Purpose of the Exposure Hierarchy
This section focuses on the development of an exposure hierarchy for Mark. This targeted avoidance behaviors, which were key drivers of his symptoms. The therapist worked with him to identify internal experiences – memories, thoughts, and emotions – as well as situational experiences that triggered symptoms.
The aim of an exposure hierarchy is for the client to expose themselves to triggers and understand that their symptoms are not inherently dangerous. In this case, it was also intended to reduce Mark’s sensitivity to his PTSD symptoms. The process is gradual. It begins with less distressing or threatening situations, then slowly increases intensity, building tolerance and confidence incrementally. Potential steps for Mark ranged from reading a related police report, to visiting the event site, to interacting with the accident victim’s family.