“Exposure Hierarchy”

I was eager to dive into the treatment plan, with hopes of feeling better. Thankfully, my second appointment quickly arrived. I found my seat at the end of the couch. Damon launched into an explanation of exposure hierarchies. Phew… he wasn’t quitting on me.

An exposure hierarchy is a systematic approach to confront feared objects and situations. Anxiety inducing scenarios are rated, by the client, from least-distressing to most-distressing. This is done utilizing a scale of 0-7, 0 being no fear/anxiety and 7 being extreme, and often debilitating, fear/anxiety.

This was new to me, so we took it slow. We started discussing some fears and distressing scenarios, I had recently experienced, and Damon offered exposure suggestions. Example: My Fear – non-organic produce was toxic and caused cancer; Exposure – eat x1 slice of a non-organic apple x3 days/week; My fear/anxiety rating – 3.

The beginning of my exposure hierarchy (listed by anxiety rating):

1: -None

2: -Touch unwashed organic fruit and touch all around the house (Fear: Unwashed fruit was covered in pesticides that were toxic and caused cancer). -Hold a receipt (Fear: Receipts had BPA, an industrial chemical, that was toxic and caused cancer if touched).

3: -Look at a crooked lampshade and don’t fix it (Fear: Out of place items didn’t meet perfectionism expectations; I was a failure). -Use tiny amounts of antibacterial hand soap x5/day (Fear: Antibacterial hand soap suppressed the immune system).

4: -Put x1 item out of place in my son’s closet (Fear: All clothes and shoes were organized by size and color; any disorder didn’t meet perfectionism expectations; I was a failure). -Turn x1 food can so the label is facing the right (Fear: If a label did not face left, something tragic would happen to someone I loved).

5: -Wash hands with only water x1/day (Fear: Had to wash hands every time I touched something “contaminated” or they felt “sticky/oily”). -Limit toy clean up to x2/day (Fear: I was cleaning up toys x20+ per day; disarray equated to loss of control and failure to meet perfectionism expectations).

6: -Touch plastic grocery bag and touch all around house (Fear: Plastic grocery bags were toxic and caused cancer if touched). -Turn all food cans so the label is facing right (Fear: If a label did not face left, something tragic would happen to someone I loved).

7: -Wash hands ~20-25% less often then currently washing (Fear: I was washing my hands ~x50-75/day; Had to wash hands every time I touched something “contaminated” or they felt “sticky/oily”). -Kitchen cupboard in complete disarray (Fear: If a label did not face left, something tragic would happen to someone I loved and disarray equated to loss of control and failure to meet perfectionism expectations).

Alright, my hierarchy was in progress. Now what? Next up, a Ban Book and Exposure Response Prevention (ERP).

~Brooke~