How to Break Down Overwhelming Fears in ERP (Step-by-Step Worksheet)

One of the things I’ve noticed in therapy sessions with clients is that when I explain the concept of Exposure and Response Prevention (ERP) many people worry that it will be too much for them, telling that even though they agree in principle with the model, their own particular fears are just too big and they feel overwhelmed, not knowing where to start. In fact, research notes that ERP sometimes is not as effective as it could be, but not due to the model, rather due to pitfalls not being address, and I want to address one in this article. In a previous article, I explained how to construct your exposure hierarchy and today I want to help you overcome the fear of starting by breaking down complex fears into structured exposure steps so ERP becomes manageable and effective. If you’ve worked with me before you probably heard me say, that that is the beauty of models, they break seemingly overwhelming fears into smaller parts that we can see and understand and I shall show you how to do the same, in what are hope, are simple steps.

To help you get on board with model, I recommend reading the Rationale for doing ERP. If you want a detailed read on the model, please see my Complete Guide to ERP.

Step 1: Define Your Core Fear Clearly

Before breaking it down, clarify exactly what you fear. A broad fear like “I’m afraid of getting sick” or “I’m afraid something bad will happen” needs more specificity.

Ask Yourself:

• What is the worst possible outcome I fear?
• What specific situation triggers this fear the most?
• What compulsions do I do to reduce this fear?

Example: Instead of “I’m afraid of getting sick,” break it down into:

• “I’m afraid of touching public surfaces because I might catch a disease.”
• “I’m afraid of not washing my hands properly and getting ill.”
• “I’m afraid of feeling nauseous and not being able to stop it.”

Each of these is now a specific concern that can be addressed in ERP.

Step 2: Identify the Behaviours Keeping the Fear Alive

Fears persist because of compulsions—behaviours used to feel safe. Identifying these is key to structuring effective exposures. If you need to, you can read more on compulsions in my Guide to OCD.

Common Compulsions That Maintain Fear:

• Avoidance (staying away from feared situations, people, or objects)
• Checking (Googling symptoms, checking body sensations, etc.)
• Reassurance-seeking (asking others for safety confirmation)
• Mental reviewing (going over the fear repeatedly in your head)

Example for health anxiety:

• Compulsion: Googling symptoms
• Exposure: Purposefully not Googling and sitting with the uncertainty

Step 3: Break the Fear into Smaller Exposure Steps

Jumping straight to the most feared exposure can feel impossible. Instead, use a gradual step-by-step approach by creating a structured exposure hierarchy.

The 3-Level Breakdown Method

1. Low-Level Exposures (Mildly uncomfortable)
2. Medium-Level Exposures (Moderate discomfort)
3. High-Level Exposures (Your biggest fear)

Example: Fear of Contamination from Public Places

Low-Level Exposures:

• Touching your own bathroom sink without washing hands immediately
• Letting your phone touch a table without wiping it

Medium-Level Exposures:

• Touching a doorknob in a public building
• Eating food without washing your hands first

High-Level Exposures:

• Using a public toilet and not washing hands for a set time
• Shaking hands with someone and not washing immediately

Gradually increasing difficulty allows confidence-building at each step.

Step 4: Make Exposures More Specific

If an exposure still feels too broad, narrow it down further.

Example: “I’ll sit with the thought that I might have a disease.”

• What specific thought?
• How long will I sit with it?
• What will I avoid doing (e.g., no Googling)?

Example: “I’ll touch something dirty.”

• What specific object?
• How long will I resist washing my hands?
• What thought will I practice sitting with?

Making exposures specific reduces avoidance and makes progress measurable.

Step 5: Track Your Progress and Adjust as Needed

Keep a record of your exposures, distress levels (SUDs), and anxiety duration. If an exposure is too hard, break it into smaller steps. If it feels too easy, move to the next level.

Example of an ERP Progress Log:

Tracking your progress proves that anxiety naturally fades over time.

Final Tips for Success

If your fear feels too big, break it down further—start as small as needed. Expect anxiety at first, but trust that it will drop as you practice. If you feel “stuck,” check for hidden compulsions (e.g., mentally reassuring yourself). Keep pushing forward—if an exposure feels too easy, challenge yourself with the next step.

Downloadable Resource: Exposure Hierarchy Worksheet

To help you apply this, I’ve created a free downloadable Exposure Hierarchy Worksheet. This will guide you through creating structured exposure steps and tracking your progress.