How to use a 'hierarchy of fears'

This really useful technique relies on the fact that it’s impossible to be relaxed and tense at the same time.
Although, as most of our readers are hypnotherapists, we're assuming you will use this technique in trance, if your client is contraindicated, or you work in some other modality, you can use this approach without a hypnotic induction.

Creating a hierarchy of fears

Firstly, out of trance, ask the client to make a list of what they fear, starting with the least scary aspect of it and ending with the scariest. Assign a SUDS score to each level. As an example, for someone scared of sharks that might be:

• A cartoon shark like the one accompanying this article – 1   
• A realistic drawing of a shark - 3
• Touching a cuddly toy shark – 5   
• Looking at a photo of a real shark – 5
• Watching a video of a real shark – 6  
• Being around a real shark, for example in a sea life centre – 10

I'd suggest restricting this list to no more than a dozen or so items. It's useful to use a pro forma for this; please ask for my free 'Fear Hierarchy worksheet' if you want to use it with your clients

Safely expose the client to their fears

Before you start this step, make sure your client knows at least one relaxation technique and set up a positive anchor or stacked positive anchors.

• Achieve deep relaxation in trance, and go to a safe place. 
• Ask the client to imagine being around the lowest item in the hierarchical list and let you know when their fear reaches the scored level. In our example, ‘imagine looking at a cartoon shark’ and letting it reach 1/10.
• Talk them through using the relaxation technique and setting off the positive anchor, make suggestions about reducing fear/anxiety, then ask them to score the fear again by saying a number aloud. It should have gone down. 
• Keep using the anchor and the relaxation until it goes all the way down to a zero. That may take some time but don’t move on until the fear is definitely at zero. If you move on too soon it won’t work properly.
• Once it’s at zero for the cartoon, move on to the next step (a realistic drawing of a shark at 3/10 in the example) and repeat the same procedure.

Essentially you do the same with each item on the list, working from easiest to hardest. It’s very repetitive and it may take several sessions to work your way through the whole hierarchy. Take your time and do not move on to the next stage until the client is 100% confident at the current one. Don’t be afraid to add extra help, like a dial for turning down the fear in addition to the relaxation technique and anchor, if it helps.

Tips when using a hierarchy of fears with clients

• It can take a long time to get the first couple of items down to zero. Be patient, sooner or later most clients will get ‘on a roll’ and the scores will reduce more quickly.
• If you hit a problem and they can’t reduce something to zero, one of the following may help.
• teach a different relaxation exercise or strengthen the anchor 
• go back to the previous item on the list and build their confidence again 
• dissociate the client slightly, for example, watching another person (or an image of themselves) looking at a real shark before imagining doing it themselves.
• If none of this helps, consider moving to a different de-sensitisation technique for that item.
• After you have the first three or four items down to zero, ask the client to check their original hierarchy and tell you if any of the higher scores have changed. Often, they have come down spontaneously as you cleared out the items underneath. If it’s a long list, do this periodically.
• If you don’t get whatever you are working on down to zero by the end of a session, add some suggestions that it will stay at whatever it is at that point until the next session, and go back and pick up where you left off when you see them again.
• Always finish each session on a good result/at the end of a level and add self-esteem and confidence boosting suggestions before awakening.

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Author: Debbie Waller is an experienced hypnotherapist and hypnotherapy trainer. She is the author of Their Worlds, Your Words and has co-written the Hypnotherapy Handbook, both of which are available from Amazon.
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