Systematic Desensitization in Action
If you suffer from any type of anxiety or especially a phobia you may have heard of the method of systematic desensitization to treat it. A good description of this method can be found in our anxiety treatment section where several characteristics of systematic desensitization are defined including:
• Relaxation training
• A list composed by the patient that prioritizes anxiety-inducing situations by degree of fear
• The desensitization procedure itself, confronting each item on the list, starting with the least stressful
But what does this textbook description look like in real life? And how does one go about this if the subject is a child? I am going to give you my firsthand account of how I have helped my son cope with some of his phobias by sharing a specific real life example of systematic desensitization in action.
Just to give you some background, my son Max has autism. I have written about many of our experiences on our ADHD site. Anxiety is an extremely common co-morbid condition of autism and the development of phobias can result. Phobias are something I understand all too well as I have them too. Yet empathy only goes so far in helping a loved one deal with irrational fears. You have to also have a plan of action.
The object of fear for one of my son’s early phobias was also, strangely enough, a source of great fascination and attraction. When Max was about three he developed a phobia to trains. It started off as a fear of a specific train. We took him on a small train ride at an outdoor museum exhibit. The train ride, although, limited in duration, went through a tunnel where the children would scream loudly and you could hear the echoes. People with autism have some difficulty modulating incoming sensory stimuli. So sounds which might not bother you or me may be perceived as painful and frightening to my son. In addition to the screaming sounds there was also the issue of the loud train whistle which delighted all the other children except for my own.
After that first fateful train ride, Max would cringe in fear every time we went to this particular museum and saw that train. He would go so far as to begin running away into the crowds if he saw it. One danger with phobias is that the fear response can generalize to other objects and situations resembling the first trigger. At first my son’s panic was fixed upon one particular train but then it grew to include all trains. He became afraid when we had to stop the car to let a train pass by. Max cried and screamed when he saw a train at an amusement park. All of a sudden it seemed there were trains everywhere to avoid.
My son's train phobia hit a critical point when his fear response was increasing to an almost daily event. He had also generalized his phobia to include anything which remotely resembled a train. We have a playground near our home which has a variety of playground equipment including the usual swings and slides. But it also has this structure which looks like a train. Regardless of the fact that this train did not move or make any sounds Max was terrified of it. At this point I felt I had to do something because this train phobia was interfering with our daily routines and paralyzing my son from enjoying the neighborhood playground.
What made the process of systematic desensitization a little easier was the fact that my son still enjoyed being in a stroller. There he felt safe. I felt that it was a good idea to start with the train in the nearby playground as our first target as this site was so close to home. It was also becoming a hindrance to our everyday functioning as walks or car rides going past this playground train would induce his panic reaction. If he could see the structure anywhere in his range of sight, no matter how far away, he would react. One variable not in our favor was the fact that my son’s communication skills were nil. He was simply not able to communicate why the train scared him. So we had to take some educated guesses and hope we were right.
Here are the steps I used in our homespun systematic desensitization program:
1. I took a photo of the train structure in the playground and would present this to him everyday talking about how this train did not make loud sounds and could not move. I showed how children played on it and had a good time.
2. We also developed some calming strategies which were individually tailored for my son. You really need to take time to choose such strategies because what will calm one person may agitate another individual. We created a list of known calming agents such as firm hugs, having him hold his stuffed animals, and singing nursery rhyme songs he liked.
3. After a week of showing him the photos of the playground train we took a walk with Max in the stroller with his favorite stuffed animals. I told him we were going to walk down the sidewalk across the street from the playground. When he began to react with any fear I would pause and hold him and sing to him. When he calmed some I would point out the train across the street so he knew I could see it too. I talked about it in positive terms and how I could see all the kids playing on it and how much fun they were having.
4. After a week of walking down the street across from the park my son’s reactions began to diminish some. When I felt he was ready I then told him we would cross the street and just stop at the entrance to the playground. We would pause there and again, I would use our calming strategies for any fearful reactions. I kept telling him too, that he was safe.
5. It may have been about a month before we worked our way to the actual train structure where he was out of his stroller and touching it without any signs of panic.
6. The happy ending in this story is that Max was finally not only able to enjoy our neighborhood playground; he also loved playing on the train which originally scared him so. We then proceeded to work on other trains up to the point where nowadays he has ridden on a real train even with the loud engine sound and whistle.
The point of sharing this real life vignette with you is to show that phobias can be overcome. It can take a lot of time but it is very worth it. When phobias and fears are disabling you from enjoying your life and freedoms then it is time to act. I have learned a lot from my son’s experience in battling my own fears. If he can do it, so can I. And so can you!