Coastal Center for Anxiety Treatment

Name card of Dr. Eric goodman.

The Fear Hierarchy

The thought of dealing with a fear or phobia can feel overwhelming. Think about your own irrational fears. It is normal for it to feel impossible to ever face that fear without being overwhelmed by panic—and we know that the primary way of getting over a fear is to face it directly without avoidances or safety behaviors (ERP).

There are two main ways to face a fear. One way involves directly confronting your fear full-force without much prior exposure. The advantage to this method, known as “flooding,” is that it has the possibility to bring about very rapid improvement. The disadvantage is that because it is so intense, the likelihood of you either refusing this treatment outright or quitting after a short time is high.

The other method of exposure involves breaking your fear up into smaller, more manageable steps and facing your fears along an increasing hierarchy. Each step should feel challenging, but not overwhelming. So how do you create an exposure hierarchy?

1. First, identify your fear.


What is your scary thought/belief about dogs?

They don’t like me. They’ll smell my fear and attack! Their powerful jaws will tear the flesh and muscle from my body! I’ll panic and be in agony! I’ll be mauled, disfigured, and maybe die a painful death!

 2. Next, generate activities that would trigger those scary thoughts.

  • Being in a room with a dog
  • Petting a dog on the back
  • Petting a dog around its head/face
  • Sitting next to a dog and not touching it
  • Reading an article about German Shepherds
  • Looking at pictures of different dogs
  • Reading an article about poodles
  • Watching a Scooby-Doo cartoon
  • Watching Cujo
  • Imagine playing with a friendly dog
  • Watching Lassie
  • Seeing my friend play with and pet their dog
  • Walking in a dog park

3. After your initial list is complete, assign a “Discomfort Level” for each item on a scale of one to ten with “one” being minimal discomfort, “five” being moderate, and “ten” being the worst panic you can imagine.

Watching Lassie               2

Watching Cujo                  6

Petting a dog near the head/face             10

4. Start with the items on your hierarchy that are challenging, but doable. Set aside plenty of time and face a specific challenge until your anxiety diminishes by at least half (you are well on your way at this point!).

5. Once an item is no longer significantly anxiety producing then move on to the next level.

Try not to fixate on those items at the top of your hierarchy. Those items will seem less insurmountable once you get higher up your hierarchy. If you were out of shape, lifting one hundred pounds feels like an impossible goal, but if you start with ten pounds and work up over time, the higher weight will seem less intimidating by the time you reach eighty pounds.

Be flexible. Some items on your hierarchy will turn out to be easier than you imagined. Simply move on to the next item more quickly. Other items will turn out to be harder than you had thought. You can either stay with that more challenging task or you can break it down into smaller steps.

As you face your fears, you can notice that your feared consequence does not occur and, therefore, safety learning can take place.

There are almost always “micro-steps” you can break your fears into. Focus on the next step, work consistently, and you will achieve your goal.

Eric Goodman, Ph.D.