Hidden Fear Ladder Building: Getting Started Now that you understand the why and how of doing exposures. The next step is to make a plan to gradually face your fears. That plan is called a fear ladder. Watch the video to learn how to build a fear ladder. Then use the fear ladder library below to pick items to put on your ladder. The fear ladder library lists activities you can use to face your fears, organized by the type of situation, thought, or feeling that sets off anxiety or OCD. Each activity you select will be added to the fear ladder(s) that you can download on the next page. You can also write in your own activities under the Other Items option available in each section. Things in the world (Social) Things in the world (Social) OptionsBasic Social Anxiety Fear Ladder Make eye contact and Say "Hi" to people while walking Start a conversation Join a conversation Have an awkward pause during a conversation Give a presentation in front of a few people Give a presentation in front of a large group Make mistakes while giving a presentation Ask questions in public (e.g., store clerks, people walking) Make a mistake while asking questions in public (e.g., order pizza in an ice cream shop) Make plans with peers to do something social Join an activity with peers People watching me Read in a public place Stoll through a crowded mall Walk in a public place and make eye contact with strangers Attend a concert or sporting event Try on clothes in a store Wear different hair styles or clothers Shop in a crowded store Change directions when walking as if lost Work out at the gym in front of other people Drive slowly in the left lane for several miles Do silly things in public (such as cart wheels) Slowly use an ATM machine with others waiting Sing silly songs at recess Go into a store (or department) that sells clothing for the opposite sex Volunteer to demonstrate new skill in Gym Drop a few coins in public Drop something (handful of change on the floor) in mall Drop something such as coins or food (to call attention to yourself) in the middle of a social situation Draw attention to yourself (drop a book while walking into class) Spill your drink in public Eat in public with support person Eat alone in a public place (e.g. food cout) Eat in front of other people at a party Walk in public while sweating from exercising Invite people over for a meal Sit in a restaurant Meet a friend at a restaurant Have lunch with coworkers or classmates Eat unfamiliar food or with unfamiliar utensils (chop sticks) Eat slower than everyone else Performance Perform dance/sport at home Perform (music, dance, singing) for one or two people you know Perform (music, dance, singing) for a group of people you know Sing loudly in a place of worship or community gathering Perform (music, dance, singing) in public Perform (music, dance, singing) without preparation Perform (music, dance, singing) poorly for people you know Perform (music, dance, singing) poorly in public Take a drama, exercise, or music class Take a standup comedy class Go running in an empty place Practice sports, exercise, or dance at an empty public park Do sit-ups in an unusual place like a park Go running in a crowded place Practice sports, exercise, or dance at a crowded public park Work out at a crowded gym Play racquetball at a popular gym Ask a trainer at a gym how to do an exercise Join a pick-up basketball game at the gym Join a recreational sports team Talking to authority figures With support person, role play conversation with your teacher Whisper "Hi" to teacher Say "Hi" to teacher Answer "yes" or "no" to teacher Ask the teacher a question before or after class With support a person, role play your teacher being difficult Talk to a teacher about make-up work Ask teacher about a question marked wrong that you think is right With support person, role play conversation with Boss Ask an experienced co-worker a question With support a person, role play your Boss being difficult Ask your Boss a question Schedule a meeting with your boss Ask your Boss for time off Ask therapist to reschedule appointment Ask therapist to explain diagnosis or treatment plan Ask your doctor to explain a medical problem Have therapist be difficult when you ask a question Ask a police officer for directions to a local landmark Call a lawyer and ask if they give free initial consultations Talking in public Role play making conversation with a support person Ask desk staff for a pen/another pen/pencil Make eye contact with people while walking in public Step away from mom's side when nervous Check-in for an appointment alone Say hello to people while walking in public Ask a stranger for the time Ask a stranger for directions someplace Give a compliment to a stranger (e.g., in an elevator) Ask a stranger for the time while standing near a clock Ask a stranger for directions to someplace that is obvious (such as the building you're standing in or in front of) Talk to someone watching your favorite sports team at a public place Take your child to a popular playground and talk to other parents Talk to dog owners walking their dog in the park Mumble incomprehensibly when first asking for directions Join a club or organization Engage a stranger in a conversation while trying to be as boring as possible or while making foolish statements Ask someone to turn down their music Role play ordering food at a restaurant with a support person Role play asking a server difficult questions with a support person Order your food at a restaurant Ask questions about the menu before ordering food Ask a server what he or she recommends Role play making mistakes while ordering at a restaurant (mispronounce food) with a support person Stutter when talking to wait staff At fast food restaurant ask questions and take a long time to order Role play ordering food not going well (they are out of what you order) with a support person Ask in fast food restaurant if shakes are made with skim milk or 2% Ask a server what he or she recommends and then don't order it Order an item at a restaurant that is obviously not on the menu At a sit down restaurant ask what is in a dish and ask to substitute Change order at a fast food restaurant Send food back at a restaurant saying that it's not well done enough At a sit down restaurant send back something and ask for something else Role play interacting with sales clerk with a support person Call a store and ask what time they close or for directions Ask a store clerk where an item can be found Ask a sales clerk about a product they sell Ask a bank teller questions about bank (how do you open a checking account) Call a store and pause as if you forgot what to say Go into a store in the mall and ask for directions Ask for a specific size of jeans at a clothing store Strike up conversations with store employees Call a store and make mistakes while talking (say the wrong word, stutter) Pay for items at a store on your own Dampen your shirt under your arm and order food Purchase something while making your hands shake noticeably Ask a store clerk his/her opinion of item in store Ask where the bathroom is in a store or restaurant Make mistakes while talking to a sales clerk (say the wrong word, stutter, forget what you want to say) Ask a sales clerk for an item clearly not in that store (women's clothes in a men's store) Ask a store clerk a silly question Call a store and make a silly noise while asking a question (squawk like a chicken) Check out at a store without enough money to pay for the item Return an item to a store Make a silly noise while talking to a store clerk (squawk like a chicken) Presentations Give a mock presentation in front of a support person Read out loud in front of small group Read out loud in front of a support person Give a presentation in front of a small group of peers Make mistakes while giving a presentation to a support person Read in front of class Put water under your arms to make it look like you are sweating while doing a presentation Give a presentation in front of a large group Purposely make a mistake (trip on a word, pretend you forgot what you were going to say, awkward pause, mispronounce a word) while giving a presentation Give a speech or presentation in front of class Give a presentation to people who know more than you about the topic Volunteer an answer in a meeting/class that you feel confident about (i.e. in math where there is a right or wrong answer) Volunteer an answer in an opinion class (Literature) Volunteer in class even though I'm not sure of the answer Purposely say "I don't know the answer" in a meeting/class Stumble over words when answering a question in class Purposely give a wrong answer in class Attend meeting/class Volunteer to do a reading at a place of worship or community gathering Make a comment in a meeting/class Interviewing Role play answering a question with a support person Role play asking and answering questions with a support person Role play an interview with a support person Role play answering a question wrong and being corrected with a support person Role play a challenging or difficult interview with a support person Ask businesses if they are hiring, get an application Set up an information interview to learn more about a company (not for a specific job) Apply/interview to do volunteer work Purposely make mistakes (trip on a word, pretend you forgot what you were going to say) during an interview for a job that is out of your field and that you do not want Apply/interview for a job that interests you Peers Introduce yourself (briefly) in therapy Introduce yourself (more detail) in therapy Role play making conversation with a support person Role play meeting new people and starting conversations with a support person(s) Make eye contact with people while talking to them Role-play joining an ongoing conversation Ask the person sitting next to you a question Start a conversation with someone Ask a silly question on purpose: Where is the bathroom? (While standing by it), What day of the week/year is it? Role-play joining a conversation and have people be rude Join a conversation that your friends are having Role-play joining a conversation by saying something embarrassing (e.g., misspeak or misunderstand the conversation) Pretend that you forgot what your were saying during a conversation Purposely mispronounce a word during a conversation Pause for a long time during a conversation Join a conversation that acquaintances of yours are having Start a conversation with a friend that you haven’t talked to in a while Talk about yourself (tell a story about a previous experience) with an acquaintance Strike up a conversation with friends at a party Answer questions from others about a sensitive area (e.g., health, treatment) Strike up conversations with people you don't know at a party Approach and join an ongoing conversation of people you don't know well Approach and join an ongoing conversation of people that you don't know Call a friend just to talk Call a friend and make a plan to get together Spend time with a friend and one of his/her friends that you do not know very well Go to new situations (play dates with new kids) Invite new kids to get together Accept an invitation to a party Attend a social event Join a club or organization Sit by people I don't know in class Wave "Hi" to classmate Say "Hi" to classmate Say "Hi" to someone in class I don't know Say words other than "Hi" to classmates Answer classmate with "yes" or "no" Give a compliment to someone Answer classmate with sentence Role-play completing a group project with peers Call a friend and ask about homework Call a classmate and ask for the assignment Role-play completing a group project with peers (have peers be difficult/passive/argumentative) In groups, (i.e group projects) talk to people I don't know Ask classmates to form a group for a project Disagreements Role-play disagreeing with someone Role play providing a different opinion with a support person Role-play having a difficult conversation with your parents Role-play asking a friend why s/he did not call as planned Role-play asking someone in class to be quiet so you can hear Suggest an idea for social plans (which restaurant or movie to attend) Express an opinion you know others disagree with (in group) Role-play responding to being cut off in a conversation Disagree with something a friend says Share your opinion about a controversial topic Ask a friend why s/he did not do something (e.g., call) as planned Express an opinion you know others disagree with Suggest an alternative idea for social plans (a different movie) Disagree about something with a friend Talk to parents about something you disagree or have argued about (e.g., rules) Talk to parents about a rule you broke or their punishment Talk to parents about something that they are angry about (e.g., grades) Ask a peer to stop being bothersome or teasing you Ask someone in class to be quiet so you can hear Other Items Things in the world (OCD contamination, germs, other) Things in the world (OCD contamination, germs, other) OptionsBasic OCD Contamination Fear Ladder Touch something easy (enter here), then rub your hands on your body and don't wash Touch something medium (enter here), then rub your hands on your body and don't wash Touch something challenging (enter here), then rub your hands on your body and don't wash Touch something the most challenging (enter here), then rub your hands on your body and don't wash Touch something easy (enter here) to something you would like to keep clear (enter here) Touch something challenging (enter here) to something you would like to keep clear (enter here) Touch something easy (enter here) to the thing you most want to keep clear (enter here) Touch the most challenging thing (enter here) to the thing you most want to keep clear (enter here) After you wash, re-contaminate by touching something easy (enter here) After you wash, re-contaminate by touching something challenging (enter here) Bathroom germs Touch paper towel dispenser Touch bathroom sink faucet Touch toilet seat in home bathroom Touch floor in bathroom Touch public door knobs Touch bathroom door knob Touch toilet flush handle Touch floor near toilet Touch toilet seat in public restrooms Bodily waste and secretions Wipe your nose with your own hand Put drops of a family member's saliva on your hand Touch your hand to a paper towel soiled with someone else's sweat Touch your previously worn underwear before being washed Touch a paper towel soiled with a few drops of your own bodily secretion Put a few drops of your own bodily secretions on your hand Chemicals Stay in a room with fluorescent lighting Handle a fluorescent light bulb Stand by a construction site Use a gas pump Use bug spray Walk down pesticide aisle in a home improvement store Handle a container of pesticides Use pesticides as directed Handle a bottle of household cleaning products Use cleaning supplies as directed Handle a bag of fertilizer Use fertilizer as directed Contaminating others Touch a source of reasonably safe contamination and then touch public surfaces (door knobs, railings, etc.) Touch a source of reasonably safe contamination then shake hands with someone Touch a source of reasonably safe contamination then give someone a hug Touch a source of reasonably safe contamination then touch someone else's possessions Touch a source of reasonably safe contamination then touch a loved one Touch a source of reasonably safe contamination then hug someone who is in poor health Touch a source of reasonably safe contamination then prepare food for others Dirt and germs Touch garbage can from an office Touch dirty dishes or silverware Shake hands with a stranger Touch dirty clothes bin Touch items in a hospital Touch items belonging to a sick person Touch dirty laundry Handle food that is past its expiration date Shake hands with someone who is ill or in the hospital Touch a garbage can or dumpster in a public place Public Surfaces Touch a light switch in a public place Touch a public drinking fountain Touch a public stair railing Touch a magazine in a hospital or clinic waiting room Touch a door knob or handle in a public place Touch a public telephone Touch an elevator button Shake hands with a stranger Touch the floor in a public place Other Items Things in the world (OCD patterns, thing being out of order or not just-right) Things in the world (OCD patterns, thing being out of order or not just-right) OptionsImperfection Leave food on your plate Write using imperfect handwriting Keep books on the shelf out of order Arrange a rug so that it's imperfectly aligned Arrange your clothes out of order Pronounce words imperfectly Cut the lawn imperfectly Read imperfectly Hang pictures on a wall crookedly Just Right Write an illegible word in a note for someone Step on cracks in the floor Write a letter (A, B, C, etc.) imperfectly Put clothes on in the wrong order Do things an odd (or even, if even feels wrong) number of times Tap something an odd (or even, if even feels wrong) number of times Arrange the items on your desk sloppily Arrange pictures on the wall crookedly Do things the "wrong" number of times Perform routines in the "wrong" order Say, write, and hear the word “right” without “left” Even/Odd Think of an odd number Buy something that costs an odd number of dollars Write an odd number repeatedly on a piece of paper Notice odd numbers of things in your environment Park your car with an odd number of miles on the odometer Imagine bad luck occurring because of exposure to odd numbers Complete rituals an odd number of times Write an odd number in ink on your hand Write an odd number on a picture of a loved one Symmetry Pay attention to left-right asymmetry in the environment Tie one shoe more tightly than the other Tip your hat or wear your belt to the right or left side Say or write the word "left" or "right" without saying the other word. Draw a picture of something asymmetrical Arrange things asymmetrically on a desk, table, or shelf Touch something with the right (or left) side of your body without touching it with the other side Other Items Things in the world (Phobias of things, places, or activities) Things in the world (Phobias of things, places, or activities) OptionsButtons Wear a shirt with buttons, no undershirt Wear jeans with a button Wear a shirt with buttons over a t-shirt Hug people who are wearing buttons Touch buttons Look at pictures of buttons Blood Get your blood drawn Hold a vial of blood Watch bloody scenes from movies Look at someone else's cuts Prick your finger with a sterile needle Watch a medical show on TV Look at pictures of wounds (medical books) Read stories involving blood (surgeries, accidents, crime, horror stories) Bridges Stand in the middle of a high bridge Stand in the middle of a low bridge Walk over a long bridge Walk over a high bridge Walk over a low bridge Walk over a short bridge Drive over a long bridge Drive over a high bridge Drive over a low bridge Drive over a short bridge Buses and trains Take a short ride in a bus or train Take a long ride in a bus or train Look at pictures of bus or train accidents Visualize getting in an accident Visualize being trapped on a bus or train Spend time in a bus or train station Watch videos of buses and trains Take a short ride in a bus or train with a trusted companion Crowds Sit in the middle of the row in a movie theater Stand or walk in crowds Sit far from the bathroom and exit in a crowded restaurant Sit in a mall without knowing where the bathroom is Ride a crowded bus Drive on a busy highway Walk along a busy sidewalk Movies Watch the entire movie alone Watch the entire movie with someone else Watch the most frightening part of the movie alone Watch the most frightening part of the movie with someone else Watch the trailer for the movie Listen to songs from the movie Look at pictures from the movie Talk about the movie Enclosed spaces While in a small room cover your body with a heavy blanket Ride a crowded elevator Lie in an MRI machine While in a small room wear a turtleneck or scarf Ride alone in an elevator Stand in a small closet Lie in a sleeping bag Stand in a small room with the lights off Sit in the middle of the row of a movie theater Stand in a small room with the lights on Sit in a small bathroom Sit in the back seat of car Isolated areas Go places without knowing where the bathroom is Go places without knowing where the exit is Drive in rural areas Go far away from a hospital Go for a walk alone without your cell phone Go for a walk alone without a water bottle or other safety objects Take a walk unaccompanied Leave the house alone Stay home alone Elevators Hop lightly up and down while riding an elevator alone Ride an older elevator Ride a crowded elevator to the top floor Ride a crowded elevator to the 3rd floor While riding in an elevator, visualize being trapped Ride a relatively empty elevator to the top floor Ride a relatively empty elevator to the 3rd floor Ride alone in an elevator Visualize being trapped on an elevator Dental procedures Undergo necessary dental procedures Have teeth cleaned at dental office Observe another person undergoing dental procedures Sit in dentist's chair Sit in dentist's waiting room View and handle dental tools Watch videos of dental procedures Listen to audio clips of dental sounds View pictures of dental procedures Heights Stand by the railing on top level of parking structure with hands in pockets Stand on a balcony without holding the railing Stand by floor to ceiling windows on a top floor Ride in glass walled elevator Climb a tall ladder Stand on a balcony Go up an escalator Stand by floor to ceiling windows on 3rd floor Stand on first floor balcony Ride an elevator Stand by the railing on second level of parking structure Climb a tall open stairs without holding the railing Climb a tall open staircase Driving Drive in bad weather Drive at night Drive on a highway Drive during rush hour Drive on city streets Drive in familiar neighborhoods Drive slowly on empty side streets or parking lots Drive with a trusted companion Storms Stand outside while it is raining Drive around during a storm Stand by window during a storm (not during a tornado) Watch videos of storms Read stories about powerful storms Look at pictures of storms Flying Go on a long flight Go on a short commuter flight Sit in an airplane Get a tour of an airplane Go to an airport Imagine the worst case scenario flights Spend time in airport Watch planes takeoff and land Read about planes Injections Donate blood Get your blood drawn Have an injection (e.g., immunization shot) Receive acupuncture Prick your finger with a sterile needle Observe acupuncture Press needle against your skin Watch someone get an injection (live) Watch a video of someone getting an injection Give an injection to an orange Hold a syringe Look at pictures of needles Learn about needles from a phlebotomist Medical procedures Undergo needed medical procedures Visit doctor for physical examination Have blood pressure taken by a nurse Visit doctor for minor symptoms without a full physical exam Observe someone undergoing medical procedures Sit in an exam room Sit in doctor's office waiting room Walk through a hospital View and handle medical tools Watch videos of medical procedures View pictures of medical tools and procedures Other Items Things in the world (Phobias of animals) Things in the world (Phobias of animals) OptionsBees Let a bee loose in a small room Let a bee loose in your house Catch a live bee in a clear container Hold a dead bee Be outside on a warm day where there might be bees (near flowers or fruit trees) Watch a video of bees in motion Look at pictures of bees Bugs Allow a bug to crawl on your body Allow a bug to crawl on your hand Let a bug walk around loose Be in a place where there are many bugs Hold a bug Have a bug in a bag or a box Watch a video of bugs in motion Touch plastic bugs Look at pictures of bugs Dogs Go to dog park Have dog jump up and put paws on chest (use friendly dog) Call the dog to run at me (use friendly dog) Play fetch (use friendly dog) Let dog lick hand (use friendly dog) Feed the dog a treat (use friendly dog) Have dog walk around on leash (use friendly dog) Pet dog on head (use friendly dog) Pet dog's back (use friendly dog) Stand next to dog (use friendly dog) Enter room with dog firmly held by someone else (use friendly dog) Stand outside the room and look at dog (use friendly dog) Mice and rats Hold a safe, friendly rodent (use someone’s pet, pet store, or known animal) Walk around barefoot in a place where there might be rodents (basement) Be in a place where there might be rodents (walk around in basement) Put hand in rodents cage (use someone’s pet, pet store, or known animal) Watch a rodent in a cage (use someone’s pet, pet store, or known animal) Watch a video of rodents in motion Look at pictures of rodents Sharks Go swimming in ocean Observe sharks at an aquarium Go swimming in a lake Go swimming in a pool Watch video of shark jumping out of water and attacking a cage Leaf through a new book on sharks to practice being startled by new pictures Look at pictures of sharks attacking Look at pictures of sharks swimming Non-venomous snakes Hold a non-venomous snake (someone’s pet, pet store, or other known snake) Let a snake slither around loose (someone’s pet, pet store, or other known snake) Be in a place where there might be snakes (walk around barefoot in your yard) Pet a non-venomous snake (someone’s pet, pet store, or other known snake) Visit a nature center/Zoo and watch the snakes Touch the glass of terrarium with a snake in it Look at a snake in a terrarium Watch a video of snakes in motion Look at pictures of snakes Non-venomous spiders Have spider walk in your hair (use a common, non-venomous spider) Be in a place where there are many non-venomous spiders (garage, basement) Have spider walk on your body (use a common, non-venomous spider) Have spider walk on your hand (use a common, non-venomous spider) With a staff member at a zoo or science center, put your hand in a non-venomous spider's cage Go to a zoo or science center and approach larger exotic spiders in glass cage Put hand in jar and let spider walk on hand (use a common, non-venomous spider) Look at household spider in a jar (use a common, non-venomous spider) Watch a video of spiders in motion Look at pictures of spiders Birds Hold a bird (use someone's pet or go to a pet store) Be in a place where there are lots of birds (a park, near a bird feeder, a pond with geese) Feed a bird in a cage Touch a cage with a bird in it Stand in the bird section of a pet store Look at a bird in a cage Watch a scary movie like "The Birds" Watch a video of birds in motion Look at pictures of birds Other Items Things in the world (Separation) Things in the world (Separation) OptionsBasic Separation anxiety Fear Ladder Repeat scary thoughts with parent Stay in a room alone with parent checking-in if calm and quiet Stay in a room alone and repeat scary thoughts with parent checking-in if calm and quiet Stay upstairs/downstairs alone and repeat scary thoughts with parent checking-in if calm and quiet Stay in a dark room alone and repeat scary thoughts with parent checking-in if calm and quiet Stay in bed at night with parent checking-in if calm and quiet (parents help repeat scary thoughts if needed) Stay in bed at night with parent checking-in if calm and quiet (repeat scary thoughts alone if needed) Stay home alone for a short time while parents walk around the block (if age appropriate) Stay home alone for 3-60 minutes while parents run a short errand (if age appropriate) Stay home alone for a few hours while parents go out for dinner (if age appropriate) Stay home alone without knowing where parents are going or when they will be back (if age appropriate) Do things in public alone (ride the elevator, use public restroom, walk in a store (if age appropriate) Separation at home and sleeping alone Repeat scary thoughts with parent Stay in a room alone during therapy session with parent checking Stay in a room alone during therapy session without parent checking Stay in a room alone during therapy session and think scary thoughts Stay in a room at home alone with parent checking (only if calm) frequently (every few minutes) Stay in a room at home alone with parent checking (only if calm) less frequently (every 5-10 minutes) Stay in a room at home alone without parent checking Stay in a room at home alone thinking scary thoughts Stay upstairs alone with parent checking if calm frequently (If age appropriate every few minutes) Stay upstairs alone with parent checking if calm less frequently (If age appropriate every 5-10 minutes) Stay upstairs alone without parent checking Stay downstairs alone with parents checking if calm frequently (If age appropriate every few minutes) Stay upstairs alone thinking scary thoughts Stay downstairs alone with parents checking if calm less frequently (If age appropriate every 5-10 minutes) Stay downstairs alone without parents checking (If age appropriate) Stay downstairs alone thinking scary thoughts (If age appropriate) Sit in dark alone repeating scary thoughts Stay in bed all night Go back to bed calmly if wake up in the middle of the night Stay in bed alone thinking scary thoughts Stay in bad alone without parent checking (if age appropriate) Stay in bad alone with parent checking (only if calm) less frequently (every 5-10 minutes) Stay in bed alone with parent checking (only if calm) frequently (every few minutes) Separate calmly when parents leave child with an extended family member Separate calmly when parents leave child with a baby sitter Stay home alone for a short time while parents walk around the block (if age appropriate) Stay home alone for ~30 minutes while parents run a short errand (if age appropriate) Stay home alone for ~1 hour while parent run multiple errands (if age appropriate) Stay home alone for a few hours while parents go out for dinner (if age appropriate) Stay home alone thinking scary thoughts Stay home alone without parents being available by phone (if age appropriate) Stay home alone without knowing where parents are going or when they will be back (if age appropriate) Getting to and staying in school Ride to school calmly Leave the house calmly Get ready for school calmly Walk to classroom with parent and separate at door Walk to classroom door and separate calmly (without crying or clinging) Walk to school building door and separate calmly (without crying or clinging) Separate calmly at car without crying or clinging (if age appropriate) Ride to school with another parent Get up early enough to get to school Have child take the bus if applicable Drive to school and back Talk to teacher on phone Go in to school after hours Study in school office for one hour Meet with a tutor at school in empty classroom Talk to teacher after school when students are gone Go to class for one hour Work in counselor's office for one hour and go to class for one hour Go to school for two hours Go to school for four hours Go to school for four hours and eat lunch at school Go to school all day Go to school all day and ride bus Separation in public Sit by self in the waiting room Walk around clinic floor alone (if age appropriate) Ride elevators to another floor alone (if age appropriate) Walk around in public alone (if age appropriate) Find your way to some place alone (if age appropriate) Have friend's parents bring home from a play date Play at a park away from parent if age appropriate Go to friends house without parent Go somewhere with a friend and his/her parents (like the library) Walk into a store alone while parent waits outside (if age appropriate) Go into public restrooms alone (if age appropriate) Other Items Thoughts (General Worries) Thoughts (General Worries) OptionsGeneral plan for scary or worry thoughts With parent write down scary thoughts During therapy session read easy worry or scary thoughts over and over During therapy session repeat (or read) medium worry or scary thoughts over and over During therapy session repeat (or read) biggest worry or scary thoughts over and over During the day repeat (or read) the worry/scary thoughts over and over with parent During the day repeat (or read) the worry/scary thoughts over and over in a room alone When you have a small worry in a real situation, repeat the worry thoughts over and over with parent When you have a small worry in a real situation, repeat the worry thoughts over and over alone When you have a medium worry in a real situation, repeat the worry thoughts over and over alone When you have a big worry in a real situation, repeat the worry thoughts over and over alone Worrying about bad things happening Imagine that you forget to prepare for a presentation at school Imagine that you are late to class Imagine that you get bad grades in school Create a report card with bad grades and imagine that you get bad grades in school Imagine that you fail an important exam Imagine that you have to repeat a class Imagine that you have to drop out of school Imagine that a loved one was in an accident Arrange for a loved one to be late, think about the possibility there has been an accident and do not call for reassurance Without pre-arranging, think about the possibility a loved one has been an accident when she is late and do not call for reassurance Imagine your friends are upset with you Imagine that you forget to prepare for a meeting Imagine that your house is struck by lightning Imagine that you forgot to prepare for a presentation at work Imagine that something bad has happed to your parents Imagine that your boss is upset with you Imagine that you make a bad decision at work Imagine that your family is upset with you Imagine your friends turning their back on you Imagine that one of your loved ones has a serious illness Imagine that your family is having financial difficulties Imagine you said or did something that angered a friend of yours Imagine that you have a serious illness Imagine that your house burns down Imagine getting fired from your job because of something you did Worrying about making mistakes Read something quickly without checking for mistakes Practice making mistakes by mispronouncing words while reading Purposely make errors (sloppy writing, misspellings, poor grammar) and read it over repeatedly Write imperfectly in something you will keep (i.e., diary) Practice making mistakes by writing an illegible word in a note for someone Send an email without checking the spelling or grammar Purposely make errors (sloppy, misspellings, poor grammar) on an email (or something you show someone) Turn in an assignment to someone you know and have them give you a bad grade Purposely make errors (sloppy writing, misspellings, poor grammar) in an assignment or report you are turning in Limit the amount of time that you study for a test or prepare for a meeting Purposely do an adequate, but not excellent job on an assignment and turn it in Imagine that you forget to prepare for a presentation at school Imagine that you are late to class Imagine that you get bad grades in school Create a report card with bad grades and imagine that you get bad grades in school Imagine that you fail an important exam Arrive late for a lunch date with friends Arrive late for a meeting Skip a household chore, for example don’t clean the bathroom one week Purposely say the wrong word Push the wrong button in the elevator Do school work (e.g. math problems) on a white board in front of people Write something with mistakes on a whiteboard for people to see Other Items Thoughts (OCD intrusive thoughts) Thoughts (OCD intrusive thoughts) OptionsUnwanted Thoughts Repeat an easy thought over and over (insert thought below) Repeat a medium thought over and over (insert thought below) Repeat a challenging thought over and over (insert thought below) Repeat the most challenging thought over and over (insert thought below) Repeat an easy thought while doing an activity to "make the thought come true" (insert activity below) Repeat the most challenging thought while doing an activity to "make the thought come true" (insert activity below) Tell a trusted person an easy thought (insert thought below) Tell a trusted person the most challenging thought (insert thought below) Easy Thought* Medium Thought* Challenging Thought* Most Challenging Thought* Easy thought while doing an activity.* Most challenging thought while doing an activity.* Easy thought for trusted person.* Most challenging thought for trusted person.* Causing something bad to happen Think about facing your superstitious fears (for example, walk under a ladder) Don't pray for someone to be healthy Read a book or new article about bad luck befalling someone Write the words "bad luck" on a piece of paper Imagine bad luck befalling yourself Wish for bad luck to befall yourself Face your superstitious fears (for example, walk under a ladder, step on as many cracks as possible) Imagine back luck befalling someone Wish for bad luck to befall someone Write the number 13 (on paper, on someone’s picture) Wish for a plane or automobile crash Keep a battery operated appliance on (such as a flashlight) while you leave home Keep a radio on while you leave home Keep a television on while you leave home Keep lights turned on when you leave home Keep a toaster oven turned off, but plugged in when you leave home Use the oven and turn it off without checking, then leave the room Think about how you might not have turned an appliance off and it could start a fire Imagine your home burning down because you didn't check that something was off or unplugged Drive on a rural road during the daytime Drive on a rural road at night Drive with the radio on (to distract you) without checking your mirrors to see if you hit someone Drive at night without checking your mirrors to see if you hit someone Drive past an area where there are lots of pedestrians without checking your mirrors to see if you hit someone Drive past a park or place where children are playing without checking your mirrors to see if you hit someone Imagine that you might have mistakenly hit a person with your car by accident but don't know for sure Imagine that you have hit someone with your car and got arrested for manslaughter and leaving the scene of an accident Other Items Thoughts (Memories of trauma) Thoughts (Memories of trauma) OptionsThought exposures for traumatic memories Discuss plan to do imaginal exposures with support person Repeat brief description of traumatic event without details to support person Repeat brief description of traumatic event without details alone Repeat script of moments just before the traumatic event Repeat script of moments just after the traumatic event Repeat script of most upsetting portion of traumatic event to support person Repeat script of most upsetting portion of traumatic event alone Repeat script of entire traumatic event to support person Discuss traumatic event in detail focusing on emotions Repeat script of entire traumatic event alone Reminders of trauma Look at pictures of similar traumatic events Read stories about similar traumatic events Watch movies loosely related to similar traumatic events Watch movies about similar traumatic events with a lot of detail (such as graphic war movies) View reminders of the traumatic event (pictures, damaged items, uniform, press clippings, police report, clothes you were wearing) Activity exposures for traumatic memories Walk in public or drive (not in area of accident) without excessive safety behaviors (driving overly slow, excessively checking mirrors) Visit locations similar to where the traumatic event occurred with support person (if reasonably safe) Visit locations similar to where the traumatic event occurred alone (if reasonably safe) Visit locations that remind you of the traumatic event (Red Cross office, police station, military cemetery, military base, hotel, street corner) Visit the location of the traumatic event with support person (if reasonably safe) Visit the location of the traumatic event alone (if reasonably safe) Ride as passenger in area/situation of accident Drive in area/situation of accident during good conditions (sunny afternoon, little traffic) with support person Drive in area/situation of accident during good conditions (sunny afternoon, little traffic) alone Drive in area/situation of accident during challenging conditions (night, rain) with support person Drive in area/situation of accident during challenging conditions (night, rain) alone Other Items Feelings in my body (Panic Attacks) Feelings in my body (Panic Attacks) OptionsBasic Panic Fear Ladder Hyperventilate for 15 seconds Hyperventilate continuously (stopping every 60 seconds only to rate anxiety) Breathe through cocktail straw (hold nose closed) for 15 seconds Breathe through cocktail straw (hold nose closed) continuously (pausing every 60 seconds only to rate anxiety) Spin around in a swivel chair until dizzy Run up and down a flight of stairs until heart racing Go in public after bringing on panic feelings (e.g., hyperventilation, running) Do schoolwork after bringing on panic feelings (e.g., hyperventilation, running) Have a conversation after bringing on panic feelings (e.g., hyperventilation, running) Go where you fear having a panic attach (insert place here) after bringing on panic feelings (e.g., hyperventilation, running) General panic/hyperventilation Hyperventilate for 15 seconds Hyperventilate for 30 seconds Hyperventilate for 60 seconds Hyperventilate continuously (stopping every 60 seconds only to rate anxiety) Embarrassment over appearing anxious/panicked Go in public after doing as many pushups as you can (trembling, blushing, sweating) Go in public after to placing heat pack on face for two minutes (blushing) Go in public after drinking 6oz hot water (140 F) in two minutes Purposely make hands shake as if very nervous while buying something at a store In public state, I am anxious and/or having a panic attack In public stutter Put water underarms to simulate sweating and walk around in public While walking in a crowded area commit social mishaps, such as turning around as if lost While in an public place commit social mishaps, such as looking confused Feeling unreal Stand in a dark room wearing a blindfold and sound-proof headphones Sit in a dark room with a strobe light Stare at small dot on wall Stare at oneself in a mirror Stare at a spinning spiral Heart attack Do vigorous exercise Run up and down a flight of stairs until heart racing Run in place until heart racing Lightheadedness Spin around in a swivel chair until dizzy Rotate head from shoulder to shoulder 2 or more times per second for 30 seconds Place head between legs while sitting down for 30 seconds Shortness of breath Breathe through cocktail straw (hold nose closed) for 15 seconds Breathe through cocktail straw (hold nose closed) for 30 seconds Breathe through cocktail straw (hold nose closed) for 60 seconds Breathe through cocktail straw (hold nose closed) continuously (pausing every 60 seconds only to rate anxiety) Hold breath for as long as you can Run up and down a flight of stairs until breathless Overheating Sit in a sauna Run up and down a flight of stairs until sweating Wear a winter coat while sitting in a hot car Sit in a hot car Eat spicy foods or one teaspoon of hot sauce Health Anxiety Hyperventilate for 60 seconds Repeat thoughts about physical symptoms meaning you have a serious illness Hyperventilate and repeat thoughts that your physical symptoms meaning you have a serious illness Write and repeat a story about your doctor telling you that you have a serious illness Look at scary signs on your body (e.g., bumps) and repeat thoughts about having a serious illness Other Items Feelings in my body (Throwing up and Choking) Feelings in my body (Throwing up and Choking) OptionsNausea and throwing up Ride a bus after eating Make sounds in the bathroom like vomiting Spin around in a swivel chair until dizzy Make yourself gag (not throw-up) with finger or a tongue depressor Pretend to throw-up in a trash can Eat in a restaurant Eat food you think will make you nauseous (meat) Run or exercise after eating a big meal Walk around in public after eating a big meal Say out loud in public "I need to throw up" and then run to a bathroom Eat in some else's home Run to public bathroom and act like you are about to vomit Eat in the car While in a public place look at pictures of people throwing up Eat a big meal until you feel very full Walk in a private place after eating Eat food you think is unlikely to make you nausous (dry cereal) at home then leave Make fake vomit and look at it Watch gross videos of people throwing up Watch mild videos or cartoons of people vomiting Watch detailed videos of people throwing Look at pictures of vomiting Look at pictures of vomit in a safe place (home or the doctor's office) Watch someone pretend to throw up Choking Eat food that is difficult to chew Eat normal-size bite of food you are afraid might choke you Eat a small bite of food you are afraid might choke you Eat without drinking Talk while eating Swallow as quickly as possible 10 times in a row without drinking water Eat meat Eat chunky food Wear a turtleneck Wear a tight collar and necktie Eat while wearing a necktie tied tightly Eat while wearing a turtle neck shirt Other Items PDF Temporary ID: ********* Timestamp: ********* Download Email You may enter up to three email addresses to receive your worksheet. 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