Therapy Journal


In the second session of group therapy, we were introduced to exposure therapy and the hierarchy of fear. In my previous attempts at therapy I have done exposure response before and it is something I hate.

So the way it was explained to the group was that you expose yourself to something you fear and then you go as long as you can without doing your compulsion to ease the anxiety. You then repeat this again and again many times until it becomes easier. You would then move on to something more difficult and then follow the same process.

Now with exposure response the idea is that you build it up by starting with something that causes you minimal anxiety and you create a scale from 1-10 (1 being the least, 10 being the worst) with tasks that gradually increase in difficulty to severe anxiety. This is called the hierarchy of fear.

So after explaining what ERP is they asked us to make our own hierarchy of fear. Each of us who attend group therapy has different issues within OCD so there is no one size fits all hierarchy of fear.

For me I suffer with many different obsessions and compulsions but the most problematic are fear of contamination and checking/fear of something bad happening. Although I have done this before it never gets any easier. I began to really struggle even thinking about what to put on my hierarchy, I found it overwhelming and I became very anxious and started to panic at just the thought of putting myself in situations which would contaminate me. I felt overwhelmed because to me there are a thousand different scenarios that I could think of that would cause an anxiety response and I struggled to put them in any order . I can identify between the lower and higher anxiety situations but I couldn’t link them together. Also distinguishing between contamination based fears and those based on something bad happening.

After the session ended I was not feeling good, at all. It stayed this way for several days. The thoughts of ERP would not leave me alone and it only increased the severe anxiety I was already feeling on a daily basis. With Coronovirus around and having to leave the house to take my son to school its about as much as I could take. So with all these thoughts rattling around in my head I decided to break it down even more.

I wrote down all the scenarios I could thing of into low, medium and high anxiety categories and tried to think of what for me seemed realistic goal. It felt ridiculous as for me the are all daily tasks that most people wont blink an eye at but it is what felt the most realistic. So eventually I made a shorter list of just five scenarios as to not overwhelm myself . The is my beginner hierarchy of fear.

  1. Touch the side of the vibration plate ( a workout board, no one touches the side)
  2. touch a dirty dish me or my husband has used ( without automatically washing to avoid anxiety)
  3. touch the top of my shoe ( with no visible dirt)
  4. touch my sons toy (without washing to relieve anxiety)
  5. touch washing in the washing basket.

Although this is my starting point and it feels pathetic that these even need addressing they cause enough anxiety that doing ERP will cause considerable stress. For now I will just start with number one and see how that goes.

wish me luck.


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