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Behavioral Activation & Exposure Lesson 5 of 10
Organize situations connected to one fear from lower to higher distress. Use the hierarchy to plan appropriate practice and record what you learn from each attempt.
Goal: Draft one hierarchy and agree on a manageable practice plan.
Key metric: SUDS = Subjective Units of Distress, 0 = no distress, 100 = max.
Stick to one theme per worksheet (e.g., crowds, driving, germs).
Example: “Talking to unfamiliar people.”
Narrow focus = clearer steps.
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.
Quickly rate each scenario 0–100 imagining doing it now.
Hi (30), Party (65), Presentation (90).
These are personal estimates, not a diagnosis or a pass/fail score.
Reorder the list from lowest to highest SUDS.
30 → 45 → 55 → … → 90.
If tied, go with whichever feels safer first.
Choose an easier item that fits your agreed practice plan.
Example: “Say hi to classmate.”
Start low to build confidence.
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.
Log your pre-SUDS, do the exposure, then record post-SUDS.
Example: Pre 30 → Post 10.
Follow the gradual practice plan agreed with your therapist; a fixed time or distress reduction is not a requirement for success.
Review what happened and decide whether to repeat, make the step smaller or progress, following the plan agreed with your therapist.
Example: Repeat a brief greeting before planning a longer conversation.
There is no universal distress score or number of attempts required to move on.
Review the steps you attempted, what you learned and what needs adjusting.
Example: “I tried greeting a colleague; next time I want to practice asking one question.”
Seeing progress reinforces the habit.
0/10 lessons completed
Next up: Imaginal Exposure
In earlier lessons, you practiced getting unstuck with tools like the Activity Schedule, the Five-Minute Starter, and Graded Task Assignment. These strategies help you move forward when tasks feel overwhelming or motivation is low. Now it’s time to apply a similar step-by-step method to situations that trigger fear or avoidance.
An exposure hierarchy is a list of feared or avoided situations arranged from easier to harder. It can help organize gradual practice instead of treating every situation as one large challenge. The worksheet records the situation, an estimated distress rating and what happened when you practiced.
The examples below illustrate how to organize a list; they are not a treatment schedule. Choose situations that are safe in reality. If you are working with a therapist, agree on the starting step, support and pace together.
Does my distress have to fall by a fixed amount?
This worksheet does not require a particular percentage drop. Record what happened and review it against your individual practice plan with your therapist.
Can I skip to a harder step?
Use the pace agreed in your plan. If a jump feels too large, add an intermediate step rather than treating the original list as fixed.
What about distractions or reassurance?
Note what you rely on during practice and discuss its role with your therapist. This worksheet does not prescribe removing every form of support.
What if the step is more difficult than expected?
Record that information and review the step and support with your therapist before deciding what to practice next. Do not use the hierarchy to enter genuinely unsafe situations.
This lesson is an educational practice resource, not a substitute for professional assessment, diagnosis, or treatment. Discuss behavioral health questions or concerns with a qualified healthcare professional.
These resources explain the background approach. They do not validate this worksheet as a standalone treatment or its suggested practice schedule.
Pencil in one mastery & one pleasure task per day.
Make a manageable start on a task by trying it for five minutes, then deciding what to do next.
Score each activity 0-10 to find mood boosters.
Break big chores into 10-min bites; tick off live.
Organize feared or avoided situations from easier to harder to help plan gradual practice.
Visualize success on Step 1 of hierarchy.
Do the behavioral opposite of an avoidance urge.
Break a goal into small, observable steps and acknowledge progress as you practice.
Link each completed task to a small incentive.
Rehearse (thought + action) for a known trigger tomorrow.
Exposure Hierarchy
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