Lesson 17: Building a Fear Hierarchy

The previous lesson introduced graded exposure. This lesson focuses on the practical first step: building the ladder you’ll climb. A good fear hierarchy makes exposure work manageable. A poor one makes it feel impossible.

Module: 6, Putting it together

Learning objective

By the end of this lesson, you should be able to construct a fear hierarchy with appropriate steps, rate situations using SUDS, and identify a realistic starting point.

The concept: a roadmap for exposure

The fear hierarchy was introduced by Wolpe as part of systematic desensitization in the 1950s [1]. The idea is to list situations related to your fear, rate how much anxiety each causes, and arrange them from least to most threatening.

The SUDS scale

Each situation is rated on the Subjective Units of Distress Scale:

SUDS	Level
0	No anxiety at all
25	Mild discomfort, easily tolerable
50	Moderate anxiety, unpleasant but manageable
75	High anxiety, very uncomfortable
100	The worst anxiety you can imagine

These are subjective. Your 60 is not someone else’s 60. The ratings help you order your steps, not measure you against anyone else.

Building the hierarchy: step by step

Step 1: Brainstorm. Write down every situation related to your fear that you avoid or endure with significant anxiety. Don’t worry about order yet. Aim for 15–20 situations.

Step 2: Rate each one. Assign a SUDS score to each situation. Be specific: “Giving a talk” is too vague. “Giving a five-minute update to my team of six” is better.

Step 3: Order them. Arrange from lowest to highest SUDS.

Step 4: Fill gaps. If there’s a jump of more than 15 SUDS between steps, create an intermediate step. You want relatively even spacing.

Step 5: Trim. Aim for 8–15 steps. Cut duplicates or situations you’ll never realistically encounter.

What makes a good step

Each step should be:

• Specific. Not “social situations” but “ordering coffee at the busy café on High Street.”
• Repeatable. You need to be able to do it more than once to consolidate the learning.
• Within your control. You can set it up without relying on rare events.
• Linked to a prediction. What do you expect will happen? This connects to the expectancy violation principle from Lesson 16.

A worked example

The following is a fictional example used for teaching.

Hana avoids phone calls because she fears sounding awkward and being judged.

Her brainstorm and hierarchy:

Step	Situation	SUDS
1	Listening to a voicemail without replying	15
2	Calling an automated service (bank, booking line)	25
3	Calling a shop to check opening hours	35
4	Calling a friend she’s comfortable with, planned topic	40
5	Calling a friend, unplanned conversation	50
6	Calling a colleague about a work question	55
7	Calling someone she doesn’t know well to arrange something	65
8	Making a complaint by phone	70
9	Calling her manager about a problem	80
10	Making an unexpected phone call to someone senior	90

The steps are evenly spaced, specific, repeatable, and within her control. She starts at step 2 or 3 (moderate anxiety, around 25–35 SUDS).

Common mistakes

• Starting at the top. This is flooding, not graded exposure. It’s likely to overwhelm and reinforce avoidance.
• Steps too vague. “Go to a party” doesn’t specify whose party, how long to stay, or who’ll be there. Vague steps can’t be repeated consistently.
• Steps too far apart. A jump from SUDS 30 to SUDS 70 skips the middle territory where most of the useful learning happens.
• Only including the hardest situations. A hierarchy needs easy wins at the bottom to build momentum and confidence.

A common misunderstanding

“I should wait until I feel ready before moving up.” If you wait until you feel completely comfortable at each step, you may never move. The inhibitory learning model suggests that some anxiety during exposure is not just tolerable but useful — it’s what makes the learning stick [4]. Move up when the prediction at the current step has been violated a few times, not when all anxiety is gone.

Optional reflection

Pick a fear you’d like to work on. Brainstorm 10–15 situations related to it, rate each with a SUDS score, and arrange them in order. Check for gaps and fill them. You now have a working hierarchy.

When to get support. If you find it very hard to identify manageable lower steps, or if even the lowest step feels overwhelming, a therapist can help you grade the hierarchy and may suggest preparatory work before starting exposure. For complex anxiety conditions, therapist-guided hierarchy construction is recommended [3]. If you are in crisis, contact emergency services or a crisis line: in the UK and Ireland, Samaritans on 116 123; in the US, call or text 988.

Recap

• A fear hierarchy is a ranked list of feared situations from least to most anxiety-provoking.
• Situations are rated using SUDS (0–100) and arranged with even spacing.
• Good steps are specific, repeatable, within your control, and linked to a testable prediction.
• Start in the moderate range (SUDS 30–40), not at the top.
• Move up when the feared prediction has been violated, not when anxiety reaches zero.

Previous lesson: Lesson 16: Graded Exposure | Next lesson: Lesson 18: Anxiety and Perfectionism