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(p. 89) Establishing a Hierarchy of Agoraphobia Situations 

(p. 89) Establishing a Hierarchy of Agoraphobia Situations
(p. 89) Establishing a Hierarchy of Agoraphobia Situations

Michelle G. Craske

, and David H. Barlow

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date: 21 May 2022

This chapter assesses the process of establishing an individualized hierarchy of agoraphobia situations for the client, in preparation for in vivo exposure. A hierarchy composed of situations that range in anxiety level from mild to moderate, and all the way up to extremely anxious, will form the basis of a graduated approach to in vivo exposure. Although exposure exercises are not scheduled to take place for the next couple of weeks, it is important to introduce the hierarchy now. It is important to take into account the various conditions that moderate levels of anxiety, such as distance, being accompanied or being alone, the time of day, proximity to an exit, and so forth. Clients’ reliance on safety signals, safety behaviors, and distractions are also restated as other forms of avoidance that will interfere with corrective learning and contribute to anxiety in the long term. Thus, the goal of treatment is to learn to face agoraphobia situations without these forms of avoidance.

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