The Cognitive Behaviour Therapist

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The Cognitive Behaviour Therapist (2009), 2:51-62 Cambridge University Press
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2009

Practice article

Dynamic hierarchies: a control system paradigm for exposure therapy

Alec Bradya1 c1 and David Rainesa1

a1 Department of Psychology, University of Chester, Chester, UK
Article author query
brady a [Google Scholar]
raines d [Google Scholar]


Exposure therapy is a widely used and well-evidenced treatment for a variety of avoidance behaviours. This paper offers a modest proposal for an improvement in how it is carried out (‘dynamic hierarchies’). The theoretical and practical context is set out, including some thoughts on the role of appraisals and cognitive dissonance, and some advantages of the method are suggested.

(Received August 22 2008)

(Accepted November 19 2008)

(Online publication January 05 2009)

Key words:Acceptance; behavioural therapy; belief modification; cognitive appraisals; therapy


c1 Author for correspondence: Mr A. Brady, Whittington CBT, 25 Hunshelf Park, Stocksbridge, Sheffield S36 2BT, S. Yorkshire, UK. (email: