The anxiety hierarchy is one of the most important worksheets you will fill in your recovery journey. An anxiety hierarchy is a list of all anxiety provoking stimuli arranged from the least anxiety provoking to the most anxiety provoking (Obi & Oguzie, 2019). It is a complete listing of all your triggers, obsessions and compulsions. It provides an understanding of the breadth and depth of your Harm OCD and the presence of any other forms of OCD. It will need to be worked upon and updated continuously. It will be a tool that you will use for regular assessment of the changes in your thoughts.

Refer to the Worksheet 3.18 – ‘Anxiety Hierarchy’. You have to fill part A right now. In the box provided, write the name of your Harm OCD. Next, map the earlier worksheets and fill out the triggers, obsessions, dimensions, associated compulsions, and elements from the compulsion matrix. The following are the columns that need to be filled in.

               Col 1: Serial Number

               Col 2: Presentation of OCD (Worksheet 1.5, Presentation of OCD column)

               Col 3: Triggers (Worksheet 3.4, Trigger column)

               Col 4: Obsessions (Worksheet 3.6, Distancing from Obsession column)

               Col 5: Dimensions (Worksheet 3.7)

Col 6: SUDS (Table 3.13)

               Col 7: Compulsions (Worksheet 3.14, Distancing from Compulsions column)

               Col 8: Compulsion Matrix Combination (Worksheet 3.16, Column B + Column C)

               Col 9: Compulsion Matrix Action Point (Table 3.16, Action Point column)

One trigger does not have to lead to only one obsession and one obsession does not have to lead to only one compulsion. One trigger may lead to multiple obsessions and each obsession may lead to multiple compulsions. Also, some obsessions may be common to more than one trigger and some compulsions may be common to more than one obsession. Overlap is not only possible, but also highly likely and understandable. It is better to identify all obsessions and compulsions even if they are repeated than to miss out on some. This is critical to recovery, so that nothing is left unaddressed. 

Your anxiety hierarchy is likely to be dynamic. Newer triggers, obsessions and compulsions may get added into it all the time, as you learn to recognize them. Older ones will keep getting struck off. As you learn to handle your anxiety better, the SUDS score for some compulsions that you have not even picked up to deal with may also change – it may go down. Your anxiety hierarchy may always keep changing. Do it well, follow it through, and you will see immense progress. There are some more columns in the Anxiety Hierarchy Worksheet (part B). We shall look at them in the subsequent sections.

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