Exposure hierarchy

Exposure hierarchies are included in the treatment of a wide range of anxiety disorders.

An exposure hierarchy itself is a list of objects and situations that an individual fears or avoids that are graded or rank-ordered in their ability to elicit anxiety.

[4] Second, the therapist and client work collaboratively to develop an individually tailored list of feared situations that center on the identified target area (e.g. social anxiety).

The items are then ordered on the hierarchy from lowest to highest SUDS ratings (see Image 1).

In general, the most effective hierarchies are ones in which the items are specific to the client and that most closely resembles their experience of fear in the real world, particularly ones that elicit the same cognitions and physiological reactions.

[6] In some cases, other individuals should be involved in the exposure to mimic the experience of fear more closely (e.g. a client with social anxiety giving a presentation to her group of peers).

It is generally recommended that clients continue the exposure long enough to initiate their typical fear response, and adjusting the duration is one strategy for generating moderate anxiety rather than arousal that is too low or too high.