Creating a graded list of situations, sensations, or emotions that the client avoids, ranked by expected distress.
Step-by-step guide
- Identify avoided situations, sensations, and emotional themes
- Rate each item from 0 to 10
- Separate safety behaviors from truly dangerous situations
- Arrange items from easier to harder
- Choose a starting point around moderate distress
- Define clear exposure tasks and success criteria
When to use
- Before modules 6-7 exposure work
- When avoidance is broad or unclear
Key phrases
What situations are you avoiding because of the emotion they bring up?
Follow-up questions
How intense would this be from 0 to 10?
Which safety behavior would make it too easy?
Which item is difficult but doable?
Alternative phrasings
The hierarchy is a training plan, not a test.
Warnings
- ⚠️ Do not start with the most intense item
- ⚠️ Distinguish emotional avoidance from realistic safety concerns
Source: Barlow et al. 2018
Materials are informational and educational and summarize publicly available scientific sources. They are not medical or psychological advice, are not intended for self-diagnosis or self-treatment, and do not replace consultation with a qualified professional.