ERP In Vivo Exposure Homework Form: Tracking Exposure Practice & SUDS Ratings

This worksheet guides clients through the essential self-monitoring phase of Exposure and Response Prevention (ERP) by providing a structured framework for documenting “In Vivo” (real-life) exposure exercises. The layout allows for the tracking of five distinct exposure trials, requiring clients to record the date, time, and specific situational context of their practice. A critical clinical component of this tool is the triple-point Subjective Units of Distress Scale (SUDS) monitoring system. By asking clients to rate their anxiety “Before,” “After,” and at the “Peak” of each exposure on a 0–10 scale, the worksheet provides a granular view of the client’s emotional arc and their ability to tolerate physiological arousal without resorting to compulsions.

The structured layout is designed to facilitate “Habituation” and “Inhibitory Learning.” By visualizing the trajectory of SUDS ratings across multiple trials, clients gain empirical evidence that anxiety naturally peaks and then dissipates when response prevention is maintained. This process is essential for deconstructing the belief that anxiety is dangerous or permanent. By documenting these real-world experiments, the worksheet serves as a vital bridge between the clinical session and the client’s natural environment, ensuring that the work of recovery continues consistently outside the office.

How This Worksheet Can Be Used

Clinical Review and Troubleshooting:
Therapists use the form as the primary agenda item for individual ERP sessions. By reviewing the “Peak” and “After” scores, the clinician can identify if an exposure was too difficult, if the client engaged in subtle safety behaviors, or if they are ready to move higher up the fear hierarchy.

Evidence of Mastery:
This tool is highly effective for clients who feel they are not making progress. Showing them a week’s worth of forms where SUDS ratings consistently drop from “Peak” to “After” provides tangible proof of their growing distress tolerance and resilience.

Between-Session Compliance:
Clients use the form as a behavioral contract. The requirement to document five specific trials encourages consistent daily practice, which research suggests is a significant predictor of successful treatment outcomes in OCD and phobia recovery.

Benefits of the ERP In Vivo Exposure Homework Form

• Provides a structured format for high-frequency real-world exposure practice.
• Utilizes a triple-SUDS tracking system (Before, Peak, After) to visualize habituation.
• Identifies patterns in anxiety triggers and physiological responses across different times of day.
• Supports “Inhibitory Learning” by proving that distress is tolerable and finite.
• Reduces “Recall Bias” by requiring real-time documentation of emotional intensity.
• Builds clinical self-efficacy by quantifying successful resistance to compulsions.

Integrating This Tool into Clinical Work

Integrating the ERP In Vivo Exposure Homework Form is most effective when clinicians emphasize that “the Peak score is the learning score.” Clinicians should guide clients to stay in the exposure until the “After” score shows a significant reduction from the “Peak,” reinforcing the biological reality of habituation. If the “After” and “Peak” scores remain identical across multiple trials, the clinician should use the form to investigate the presence of “mental rituals” or safety behaviors. It is vital to validate the courage required to reach a SUDS of 8 or 9 intentionally. By consistently reviewing these homework forms, the clinician reinforces the idea that the client is an active participant in their own neurological retraining, leading to a more autonomous and unrestricted life.

References

• Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. H. (2019). Exposure Therapy for Anxiety: Principles and Practice. Guilford Press.
• Craske, M. G., et al. (2014). Maximizing inhibitory learning during exposure therapy. Behaviour Research and Therapy.
• Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin.
• Hyman, B. M., & Pedrick, C. (2010). The OCD Workbook: Your Guide to Breaking Free from Obsessive-Compulsive Disorder. New Harbinger Publications.