Exposure Therapy or Systematic Desensitization | CBT Counseling Skills

Hey there everybody, and welcome to today's presentation on systematics desensitization. This is part of the cognitive Behavioral Therapy Nuggets series. I'm your host, Dr. Donnellice Snipes. What is systematic desensitization? Well, basically it's exactly what it sounds like. You are systematically, or in a step by step fashion, becoming less sensitive to a particular trigger or stimulus. Systematic desensitization helps you alter your reactions to triggers or stimuli in the environment. You can kind of think of them like allergy shots for cognitive allergens. You know, if you've got allergies, you may go to the doctor and get a shot once a month. And by exposing yourself a little bit at a time to those things that you're allergic to, your body starts developing the understanding that it's not something that it needs to get all fired up about and trigger your allergic reaction. So this is sort of what we're talking about with systematic desensitization. The first thing, first thing that you're going to do with systematic desensitization is create an environment where you feel safe and empowered. You certainly don't want to be starting to try to deal with things that are stressful. If you don't feel like you're in a safe place, if you don't feel like you have options. So if you start feeling overwhelmed, you have the ability to get back to safety. You're empowered to leave that stressful situation. So create an environment of safety and empowerment. For some people, this means doing systematic desensitization activities with their therapist or, or when they're rehearsing at home, doing it when there is somebody else around, at least in the house. So they know that if they start to spiral, that they've got somebody there that they can rely on. Whatever it is for you, it's important that you feel safe and empowered. When you start. You need to feel really grounded before you take the next step. Then you need to master the ability to use breathing, relaxation and distress tolerance skills to down regulate your stress response. You don't want to start trying to figure out how to do this when you are practicing systematic desensitization. You want to learn these skills in day to day life before you launch into this. So when you start to feel stressed during the day, practicing slow focused breathing in order to down regulate your stress response, practicing different relaxation skills to down regulate that stress response and your distress tolerance skills. Remember, these are the mnemonic tags. Thoughts that are empowering, stopping thoughts that are distress intolerant and replacing them with empowering thoughts. So thoughts, activities that can help either distract you from what you're going through until you can get into your wise mind, or that actually trigger the opposite emotion, that trigger a sense of happiness or safety and empowerment. G stands for guided imagery. And guided imagery can be used to see yourself successfully completing the task or getting through something that's difficult. And S is for sensations. And sometimes sensations like a smell, like essential oils or even just a wax tart that you particularly like the smell of, can help you feel more grounded and more relaxed. Either way, you want to have a toolbox of tools that you can use in order to help you when you start feeling stressed, to downregulate that stress response, to slow your heart rate, to slow your breathing, to relax your muscles, to tell your body that there is no threat. Thanks for letting me know. But really, there is no threat. Once you have mastered the ability to use these skills to regulate your emotions, to downregulate that stress response, then you can start launching into systematic desensitization. When I work with clients, one of the first things I do is I have them learn about the trigger. And then as they're learning about it, you know, they start thinking about a trigger. And I'm going to use the example of snakes because lots of people are afraid of snakes. So I will have them start learning about snakes. And while they're learning about it, because they're reading about something that they're afraid of, they're going to experience an enhanced stress response. So while they're learning, they're also going to be mindful and take breaks to down regulate that stress response using breathing, relaxation, distress, tolerant thoughts, those sorts of things. So they're going to learn about this trigger. In other videos we've talked about facts, control and probability. One of the things that's important in systematic desensitization is to help you, your brain, make decisions based in fact, not based in emotion. Which is why I start with let's learn about this trigger. Why is it that it triggers you and what is it related to? If it's related to a prior experience, a past memory, a trauma, okay, knowing that is important. And gathering fact based information about the threat that this particular thing, whatever it is, poses in the present. Now, you may have no history with snakes, so it may not be related to anything in the past. You just always assumed that they were dangerous. So the fact based information is what's important there for other people and for other issues that are triggering it may be a phrase somebody says or a cologne that they wear. You want to think about, why does that trigger you? What is it related to? And what do you need to do in order to recognize that in the present you are safe, secure, and empowered. Once people have gone through learning about the trigger and have gotten to the point where they can think about it objectively, you know, this is a smell, this is a snake, whatever, and not get stressed out, then we move to the next step. And it's really important with systematic desensitization to take what I call micro steps, because if you jump forward too quickly, it could overwhelm your stress response. So take the next step. And what I usually start out with is in a safe environment, generally in session. Imagine the trigger or remember a recent time when you were triggered. So with the snake, you're imagining seeing a snake on a path, on a hiking path, for example. Or if it's a sound or a smell, remembering a recent time when you've heard that phrase or that sound or smelled that smell. When you're transporting your memory back that way, it's kind of using guided imagery, kind of using memory, whatever you want to label it as, it's not really important. But that again, will trigger the stress response because it's taking your brain back to a time or putting your brain in a place where it says, oh, this thing is present. Imagine that situation and down regulate the stress response. Get to the point, and you don't just do this once and done. You want to get to the point where you can imagine the snake, you can imagine seeing a snake, and it doesn't bother you. It actually doesn't trigger your stress response anymore. Just like with an allergy shot, after a while you have gotten enough exposure to it that when you encounter the allergen in real life, it doesn't trigger your histamine response. This is the same thing we're going for. And then moving on to exposure in a safe situation or from a distance. And I'm going to give you some examples in just a minute. The final step can be. It doesn't have to be, but the final step can be what I call immersion or ownership. When you're regularly exposed to something and you realize you are able to manage your response, it loses much of its power. You can own it or make it yours. I had one person that I worked with who there was a particular phrase, and actually there are a couple phrases that I can think of that when I hear them, it triggers that stress response. And I'm like, oh, don't say that. Even though it has nothing to do with the current situation. You know, somebody's just using a turn of phrase. It reminds me of a time in the past that was very stressful when somebody habitually used that phrase. So you can own it. Instead of avoiding the phrase and trying not to hear it say it, start using that phrase as much as possible. And for me, one of those phrases is, at the end of the day, oh, that gets under my skin. So I took ownership of it and I started using that phrase. So now when I say it, you know, I'm used to saying it, I'm used to hearing it, and I associate that phrase now with me saying it, not with that prior time. So you can own it. And that can be really helpful, especially for phrases that are triggering because somebody used to say them to you in a stressful situation. The same thing can be done for smells. And you do want to recognize that smells are our strongest memory trigger. So it's important to not overwhelm yourself. But if there's a particular smell, like somebody, a prior relationship that you were in, the person wore a particular aftershave or lotion. Exposing yourself to that and being around it and even associating it with positive things can help you switch your association and reduce your stress response to it. You can associate it with positive things. Holidays, for example, can be very triggering for a lot of people. My stepfather is a perfect example. He had a very traumatic Christmas one year, and Christmas decorations and Christmas songs and Christmas, anything can be very triggering for him. However, once the grandkids came along, that started creating new memories that were now associated with the holidays, and it became less potent. His trauma was not obviously completely relieved by associating it with new things. You know, he had to do a lot of work in therapy, but he was able to now be in a room with a Christmas tree and not be completely triggered. Regularly expose yourself to it while regulating your stress response. I've talked in other videos before about my somewhat irrational fear of bridges. And when we lived in Florida, there was a particular bridge going to my grandmother's house in St. Petersburg that we would have to go over. When we lived in Virginia, there were bridges we had to go over. And even here in Tennessee, there's a bridge that we go over. And just regularly going over that bridge and noticing, hey, nothing bad happened helps desensitize my reaction, my stress response. When I see a bridge now, I don't think, oh, my gosh. And my stress response doesn't kick off nearly as intensely. So here are some examples. These Are examples only and not suggestions. Again, if you take steps that are too big, it can actually contribute to your anxiety. So it is best with systematic desensitization. To start low, go slow and ideally do it under the supervision or guidance of a, of a professional so you don't over overwhelm yourself. But in terms of snakes, you know, again I said that's a really common concern for some people. Learn about snakes. Here in Tennessee there are really only five poisonous snakes and they are very identifiable. So learning about those. So now when I see a snake, when I'm out hiking or working in the bar or working on the farm, if I see one, I can look at it and go, that's not a poisonous snake. And that can be the first step. Getting that knowledge so you can make fact based judgments can help you feel empowered. And then thinking about seeing a snake, you know, not holding it or anything, just thinking about coming, coming across a snake, whether it's when I'm cleaning the barn or hiking or whatever, getting to the point where I can imagine encountering a snake and not getting stressed out. Then think about being in a room with a caged snake. Obviously a snake in a cage is not going to be able to access you. But for some people, being that close, even though they are, you know, locked up, can be intimidating. So think about being in a room with a caged snake and then move to being in a room with a caged snake. Think about being in a room with someone else holding a snake and then think about petting a snake somebody else is holding and then think about holding a snake and then you can move. Once you are able to think about these things, you can also then start moving to doing them. But, but ideally you want to envision it first and be able to see it in your mind's eye going successfully. You want to be able to envision it or imagine it, or think about it, whatever you want to call it and down regulate your stress response. You want to get to the point where you can think about it and it doesn't stress you out before you move to trying to expose yourself to it. For smells and phrases, identify the smell or phrase and the memory that it's related to. Remember a recent time that you've encountered that and it stressed you out. So get to the point where you can think about past times when somebody has worn that cologne or said that phrase and you can think about those times and it's like eh, whatever. In the safety of your chosen space, expose yourself to that smell or phrase. Which can mean if it's a phrase, just saying it to yourself or having somebody else that you trust use it in conversation and then ownership, you know, expose yourself to that phrase, you know, repeatedly, you start using it yourself. So now it's yours and you can choose how you use it and you can choose when you use it and you feel empowered. Those are some steps that you can take. Systematic desensitization should be undertaken with care to prevent moving forward too quickly and causing additional anxiety. It always starts with ensuring you feel safe and empowered. Before beginning any type of exposure, even imaginal imagination type exposure, it's essential to have mastered the skills of distress tolerance and, and emotion regulation because that's what you're going to have to do when you start to get stressed out. You're going to have to override that stress response and convince your body to down regulate your stress response. You're going to teach, train your body that your brain, your nervous system, whatever you want to call it, that this is not something that you need to be concerned about in the moment.