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Tuesday, 19 June 2012 20:55

In Vivo Desensitization to Treat Anxiety

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Desensitization Therapy

In Vivo Desensitization is defined as:
A variation of systematic desensitization in which the anxiety-arousing situations to which the person is exposed are real, rather than imagined.
This differs from Flooding, another technique for treating Anxiety, by using a more measured approach to treating Anxiety.  Typically, with In Vivo Desensitization, the patient is gradually exposed to the actual feared stimulus over a period of sessions based on a hierarchical list of Anxiety evoking stimuli.  The treatment is based on the theory that the fear response has been conditioned and that avoidance of the fear maintains the fear.  The idea is that through exposure to the stimulus, this harmful conditioning can be “unlearned”.

How does it all work?

Well back in 1958 John Wolpe developed a method of a creating a hierarchical list of anxiety evoking stimuli in order of intensity which allows patients to undergo adaption.
Wolpe further writes: “An Anxiety hierarchy is the thematically related list of anxiety evoking stimuli, ranked according to the amount of anxiety they evoke.  There are a number of considerations in constructing desensitization hierarchies.  First, suitable themes have to be identified around which anxiety-evoking stimuli can be clustered. Second, clients can be introduced to interviews in which therapists focus on other problems using other methods.  A record is then kept of all scene presentations and their outcomes.
The sessions range in length of exposure and typically gets longer as the patient gets more into advanced stages.

Step by Step

As one of my largest fears is driving alone an example of a desensitization hierarchy might look like this.

  1. Get in the car and spend some time alone sitting in the drivers seat.
  2. Turn on the car and spend some time alone with the car idling.
  3. Turn the car around or maybe park the car in a different spot alone.
  4. Drive the car to the end of the street and return alone.
  5. Drive the car around the block then return alone.
  6. Drive the car to the store and return alone.
  7. Drive to the next therapy session alone, and so on.

The idea is that the patient exposes himself to the Anxiety, then uses relaxing techniques, and cognitive training to recover from the attempted step.  Building upon each success it is possible to unlearn the Anxiety and replace it with positive conditioning.


In Vivo Desensitization is not for everyone and I strongly suggest you seek the guidance of a good therapist before attempting this on your own.  It needs to be pointed out, that as you can learn good habits, you can also learn bad habits, so doing this therapy under the watchful eye of someone who is trained in this technique is vital.  With that said using In Vivo Desensitization to treat Anxiety can really help you overcome your conditioned fears.

Last modified on Tuesday, 19 June 2012 21:04


  • Comment Link Greg Weber Friday, 29 June 2012 01:53 posted by Greg Weber

    I've never heard of "In Vivo Desensitization" either, but I've done exposure therapy and generally agree with your philosophy.

    Most people need some combination of exposure / other tools in order to fully recover. Exposure, or desensitization (or whatever you call it) is necessary because we need to learn that the real power of our fears are INSIDE of us, not outside.

    But we also need tools in order to "hang in there" when the fear gets intense! That's why relaxation, mindfulness ( and other "brain rewiring" coping skills are so critical.

    I love your emphasis on tracking and measuring real-world results. Empirical data is also an important part of effective anxiety recovery.

    Good article!

  • Comment Link shaan Sunday, 24 June 2012 20:04 posted by shaan

    Excellent article and extremely well written. This is my opinion of the topic..

    I think this approach has it's pros and cons. I definitely use relaxation myself and with the clients i work with, but i find that relaxation is only part of the solution. You can be relaxed and feel great at that moment but that doesn't mean the cause of the problem has gone.

    I think that we should work on both sides of the problem, and this is best done with the help of someone like me who is a qualified therapist. I don't think much of exposure therapy myself, as i think it is very traumatic to the client, and i know that if someone did that to me, i would run a mile, fast in the opposite direction, lool..

    I guess we are all so different and that's the beauty of it!! I think in cases In-Vivo desensitisation will work for some people, but not for others. I love the fact you mentioned that proper help should be sought before doing this kind of approach, superb advice.

    Thank you again for the post. Keep up the excellent work:)

  • Comment Link Asho_DirtyPoo Wednesday, 20 June 2012 22:28 posted by Asho_DirtyPoo

    Never heard of it as "In Vivo Desensitization" before, but this was a major part of what's helped me overcome. Probably the biggest part, actually.

    I generally refer to it as "exposure therapy", but that label can leave it a little vague. :)

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