A PE technique for approaching safe real-life trauma reminders step by step, using a hierarchy and SUDS ratings to reverse avoidance.
Step-by-step guide
- Define the immediate clinical target and confirm safety.
- Explain the rationale in simple, concrete language.
- Choose a manageable first step and set a clear frame.
- Track distress, avoidance, body signals, or caregiver response as relevant.
- Process what changed and decide the next step.
When to use
- PTSD with avoidance of safe reminders
- Preparation or review of exposure homework
- When SUDS data or avoidance patterns need to guide treatment
Key phrases
Let's work with in vivo avoidance hierarchy construction in a structured way: what are we approaching, what do you expect will happen, and what do you notice as you stay with it?
Follow-up questions
What did you notice while staying with it?
What was different from what you expected?
Alternative phrasings
Let's slow this down and make it specific.
What is the smallest safe next step?
Warnings
- ⚠️ Do not use exposure when the situation is actually unsafe.
- ⚠️ Do not use reassurance or safety behaviors to neutralize exposure.
- ⚠️ Stabilize active crisis, current danger, or severe dissociation before proceeding.
Source: Foa, Hembree, Rothbaum & Rauch (2019), Prolonged Exposure Therapy for PTSD
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.