Exposure Ladders: Facing Anxiety Step-by-Step
Create and use exposure ladders to gradually face fears: building your hierarchy, practicing exposures, and tracking progress.
Clinically Reviewed: Licensed Clinical Psychologist |Next Review: August 2025
Key Takeaways
- Exposure therapy is gold-standard treatment for anxiety disorders and OCD
- Exposure ladder ranks feared situations from least to most anxiety-provoking
- Start with easier exposures and gradually progress to harder ones
- Habituation (anxiety decrease) happens with repeated, prolonged exposure
- Therapist guidance helps make exposure safe and effective
How Exposure Works
Exposure therapy is based on habituation—when you stay in an anxiety-provoking situation without escaping, your anxiety naturally decreases over time. Your brain learns the situation is safe.
Avoidance maintains anxiety. Exposure extinguishes it.
Creating Your Exposure Ladder
Example for Social Anxiety:
- 10: Say hi to cashier
- 25: Make small talk with coworker
- 40: Ask question in small meeting
- 55: Attend social gathering for 30 minutes
- 70: Give presentation to small group
- 85: Attend party, talk to 5 people
- 100: Give speech to large audience
Frequently Asked Questions
What is an exposure ladder?
A ranked list of feared situations from least to most anxiety-provoking (0-100 scale). You start at the bottom (lower anxiety items) and work your way up gradually as earlier exposures become easier.
How do I create my exposure ladder?
With your therapist, list all situations you avoid due to anxiety. Rate each 0-100 for anxiety level. Arrange from lowest to highest. Identify specific, concrete steps for each level. Start with items rated around 30-40.
How long should I stay in an exposure?
Stay until anxiety reduces by at least 50% (habituation). This might be 20-60 minutes depending on the situation. Leaving while anxiety is still high can reinforce fear. Your therapist will guide timing.
What if my anxiety doesn't go down?
Sometimes the exposure is too difficult (start with easier step) or you're using safety behaviors (subtle avoidance that prevents habituation). Your therapist will help troubleshoot and adjust the plan.
Can I do exposure therapy on my own?
While self-help is possible, working with a therapist is strongly recommended, especially for severe anxiety or OCD. Therapists ensure exposures are done correctly, provide support, and prevent common mistakes.
Is exposure therapy safe?
Yes, when done properly. Exposure is uncomfortable but not harmful. You're in control—we never force you into situations. The goal is building confidence through gradual, supported challenge, not traumatization.
References
- 1. Foa EB, McLean CP. (2016). "The efficacy of exposure therapy for anxiety-related disorders." Annual Review of Clinical Psychology 12:1-28.
- 2. Olatunji BO, et al. (2009). "Cognitive-behavioral therapy for anxiety disorders: A meta-analysis." Psychiatric Clinics of North America 32(3):527-544.