Systematic Desensitization Exercise

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. 

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  • 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.