Systematic Desensitization for Panic Disorders

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Joseph Wolpe, a pioneer of behavioral therapy, developed a technique called systematic desensitization for the treatment of anxiety-related disorders and phobias. This technique is based on the principles of classical conditioning and the premise that what has been learned (conditioned) can be unlearned. Ample research shows that systematic desensitization is effective in reducing anxiety and panic attacks associated with fearful situations.

Systematic desensitization usually starts with imagining yourself in a progression of fearful situations and using relaxation strategies that compete with anxiety. Once you can successfully manage your anxiety while imagining fearful events, you can use the technique in real-life situations.

The goal of systematic desensitization is to become gradually desensitized to the triggers that are causing your distress.

Learning to Relax

Before you can begin gradually exposing yourself to your feared situations, you must first learn and practice some relaxation techniques. Some techniques commonly used in relaxation training include:

Deep Breathing

When people are anxious, they tend to take rapid, shallow breaths that come directly from the chest. This type of breathing is called thoracic or chest breathing. When you’re feeling anxious, you may not even be aware that you’re breathing this way. Chest breathing disturbs the oxygen and carbon dioxide levels in the body, resulting in increased heart rate, dizziness, muscle tension, and other physical sensations. This may signal your body to produce a stress response that contributes to anxiety and panic attacks.

Progressive Muscle Relaxation

If you have panic disorder, agoraphobia or another type of anxiety disorder, you may experience frequent muscle tension. In fact, chronic muscle tension may be so automatic that it seems normal, and you may have forgotten what it feels like when your muscles are completely relaxed. By employing the progressive muscle relaxation technique, you will be able to quickly rediscover the distinctions between relaxation and tension of various muscle groups.


By imagining yourself in a peaceful, stress-free setting, you can reach a state of mental and physical relaxation. For example, imagine yourself sitting near a beautiful, peaceful lake. Focus on the scene for a period. Feel the soft sand on the bottom of your feet. As a gentle breeze sweeps across the water, imagine the warm air on your face as you watch a magnificent sunset on the horizon.

How Systematic Desensitization Works

Before beginning systematic desensitization, you need to have mastered relaxation training and developed a hierarchy (from least feared to most feared) list of your feared situations. If you have difficulty getting to a state of relaxation or identifying your anxiety hierarchy, you should consult with a professional who will be able to provide you with guidance.

Systematic desensitization begins with imaginary exposure to feared situations. Use your anxiety hierarchy to break down the feared situation into manageable components.

For example, let’s say you fear to go into large stores. You may have the least anxiety walking into the store and your anxiety likely intensifies as you get further from the exit doors. Standing in the checkout line represents your highest fear response. In this case, you would start the process by focusing on the action that causes the least amount of distress and then work your way up. The result is that you will gradually, or systematically, become desensitized to shopping in large stores.

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  • Breaking Free From Anxiety Disorders – Self-Care Handbook. (1998). Deerfield, MA: Channing L. Bete Co.
  • Corey, Gerald. (2009). Theory and practice of counseling and psychotherapy. Belmont, CA: Thomson Brooks/Cole.

By Sheryl Ankrom, MS, LCPC
Sheryl Ankrom is a clinical professional counselor and nationally certified clinical mental health counselor specializing in anxiety disorders.