Exposure Hierarchy

Exposure Hierarchy: The Fear Ladder

Cognitive Behavioural Therapy

Exposure therapy helps reduce fear and avoidance by approaching the situations, sensations, or memories that trigger anxiety — gradually and repeatedly, in a planned way. Over time, the trigger feels less powerful and you gain confidence in your ability to cope. This worksheet helps you build your personal fear ladder and plan your exposures step by step.

🧠 New Learning

Your brain learns that the feared outcome is less likely — or more manageable — than it predicted. Each exposure rewrites the threat message.

💪 Confidence Through Action

Each approach step shows you that you can cope, which reduces reliance on avoidance and safety habits that keep anxiety going.

🔍 Attention Shift

You begin to notice the full picture rather than only the threat cue — breaking the cycle of hypervigilance and anxiety.

🪜 Gradual Steps

Starting with easier situations and working up the ladder builds momentum — each step making the next one more manageable.

Types of Exposure

Exposure can take different forms depending on the nature of the fear. Your therapist will help you decide which type is most appropriate for your situation.

In Vivo

Interoceptive

Imaginal

Facing real life situations — for example driving on a motorway, using a lift, or entering a crowded shop.

Bringing on body sensations linked to panic — for example spinning to feel dizzy or running in place to raise heart rate.

Recalling a feared memory or image step by step — used when direct exposure is not possible or when working with trauma in a structured plan.

How Exposure Works

Follow these five steps each time you do an exposure. Over time, this process retrains your brain's threat response.

Define the Target

Name the feared cue or situation as clearly and specifically as you can. Vague targets make it hard to know when you have succeeded.

Predict

Write down the feared outcome and how intense you expect the anxiety to feel (using SUDS 0–100). This gives you something concrete to test against reality.

Approach on Purpose

Enter the situation and stay long enough for learning to occur. Leaving too quickly can reinforce the fear — aim to stay until anxiety reduces or levels off.

Drop Safety Behaviours

Reduce behaviours that hide real learning — such as constant reassurance seeking, distraction, or carrying safety objects. Your brain needs to experience coping without them.

Repeat and Review

Practise across different places and times until fear reduces and confidence grows. Record your SUDS before, during, and after each exposure to track progress.

💡 What to expect: Anxiety usually rises first, then levels or drops as you stay in the situation. The goal is learning, not forcing the feeling to disappear. You may feel uncomfortable — that is expected and normal. The discomfort is temporary; the learning is lasting.

My Exposure Hierarchy Worksheet

Complete This Section

Work through the worksheet in three parts: first build your fear ladder, then plan a specific exposure, then record what happened afterwards.

Part 1: My Fear Ladder

What I Am Working On

Briefly describe the situation or area you want to work on:

My Exposure Hierarchy

List situations that cause you anxiety, from easiest (Step 1) to most challenging (Step 10). Rate each one using the SUDS scale below.

90–100: Extreme — feel out of control 70–89: Very distressed, physical symptoms 50–69: Moderate to strong anxiety 30–49: Mild to moderate anxiety 0–29: Minimal — alert and calm

↑ Top of ladder — most challenging

Step	Situation — What is the anxiety-provoking situation?	SUDS (0–100) — How strong is the fear?
10
9
8
7
6
5
4
3
2
1

↓ Bottom of ladder — start here (easiest)

Part 2: Plan My Exposure

Step 1: Define the Target

Which specific step from your ladder will you attempt? Describe it clearly:

Step 2: My Prediction

What do you fear will happen? How anxious do you predict you will feel (SUDS 0–100)?

Step 4: Safety Behaviours I Will Drop

Safety behaviours give short-term relief but block learning. Aim to reduce or remove them during this exposure.

List the safety behaviours you will aim to drop:

Part 3: After My Exposure

Track My Anxiety (SUDS 0–100)

Rate your anxiety before, at the highest point during, and after the exposure.

Before

During (highest)

After

What Actually Happened?

Describe what happened during the exposure. Did your prediction come true?

What Did I Learn?

What does this experience teach you about your feared situation or your ability to cope?

🌿 Remember: The goal of exposure is not to eliminate anxiety — it is to learn that you can tolerate it and that your feared outcomes are less likely or less catastrophic than your anxiety predicts. Each step up the ladder, however small, is genuine progress.

The Fear Ladder