behaving calmly and succeeding at the goal.
The examples that follow give you an idea of how to create your ladder.
Panic ladder
Here’s an exposure ladder for someone who had a panic attack in a busy supermarket and now dreads going back there in case it happens again. Their ultimate goal is to return to the supermarket and they devise the following steps:
Visit corner shop when quiet.
Visit corner shop when busy.
Visit shopping precinct and walk past supermarket late in the day, when deserted.
Visit supermarket at quiet time, with a helper, and buy one item.
Visit supermarket at quiet time, without helper, and buy one item.
Visit supermarket at quiet time, with a helper and buy several items.
Visit supermarket at quiet time, without helper, and buy several items.
Visit supermarket at busier time, with a helper, and buy one item, and so on.
Agoraphobia ladder
Let’s look at someone who’s housebound and who feels there’s no point in trying any more. In fact the tiniest goals can lead to bigger things – it’s always worth trying, however silly or ridiculous it might seem to do these things.
Visualise leaving house.
Put on coat and outdoor shoes (to get used to the feel of them again).
Put on coat and outdoor shoes, stand by front door till Anxiety subsides.
Put on coat and shoes, take rubbish to dustbin.
Walk to first lamppost, return home.
Walk to second lamppost, return home.
Walk to postbox, post letter.
Eventually someone with agoraphobia needs to practise staying in situations, so they could move on to the shopping ladder in the panic example, or they could devise a new ladder that focuses on being with other people.
Specific phobia ladder
If you have a specific phobia, exposure is designed to increase your tolerance of the thing you fear. Each ladder has to be individually tailored. Here is an example for someone with spider phobia.
Look at a cartoon of a spider.
Look at a photo of a spider.
Touch the photo of a spider.
Watch a video about a spider.
Look at a spider in a sealed jar.
Hold a jarwith a spider in it.
Hold a spider.
Sometimes it can be difficult to repeat the exposure – thunderstorms for instance only occur occasionally. Consider buying a CD or DVD of the thing you fear and using that in your ladder.
Generalised Anxiety Disorder ladder
If you have GAD, exposure work can be used to increase your activity level and build up your stamina. Goals might include meeting friends,going to public places, doing voluntary work or doing a sport or social activity. Construct a separate exposure ladder for each one.
There is another aspect to GAD which is the act of worrying itself. If your attempts to do more are constantly interrupted by worry, you can create an exposure ladder to help you reduce the time you spend worrying. Start by writing down your worries in your notebook – this will help you see them more objectively. You can set goals that aim to cut down the number of thoughts, or reduce how many times you allow yourself to go round the thinking loop. Another approach is to set aside times for worrying:
Worrying allowed on the hour, every hour, for ten minutes.
Reduce each session to five minutes.
Omit every other session, and so on.
Travel phobia ladders
Fear of travelling often forms part of a wider group of phobias which make up the agoraphobia cluster, or may apply to a specific situation such as driving on motorways. Here are two examples.
Travelling by bus
Take the bus for one stop, at a quiet time, sitting near the door with helper beside you.
Repeat, but for two stops.
Take the bus for five stops, sitting apart from helper.
Take the bus for one stop with helper following by car.
Take the bus for two to five stops with helper following by car.
Take the bus one stop without helper following.
Take the bus two to five stops without helper following.
Repeat the journey at a busier time.
Practise taking the bus to visit friends, go shopping etc.
Travelling by car
Be a passenger with
The examples that follow give you an idea of how to create your ladder.
Panic ladder
Here’s an exposure ladder for someone who had a panic attack in a busy supermarket and now dreads going back there in case it happens again. Their ultimate goal is to return to the supermarket and they devise the following steps:
Visit corner shop when quiet.
Visit corner shop when busy.
Visit shopping precinct and walk past supermarket late in the day, when deserted.
Visit supermarket at quiet time, with a helper, and buy one item.
Visit supermarket at quiet time, without helper, and buy one item.
Visit supermarket at quiet time, with a helper and buy several items.
Visit supermarket at quiet time, without helper, and buy several items.
Visit supermarket at busier time, with a helper, and buy one item, and so on.
Agoraphobia ladder
Let’s look at someone who’s housebound and who feels there’s no point in trying any more. In fact the tiniest goals can lead to bigger things – it’s always worth trying, however silly or ridiculous it might seem to do these things.
Visualise leaving house.
Put on coat and outdoor shoes (to get used to the feel of them again).
Put on coat and outdoor shoes, stand by front door till Anxiety subsides.
Put on coat and shoes, take rubbish to dustbin.
Walk to first lamppost, return home.
Walk to second lamppost, return home.
Walk to postbox, post letter.
Eventually someone with agoraphobia needs to practise staying in situations, so they could move on to the shopping ladder in the panic example, or they could devise a new ladder that focuses on being with other people.
Specific phobia ladder
If you have a specific phobia, exposure is designed to increase your tolerance of the thing you fear. Each ladder has to be individually tailored. Here is an example for someone with spider phobia.
Look at a cartoon of a spider.
Look at a photo of a spider.
Touch the photo of a spider.
Watch a video about a spider.
Look at a spider in a sealed jar.
Hold a jarwith a spider in it.
Hold a spider.
Sometimes it can be difficult to repeat the exposure – thunderstorms for instance only occur occasionally. Consider buying a CD or DVD of the thing you fear and using that in your ladder.
Generalised Anxiety Disorder ladder
If you have GAD, exposure work can be used to increase your activity level and build up your stamina. Goals might include meeting friends,going to public places, doing voluntary work or doing a sport or social activity. Construct a separate exposure ladder for each one.
There is another aspect to GAD which is the act of worrying itself. If your attempts to do more are constantly interrupted by worry, you can create an exposure ladder to help you reduce the time you spend worrying. Start by writing down your worries in your notebook – this will help you see them more objectively. You can set goals that aim to cut down the number of thoughts, or reduce how many times you allow yourself to go round the thinking loop. Another approach is to set aside times for worrying:
Worrying allowed on the hour, every hour, for ten minutes.
Reduce each session to five minutes.
Omit every other session, and so on.
Travel phobia ladders
Fear of travelling often forms part of a wider group of phobias which make up the agoraphobia cluster, or may apply to a specific situation such as driving on motorways. Here are two examples.
Travelling by bus
Take the bus for one stop, at a quiet time, sitting near the door with helper beside you.
Repeat, but for two stops.
Take the bus for five stops, sitting apart from helper.
Take the bus for one stop with helper following by car.
Take the bus for two to five stops with helper following by car.
Take the bus one stop without helper following.
Take the bus two to five stops without helper following.
Repeat the journey at a busier time.
Practise taking the bus to visit friends, go shopping etc.
Travelling by car
Be a passenger with
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