Hierarchy Building

Virtual Hierarchy

The ERP Resources Page of this website provides an excellent hierarchy of fears for emetophobics. The therapist will need to assess which levels to work on, in which order, based on the client’s choices.

Even though many clients will have seen these resources already, and may tell you, “I can look at them all,” can is the operative word in that sentence. Granted, many clients can “white knuckle” their way through the resources, but the wise therapist will begin at the beginning, carefully tracking the SUD numbers at each level, and asking the client if they can raise and lower their anxiety.

In Vivo Hierarchy

Simultaneously with working on the Virtual Hierarchy, and generally for homework, clients may work on their in vivo hierarchy at home. To generate the hierarchy, simply have the client make a list of their AVOIDANCE and SAFETY BEHAVIOURS. Then work through the list as they are able, carefully working from the least to the most anxiety-producing.

If the client cannot move from one in vivo item to the next on the hierarchy, try to find a step in between which is more manageable. Ensure that the client does not use safety behaviours while working on avoidance behaviours.