Exposure hierarchy worksheet: build your ladder step by step

What an exposure hierarchy is

Anxiety tends to shrink your world. When something feels threatening, avoiding it brings quick relief, and that relief teaches you to avoid it again next time. Over months, the list of places, people and activities you steer around can quietly grow.

An exposure hierarchy turns that list into a plan. You write down the situations you avoid, rate how anxious each one would make you, and arrange them from easiest to hardest. Then you practise them in order, starting low, so each step is challenging but doable.

How to build yours in five steps

Set aside 20 minutes and work through these steps on paper or in the worksheet below.

• Name the fear you want to work on in one sentence, for example "I avoid driving on busy roads."
• Brainstorm 10 to 15 situations linked to it, from mildly uncomfortable to very hard. Vary them by place, time, length and who is with you.
• Rate each one from 0 to 100 for how anxious you'd expect to feel doing it without your usual safety behaviors.
• Put them in order from lowest to highest rating, and fill any big gaps with in-between steps.
• Pick a first step rated around 30 to 40 and decide when you'll practise it.

Rating anxiety on a 0–100 scale

The 0–100 scale is sometimes called SUDS, short for subjective units of distress. 0 means completely calm, 50 means clearly anxious but able to carry on, and 100 is the most anxious you can imagine being.

Your ratings are guesses, and that's fine. They help you put the steps in order and notice change later. Re-rate a step after you've practised it a few times; the number often looks different once you've done it.

Example: a hierarchy for fear of driving

Here is how one person's ladder for driving anxiety might look. Yours will be different, so use it for shape, not content.

• Sit in the parked car with the engine running for five minutes (20)
• Drive around an empty parking lot (30)
• Drive two quiet residential streets with a passenger (40)
• Drive the same streets alone (50)
• Drive to a local store at a quiet time (55)
• Drive on a main road for ten minutes (65)
• Drive on a main road at rush hour (75)
• Drive a short stretch of highway with a passenger (85)
• Drive a short stretch of highway alone (95)

How to practise each step

Stay in the situation long enough to learn something new: often until the anxiety starts to settle, or until you've seen that what you feared didn't happen. Leaving at the peak of anxiety can teach your brain that escaping was what kept you safe.

Repeat a step several times, ideally close together, before moving up. Notice the safety behaviors you lean on, such as checking, distracting yourself or bringing someone along, and drop them gradually, because they can stop you learning that you can cope.

Common snags and how to handle them

Progress rarely goes in a straight line. These are the snags people hit most often.

• The first step feels impossible: break it into smaller pieces or shorten the time.
• Your anxiety doesn't drop during practice: that's common. Ask what you learned about your prediction instead.
• You skipped a planned practice: reschedule it for the next day rather than waiting to feel ready.
• A step goes badly: repeat the step below it a few times, then try again.

Free printable worksheet

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