Abby’s Ruff Problem

Abby, a 21-year-old girl, has a strong phobia of dogs. She cannot get near a dog without experiencing strong symptoms of anxiety (e.g., trembling, shaking, heart-racing). This problem stemmed from an incident when Abby was 12, when a particularly nasty Dobermann chased her around the park and bit her on the arm. Her partner Jack recently told her that he wants to adopt a puppy. To support Jack’s dream, she is seeking help with a mental health professional to overcome her canine anxiety.

Adorable dog or terrifying hellhound?

How would you tackle Abby’s Doggy Dilemma?

If you were the therapist that Abby was seeing, how would you go about reducing her anxiety disorder around dogs? If your answer was to get Abby to face her fears (i.e., exposure therapy), you would be right! However, it might be somewhat cruel to start the treatment by releasing the hounds on Abby. This is where creating an exposure hierarchy can be really helpful! An exposure hierarchy is a tool that cognitive behavioural therapists use to allow patients to face their fears in a safe and controlled way. This will allow Abby to start with something that is challenging, but not too challenging that she cannot complete the task. Over time, Abby will acclimate to the different situations and make her way to the top!

Steps for completing an exposure hierarchy

1. Write down what the goal is (“to reduce anxiety around dogs”)

2. Generate a list of activities that could be potential exposures (“looking at a picture of a dog”, “being in the same room as a poodle”, “feeding a dog a treat”) – be creative!  

3. Next to each activity, write down a number from 0 to 100 (0 = “not anxious at all” to 100 = “most anxious I will ever be”)

4. Sort the activities from lowest to highest

5. Pick an activity that you feel that is not too hard but not too easy – something doable but challenging. For Abby, this might be “looking at pictures of dogs on the internet” – anxiety level = 40.

7. Rate your anxiety before and after engaging in the task.

8. Move up the hierarchy as you become more comfortable!

The exposure hierarchy can be used for any type of fear. For example, someone might be afraid of social situations, and they can create a similar exposure hierarchy. For example, they might start with something that is somewhat anxiety-provoking (e.g., “saying hello to the bus driver”) to something higher (e.g., “making an appointment on the phone”) to something very anxiety-provoking (“asking someone on a date”).

When generating your list, a simple format is best!

Things to take note of before you begin

1. Set yourself up for success! It’s important to begin with something that feels doable, so the anxiety is not too high and makes you want to quit.

2. Try not to avoid the situation when you are in it. Anxiety will spike up when you are facing the situation and will take some time for our brain to realize there is no danger (or that it is minimal compared to our reaction) and stop the fight-or-flight response. Stopping the exposure too early might maintain the anxiety and minimize the excellent work you are doing. Give yourself some time to really process the situation and let the anxiety subside before discontinuing the exposure.

3. Be creative! Let your creative juices flow when making your exposure hierarchy – there are a lot of ways to take a scary situation and make it easier for you to engage in exposures.

If there’s a specific fear/phobia you want to face, try using the skills you have learned here to develop your first exposure hierarchy. There’s no need for perfection and your list doesn’t have to be the most beautiful thing in the world. Just get started to take the first step in slaying your fears! If the anxiety is a bit too high, try out a few relaxation strategies to support your goals.

If there’s a specific strategy you used that was particularly helpful for you, let us know in the comments!

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Best wishes,