Practice makes Tolerable

Desensitization is a technique used in Dialectical Behavior Therapy, Cognitive Behavioral Therapy, and Eye Movement Desensitization and Reprocessing (EMDR) to blunt the effect of a provocative stimulus.  For example, somebody with OCD who has a specific compulsion around hand washing would touch something they would consider contaminated deliberately and tolerate not washing their hands while using an adaptive coping skill.  A person with a traumatic memory would revisit the images connected to that memory, or watch the “movie” of that memory over and over again.  Over time, the impact of the prompt reduces as the individual begins to understand that whatever they feared would happen doesn’t.

Desensitization around significant issues usually requires a good deal of assessment and capacity building to ensure that it is safe for a person to engage in the technique.  If an individual throws themselves in front of the prompt too fully, too quickly, or under-skilled he or she may run the risk of resensitizing themselves to the prompt and making the situation worse.

Imaginal Desensitization and Imaginal Rehearsal (ID/IR) are types of desensitization/practice where one imagines, or plays the movie of confronting the prompt – it is one of the most effective methods for treating historical trauma and is a safe bridge to getting an individual who struggles with phobias or compulsions to get more comfortable with the real thing.  I’ve also used it in helping folks reduce nightmares. In fact, it’s a great way for anyone to practice and prepare for whatever is uncomfortable.  It is often paired with a relaxation technique so that the feeling of relaxation, not tension, is associated with the behavior(s).

Let’s imagine you would like to discuss getting a raise with your boss.  This is a situation that tends to make many people uncomfortable.  A possible IR would like this,

(1) Begin a structured breathing exercise and remain in this exercise throughout the entire IR.

(2) Begin to see yourself in front of your boss, requesting a raise and it going well. Be mindful of what you are saying and his reaction.

(3) Notice where you feel the distress (physically) and how intense it is.  Lean into that part of the body.

(4) Play the movie over and over again until your distress is at a 1-2 out of 10.

(5) Relax your body and now add something a little more uncomfortable, imagine he demonstrates reluctance. See yourself responding to that reluctance effectively. Be mindful of what you are saying and his reaction.

(6) Notice where you feel the distress and how intense it is.  Lean into that part of the body.

(7) Play the movie over and over again until your distress is at a 1-2 out of 10.

(8) Relax your body. Now imagine him being more firm in his disagreement and then respond to that firm disagreement effectively, moderate and poised. Be mindful of what you are saying and his reaction.

(9) Notice where you feel the distress and how intense it is.  Lean into that part of the body.

(10) Play the movie over and over again until your distress is at a 1-2 out of 10.

(11) Relax your body. Now imagine him outright refusing your request and then respond by thanking him for his time while maintaining a posture of dignity and self-respect. Be mindful of what you are saying and his reaction.

(12) Notice where you feel the distress and how intense it is.  Lean into that part of the body.

(13) Play the movie over and over again until your distress is at a 0 out of 10.

(14) Step out of the exercise.

One objection to the skill or exercise is the judgment of “I should just be able to do this”.

My response to this is that there are professional athletes whose talents and ability surpass the majority of the world’s population and who make millions because of their skill.

They still show up to practice every day.

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