Avoidance Hierarchy (Archived)
NOTE: An improved version of this resource is available here: Fear Ladder. Older versions of a resource may be archived in the event that they are available in multiple languages, or where data indicates that the resource continues to be frequently used by clinicians.
The Avoidance Hierarchy exercise has been archived and will remain available while translated versions of the Fear Ladder are collated. Avoidance and safety-seeking behavior serves to maintain anxiety, and exposure to the fear stimuli/situation is an effective treatment for anxiety. This Avoidance Hierarchy CBT worksheet helps clients to plan exposure tasks.
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Introduction & Theoretical Background
Avoidance Hierarchy is a CBT worksheet introducing a fear hierarchy or an avoidance hierarchy. Using this worksheet the client can be guided into developing a hierarchy of feared situations ranging from most-feared at the top to least-feared at the bottom. The client is encouraged to give anticipated fear, anxiety, or distress ratings for each item – according to how distressing they feel it would be to encounter that situation. The order of items can be changed to reflect these anticipated fear ratings until a final hierarchy has been constructed. Once completed the avoidance hierarchy can be used to guide a process of graded exposure. Clients can be guided to start by exposing themselves to the least-feared items, building up as more confidence is gained. Key principles of exposure should be discussed (e.g. stay in situation without escaping, attempt multiple repeats of each exposure to encourage extinction).
Therapist Guidance
Using this worksheet the client can be guided into developing a hierarchy of feared situations ranging from most-feared at the top to least-feared at the bottom. The client is encouraged to give anticipated fear, anxiety, or distress ratings for each item – according to how distressing they feel it would be to encounter that situation. The order of items can be changed to reflect these anticipated fear ratings until a final hierarchy has been constructed. Once completed the avoidance hierarchy can be used to guide a process of graded exposure. Clients can be guided to start by exposing themselves to the least-feared items, building up as more confidence is gained. Key principles of exposure should be discussed (e.g. stay in situation without escaping, attempt multiple repeats of each exposure to encourage extinction).
References And Further Reading
- Kircanski, K., Mortazavi, A., Castriotta, N. et al. (2012). Challenges to the traditional fear hierarchy in exposure therapy. Journal of Behavior Therapy and Experimental Psychiatry, 43, 745–751.