Anxiety Hierarchies and Exposure Therapy

Anxiety often involves a range of situations that trigger fear and avoidance, ranging from mild discomfort to debilitating panic. Exposure therapy, a powerful tool in Cognitive Behavioral Therapy (CBT), helps individuals gradually confront these feared situations and overcome anxiety. But how do we know where to start? This is where anxiety hierarchies come in.

What are Anxiety Hierarchies?

An anxiety hierarchy is a personalized list of anxiety-provoking situations ranked in order of their intensity, from least to most feared. This tool serves as a roadmap for exposure therapy, guiding individuals through a gradual process of confronting their fears.

How are Anxiety Hierarchies Developed?

Creating an anxiety hierarchy involves:

  • Identifying feared situations: Collaboratively, therapist and client identify situations that trigger anxiety, ranging from specific triggers to broader categories.
  • Assigning Subjective Units of Distress (SUDS): Each situation is assigned a SUDS rating between 0 (no anxiety) and 100 (highest imaginable anxiety).
  • Ranking: Based on SUDS ratings, situations are ranked from least to most anxiety-provoking, forming the anxiety hierarchy.

The Power of Anxiety Hierarchies:

Anxiety hierarchies help people with cognitive distortions and automatic thoughts by letting them face their fears in a step-by-step, manageable way. Here’s how it works:
  1. Starting Small: People make a list of things that scare them, starting from the least scary to the most scary.
  2. Testing Fears: By facing these fears one at a time, starting with the easiest, people get to test whether their anxious thoughts and beliefs are true. For example, someone afraid of talking to new people might start by just saying hi to a neighbor.
  3. Building Confidence: Each time they face a fear and see that their anxious thoughts were maybe exaggerated, they feel more confident.
  4. Reducing Avoidance: This approach helps people stop avoiding things they are scared of. They learn that the scary things are often not as bad as they thought.
  5. Learning Coping Skills: While moving up their fear list, people also learn ways to calm themselves, like deep breathing, which helps them handle their fears better.
Anxiety hierarchies help people slowly face their fears and learn that their automatic thoughts or worries are often not as accurate as they thought, reducing their overall anxiety.

An Example of an Anxiety Hierarchy:

Situation SUDS Rating
Speaking in front of a small group (5 people) 40
Giving a presentation in a classroom setting 60
Participating in a public debate 85
Delivering a speech at a conference 95

This hierarchy allows the individual to start with less anxiety-provoking situations and gradually work their way up to the most challenging ones, building confidence and resilience along the way.

Getting Started with Anxiety Hierarchies:

  • Seek professional guidance: A therapist, like Longmont therapist David Ejchorszt, can help you develop a personalized anxiety hierarchy and guide you through the process of exposure therapy.
  • Be patient and compassionate: Facing your fears takes time and effort. Be kind to yourself and celebrate your progress, even small steps forward.
  • Remember: Anxiety hierarchies are not static. As you progress through exposure therapy, your hierarchy may need to be adjusted and updated.

By building a ladder of courage through anxiety hierarchies with your anxiety therapist, you can have a partner to help you out of anxiety and experience lasting change in your life.

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