Fear Hierarchy Worksheet

What is a Fear Hierarchy?

A Fear Hierarchy is a concept that arranges specific fears from most terrifying to least terrifying or vice versa. When we say “specific,” we mean specific to whoever is creating a fear hierarchy because every person has different sets of fears. Even if people share the same fears, the intensity of how they feel about these fears will differ.

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An example would be the fear of heights. Let’s stipulate two people share this fear. However, one of them fears heights to a degree that they cannot stand being in high places, even if they are safe because of railing, flooring, and other structures that will keep them from falling. The other person fears heights, but they can still go to high places (e.g., mountain paths, upper floors in tall buildings, etc.) so long as they know that their safety is accounted for.

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The concept of the Fear Hierarchy is sometimes used in mental health therapy, most notably Exposure Therapy. This type of therapy has professionals expose patients to their triggers. In this context, it would be their fears. The goal is to expose them enough that they become desensitized to it over time, though note that this could fire back as well and heighten their fears even more, so if you practice this, proceed with caution.

How to use the Fear Hierarchy Worksheet

The Fear Hierarchy Worksheet takes this concept and turns it into an exercise. It is used as a way for mental healthcare professionals to understand the kinds of fear their patients have and how distressing each fear is for them.

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Using it is easy. The instructions will ask the person engaging with the worksheet to list their fears. They can list down anything, from objects to concepts, even situations. They can even list down “ridiculous” kinds of fears; the worksheet (and the therapist, supposedly) doesn’t judge.

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They also have to list these in order of what they fear the least to what they fear the most. 

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There is also a column that’s specifically used to indicate if the patient avoids these fears.

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This worksheet doesn’t have any scoring. It’s just for listing things down. What the therapist will do once they receive an accomplished copy of this worksheet will depend on the type of therapy they practice and what they’re planning to do to help the patient work through these fears.

Fear Hierarchy Worksheet Example

Now that you know what a Fear Hierarchy is and what the Fear Hierarchy Worksheet is all about, it’s time for you to see what it looks like. The look of this worksheet is as simple as the instructions. It’s separated into four columns:

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• The first column is for indicating the rank of the fear from lowest to highest

• The second column is for listing the actual fears

• The third column is for indicating if they avoid these fears or not

• The last column is for rating each fear in terms of how distressing they are for the patient. This one should reflect the ranking of each fear as well

Download this Fear Hierarchy Worksheet Example:

When is it best to use the Fear Hierarchy Worksheet?

The best time to issue the Fear Hierarchy Worksheet is during the middle of your mental health therapy sessions with your patients. To clarify what we mean when we say “in the middle of your therapy sessions,” we mean when you’ve gone past the stage of getting to know your patient and trust and rapport have been established. The reason why you shouldn’t issue this immediately is that your patients might not be willing to talk about their anxieties and fears, especially ones that might seem “trivial."

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Issuing this during the middle of your program is the best time to do so because this is (supposedly) the phase where your patient trusts you and is willing to talk about their anxieties and fears. The middle phase of a therapy program is usually when patients reveal what is specifically contributing to (or has the potential of contributing to) their anxieties. It’s also the phase where you should be developing ways to support them and even teach them certain things to cope better with their anxieties and fears, especially if they are fears that they have difficulty avoiding.

What are the benefits of using this Fear Hierarchy Worksheet?

Help professionals understand what distresses their patients.

Even if trust and rapport have been established, that doesn’t necessarily mean that the patient will reveal things about their lives that contribute to their mental health issues. Issuing the Fear Hierarchy Worksheet will allow the professional to learn about the specific fears of a patient, which might be notable factors of what’s causing their anxieties or psychological distress. Knowing what triggers their anxieties and distress is essential to therapy because if the professional isn’t aware of these, they won’t be able to do their job.

Help patients reflect on their fears.

Since we’re talking about fears, most people will do everything they can to avoid thinking about them or getting into situations where their fears may come to life. That’s not the same as establishing emotional distance to properly assess these fears. Since this worksheet will likely be used in therapy settings, patients can think about their fears from a more “objective” standpoint. This means they can adequately think about why they fear what they fear, how distressing they are, and if they can avoid them. By establishing the necessary distance to think about these, they open up the opportunity to develop ways to work through these fears.

Help professionals determine what to teach patients and how to support them.

To jump off the previous point, the Fear Hierarchy is also beneficial for mental healthcare professionals for the same reason. Once their patients can think more clearly about their fears and triggers, professionals can work with them to develop ways for the patient to ward off these fears, work through them, or overcome them completely. They can focus on factors like why they can’t avoid certain fears and then formulate plans on avoiding them, or if not avoiding them, determine how to cope healthily. Another would be Exposure Therapy, but as we mentioned earlier, this type of therapy is considered problematic, so proceed with caution and get your patient’s consent before exposing them to their fears.

Why use Carepatron for mental health therapy-related work?

Since you’re reading this guide, you’re likely to be a therapist, psychologist, counselor, or an adjacent mental healthcare professional. If so, then welcome! We hope this guide was informative and the Fear Hierarchy template helps you. We’d also like you to take the time to explore more of our platform because you’ll surely find more things that will help your practice.

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One of the features we have (and one that we’re quite proud of) is our resource library. This library houses a massive collection of guides and resources, like this Fear Hierarchy Worksheet. It covers a wide range of healthcare practices, especially mental health therapy! We have numerous worksheets (from Cognitive Behavioral Therapy to Art Therapy), assessments that can be used to gauge symptoms of mental health issues, survey templates you can use to know how patients feel about their experience, general treatment plans, and much more. Our resources are all free – download as much as you want and need!

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If you subscribe to our platform, you will gain access to our useful storage system, which allows users to store their clinical documents with us in a HIPAA-compliant manner. This means that even if they’re storing them with us, we can’t access them because only the user can dictate who can access their files. If you have filled-out Fear Hierarchy Worksheets, you can store them with us!

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Storing files with us is the same as creating backups of your files. In the event your physical files, files in personal cloud storage because you lost access to the cloud storage, or your work device stops working and can’t be fixed, you can redownload your files from the storage, reprint them, upload them to a new personal cloud storage, and/or store them in a new work device.

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Not only will Carepatron help you streamline your workflow and provide you with resources, but we can also help preserve your work by securing them!