BA5: Exposure Hierarchy
Virtual Coach
Work step-by-step through the Behavioral Activation & Exposure exercise with the virtual coach.
Introduction
Avoidance keeps anxiety (and some forms of depression) locked in place. Exposure hierarchies flip that pattern by listing feared or avoided situations, ranking them by the distress they spark, and then tackling them gradually from easiest to hardest. Dozens of clinical trials show that a step-wise approach (also called graduated exposure) drops fear faster and with fewer drop-outs than jumping straight to the scariest step.
Instructions
Goal: Build one hierarchy and complete at least two exposures per week for the next month.
Key metric: SUDS = Subjective Units of Distress, 0 = no distress, 100 = max.
Step 1: Define the Fear Family
Stick to one theme per worksheet (e.g., crowds, driving, germs).
Example: “Talking to unfamiliar people.”
Narrow focus = clearer steps.
Step 2: Brain-Dump Situations
List 10–15 anxiety-provoking or avoided scenarios.
Example: “Say hi to classmate,” “Attend office party,” “Give work presentation.”
Don’t censor—range helps build a strong ladder.
Step 3: Estimate SUDS
Quickly rate each scenario 0–100 imagining doing it now.
Hi (30), Party (65), Presentation (90).
Use your first instinct—it’s usually most accurate.
Step 4: Sort Easiest → Hardest
Reorder the list from lowest to highest SUDS.
30 → 45 → 55 → … → 90.
If tied, go with whichever feels safer first.
Step 5: Pick Start Point
Choose a starting item rated ≤ 40 SUDS.
Example: “Say hi to classmate.”
Start low to build confidence.
Step 6: Plan the Exposure
Answer: What will you do, where, when, and for how long?
Example: “Tomorrow 9 a.m. hallway, 3 min conversation.”
Calendar it—specifics beat intentions.
Step 7: Run & Record
Log your pre-SUDS, do the exposure, then record post-SUDS.
Example: Pre 30 → Post 10.
Stay in until distress drops ≥ 50% or 30 minutes pass.
Step 8: Repeat / Step Up
Repeat the same item until two sessions end ≤ 20 SUDS, then move to the next.
Three successful sessions? Advance to next rung (e.g., 45-SUDS task).
Slow is smooth, smooth is fast.
Step 9: Review Weekly
Graph average SUDS drop and mark completed rungs.
Example: 3 rungs cleared; anxiety down 20%.
Seeing progress reinforces the habit.
FAQs
What if my distress never drops 50 %?
Stay until the highest plateau ends (max 60 min), or repeat the exposure next day. Habituation can be slower for certain fears—consistency wins.
Can I skip to a harder rung if I feel brave?
Yes, but only if the jump is ≤ 15 SUDS above your current mastered level. Overshooting too far risks reinforcing avoidance.
Isn’t distraction (music, phone) okay during exposure?
No—those are safety behaviors. They blunt learning. Drop or delay them as much as possible.
What if distress spikes higher than predicted?
Pause, rate the spike, stay put, use Five-Senses Grounding (SM8) to ride it out, then re-rate. Post-exposure drops are what matter.
Disclaimer
If you have any behavioral health questions or concerns, please talk to your healthcare or mental health care provider. This article is supported by peer-reviewed research and information drawn from behavioral health societies and governmental agencies. However, it is not a substitute for professional behavioral health advice, diagnosis, or treatment.
