiety, he signals the therapist, who then guides him back to a state of relaxation before repeating the scenario. This process is continued until he can imagine the situation without fear. This method is applied sequentially for every item in the hierarchy. Once Jayden is desensitized to all imagined scenarios, the therapy transitions to real-world practice, where he gradually confronts the actual situations, starting from pressing the elevator button to eventually riding it to his 29th-floor office, with the goal of eliminating his anxiety response entirely.

Example of Systematic Desensitization for Elevator Phobia

A therapist is treating a client with an intense fear of flying. The therapist helps the client construct a list of anxiety-provoking situations, from looking at a picture of a plane (rated 10/100 for anxiety) to taking a transatlantic flight (rated 100/100). The therapist then immediately asks the client to imagine the transatlantic flight while practicing deep breathing exercises. What is the most significant procedural error in this therapeutic approach?

Based on a therapeutic approach that combines gradual exposure to a feared stimulus with relaxation techniques, what would be the most appropriate *initial* steps a therapist would take with Maria before any direct exposure to dogs begins? Explain your reasoning.

Therapeutic Plan for Cynophobia

Developed by Joseph Wolpe in 1958 as a refinement of earlier techniques, systematic desensitization is a form of exposure therapy that pairs graduated exposure to a feared stimulus with relaxation techniques. The process involves creating a hierarchy of anxiety-provoking situations and teaching the client relaxation methods. The client then confronts the stimuli, starting with the least frightening, while in a relaxed state. The therapy is based on the principle that an individual cannot be anxious and relaxed simultaneously, aiming to replace the fear response with a relaxation response.

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- Graded exposure
- Flooding
- Systematic Desensitization

 Paces for Exposure Therapy



Exposure therapy is a therapeutic technique where a client is presented with a feared object, situation, or activity in a safe environment, with the goal of reducing their fear and avoidance through habituation, or getting used to it. This method can be implemented through real-life exposure (in vivo), imagination, or virtual reality. First reported by Mary Cover Jones in 1924, this approach is used to treat various anxiety-related conditions like phobias, PTSD, and OCD. It works by facilitating processes such as habituation, extinction, building self-efficacy, and emotional processing.

Exposure Therapy

In graded exposure, individuals are assisted by psychologists to construct an exposure fear hierarchy. Feared objects, activities, or situations are ranked by difficulty. Beginning with mild or moderate difficulty exposures, and then progressing to harder ones. 


Graded Exposure 

Relaxation therapy training has various different protocols, including progressive relaxation therapy.  Relaxation therapy is often used alongside  cognitive-behavioral therapy and focuses on becoming aware of tension within the mind and body. Then, systematic relaxation methods (such as diaphragmatic breathing, progressive muscle relaxation, guided imagery) are used to reduce tension and to change the perception of physical pain.

Relaxation Therapy

What Is Exposure Therapy? (n.d.). American Psychological Association. Retrieved July 20, 2022, from https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy

What is Exposure Therapy ? 

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

Flooding starts individuals with the most difficult tasks using the exposure fear hierarchy. 


Flooding 


Systematic Desensitization



- In Vivo Exposure
- Imaginal Exposure
- Virtual Reality Exposure
- Interoceptive Exposure

Variations of Exposure Therapy



Add reference nodes for Exposure Therapy here.

References for Exposure Therapy

You can learn more about how exposure therapy is used in treating PTSD here: 

Video: Exposure Therapy and PTSD

This example illustrates how exposure therapy, based on classical conditioning principles, can be used to treat a phobia. The process involves four stages:
1.  **Initial State**: A rabbit, the conditioned stimulus (CS), elicits a fear response in the individual.
2.  **Introduction of Pleasant Stimulus**: A naturally enjoyable item, like milk and cookies, serves as the unconditioned stimulus (US), which produces a positive unconditioned response (UR).
3.  **Pairing**: The rabbit (CS) is repeatedly presented to the individual at the same time as the milk and cookies (US). This pairing causes the individual to experience the positive unconditioned response (UR) in the presence of the rabbit.
4.  **New Association**: After multiple sessions, the rabbit (CS) alone begins to trigger a new, positive conditioned response (CR), replacing the original fear.

Example of Exposure Therapy for Phobia of Rabbits

Given the following case study, propose a therapeutic intervention based on the principle of confronting a feared situation in a safe environment to reduce the associated anxiety. Explain the psychological mechanism that is expected to lead to a reduction in fear.

Therapeutic Application for Fear of Public Speaking

A therapist is helping a client who has an intense fear of public speaking. Together, they create a list of feared situations and rank them from least to most anxiety-inducing. The first step they successfully completed was having the client give a one-minute speech to an empty room. Based on the principles of a graduated approach to confronting fears, what would be the most appropriate next step for the client?

Progressive relaxation therapy (PRT) emphasizes the importance of awareness concerning muscle tension by contracting and relaxing individual muscle groups. Training occurs sequentially in smaller steps, and the skill acquisition may require up to one hundred sessions to fully accomplish. This therapy does not include any hypnotic suggestion or imagery. 

Progressive relaxation training 

Passive relaxation therapy is designed to be effective in as few as seven sessions. A central element of the passive relaxation process is the use of guided imagery. The clinical use of imagery is verbally guided by the therapist and includes multiple sense modalities.

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