Exposure Hierarchy

Exposure or fear hierarchies are a CBT tool for the treatment of avoidance-oriented anxiety in a wide range of disorders such as obsessive-compulsive disorder, panic disorder, social anxiety disorder, and specific phobias. Use the Exposure Hierarchy worksheet during exposure therapy to introduce your clients to feared stimuli in a gradual, stepwise fashion.

In collaboration with your clients, begin by creating a list of anxiety-producing situations and rate the severity of anxiety they would provoke if confronted. Typically, a Subjective Units of Distress Scale (SUDS) from 0-100 is used, with 0 equating to no anxiety and 100 equating to the worst-possible anxiety.

You will support your clients as they slowly face these situations, beginning with the least anxiety-producing scenario and ending with the most anxiety-producing scenario. In addition to in-vivo exposures, imaginal exposures can be included when real-life confrontation would be difficult or unadvisable.

It is important to identify clients’ safety behaviors and instruct them on how to eliminate these during the exposure exercises.

To learn more about the correct use of an exposure hierarchy, check out our treatment guide: