Monday, November 5, 2012

My fear hierarchies

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?


  1. Good Morning Tina!

    I am so impressed at how you are doing your own therapy at home! I know you are using a wonderful book and all, but I am still so impressed!!!
    May yu continue and press on, ... be strong and courageous in the Lord:)

    I like the SUD's scale that Sunny shared a while back too.

    God Bless you Tina!!!
    Hoping this November has been good so far, and I love the fall pictures you've shared -especially because we don't have fall colors here in Florida ... that is unless you count the artificial strand of fall leaves that I've adorned the top of our entertianment shelf with.


    1. Deanna, thank you for your encouragement! I'm glad you enjoyed the photos of fall colors.

  2. Hey, thanks for the mention, Tina!

    Yes, m'am I sure have used a hierarchy! It's so funny that you posted yours, because I was thinking of posting mine from when I first started CBT. You are much more organized and detail oriented than I am - your lists are definitely better. I was pretty lazy about a lot of this stuff. It's kind of a miracle that I made progress. But you know, that will really benefit you because you are working on this stuff on your own. I just know you're gonna make progress - I can tell you are determined.

    You mentioned that you were going to work on multiple hierarchies a day - just don't be too rough on yourself if you find that you can only work on one exposure per day. This stuff is really hard and can take a lot out of you - so don't be surprised if you can only do one at a time. The other thing is that initially, your OCD may get worse because you are really fighting it and facing things that maybe you avoided in the past. Again, don't let this discourage you. It seems to be part of the process for a lot of people (it sure was for me).

    You can do it - rooting for ya!!!

    1. Sunny, you have accomplished so much! You're an inspiration to me. I know you've used the fear hierarchies to great advantage, and I hope you'll still share yours, because I know it would be helpful to your readers, including me! Thank you for your encouraging words!

  3. These are very educational Tina! I feel that I'm learning a lot

    1. Keith, thank you for reading! I'm glad it's educational.

  4. I'm afraid making a hierarchy like this would only discourage me as it would probably be as long as yours.
    I just try to overcome one thing at a time and then see which next one "pops up". I'm not as organised as you at all.
    But I'm making progress and that's what counts, isn't it?
    You are doing a great job Tina, it's encouraging to read your posts, every time again!

    1. Klaaske, You are so right--making progress is what counts, whatever the means is to getting there. I'm glad you're making progress. Thank you for your encouragement!

  5. I hope your fears get easier over time. The top of my fear hierarchy is vomit. I have a phobia of it. Most people don't like it - it grosses them out - but with me it's a full fledged phobia. Panic attack style. Kind of a weird thing to cause panic attacks, but at least it seems to be the only thing that does that to me.

    FWIW, I have always understood your written word perfectly - you are always very clear!

    1. Lisa, Thank you for commenting on my written word--I appreciate it! :-)

      I can understand the difference between something that grosses out people and something that is a phobia, so I don't think vomit is a weird thing to cause panic attacks. I hope the fear lessens for you over time.

  6. This seems like it will be so helpful! so glad you are doing this, helping all around you!

  7. I remember doing this -- and it was very helpful. These days, I've noticed that over time, some of my anxiety triggers have dropped off the map entirely, while others are still high in the hierarchy. For example, I can now make a left-hand turn on a busy street without batting an eyelash, but I still cringe when I have to pick up the phone. Still, it makes me want to find my old list and take a look at it, because so much has changed.

    Good luck! You're doing great work!

    1. Thank you, Nadine! I like the idea of anxiety triggers going away. I don't think I'll ever like picking up the phone, though.

  8. Tina, you amaze me, you are tackling this with such devotion and I am really impressed. I have a similar workbook and it seemed so overwhelming to me to list all my fears and the hierarchy that I quit. So I am reading yours and going "wow" Plus we share many of them..I almost feel like using yours as a blueprint, but I know deep down I have to do my own work to be successful. I have lots of catching up on blogs to do..miss the blogging community. I am rooting for you!

    1. Krystal Lynn, so good to hear from you! :-) Thank you for your encouragement. Support from readers helps me so much.

  9. Tina, wow, you are doing some hard work! That is a lot of anxiety to deal with. I agree with Sunny that you shouldn't be too hard on yourself if you don't get as many exposures done as fast as you plan, but if you do, great! Also, I, too, experienced a worsening of my OCD before it got better.

    Your "only buying items that are perfect" one struck a chord with me. So often I want to reach behind the first box of cereal or can of soup or whatever to get one behind them, because I somehow expect the one behind to be more clean. And I like to inspect for perfection as well, even if a little bend in a cardboard carton really wont hurt anything.

    Thanks for sharing your experience with us!

    1. Abigail, thank you for your kind comment. I do the same thing when I'm shopping, like pulling the back magazine out instead of taking the front one.

  10. Wow,Tina, good for you for tackling your OCD head on, and sharing your fear hierarchies with us. By the way, I almost always never take the "first" item off the grocery shelf. I never thought much of it!

    1. Thanks, Janet. That shopping habit--I've had it for most of my life, I think.

  11. This is a wonderful list, Tina. Wow. You have really done your homework. I bet this helps in so many ways. I love the SUD "Subjective Units of Discomfort."

    My oldest daughter has the excruciating "Analyzing appropriateness" obsession. I feel terrible that she's always second guessing herself. Fortunately she trusts my opinion when I tell her she's normal and that what she did was perfectly acceptable.

    I tend to do the check and recheck my writing. Amazing how much still gets past me.

    I hope and pray that eventually all of these SUDs will be at 0!

    1. Grace, I'm looking forward to all the SUDs going down, too. Thanks for your encouragement!


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