For clinician-guided ERP and exposure work. This worksheet does not diagnose OCD, prescribe treatment, or replace clinical judgment. If someone is in crisis, contact the 988 Suicide & Crisis Lifeline.

Free ERP tool

Free Exposure Hierarchy Builder

Build an exposure hierarchy for ERP, OCD, and anxiety work. Add triggers, rate predicted SUDS, define response prevention rules, and export a clinician-ready worksheet.

Open CY-BOCS Exposure Timer

Build an ERP Exposure Hierarchy Online

An exposure hierarchy is a ranked list of feared situations, triggers, thoughts, sensations, or avoided actions. This free builder helps therapists and clients list exposure steps, estimate SUDS, define response prevention rules, and sort the plan from easier to harder.

Exposure hierarchy ladder

The goal is not a pretty worksheet. It is a clear next step with SUDS, response prevention, and pacing.

  1. 20 SUDS
    Read a low-trigger word
  2. 35 SUDS
    Look at a neutral image
  3. 50 SUDS
    Write a brief script
  4. 65 SUDS
    Practice response prevention
  5. 80 SUDS
    Do the real-world exposure
Pair the ladder with CY-BOCS scores, exposure timer logs, and therapist-reviewed progress notes.

What to Include in an Exposure Hierarchy

A useful hierarchy usually includes a specific exposure step, the feared situation or trigger, a response-prevention rule, a predicted SUDS rating, an actual peak SUDS rating after practice, duration or repetition targets, and short learning notes. The tool is flexible enough for OCD ERP, social anxiety, panic/interoceptive exposure, and other clinician-guided exposure work.

Clinical Guardrails

Exposure planning should be collaborative and clinically supervised, especially when risk, trauma history, self-harm concerns, medical issues, or severe impairment are present. This page organizes the worksheet; it does not decide readiness, safety, pacing, or treatment fit.

Therapist Guide to Exposure Hierarchies

For a practical walkthrough of fear ladders, SUDS ratings, response prevention rules, and ERP documentation, read the exposure hierarchy worksheet guide. It includes examples for contamination OCD, checking OCD, social anxiety, and panic-focused exposure.

Documentation Example

Therapist and client collaboratively built ERP hierarchy with predicted SUDS ratings and response prevention rules. Client identified initial lower-range exposure step, completed in-session practice with peak SUDS 45/100 and ending SUDS 28/100, and reviewed homework parameters for continued practice.

Related OCD and Anxiety Tools

CY-BOCS Assessment

Score childhood OCD symptom severity with clinical context.

GAD-7 Assessment

Screen generalized anxiety symptom severity.

Exposure Timer with SUDS

Time exposure practice and log distress checkpoints.

Therapy Session Tools

Open the full set of free clinical and in-session tools.

Frequently Asked Questions

What is an exposure hierarchy? +

An exposure hierarchy is a ranked list of feared or avoided situations, usually ordered from easier to harder based on expected distress.

Is this tool only for OCD? +

No. It can support ERP for OCD and exposure-based anxiety work when a trained clinician determines exposure is appropriate.

Does the hierarchy builder prescribe exposures? +

No. It organizes a worksheet. Readiness, pacing, safety, response prevention, and treatment fit remain clinical decisions.

Can I export the hierarchy? +

Yes. You can copy or export a clinician-ready worksheet for your note, homework plan, or treatment planning workflow.

Keep going

See the anxiety and OCD workflow we are building

Use the free hierarchy builder now, then see how CoralEHR structures ERP hierarchies, SUDS tracking, CY-BOCS scores, notes, and progress inside one chart.

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