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What this tool is built on

Graded exposure is one of the better-evidenced things in clinical psychology. This page says which parts of that evidence the builder actually relies on, and where the suggested steps come from.

Where the rungs come from

They are not generated by a language model and they are not improvised here. When you name a fear, this page sends it to Bia, which maps it onto one of the conditions it has a tuned exposure library for and returns a graded ladder built by the same scoring engine that runs inside the app: real activities from a curated catalog, ordered by difficulty, each with an estimated distress rating on the 0 to 10 scale.

Where a fear falls outside that set, Bia says so by returning a broader anxiety and avoidance ladder rather than a condition-specific one. It is still a reasonable starting point, and it is still yours to edit.

What the tool does not do

• It does not diagnose anything. Nothing here reads a score and tells you what you have.
• It does not decide whether exposure is appropriate for a given person. That is a clinical judgement, and there are people for whom a graded ladder is not the right first move.
• It does not screen for risk beyond refusing to build a plan when the words you type suggest a crisis, at which point it shows crisis lines instead.

The reference list

• Psychotherapy by Reciprocal Inhibition

  Wolpe, J. (1958) — Where systematic desensitisation, the graded hierarchy and the 0 to 10 SUDS scale come from.

• Emotional processing of fear: exposure to corrective information

  Foa, E. B. and Kozak, M. J. (1986), Psychological Bulletin — The habituation account of exposure: activate the fear structure, then supply information that contradicts it.

• Optimizing inhibitory learning during exposure therapy

  Craske, M. G. et al. (2008), Behaviour Research and Therapy — The argument that within-session habituation predicts outcome poorly, and that expectancy violation is the active ingredient.

• Maximizing exposure therapy: an inhibitory learning approach

  Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T. and Vervliet, B. (2014), Behaviour Research and Therapy — The practical version: expectancy violation, variability, removing safety signals, and occasional reinforced extinction.

• Psychological approaches in the treatment of specific phobias: a meta-analysis

  Wolitzky-Taylor, K. B. et al. (2008), Clinical Psychology Review — In vivo exposure outperforms the alternatives at post-treatment for specific phobia.

• One-session treatment for specific phobias

  Ost, L.-G. (1989), Behaviour Research and Therapy — Evidence that a well-built graded hierarchy can be climbed rapidly for circumscribed phobias.

• The importance of behaviour in the maintenance of anxiety and panic

  Salkovskis, P. M. (1991), Behavioural Psychotherapy — Why a completed exposure with a safety behaviour attached leaves the original prediction intact.

• Exposure therapy for anxiety disorders

  Kaczkurkin, A. N. and Foa, E. B. (2015), Dialogues in Clinical Neuroscience — A clinical overview of exposure across the anxiety disorders, including hierarchy construction.

• NICE guideline CG113: Generalised anxiety disorder and panic disorder in adults

  National Institute for Health and Care Excellence — CBT with exposure as a first-line psychological treatment in the UK.

The Bia hand-off maps your ratings straight onto the SUDS its hierarchy builder already expects, so nothing is re-estimated when a plan is opened there.