Exposure and response prevention
Exposure menu for choosing what to practise next
A running list of the situations that set the problem off and what you do about each one, kept so that you can pick the next exposure from it rather than climb it rung by rung.
A4, free, no sign-up. The PDF is tagged for screen readers.
A menu rather than a ladder
Exposure, which means facing a feared situation on purpose, is often planned as a ladder
climbed from easiest to hardest. This sheet keeps the list and drops the strict order,
because moving between easier and harder items, and changing where and when you do them,
gives the learning a better chance of holding up where the anxiety actually turns up. The
sheet is for adults and teenagers with OCD, a phobia, health anxiety or panic, and it is
useful from the start of treatment, changing as items are tried, rated again and added.
What two rows might look like
These made-up rows are for someone with harm-related OCD whose unwanted thoughts are about
hurting their daughter.
Example rows | Situation | What I usually do about it | Hard |
|---|
| Chopping vegetables with my daughter in the kitchen | Put the knife away the moment I finish, check the drawer is shut, ask my husband whether I seemed normal | 70 |
| Watching a crime drama on my own | Switch it off, then go back over the scene to check I felt nothing | 55 |
The middle column matters as much as the first. Some of what goes there happens silently,
such as checking a feeling or replaying a scene, and if only the obvious compulsion is
written down, the exposure gets planned with the quieter ones still running. The person then
misses the chance to learn that they can handle the anxiety and the doubt without any of
them.
Common mistakes
The first is keeping the list short and safe, when the situations that seem out of reach
show where the work is heading. The second is using the rating as a gate, where nothing
above 40 is allowed until everything below it is easy, which brings back the ladder by
another route. I would rather you pick a 60 on a good day and a 30 on a bad one than wait
for each number to reach zero.
The research on varying the order is less settled than the research on exposure overall,
and much of it comes from small studies, several in specific phobias, so variety is a
sensible default rather than a rule.