Panic Disorder Treatment Systematic Desensitization Exercise By Sheryl Ankrom, MS, LCPC Sheryl Ankrom, MS, LCPC LinkedIn Sheryl Ankrom is a clinical professional counselor and nationally certified clinical mental health counselor specializing in anxiety disorders. Learn about our editorial process Updated on November 11, 2021 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Systematic Desensitization. Getty Images Credit: Tetra Images Systematic desensitization is a technique sometimes used to manage anxiety, panic attacks, and phobias. It usually starts with imagining yourself in a progression of fearful situations. Before beginning systematic desensitization exercise, you need to have mastered relaxation training and develop a hierarchy (from least feared to most feared) list of your feared situations. Once you can successfully manage your anxiety in this way, you can repeat the steps in the actual situations that you fear. The process takes you from your imagination to real life (in vivo) exposure. Systemic Desensitization Steps Using systematic desensitization to conquer a fear of shopping in large stores may go something like this: Create an Anxiety Hierarchy Create an anxiety hierarchy of the steps involved in going shopping in a large store. For example, you may have the least anxiety walking into the store. As you get further from the exit doors, your anxiety intensifies. Standing in the checkout line may represent your highest fear response. Arrange your list from the least to most distressful. Start With Your Least Fear Next, imagine yourself standing at the entrance outside of a store. Closing your eyes may help you to picture the scene. As you imagine yourself in this situation, you are likely to feel a sense of anxiety. Use deep breathing to regain a sense of calm. Perform this exercise several times a day until you can imagine yourself at the store entrance without too much discomfort. Take the Next Step Now, imagine yourself entering the store. You counteract your anxiety with the relaxation techniques you’ve learned. Once you are able to imagine yourself entering the store without a great deal of anxiety, go to the next step. Continue to Journey up the Fear Ladder You’re walking down a store aisle, getting further from the exit door. You continue to picture this scene, using your relaxation training to counteract your anxiety. Continue this step several times per day for as long as it takes you to effectively manage your anxiety. Face Your Greatest Fear Now you’re ready for your most feared situation — standing in the checkout line. Just as in the other steps, you imagine the scene and counteract your anxious feelings with relaxation techniques. Once you feel comfortable with all of these steps, you are ready to try the exercise “in vivo,” or for real, beginning with standing outside of the store’s entrance. The result of systematic desensitization is that you have gradually (systematically) become desensitized to the various anxiety-provoking triggers of shopping in a large store. Get Professional Help to Work Through Fears 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. A mental health professional can assist you in developing your relaxation response. They will also be able to guide you through the remaining steps of systematic desensitization, helping you work through your fears and reaching a more relaxed state. Aside from assisting through the steps of systemic desensitization, your provider will be there to help you get past anxiety, overcome emotional issues, and return to your previous level of functioning. Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Bourne, E. J. (2011). The Anxiety and Phobia Workbook. 5th ed. Oakland, CA: New Harbinger. Forsyth, J. P. & Eifert, G. H. (2016). The Mindfulness and Acceptance Workbook for Anxiety: A Guide to Breaking Free From Anxiety, Phobias, and Worry Using Acceptance and Commitment Therapy, 2nd ed., Oakland, CA: New Harbinger. By Sheryl Ankrom, MS, LCPC Sheryl Ankrom is a clinical professional counselor and nationally certified clinical mental health counselor specializing in anxiety disorders. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for Panic Disorder Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.