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 ROCD 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 15 – ‘Anxiety Hierarchy’. In the box provided, write the name of your ROCD. Next, map the earlier five worksheets and fill out the triggers, obsessions, associated compulsions and contradictions (if any) in Worksheet 15. The second column (after serial number) is Presentation of OCD. Note down all the presentations that you have observed in yourself here from Worksheet 2. The next column is Triggers. Under triggers, everything that triggers you needs to be filled in. Use Worksheet 10 to fill this column.

Triggers may lead you to some general obsessions, which you can fill under the Obsessions column. Use Worksheet 11 for filling in your obsessions. Use the statements under column ‘Distancing from Obsessions’ instead of the ‘Obsessions’ column. So instead of writing, ‘What if my partner is cheating on me?’ write, ‘Kay is telling me that my partner is cheating on me’. Once all the triggers and obsessions are listed down, use the SUDS to fill in the SUDS column with the SUDS score. Look at each obsession and determine how much anxiety you would experience if you were disallowed from performing your compulsions to deal with the obsession. 

These obsessions may lead to compulsions that you may do to reduce the anxiety you experience. Use Worksheets 12, 13 and 14 to fill in the compulsions, again using the ‘Distancing from Compulsions column’. Worksheets 13 and 14 offer better insight so that you can handle your compulsions better.

If you see, 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. We shall look at them in the subsequent sections. 

In the next chapter, we shall look at reorganizing the Anxiety Hierarchy. 

To-Do:

Fill WS15 – the anxiety hierarchy (up to compulsions)