Exposure hierarchy builder
List feared situations, rate the distress you predict each would cause, and reorder them into a ladder. Kept privately in your browser.
This tool is not a substitute for care. It does not provide therapy, diagnosis, or emergency support. If you are in crisis or at risk of harm, contact the Samaritans of Singapore (SOS) 24-hour hotline on 1767 or call 995 (ambulance) / 999 (police). Outside Singapore, contact your local emergency service. More support options
Planning a specific exposure with your therapist? Use the Exposure form.
Exposure hierarchy
ICP Asia · icp-asia.com · Printed 14 Oct 2026
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For personal reflection, ideally alongside a therapist trained in exposure work. Not a substitute for clinical care.
This worksheet is for personal reflection and, ideally, for use alongside a therapist trained in exposure work. It is not a substitute for clinical care. Nothing you type is uploaded - your entries live in this browser only unless you choose to email a copy. See ourpsychotherapy service.
What is an exposure hierarchy?
An exposure hierarchy - often called a fear ladder - is an ordered list of the situations a person avoids because of anxiety, OCD, phobia or trauma-related fear. Each item is rated for the distress it is expected to cause, then worked through from the more manageable steps upward. It is the planning stage of exposure and response prevention (ERP), the best-evidenced psychological treatment for OCD and anxiety disorders.
What SUDS means
SUDS stands for Subjective Units of Distress, a 0–100 self-rating where 0 is completely calm and 100 is the most distress imaginable. It is deliberately subjective: the number only has to be meaningful relative to your own other ratings. In this worksheet SUDS is recorded in steps of 5, which is precise enough to order a ladder without inviting over-analysis.
How to build a fear ladder, step by step
- List what triggers your fear. Tap “Add situation” for each one. Include:
- things you avoid
- things you do but only with a ritual or safety behaviour afterwards
- thoughts, images or doubts you try to push away
Write each as something specific and doable, including the ritual you'll hold back. For example, “Touch the door handle in the clinic waiting room and don't wash for 30 minutes” rather than “germs”.
- Rate predicted distress. Use the slider to give each situation a SUDS score from 0 to 100 for how anxious you expect to feel.
- Order the ladder. Tap “Sort by SUDS” so it runs from easiest to hardest, then drag items to fine-tune the order.
- Choose your starting step. Begin with something challenging but achievable rather than the hardest item.
- Plan each exposure with your therapist. Before doing a step, your therapist may use the Exposure form to note what you predict will happen and which safety behaviours to drop.
Common mistakes
- Items written too vaguely to actually carry out.
- Starting at the top of the ladder, then abandoning exposure altogether.
- Completing the exposure while keeping a safety behaviour, which prevents the new learning.
- Seeking reassurance about whether you did it “correctly” afterwards.
- Judging success by whether anxiety dropped, rather than by what was learned.
Who this worksheet is for
Anyone can use it to organise their thinking, and clinicians are welcome to use it with clients in session. It works best alongside a therapist trained in ERP, who can help judge which steps to take and when. Nothing you type leaves your browser unless you email yourself a copy.