In CBT, what is the role of exposure hierarchy in ERP for OCD?

• A. A stepwise plan guiding systematic exposure from least to most distressing to reduce avoidance and distress.
• B. A method to schedule medication dosing
• C. A technique to analyze dreams
• D. A way to measure social skills

Answer: (B)

In ERP for OCD, the exposure hierarchy is a graded plan that guides exposure from least to most distressing so the person faces feared triggers in a manageable way. By collaboratively listing triggers or situations and ranking them, the client begins with tasks that provoke moderate anxiety and gradually works up as fear tolerance improves. This stepwise approach reduces avoidance, fosters habituation to anxiety, and supports extinction learning, making compulsive urges less automatic over time. The hierarchy also provides a clear structure for practice and homework, helping both client and clinician track progress. It’s not about medication scheduling, dream analysis, or measuring social skills.