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Exposure Tracking Log

Exposure therapy is an evidence-based protocol for helping clients face their fears in a gradual, methodical way.

Early in treatment, clients will create an exposure hierarchy, which is a list of scenarios they view as anxiety-provoking. Using the Subjective Units of Distress Scale (SUDS), they will rate these scenarios from 0 (no anxiety) to 100 (extreme anxiety) based on the level of anxiety they anticipate. Next, clients will gradually confront the situations on their hierarchy, either in session or as homework.

This is where the Exposure Tracking Log comes in. This tool allows clients to document their experience confronting their fears, and track progress over time. Clients will log the type of situation, safety behaviors to avoid, exercise length, and the SUDS rating throughout the exercise. As clients progress through treatment, they will observe their SUDS ratings falling, reinforcing their success. If there is a problem, this log will help you catch it.

Use this resource to support clients in their completion of exposure therapy homework. Review clients’ logs at the beginning of each session to track their progress and evaluate the need for any adjustments. Check that clients are continuing exposure exercises until their peak SUDS ratings reduce by half.

To learn more about creating an exposure hierarchy, pick up helpful tips, and download more tools, check out our clinician’s guide:

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1. Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. H. (2019). Exposure therapy for anxiety: Principles and practice (2nd ed.). Guilford Press.

2. Foa, E. B., Yadin, E., & Lichner, T. K. (2012). Exposure and response (ritual) prevention for obsessive-compulsive disorder: Therapist guide (2nd ed.). Oxford University Press.

3. Gillihan, S. J., Williams, M. T., Malcoun, E., Yadin, E., & Foa, E. B. (2012). Common pitfalls in exposure and response prevention (EX/RP) for OCD. Journal of Obsessive-Compulsive and Related Disorders, 1(4), 251–257.

4. Hembree, E. A., & Cahill, S. P. (2007). Obstacles to successful implementation of exposure therapy. In D. C. S. Richard & D. L. Lauterbach (Eds.), Handbook of exposure therapies, 389–408. Elsevier.

5. Hyman, B. M., & Pedrick, C. (2010). The OCD workbook: Your guide to breaking free from obsessive-compulsive disorder (3rd ed.). New Harbinger Publications.

6. Jordan, C., Reid, A. M., Guzick, A. G., Simmons, J., & Sulkowski, M. L. (2017, January 1). When exposures go right: Effective exposure-based treatment for obsessive–compulsive disorder. Journal of Contemporary Psychotherapy, 47(1),31–39.

7. Steketee, G. S. (1993). Treatment of obsessive compulsive disorder. Guilford Press.

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