A core component of exposure therapy is working up a fear ladder gradually, from less anxiety-provoking situations to more anxiety-provoking situations. With older children and adults, it is possible to ask them about their levels of anxiety, while with younger children the therapist needs to be attuned to the way that each child expresses their anxiety to gauge anxiety levels. Below are examples of the fear ladders for some of the children who have engaged in this therapy, illustrating how the exposures for these children gradually moved up the fear ladder. Fear ladders are tailored to each individual child. The children here vary in age, developmental level and intensity of their fear at the beginning of intervention.
Vacuum Cleaners | Blenders | Blood Pressure Cuff | Hand Dryers
Vacuum Cleaners
In this video example, you will observe how a therapist works through a fear ladder with Andy, a child who is fearful of vacuum cleaners. The clinician begins with exposure to a toy vacuum cleaner, which after a very short time does not elicit a lot of anxiety for Andy, and gradually builds his tolerance to a working vacuum cleaner using play, humor, and games.
Blenders
In this example, the therapist gently guides the child through exposures to the previously feared stimulus using play and humor approaches. The type of exposure (e.g., indirect or direct contact, using a toy or the real item) as well as the intensity of the exposure (e.g., gradually louder volume) is ultimately determined by the child’s progress and mastery of the previous fear ladder step.
Blood Pressure Cuff
Here is an example of a fear ladder for a child who has strong reactions to blood pressure measurement – particularly the blood pressure cuff. The therapist gently guides the child’s exposure to varying intensity levels of the feared stimulus, which in this example is the blood pressure cuff. The clinician works flexibly and adaptively to accommodate the child’s needs and ability levels including language skill level.
Hand Dryers
In this video example, the clinician works with a child named Don, who is fearful of hand dryers. The clinician works through a fear ladder using gradual exposures to less challenging stimuli (videos, toys) then more challenging stimuli (toy hand dryers with louder sound and real hand dryers in public restrooms) as the child demonstrates reduced anxiety and avoidance.