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Vicky Davis

Reviewed by Vicky Davis, FNP

Written by Our Editorial Team

Published 02/19/2023

Wondering about anxiety hierarchy treatment? Here’s everything you need to know.

There are a number of people in the United States living with anxiety. In fact, an estimated 40 million adults have some type of anxiety disorder. 

Living with an anxiety disorder (whether it’s generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder or another type) is no way to live at all. From feeling stressed and worried to sleepless nights, symptoms of anxiety can really impact your quality of life.

There are many options available to treat anxiety levels.

One thing some mental health professionals think can help is anxiety hierarchy treatment. This type of treatment is thought to help you learn how to better deal with your source of anxiety.

What Is the Anxiety Hierarchy?

The American Psychological Association (APA) defines anxiety hierarchy as a series of graduated anxiety-arousing stimuli centering on a specific source of anxiety in a specific individual, such as a difficult item or a real-life situation.

This form of therapy is an exposure exercise most often used to treat various phobias through systematic desensitization. Some people also refer to anxiety hierarchy around phobias as fear hierarchy.

Essentially, people will come up with a hierarchy of things (or difficult items) that give them anxiety in relation to their phobia. From there, you’re guided along the hierarchy from least to most threatening as a way of facing your phobia head-on.

Systematic desensitization is often used in conjunction with exposure therapy (the process of exposing yourself to fears to help you get over them). Sometimes called exposure fear hierarchy, systematic desensitization involves relaxation exercises to make your fear feel more manageable as you’re exposed to the things that cause it.

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Anxiety Hierarchy Situations

When using anxiety hierarchy for managing phobias or fears, you’ll be tasked with coming up with a list of things that trigger your fear. A hierarchy of anxiety-triggering experiences can look different for every individual — it really depends on what your phobias are and your level of fear for each difficult item. 

Say you have social anxiety disorder, which affects approximately 15 million adults in the United States. This condition involves feeling anxious or fearful in situations when you think others may be judging you or paying close attention to what you do. This could be one-on-one interactions, speaking in public, being in large groups or anything else involving other people.

In this case, if you were working on a social anxiety hierarchy, you’d start by listing things that make you a little nervous. Then, you’d move on to things that spike your social anxiety in a moderate way, followed by things that make it very bad.

Here’s what someone’s social anxiety hierarchy may look like: Perhaps being in a crowd in social situations gives you a bit of anxiety, interacting with a new person one-on-one gives you moderate feelings of fear and speaking in front of a large group feels all-out paralyzing. 

Figuring out the levels of anxiety hierarchy situations is almost like coming up with a treatment roadmap you can use to work your way through whatever your fear or phobia is in a way that feels manageable.

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How to Use Anxiety Hierarchy as Treatment 

The idea of coming up with an anxiety hierarchy is that it gives you a list of things you can gently expose yourself to in order to lessen your anxiety around those things. 

Whether you’re creating a social anxiety hierarchy, a hierarchy of fears or a hierarchical list connected to another type of phobia, you’ll want to work with a mental health professional. 

Anxiety hierarchies aside, talk therapy is thought to be a very effective way to treat anxiety. Specifically, cognitive-behavioral therapy (CBT) can help. With this form of therapy, you work with a trained mental health professional to figure out behaviors that boost your anxiety. From there, you’ll work together to determine how to change those behaviors. 

Exposure therapy is a type of CBT that can be particularly helpful when you come up with a hierarchy of fears. In exposure fear hierarchy treatment, you’ll confront your list of fears and phobias in a safe way.

You may start with the things on the low end of your hierarchy, then move to things that spike more anxiety as time goes on and you begin feeling like you can handle more. 

Exposure therapy is thought to help in a number of ways, including: 

  • Getting you used to be exposed to your fear or phobia

  • Weakening anxiety associations tied to specific scenarios or objects

  • Helping you learn how to attach more realistic beliefs around your phobia

  • Giving you confidence that you can overcome your fear

Sometimes, a mental health professional may suggest you take medication along with doing therapy. Anti-anxiety medications don’t cure anxiety, but they can reduce the symptoms.

Common medications used for anxiety include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, as well as beta blockers and benzodiazepines.

Anti-anxiety medication must be prescribed by a licensed healthcare professional. 

Hers offers online consultations, making it easy to find a professional who can assist with both medication and therapy. You can also use this time to discuss anxiety hierarchies and whether or not creating one could help you manage any fears and phobias you have. Get started today.

7 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

  1. Anxiety Disorders - Facts & Statistics. (2022, October 28). Anxiety and Depression Association of America, ADAA. Retrieved January 7, 2023, from https://adaa.org/understanding-anxiety/facts-statistics
  2. Psychology. (n.d.). APA Dictionary of Psychology. Retrieved January 7, 2023, from https://dictionary.apa.org/anxiety-hierarchy
  3. What Is Exposure Therapy? (n.d.). American Psychological Association. Retrieved January 7, 2023, from https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy
  4. Social Anxiety Disorder: More Than Just Shyness. (n.d.). National Institute of Mental Health.Retrieved January 7, 2023, from https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness
  5. What is Cognitive Behavioral Therapy? (n.d.). American Psychological Association. Retrieved January 7, 2023, from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
  6. What Is Exposure Therapy? (n.d.). American Psychological Association. Retrieved January 7, 2023, from https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy
  7. NIMH » Anxiety Disorders. (n.d.). National Institute of Mental Health. Retrieved January 7, 2023, from https://www.nimh.nih.gov/health/topics/anxiety-disorders/

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Vicky Davis, FNP

Dr. Vicky Davis is a board-certified Family Nurse Practitioner with over 20 years of experience in clinical practice, leadership and education. 

Dr. Davis' expertise include direct patient care and many years working in clinical research to bring evidence-based care to patients and their families. 

She is a Florida native who obtained her master’s degree from the University of Florida and completed her Doctor of Nursing Practice in 2020 from Chamberlain College of Nursing

She is also an active member of the American Academy of Nurse Practitioners.

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