How do you create a fear hierarchy for exposure therapy?

• A. Start with the most frightening situations.
• B. Randomly select situations without rating.
• C. Create a structured exposure plan without using a fear hierarchy.
• D. List feared situations from least to most frightening, rate each on a fear scale, and design a gradual exposure plan.

Answer: (D)

The main idea is to build a graded, structured path for exposure by using a fear ladder and distress ratings. You start by listing feared situations from least to most frightening, rate each one on a fear scale, and then design exposures that move gradually up the ladder as distress drops. This approach supports habituation, reduces avoidance, and provides clear, achievable steps and measurable progress. Starting with the most frightening, selecting items at random, or skipping the hierarchy all miss the key graded-exposure framework that makes the intervention effective.