Panic Disorder and Agoraphobia Hierarchy
Panic and Agoraphobia Exposure Hierarchies
Patients with panic disorder are often hypervigilant to their bodies, so they begin to avoid any activities that produce physical discomfort. They also tend to avoid any activity/situation in which they have had a panic attack before, even if it was something that they have always loved. With time, this can severely restrict their lives. The activities on the list below are meant to re-expand your comfort zone.
Rate each activity on a 0-100 anxiety scale for how anxious it would make you feel on a typical day (with "100" being the most anxious you've ever felt and "0" being totally calm). Activities currently rated between a 20 and a 60 are usually good to try as Real-Life Exposures. With repetition, you should notice that any particular activity becomes easier with time. You can then move on to a harder activity on your list. You can also re-rate the hierarchy periodically to track your progress.
Panic and Agoraphobia Exposure Hierarchies
“Safety Object” (i.e. medications, water, food, a cell phone)
- Leaving the safety object nearby instead of in your pocket/purse
- Leaving the safety object in your car for one hour
- Leaving the safety object in your car all day
- Leaving home without the safety object for one hour
- Leaving home without the safety object all day
Drinking Coffee
- Drinking just one sip of tea
- Drinking half a cup of tea
- Drinking a full cup of tea
- Drinking just one sip of decaffeinated coffee
- Drinking half a cup of decaffeinated coffee
- Drinking a full cup of decaffeinated coffee
- Drinking just one sip of caffeinated coffee
- Drinking half a cup of caffeinated coffee
- Drinking one cup of caffeinated coffee
Exercising
- Doing 5 jumping jacks in a row
- Doing 10 jumping jacks in a row
- Doing 20 jumping jacks in a row
- Doing 50 jumping jacks in a row
- Exercising for 20 minutes
- Exercising for 40 minutes
- Exercising for an hour
Driving your Car
- Looking at your car
- Sitting in your car
- Driving around the block once
- Driving in your neighborhood for 5 minutes
- Driving in your neighborhood for 15 minutes
- Driving outside your neighborhood for 5 minutes
- Driving outside your neighborhood for 15 minutes
- Driving on the freeway for one exit in the slow lane
- Driving on the freeway for 5 minutes in the slow lane
- Driving on the freeway for 5 minutes in a middle lane
- Driving on the freeway for 5 minutes in the fast lane
- Driving on the freeway in traffic for one minute
- Driving on the freeway in traffic for 10 minutes
- Driving a medium distance away from your home
- Driving a long distance away from your home
Being in a Crowd
- Sitting in a park
- Sitting in a coffee shop
- Sitting in a mall
- Going to a party
- Going to a concert
Eating at a Restaurant
- Drinking water alone in a restaurant
- Eating a small item alone in a restaurant
- Eating a meal alone in a restaurant
- Eating a small item with a close friend (who knows what you are doing)
- Eating a meal with a close friend (who knows what you are doing)
- Eating a small item with a friend (who doesn’t know what you are doing)
- Eating a meal with a friend (who doesn’t know what you are doing)
- Eating a quick meal with a group
- Eating a long meal with a group
Flying in an Airplane
- Riding in a bus
- Riding in a subway
- Driving to the airport
- Sitting in the airport
- Taking a short flight with medication
- Taking a short flight without medication
- Taking a medium flight with medication
- Taking a medium flight without medication
- Taking a long flight with medication
- Taking a long flight without medication
Watching a Movie in a Theater
- Sitting in the back row near the aisle for 5 minutes
- Sitting in the back row near the aisle for 30 minutes
- Sitting in the back row near the aisle for the whole movie
- Sitting in the middle row near the aisle for 5 minutes
- Sitting in the middle row near the aisle for 30 minutes
- Sitting in the middle row near the aisle for the whole movie
- Sitting in the middle row far from the aisle for 5 minutes
- Sitting in the middle row far from the aisle for 30 minutes
- Sitting in the middle row far from the aisle for the whole movie