Building Your Graduated Exposure Plan
A Structured Approach to Facing Trauma Reminders Safely
Building Your Graduated Exposure Plan
A Structured Approach to Facing Trauma Reminders Safely
Building Your Graduated Exposure Plan
A Structured Approach to Facing Trauma Reminders Safely
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 (American Psychological Association, 2017; Foa et al., 2019), 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. This is the trauma-focused version of a fear ladder; for the general approach see Build Your Fear Ladder, and for how to run each step see the graded exposure guide.
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.
| Exposure Activity | SUDS Rating (0-100) |
|---|---|
References
- American Psychological Association. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. https://www.apa.org/ptsd-guideline
- Foa, E. B., Hembree, E. A., Rothbaum, B. O., & Rauch, S. A. M. (2019). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences: Therapist guide (2nd ed.). Oxford University Press. https://doi.org/10.1093/med-psych/9780190926939.001.0001
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Avoidance of trauma-related triggers is a natural protective response, but over time it maintains and intensifies distress.
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