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Displaying items by tag: In Vivo Desensitization

Tuesday, 19 June 2012 20:55

In Vivo Desensitization to Treat Anxiety

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.

Published in Anxiety General Blog

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