The exposure hierarchy is one of the most effective tools in CBT for anxiety. Below is an interactive version — build the fear ladder collaboratively, then share it with your client to track progress between sessions.
A graded exposure hierarchy — sometimes called a fear ladder or anxiety hierarchy — is a structured list of feared situations ranked by how much anxiety they provoke. Each situation is rated using Subjective Units of Distress (SUDS) from 0 to 100. The client works up the ladder gradually, starting with situations that cause mild anxiety and progressing toward their target fear.
Exposure is the most evidence-based intervention for anxiety disorders. NICE recommends it for specific phobias, social anxiety, agoraphobia, OCD (as Exposure and Response Prevention), and PTSD. The hierarchy gives the work structure and pace — clients know what comes next and can see their progress.
A paper hierarchy sits in a folder between sessions. A digital one lives on your client's phone — they can review their ladder, mark steps as completed, and see how far they've come. You review their progress before each session, so you spend clinical time on the exposure work rather than updating a list.
Build a hierarchy of feared situations ranked by anxiety level, from least to most challenging, to guide graded exposure work.
This is a worksheet calculation, not a validated clinical score.
Sign up free and send your client a link. They track their exposure progress on any device — you review it before the next session.
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