Question 1

How do I build an exposure hierarchy for anxiety?

Accepted Answer

List situations the patient avoids, rate each on a 0–100 SUDS (Subjective Units of Distress) scale, then arrange them from least to most distressing. A good hierarchy has 8–15 items with small, roughly even jumps in difficulty so the patient can progress gradually without large gaps that stall momentum.

Question 2

How do I handle safety behaviors during exposure?

Accepted Answer

Safety behaviors — such as carrying medication "just in case," avoiding eye contact, or mentally rehearsing escape routes — reduce short-term anxiety but prevent the patient from learning that the feared outcome does not occur. Identify them collaboratively before the exposure, then work toward dropping them progressively as the patient moves up the hierarchy.

Question 3

How does this tool help you build exposure hierarchies?

Accepted Answer

Enter the patient's feared situation and the tool generates a graded hierarchy of exposure steps rated by difficulty. You can reorder, edit, or add items, then export the finished hierarchy as a worksheet the patient can use between sessions.

Exposure Hierarchy Builder

What you can do with it