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In exposure therapy, an exposure hierarchy is developed to help clients confront their feared objects and situations in a manner that is systematic and controlled for the purpose of systematic desensitization. Exposure hierarchies are included in the treatment of a wide range of anxiety disorders to guide the clinician and the client in what areas should be targeted in treatment. An exposure hierarchy itself is a list of objects and situations that an individual fears or avoids that are graded or rank-ordered in their ability to elicit anxiety. The least anxiety-provoking situations are ordered at the bottom of the hierarchy while the most anxiety-provoking situations are at the top. Exposure hierarchies typically consist of 10-15 items and guides the client’s exposure practices. When exposure to a hierarchy item leads to moderately reduced distress or increased tolerance, clients progress to more and more difficult exposures up the hierarchy. An exposure hierarchy can also be used as an assessment tool of the client's progress and their increasing ability to habituate to fearful situations further up in their hierarchy. == Designing an Exposure Hierarchy == First, therapists should conduct a thorough assessment of their client’s fear with particular attention to the (a)feared object or situation, (b)feared consequences of confronting the object, (c)fear-related avoidance or safety behaviors, and (d)triggers and contexts of the fear. The assessment often focuses on a target area (e.g. social anxiety, specific phobia) that the client hopes to address the most, often because it is the most distressing or causes the most impairment. A wide range of areas can be targeted in exposure therapy and included in the exposure hierarchy. Second, the therapist and client work collaboratively to develop an individually tailored list of feared situations that center on the identified target area (e.g. social anxiety). A list often includes several different situations that cause fear to varying degrees. For example, a fear hierarchy for a client with public speaking fears and social anxiety could include various situations that might trigger fears of embarrassment or judgment like: identifying a topic for a presentation, watching others give a presentation, practicing the presentation alone, practicing the presentation in front of a small and familiar audience, and giving the final presentation in front of a large audience. Though it is not uncommon for those with social anxiety to have fears of other situations (e.g. eating in public, making mistakes) if the situation is not feared or avoided by the client, it would not be included in his or her individualized fear hierarchy. Third, after a list of several feared or avoided items is generated, therapists guide clients to rank-order the level of distress elicited by each of the situations. The client uses the Subjective Units of Distress Scale (SUDS) to rate the degree of distress elicits on a scale of 0 (no fear) to 100 (most severe distress ever experienced). Returning to our example of a client with social anxiety, she may rate choosing a presentation topic as 20 SUDS while speaking in front of a large audience as 95 SUDS. The items are then ordered on the hierarchy from lowest to highest SUDS ratings. Finally, after the hierarchy is developed, the client completes exposures from the bottom of the hierarchy to the top. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Exposure hierarchy」の詳細全文を読む スポンサード リンク
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