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Treating Male Suicide & Depression
Male Suicide & Depression continuing education addiction counselor CEUs

Section 13
Treatment using Systematic Desensitization Therapy for Depressive Disorder

CEU Question 13 | CE Test | Table of Contents | Depression
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs, Nurse CEUs

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Now that we've discussed the Anger Diary technique, let's turn to another approach regarding anger that masks depression. To unmask the anger, they hide his depression, with Neil, whom you remember from the previous track, we also tried "Systematic Desensitization." This strategy works by exploring a client's anger hierarchy to help him relax during anger-provoking situations.

Eight Steps in "Systematic Desensitization"
I used this technique with Neil after he began keeping his Anger Diary and realized his anger was a problem. The basic thrust of Systematic Desensitization is that it enables your client to decrease the intensity of his anger by teaching him to be more relaxed in certain anger-provoking situations. By doing so unmasking the depression that lies below the anger. Let's now review the steps to "Systematic Desensitization." There are eight steps in this process, developed by Dr. Joseph Wolpe. As I read the list, think of a client you are treating for whom you might consider using this technique.

Step One: Selecting a topic for your anger hierarchy
I told Neil to look through his "anger diary" and make a list of five situations that most frequently provoked his anger. Then, I asked him to pick one of those situations, one that often caused him intense anger. Neil chose to examine meetings at work that aroused his anger.

Step Two
: Choosing situations for your hierarchy
Next, I asked Neil to write down, on separate index cards, ten to twenty anger-provoking situations within the broad category of work meetings. Neil chose situations like "a co-worker comes to the meeting unprepared" or "the boss makes unrealistic demands on me and my group."

Step Three
: Arranging your anger hierarchy
I asked Neil to arrange his cards in a hierarchy, with the least anger-provoking situation on top of the stack and the most anger-provoking situation on the bottom.

Step Four
: Confirming the order of your hierarchy
I told Neil it was important that he had correctly arranged his situation cards. I suggested that he close his eyes and briefly visualize each situation individually. He was to watch specifically for how angry he was as he imagined each situation. Then he was to compare his reactions with a range of emotional intensity from one to five, one being annoyed, and five being enraged. Ideally, his emotional reactions would become increasingly intense as he progressed through the hierarchy he had established. Here's part of Neil's hierarchy:
-- Intensity #1. A meeting was supposed to start five minutes ago and three co-workers amble into the room.
-- Intensity #2. You're supposed to listen to a presentation of a co-worker and he's clearly unprepared, searching for information and bumbling around as you and others wait.
-- Intensity #3. You need information from a co-worker before you can move on in your project, but she tells you she's going to have it later than expected.
-- Intensity #4. You're supposed to give a presentation, but moments before the meeting you dropped your papers, and they fell into an incoherent mess.
-- Intensity #5. Your boss sees an inadequacy in a group project, and she blames you, even though the mistake was the fault of your co-workers,' not yours.
The list goes on of items that Neil recognized as anger-provoking situations, each of increasing intensity.

Step Five
: Learning to relax
Before we began the actual desensitization process, I asked Neil to relax. We went over the "Power Technique" and the "Counting Technique," which you remember from earlier in the course. Any relaxing technique will do for this step. The important thing is to find a tranquil place to "let go."

Step Six
: Selecting a positive mental image
After Neil had relaxed his body and mind, I told him, "Now paint a mental picture of the most restful, relaxing, and rejuvenating place you can think of." In Neil's case, that place was a secluded sunny beach. Other clients say they picture a remote mountain cabin, or a social gathering with some of their favorite people. Any of these will do; what's important is that you select an image that truly makes you feel relaxed and one that you can call forth many times.

Step Seven
: Beginning to desensitize yourself to anger-provoking situations
Neil was ready to begin desensitizing himself from the situations that had always made him angry. He was completely relaxed, and I told him to look at the first situation card. He looked at it for about twenty seconds and reported no increase in tension. Then he moved onto the next card. I told Neil that if he began to feel tense, to immediately replace the anger-provoking image with his positive mental image of a secluded sunny beach.

After picturing his pleasant image, it took Neil awhile to fully relax again. He then looked at the first card and then the second, but he felt the tension again. I told him to use his positive mental image to relax himself, and then to stop the exercise. I find that it's most useful to do only a few of the situations at a time, so Neil and I resumed the Systematic Desensitization exercise during our next session.

Step Eight
: Progressing through your anger hierarchy
Neil eventually worked through his list of anger-provoking situations, moving onto the next and more intense situation only if he had endured the previous one and remained relaxed. At times, he would really struggle with certain situations. If this occurred, we would go back to the previous situation, and he would gain control of his anger there. By the end of our exercise, weeks later, Neil was able to visualize almost 20 situations that had always made him angry before. Now, he could minimize the anger with concentration and relaxation.

Neil gradually applied what he learned using Systematic Desensitization to new anger-provoking situations. Along with the Anger Diary, this technique helped Neil better understand and control his anger. Do you think the Systematic Desensitization technique would help a depressed male client of yours who is hiding his depression behind a mask of anger? Could you start with the steps in your next session?

Now that I've discussed systematic desensitization as a way to help clients assist your depressed possibly suicidal client, in the next track, we'll look at costs and pay-offs to batterers, whose depression and anger result in physical violence.

Peer-Reviewed Journal Article Reference:
Cole, B. P., & Davidson, M. M. (2019). Exploring men’s perceptions about male depression. Psychology of Men & Masculinities, 20(4), 459–466.

Davis, H., & Turner, M. J. (2019). The use of rational emotive behavior therapy (REBT) to increase the self-determined motivation and psychological well-being of triathletes. Sport, Exercise, and Performance Psychology. Advance online publication.

Dyar, C., Feinstein, B. A., Zimmerman, A. R., Newcomb, M. E., Mustanski, B., & Whitton, S. W. (2020). Dimensions of sexual orientation and rates of intimate partner violence among young sexual minority individuals assigned female at birth: The role of perceived partner jealousy. Psychology of Violence, 10(4), 411–421

Gaylord-Harden, N. K., So, S., Bai, G. J., & Tolan, P. H. (2017). Examining the effects of emotional and cognitive desensitization to community violence exposure in male adolescents of color. American Journal of Orthopsychiatry, 87(4), 463–473.

Triscari, M. T., Faraci, P., D'Angelo, V., Urso, V., & Catalisano, D. (2011). Two treatments for fear of flying compared: Cognitive behavioral therapy combined with systematic desensitization or eye movement desensitization and reprocessing (EMDR). Aviation Psychology and Applied Human Factors, 1(1), 9–14.

Online Continuing Education QUESTION 13
What is the purpose of "Systematic Desensitization?" To select and enter your answer go to CE Test.

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