what is an exposure hierarchy

In exposure therapy, an exposure hierarchy is developed to help clients confront their feared objects and situations in a manner that is systematic and controlled for the purpose of systematic desensitization. Exposure hierarchies are included in the treatment of a wide range of anxiety disorders.

An exposure hierarchy itself is a list of objects and situations that an individual fears or avoids that are graded or rank-ordered in their ability to elicit anxiety. The least anxiety-provoking situations are ordered at the bottom of the hierarchy while the most anxiety-provoking situations are at the top. Exposure hierarchies typically consist of 10-15 items and will guide the client’s exposure practices

When exposure to an item at the bottom of the hierarchy leads to moderately reduced distress or increased tolerance, a client progresses up the hierarchy to more and more difficult exposures. An exposure hierarchy can also be used as an assessment tool of the client’s progress and their increasing ability to habituate to fearful situations further up in their hierarchy