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Avoidance Hierarchy

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.

Exercise

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Description

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).

Instructions

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

  • 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.