Behavioral Experiment

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Step ladders

5 minute read

Sometimes the best test of a fear is too big to attempt. Giving the presentation, driving on the highway, eating alone in a restaurant. Trying it straight away can be overwhelming, and a bad first attempt can leave you more convinced than before. A step ladder breaks the goal into rungs you can climb.

Building one

The Centre for Clinical Interventions describes three steps, and the app follows them.

  1. Pick an area for change and a goal. One goal at a time. Make it specific enough that you would know when you got there: "eat lunch in the break room with colleagues twice a week," not "be more social." 2. Name the fear. What do you predict will happen in these situations? This becomes the belief the whole ladder is testing. 3. Brainstorm situations. List things that would bring on the fear, from the nearly easy to the goal itself. Aim for somewhere between five and ten. Then rate each one for how much distress you expect.

To make a step easier or harder, change one variable at a time: who is there, how many people, how familiar the people and the place are, what you do, when, where, and for how long. The same activity at a quiet time with a friend is a different rung from the same activity at a busy time alone.

Rating distress

The scale runs from 0 to 100 and is often called SUDS, for subjective units of distress. It was introduced by Joseph Wolpe in the 1960s and is still used because it is quick and it works well enough. Rough anchors:

Your numbers are yours. Nobody else can rate your steps, and the ratings only need to be consistent with each other so that the ladder sorts into an order you recognize.

Climbing it

Start where you are willing. There is no correct number of steps and no correct order. If you are ready to begin high, begin high. The only rule is to find a rung you will actually do.

Repeat before you climb. Do a step several times, close together, before moving up. One good result is easy to dismiss as luck. Three are not.

Stay long enough to test the prediction. Leaving at the peak of the urge to escape teaches you that escape was necessary. Staying teaches you that the feeling passes, and it lets you collect the evidence you came for.

Make each rung an experiment. A ladder step on its own is just exposure. Adding a prediction, dropping a safety behavior, and recording what happened turns it into learning. In the app, tap any step to plan it as an experiment.

Expect setbacks. If a step keeps feeling too hard, add a bridging step between it and the last one, go back and repeat the previous step as a refresher, or ask whether there is an untested prediction hiding underneath that needs its own experiment.

A note on hierarchies

The Oxford group points out that when the focus is on testing a belief, a formal hierarchy is often unnecessary. You choose situations by how well they test the belief and whether you are willing to try them, not by their position on a list. Use the ladder when the goal feels out of reach. Skip it when the best test is something you could do this afternoon.

A ladder puts the steps in order. The learning comes from what happens on each rung, whatever the number next to it.

References

Helpful links

Educational content, not medical advice or a substitute for professional care. Ready to try it? Open the online worksheet or get the app.