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General CBT Skills~20 min

Graded Exposure Hierarchy

Build a hierarchy of feared situations ranked by anxiety level, from least to most challenging, to guide graded exposure work.

Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed

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List situations you avoid or find anxiety-provoking, and rate how anxious each one makes you: distress 0–100 (SUDS). The list will automatically sort from most to least anxiety-provoking, creating a visual ladder. Start exposure work from the bottom of the ladder and work your way up as confidence builds.

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What Are You Working On?

Exposure Hierarchy

Step 1
Step 2
Step 3
Step 4
Step 5
Total steps in hierarchy0 items

Worksheet calculation, not a validated clinical score.

Coping Strategies

Strategies to use during exposures (not safety behaviours)

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When to use the Graded Exposure Hierarchy

The Graded Exposure Hierarchy is an interactive cognitive behavioural therapy (CBT) worksheet. As a core CBT skill it is used right across the model, with presentations including depression, anxiety, OCD, trauma and low self-esteem, rather than being tied to a single diagnosis.

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 20 minutes. It moves through three short steps:

  1. What Are You Working On?
  2. Exposure Hierarchy
  3. Coping Strategies

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 Graded 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:

  • Wells, A. (1997). Cognitive Therapy of Anxiety Disorders. Chichester: Wiley.
  • Ost, L.G. (1987). Applied relaxation: Description of a coping technique. Behaviour Research and Therapy, 25(5), 397-409. doi:10.1016/0005-7967(87)90017-9

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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