Avoidance of trauma-related triggers is a natural protective response, but over time it maintains and intensifies distress. Exposure therapy, one of the most well-supported treatments for PTSD and trauma-related anxiety (Foa et al., 2019; APA, 2023), works by gradually and systematically confronting avoided situations in a safe, controlled manner. An exposure hierarchy is the roadmap for this process: it ranks feared situations from least to most distressing so you can build confidence incrementally. Rate each activity on a Subjective Units of Distress Scale (SUDS) from 0 (no distress) to 100 (maximum distress). Include a range of ratings to ensure a gradual progression. Each activity should be safe, specific, within your control, and repeatable at least four times.

List trauma-related situations or reminders you currently avoid. Rate each one from 0 to 100 based on how much distress it would cause. Arrange them from lowest to highest distress. Aim to include at least one activity in each range: 10-30 (mild), 40-60 (moderate), and 70-100 (high). You will begin exposure with the lowest-rated items and work upward.