# Systematic Desensitization



## Razyrsharpe (May 21, 2015)

Hi,

I have been dealing with moderately severe social anxiety for many years and as part of my treatment plan I am trying to come up with a systematic desensitization hierarchy. I was just wondering if anyone has ever tried this or is in the process of trying this and was just wondering if any of you have any ideas of things I can add to my hierarchy???

So far I have some things like taking a walk in a crowded place, asking for the time, asking a salesperson a few questions, and going to a group meeting.

Does anyone have any other ideas??? Anything would be appreciated. Or perhaps some of you might want to share your hierarchy if you are trying to do this kind of thing.

I will try and update and tell you how it is going.:nerd:

- RS


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## Jhp78 (May 9, 2015)

I might suggest taking the Leberwortz test and finding which questions send fear through every part of your body. Then doing those. I think you've got a pretty terrorizing list to start though IMO.


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## Kanzi (May 10, 2015)

First off: welcome to the forums Razyrsharpe!

Here is my current exposure hierarchy for SA. My situations are ranked by anticipated anxiety on a scale from 1 to 100.

    75 - Webcam with people from SAS. 
    95 - Do free weight exercises in a crowded gym. :stu
    95 - Make small talk with a pretty female stranger, face-to-face.
    98 - Flirt with a girl.
    98 - Ask for a girl's number.
    98 - Call a girl spontaneously.
    98 - Perform magic for a friend.
    99 - Perform magic for a stranger.
    100 - Make a move on a girl. 
    100 - Perform magic for a group of strangers.

This is actually not even a really good hierarchy because all of my situations are too high in frightfulness! You really want an evenly spaced hierarchy of situations from, say, 20 (low anxiety) to 100 (maximum anxiety).

In my group therapy, if we had an exposure planned for a situation that was too highly rated (say over 80), then we would try to find a similar task that was not as anxiety-provoking in order to "work up" to the higher one. For example, doing free weight exercises in a crowded gym, which is a 95 for me, is way too high, so I'll first start with doing machine exercises when it's not crowded (a 70 rating for me). Then, I'll move up to machine exercises when it is crowded (an 85), and then finally, doing free weights when it is crowded (95). I would do these exposures on separate days, of course.

It would be hard for me to make suggestions for your hierarchy because I don't know you! (Yet .) I think you have to try to "learn thyself" to develop your own hierarchy. Discussing this with your therapist (if you have one) can give you insights into what situations cause you anxiety. Good luck!


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## Caedmon (Dec 14, 2003)

@Razyrsharpe I think those are really good. Maybe keep it simple and just try those for now? You can do more later.

Not sure at the context of your hierarchy. BUT I would be _very_ wary of trying to do systematic exposure in a purely behavioral, "how-anxious-do-I-feel" kind of way. Rather, I would create a hierarchy and use that hierarchy to do *"experiments"*. You go, do the activity least stressful on upwards. Then afterwards, sit down and do a *thought record* and a cognitive reappraisal of the situation. Start to gather data on these experiments.

Keep in mind that social anxiety isn't like a snake phobia. It is difficult and unpredictable to know all other factors, such as how other people will react. I suggest trying to select situations in which you can be more confident that the people you are around, are more likely to have a consistent personality. For example:

bank teller
jewelry store salesman
calling technical support
volunteering for non-profit
these types of things generally have people who are polite on a more consistent basis. But you will need to have your *cognitive* planning in place ahead of time if you meet with a person who acts rude or insensitive.

Plan the steps only insofar as *you can control* them. So don't say, "Get a girl's number" because what if you don't? Is that really because of something about you, or could there be other factors, like just the "luck of the draw"? We can't control others' reactions. So instead you might frame it as "Approach and initiate a conversation with 3 attractive people" and regardless of how it goes - _even_ if it goes badly - you will have succeeded.

Also, don't confuse the experiments with your personal *goals*. You can have a goal of getting a job or significant other, but those are too broad to be useful for experiments. And of course they are not things you can control.

There is the "self-focusing" trap to watch out for. It's risky to spend too much time using emotions to dictate actions. While exposure is often helpful under many circumstances, it will need to be kept with that in mind. The cognitive distortion is called *"emotional reasoning"*. You might want to be sure you are working with a therapist who can navigate that fine line with you.

Again, doing the *thought record* afterwards, and keeping data on the results is absolutely critical. (Thought records are something everyone needs to learn to do; they are your CBT bread-and-butter.)

Just my two cents!


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## Kanzi (May 10, 2015)

@Caedmon These are all really good points. Thanks.


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## Razyrsharpe (May 21, 2015)

Jhp78 said:


> I might suggest taking the Leberwortz test and finding which questions send fear through every part of your body. Then doing those. I think you've got a pretty terrorizing list to start though IMO.


So what is the Leberwortz test? I did a quick google search and not much came up.


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## Razyrsharpe (May 21, 2015)

Kanzi said:


> First off: welcome to the forums Razyrsharpe!
> 
> Here is my current exposure hierarchy for SA. My situations are ranked by anticipated anxiety on a scale from 1 to 100.
> 
> ...


Hi, and thank you for your long response lol.

Your anxiety hierarchy that you have wrote down is terrifying lol. I lift free weights several times a week, but "making a move on a girl" or even making small talk with an attractive girl would be way out of my comfort zone - I am not even close to being able to do that.

I have come up with a hierarchy that starts with some much easier tasks and progresses slowly. Hopefully I can get some exposure every day. Enough sitting around wasting my life.

My hierarchy may be atypical to some degree, I didn't really create it "by the book" - more from my own ideas about what would best challenge me, without being too challenging too fast.

Some of the last tasks are absolutely petrifying to me right now (I refer to them as tasks idk), but my hope is that by the time I make it to the last tasks on the list, they will not seem so daunting and I will have come further in my therapy by then... I can always revise the list. As long as I get exposure daily it should help. I read something about prolonged exposure being very important. So like if you try something very high up on your list to "shock" yourself and then your just a hermit for the next week, it probably won't help.

There are some rules to my hierarchy:

Practice each task for 7 days before moving on to the next task. If unable to complete a task because it is not possible to realistically do so (for example, presenting to a group - it would be hard to find a place to present every day for 7 days) than go back to the task before it and complete that one instead. If unable to complete that task as well, go back one more, and so on. This way every single day will be spent doing a task.

Anyway, here it is:

1. Going for a walk somewhere where there is a lot of people for 20 min (mall, downtown, etc.)
2. Asking 3 questions to a salesperson, 3 times, male or female
3. Asking 3 questions to a salesperson, 3 times, female
4. Having a conversation with a salesperson for 5 minutes, 3 times, male or female
5. Having a conversation with a salesperson for 5 minutes, 3 times, female
6. Greeting 5 strangers, male or female
7. Greeting 5 strangers, female
8. Going to a group meeting or fitness/sports group and introducing myself to a stranger
9. Having a conversation with a stranger for more than 5 minutes, 3 times, male or female
10. Having a conversation with a stranger for more than 5 minutes, 3 times, female
11. Handing out 5-10 resumés
12. Meeting someone new or that I don't know very well for a meeting of some kind (going for coffee, a movie, etc.)
13. Having a conversation with a girl around my age that I don't find attractive for 3 minutes, 3 times
14. Having a conversation with a girl around my age that I do find attractive for 3 minutes, 3 times
15. Talking with a small group of people/contributing to conversation with a small group of people 5 minutes, 3 times
16. Talking with a small group of people/contributing to a conversation with a small group of people 10 minutes, 3 times
17. Playing music with friend(s)
18. Calling 5 potential employers/following up on resumés
19. Having a conversation with a girl around my age that I don't find attractive for 10 minutes, 3 times
20. Having a conversation with a girl around my age that I do find attractive for 10 minutes, 3 times
21. Going on a date
22. Going to a party/get together with someone I know, no drinking
23. Going to a bar to see live music with someone I know, no drinking
24. Karaoke
25. Job interview
26. Talking with a small group of girls, 10 minutes, 3 times
27. Public speaking/presenting to a small group
28. Playing music live in front of a small group (like at a coffee house or something

So this would take 28 weeks. It may seem extensive or tedious, but I've had this problem for about a decade, with the roots of it going back 25 years so 28 weeks is nothing to me. Plus, I have made my SA therapy my priority so it is one of the first things I do every day. That being said, it is unlikely it will go perfectly and I will miss some days, but I don't care - I will just get back on track ASAP.

Any suggestions, let me know. I have to go to bed now lol, so I will post my progress next time, which will be soon. I won't wait a month this time. Sorry about that lol!!!

Hope to hear back from you!

Thanks,

RZR


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## Razyrsharpe (May 21, 2015)

Caedmon said:


> @Razyrsharpe I think those are really good. Maybe keep it simple and just try those for now? You can do more later.
> 
> Not sure at the context of your hierarchy. BUT I would be _very_ wary of trying to do systematic exposure in a purely behavioral, "how-anxious-do-I-feel" kind of way. Rather, I would create a hierarchy and use that hierarchy to do *"experiments"*. You go, do the activity least stressful on upwards. Then afterwards, sit down and do a *thought record* and a cognitive reappraisal of the situation. Start to gather data on these experiments.
> 
> ...


Hi, and thank you for response - very interesting.

I posted my hierarchy above. As for a thought record, I think that's a good idea. I started journalling and I often write about my experiences that happen when I am trying to complete my exposure therapy. But not every time. I kind of just write about whatever is on my mind in regards to my SA struggles. I will definitely consider writing after or even during my exposure therapy "outings".

I have tried to pick situations like talking to salespeople to start off with because they have to be nice - supposedly. At some point I have to branch off and put myself in more "unpredictable" situations though I think. I am trying to be more compassionate to myself and if somebody reacts "negatively" towards me I just have to be ok with that. I am trying to work on caring less about what people think of me - it's hard lol - but instead just focusing on adhering to my own values, not what others think of me.

I see what you mean about not adding goals. I personally added things like "job interview" and it would be hard to do that (especially since I am trying to do each task 7 times before moving on lol) but the thing is I could set up an interview with a couple volunteer agencies. I also know a few employment councilling agencies in my city where they will give you a "mock" interview - so it's like a fake interview to get you ready for the real thing. And I would try to get at least one legit job interview. So my plan is malleable, flexible. And if worst comes to worst, as I wrote under my desensitization plan rules, if for some reason I cannot complete a plan task on a given day, I will just go back to whichever task I can feasibly accomplish on that day. To me, the most important thing is that I am getting prolonged exposure on a regular basis coupled with helpful therapy.

As for the thing about emotional reasoning (which I had to look up lol), that is really not a problem with me at all. I always try and look at my emotional responses and see what they are telling me and balance that with logical reasoning. I am trying to turn towards my anxiety now whenever I can instead of chronically avoiding which I have been doing most of my life and is engrained very powerfully within me.

Anyway, I am seriously tired now. You guys made me stay up past my bed time! Thanks alot!!!

And for no reason, here is a devil emoticon>

RZR


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