A therapist treating a woman with a dog phobia first trains her in progressive muscle relaxation, then constructs a graded list of feared situations from looking at photographs of dogs to petting a calm dog, and pairs relaxation with each step in ascending order. This technique works primarily through which mechanism?

• A Cognitive restructuring of irrational beliefs
• B Operant conditioning with negative reinforcement
• C Reciprocal inhibition ✓
• D Massed exposure until habituation fails, extinguishing avoidance

Explanation

Systematic desensitization, developed by Joseph Wolpe, rests on reciprocal inhibition: anxiety cannot coexist with deep muscle relaxation, so pairing relaxation with progressively stronger fear cues gradually weakens the anxiety response. Option D describes flooding, which uses immediate intense exposure without relaxation or a hierarchy. Option B describes contingency-based operant methods, and option A describes the cognitive component of CBT, neither of which defines this technique. Recognizing the relaxation-plus-hierarchy structure identifies the method and its mechanism.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.

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Written and medically reviewed by the StethoPrep medical team.