ERP Hierarchy Builder
Build a graded exposure hierarchy for Exposure and Response Prevention therapy. List anxiety-provoking situations, rate them, and plan structured exposures.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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ERP Hierarchy Builder
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Worksheet calculation, not a validated clinical score.
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When to use the ERP Hierarchy Builder
The ERP Hierarchy Builder is an interactive cognitive behavioural therapy (CBT) worksheet, most often used in CBT for obsessive-compulsive disorder (OCD).
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 25 minutes. It is a single focused exercise; preview the full worksheet above to see exactly what it includes.
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 ERP Hierarchy Builder 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:
- Salkovskis, P.M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23(5), 571-583. doi:10.1016/0005-7967(85)90105-6
- 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
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