How to Build and Use a Fear Ladder
A fear ladder is a list of small steps toward something you avoid, ordered from easiest to hardest, that you work through one at a time. It is a way to organise gradual exposure: NHS inform says treating simple phobias involves gradually becoming exposed to what causes your fear, and that you might use your own self-help strategy.
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1. Why avoidance matters
NHS inform puts it this way: many people are afraid of things, and fear only becomes a phobia when you begin to organise your life around avoiding your fear.
The NHS page on panic disorder describes the same pattern with panic attacks: you may start to avoid certain situations because you fear they will trigger another attack. That can create a cycle of living “in fear of fear”, which can add to your sense of panic and may cause you to have more attacks.
NIMH describes exposure therapy as a common method within cognitive behavioral therapy (CBT) that focuses on confronting the fears and beliefs linked to panic symptoms, to help a person engage in activities they have been avoiding. A fear ladder breaks that into steps you choose.
2. Test a prediction on every step
Craske and colleagues (2014) describe an inhibitory learning approach to exposure therapy, written for clinicians. The first of the strategies they list for getting more out of exposure is expectancy violation. Others on their list are removing safety signals, variability, and practicing in multiple contexts.
The practice log on each ladder asks you to test your expectation:
- Before the step: write down what you expect to happen and how sure you are.
- During and after: rate your fear just before, at its highest, and at the end, from 0 to 100.
- Afterwards: note whether what you expected happened (yes, partly or no) and what actually happened.
3. How the ladders on this site are built
Each ready-made ladder here has 10 to 14 steps, and each step says what to do. Each one carries an example fear rating from 0 to 100. These numbers are examples, not measurements: replace them with your own.
- The first step is rated 30 or lower in our examples, so there is a place to start.
- The last step is rated 80 or higher.
- Neighbouring steps differ by no more than 20 points, so no step is a sudden jump.
- Different kinds of step: each ladder mixes at least two of these: imagining the situation (or watching videos and photos), getting near it, and doing it in real life.
You can edit, add, remove and reorder steps.
4. Dropping safety behaviors
Craske and colleagues list removing safety signals among their strategies for exposure. Each ladder on this site names things people may do to feel safer in that situation.
You do not have to drop them all at once. You can make dropping one of them a step of its own. Only drop what anxiety adds: anything that genuinely keeps you or others safe stays.
5. If panic comes during a step
The NHS suggests that the next time you feel a panic attack coming on, you:
- stay where you are, if possible (if you are driving, follow your ladder's own stop rules)
- breathe slowly and deeply
- remind yourself that the attack will pass
- focus on positive, peaceful and relaxing images
- remember it's not life threatening
The NHS says most panic attacks last between 5 and 20 minutes, and that although they are frightening, they are not dangerous. NIMH says the physical symptoms usually resolve with time. The NHS also notes that most of these symptoms can also be symptoms of other conditions, so you may not always be experiencing a panic attack. Once you are somewhere safe, you can use the free Panic Reset.
6. When to get help
This site is a self-help tool. NIMH says that if your anxiety starts to cause problems in everyday life, such as at school, at work, or with friends and family, it is time to seek professional help, and that a primary care provider can refer you to a qualified mental health professional.
NHS inform says agoraphobia and social phobia are two common examples of complex phobias, that speaking to a GP about your anxiety may help to identify a complex phobia, and that treatment for complex phobias often takes longer than for simple phobias.
In the US, if you or someone you know is struggling or having thoughts of suicide, NIMH says to call or text the 988 Suicide & Crisis Lifeline at 988, or chat at 988lifeline.org, and in life-threatening situations to call 911. The 988 Lifeline offers free and confidential support across the United States and its territories.
Ready to start your ladder?
Pick a ready-made ladder for a situation, or build your own in your browser.