Building a Graded Exposure Hierarchy for a Specific Fear

A client is willing to confront a fear but needs a structured.

Your client sees how avoidance perpetuates their fear and is motivated to make a change. The problem is a practical one: the distance between their current comfort zone and facing the trigger feels immense and unnavigable. They need a concrete plan that breaks the challenge down into tolerable pieces, preventing the shutdown that comes from feeling overwhelmed before the work can even begin.

This directive helps translate that willingness into a tangible sequence of actions. It systematically organizes feared situations into a progressive, personalized ladder tailored to the client’s specific reactions. The client walks away with a clear, predictable series of steps, moving the work from abstract intention to a concrete, manageable process.


Building a Graded Exposure Hierarchy for a Specific Fear

State the specific fear you will work on.


List all situations, activities, or triggers related to this fear that you avoid or that cause distress. Write down at least 15 items, ranging from minor to severe. Do not edit your list as you write.

Next, rate the level of fear for each item on your list. Use a scale from 0 to 100, where 0 is no fear and 100 is extreme fear.

Situation, Activity, or TriggerFear Rating (0-100)

Review your list. Select 10 to 15 items that represent a gradual increase in difficulty. Transfer them to the table below, ordering them from the lowest fear rating to the highest. This is your hierarchy.

StepSituationFear Rating (0-100)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Generated with Rapport7 — rapport7.com

Print it. Hand it over. See what changes.

Every directive in the library is printable — branded with your clinic name and logo, ready to go home with the client at the end of the session.

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