Hierarchy

Feared/avoided cue, predicted threat, safety behaviors, SUDS rating, and approach step.

Inhibitory learning goal, duration/repetition, response prevention, debrief, and next exposure.

Variant: adult
Item Responses

Not Provided/21 Score

Feeling Nervous, Anxious, or on Edge

0123

Unanswered

Not Being Able to Stop or Control Worrying

0123

Unanswered

Worrying Too Much About Different Things

0123

Unanswered

Trouble Relaxing

0123

Unanswered

Being So Restless That It Is Hard to Sit Still

0123

Unanswered

Becoming Easily Annoyed or Irritable

0123

Unanswered

Feeling Afraid as if Something Awful Might Happen

0123

Unanswered

Variant: adult
Item Responses

Not Provided/80 Score

Repeated, Disturbing, and Unwanted Memories of the Stressful Experience

01234

Unanswered

Repeated, Disturbing Dreams of the Stressful Experience

01234

Unanswered

Suddenly Feeling or Acting as if the Stressful Experience Were Happening Again

01234

Unanswered

Feeling Very Upset When Something Reminded You of the Stressful Experience

01234

Unanswered

Strong Physical Reactions When Something Reminded You of the Experience

01234

Unanswered

Avoiding Memories, Thoughts, or Feelings Related to the Stressful Experience

01234

Unanswered

Avoiding External Reminders of the Stressful Experience

01234

Unanswered

Trouble Remembering Important Parts of the Stressful Experience

01234

Unanswered

Strong Negative Beliefs About Yourself, Others, or the World

01234

Unanswered

Blaming Yourself or Someone Else for the Stressful Experience

01234

Unanswered

Strong Negative Feelings (Fear, Horror, Anger, Guilt, Shame)

01234

Unanswered

Loss of Interest in Activities You Used to Enjoy

01234

Unanswered

Feeling Distant or Cut Off From Other People

01234

Unanswered

Trouble Experiencing Positive Feelings

01234

Unanswered

Irritable Behavior, Angry Outbursts, or Acting Aggressively

01234

Unanswered

Taking Too Many Risks or Doing Things That Could Cause Harm

01234

Unanswered

Being Super-Alert or Watchful or on Guard

01234

Unanswered

Feeling Jumpy or Easily Startled

01234

Unanswered

Difficulty Concentrating

01234

Unanswered

Trouble Falling or Staying Asleep

01234

Unanswered

Exposure Hierarchy Grid

Rank	Situation	Predicted SUDS	Actual SUDS	Response prevention / notes
1
2
3
4
5
6
7
8
9

Predicted outcome:

Actual outcome:

ERP homework:

Plan and Follow-Up

Focus	Documentation
Target	Name the target situation, belief, behavior, value, skill deficit, or exposure item addressed. Target: Baseline rating / context: Patient goal:
Work completed	Record intervention steps, patient response, learning, barriers, and safety considerations. In-session work: Response / learning: Barriers / safety:
Practice plan	Specify homework, frequency, supports, measurement, and next session focus. Home practice: Measurement / review: Next focus:

Focus

Documentation

Target

Name the target situation, belief, behavior, value, skill deficit, or exposure item addressed.

Target:

Baseline rating / context:

Patient goal:

Work completed

Record intervention steps, patient response, learning, barriers, and safety considerations.

In-session work:

Response / learning:

Barriers / safety:

Practice plan

Specify homework, frequency, supports, measurement, and next session focus.

Home practice:

Measurement / review:

Next focus:

Hierarchy

GAD-7

Details

Responses

PCL-5

Details

Responses

Exposure Hierarchy Grid

Plan and Follow-Up

Counseling - Exposure Hierarchy Template

Preview