An essential part of exposure therapy
Exposure therapy can be very helpful for people suffering from obsessive-compulsive disorder (OCD). This type of therapy repeatedly involves exposing the patient to the things that reduce most fear to their anxiety . Exposure therapy takes a lot of courage and can take up a good portion of the time.
What is an exposure hierarchy?
An exposure hierarchy is a list used to guide your progress through exposure therapy.
It describes the main situations or sources of anxiety that cause your fear, arranged in order of how serious each fear is.
The SUDS Scale in an Exposure Hierarchy
Your therapist can use a scale that uses the Subjective Units of Distress Scale or SUDS scale to determine your anxiety, ranging from 0 (completely relaxed) to 100 (the worst anxiety you can imagine) when you experience the thing. what you fear.
For example, if you fear pollution , your exposure hierarchy might look like this:
- Put hand in toilet water (SUDS rating: 100)
- Touch toilet seat (SUDS rating: 95)
- Touch floor next to toilet (SUDS rating: 90)
- Handling of raw poultry or hamburger meat (SUDS rating 85)
- Touch wall in toilet (SUDS rating: 80)
- Touch bathroom door handle (SUDS rating: 75)
- Shaking hands with a stranger (SUDS rating: 65)
- Touch the bottom of your shoe (SUDS rating: 60)
- Press a button on a vending machine (SUDS rating: 55)
- Money management (SUDS rating: 50)
An exposure hierarchy is usually developed with the help of your therapist, as it can sometimes be difficult to decide in what order the items should take place.
Make your way through the exposure hierarchy
You usually start exposure exercises with items that have at least a SUDS score of 60, but it can sometimes be helpful to start with items that are ranked lower.
The point is to start with something that makes you anxious, but not so anxious that you can not get past it and gain some confidence to tackle the next fear. Once you have mastered an item in your hierarchy, you move on to a more difficult item. You continue this process until you reach your goals. This usually means, but not always, that you feel comfortable with the highest item on your hierarchy.
What happens during exposure
You and your therapist will find a fear in starting to use your exposure hierarchy. Let’s use the example above of the exposure above and start with number eight, as it has a SUDS score of 60. Your therapist will touch you on the bottom of your shoe and then not engage in any cleaning behavior for a certain amount of time, maybe several hours. You will feel anxiety because you resist the urge to enter your compulsive behavior, but repeatedly it will reduce your anxiety to the bottom of your shoe without cleaning your hands, and will not bother you at all. If this happens, you will move to the next item in your exposure hierarchy. In this example, the next item would be number seven, by the hand of a stranger.
To make progress in exposure therapy
When you go through exposure therapy, your therapist will probably do the same exposure exercise every day between sessions.
This is extremely important for your progress. It is also absolutely essential to go through everything your therapist recommends on your exposure hierarchy as the triggers that are not addressed can actually get worse and the triggers you worked to overcome come back to come back.
