BDD Exposure Hierarchy
Build a hierarchy of appearance-related situations you avoid, ranked by distress, to guide graded exposure.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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BDD Exposure Hierarchy
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BDD Exposure Hierarchy
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When to use the BDD Exposure Hierarchy
The BDD Exposure Hierarchy is an interactive cognitive behavioural therapy (CBT) worksheet, most often used in CBT for body dysmorphic disorder (BDD).
It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device — or download it as a print-ready PDF.
How it works
Most people work through it in around 15 minutes. It centres on one focused exercise:
- BDD Exposure Hierarchy
Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.
The CBT approach behind it
In common with other CBT methods, the BDD Exposure Hierarchy works by gradually and safely facing avoided situations so anxiety can subside (exposure). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going — and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Veale, D. & Neziroglu, F. (2010). Body Dysmorphic Disorder: A Treatment Manual. Chichester: Wiley.
- Wells, A. (1997). Cognitive Therapy of Anxiety Disorders. Chichester: Wiley.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- Samaritans: 116 123 — free, day or night, 365 days a year
- SANEline: 0800 689 5555 — 4:30pm–10:30pm, every day
More Body Dysmorphic Disorder (BDD) worksheets
View all Body Dysmorphic Disorder (BDD) worksheets →Body Dysmorphic Disorder (BDD)
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