In last Friday’s post about my obsessions and compulsions, I mentioned the fear hierarchy.
In his Freedom from Obsessive-Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty, Dr. Jonathan Grayson defines what that is: “A fear hierarchy is a ranked order of the situations that cause you anxiety, ranked from most to least anxiety-provoking. This hierarchy will be the blueprint for your exposure and response prevention program, guiding your decisions about what to expose yourself to and when” (p. 67-68).
He suggests using a rating of subjective units of discomfort (SUDs) to rank the anxieties (p. 68). Sunny at 71 & Sunny wrote an excellent post about SUDs, and I urge you to check it out.
I’m using a SUDs scale of 1 to 100, with 100 being the worst anxiety, 1 being the least.
I created a fear hierarchy for every type of OCD I experience. The hierarchies help me organize what I want to work on. I am trying to work on exposures from more than one hierarchy each day.
Grayson suggests starting with the lower ranked items, the ones with the lower SUDs (p. 68).
Here are some of my fear hierarchies, which reflect what I'm working on:
Contamination Hierarchy
Toilet in public bathroom 95
Shower walls and floor 90
Rinsing dishes 90
Washing dishes 80
Home bathroom door open 80
Rinsing recyclables 80
Cleaning off stove 80
Floor in public bathroom 70
Toilet seat in own bathroom 70
Sticky substances 70
Greasy substances 70
Kitchen floor 70
Walking in house with no shoes or socks 70
Walking in house with just socks 70
Cleaning off kitchen counter 60
Eating utensils in restaurants 60
Water faucets in public bathroom 50
Brushing teeth 50
Door handles in public places 40
Checking Hierarchy
Cooking on stove 98
Leaving office without checking lamps 90
Leaving home bathroom without checking lights 90
Checking for sharp objects, contaminated objects on floor at home 90
Checking coffeemaker after using 90
Writing without checking/reviewing 90
Reading without going back and rereading 80
Making sure others know of potential dangers 80
Going upstairs without checking basement lights 80
Checking area around dryer for lint 80
Using bath soap/shampoo bottles without rinsing them afterwards 80
Checking dryer vent 80
Checking between washer and dryer 70
Water taps in laundry room 70
Paperwork 70
Checking to be sure razor is on medicine cabinet shelf 70
Making sure others know of recalls 60
Driving 70
Checking food bags to make sure properly sealed 60
Car brake set 50
Mail slot at post office 50
Car doors locked 40
Perfection, Movement and Magic Hierarchy
Nodding my head 90
Being perfectly understood in written words 85
Saying things perfectly 80
Being perfectly understood in spoken words 80
Rewriting words or letters to make them perfect 50
Only buying items that are perfect 40
Counting steps 30
Mental Compulsions Hierarchy
Praying 90
Knowing or learning everything about a subject 80
Checking memory to determine if harmed in past 80
Doubting religious beliefs 80
Analyzing thoughts for appropriateness 70
Past actions, possible sins 70
Do you think using something like the fear hierarchy would help you make changes? Have you ever used anything like this before?