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Build a graded exposure hierarchy for Exposure and Response Prevention therapy. List anxiety-provoking situations, rate them, and plan structured exposures.
List situations related to your OCD that cause anxiety. Rate each with a SUDS score (Subjective Units of Distress, 0–100). Arrange from least to most distressing. Plan specific exposure tasks for each level, starting with lower SUDS items and progressing upward.
Introduce once the formulation is established and the rationale for ERP has been collaboratively agreed. Use to create a graded hierarchy of feared situations before beginning exposure work.
Present as a planning tool that puts the client in control of the pace of exposure. Emphasise that the hierarchy is a guide, not a rigid prescription, and can be revised as therapy progresses.
For clients with multiple OCD themes, build separate hierarchies for each theme and agree which to tackle first. For clients who struggle with SUDS ratings, use simpler anchors such as low-medium-high or a visual analogue scale.
Do not use if the client has not been adequately socialised to the rationale for ERP, as premature hierarchy-building can increase anxiety and dropout risk. Ensure comorbid depression is not so severe that the client lacks motivation to engage.
Include items spanning the full SUDS range (0-100) to ensure early successes and a clear progression. Collaboratively identify both the feared stimulus and the specific compulsion or avoidance to be resisted for each item.
Suitable for clients working with erp, exposure, ocd, hierarchy, response prevention, suds. This tool can be used as a standalone worksheet or as part of a structured homework plan.
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Log exposure and response prevention practice sessions with SUDS ratings, urge strength, and whether you resisted the compulsion.
Track OCD episodes — intrusions, appraisals, rituals, distress, and duration — to identify patterns and measure progress.
Challenge inflated responsibility beliefs that drive OCD by examining the appraisal and generating realistic alternatives.
Track covert / mental compulsions — mental reviewing, counting, praying, reassuring self — which are often missed because they're invisible.