Graded Exposure Record

Example Exposure Worksheet

Here is an example exposure record form. This situation involves a person who experiences high anxiety visiting a supermarket to buy groceries.

Therapist and client jointly agreed on this activity from the list of potential exposure tasks because the predicted Subjective Units of Distress (SUDS) score was the lowest from the list of available items.

Exposure worksheet

The exposure record form consists of seven columns

• Situation: Record specific details about the feared activity, focusing on behaviours and/or tasks that are performed in the situation.
• SUDS Rating: The degree of anxiety or distress predicted to occur when you enter the situation, using a scale of 0 (no distress) to 100 (worst imaginable distress).
• Plan: Write your plan to cope with the anxiety provoking scenario. You should identify and practice skills with your therapist before conducting exposure activities.
• Anxiety Before: Rate your ACTUAL anxiety (using a scale of 0 to 10 or 0 to 100 for example) immediately before entering the situation.
• Anxiety During: Rate your ACTUAL lowest and highest anxiety experienced during the exposure activity)
• Anxiety After: Rate your ACTUAL anxiety immediately after exiting the situation