Exposure log

The exposure log is the unit of exposure-based therapy. The client faced something they normally avoid; you log what they faced, how distressing they expected it to be, how high the distress actually got, and where it ended. Over a series of these, the patterns (predictions getting more accurate, peaks getting lower, ends getting closer to baseline) become the client’s evidence that exposure works. Wolpe introduced the SUDS scale in 1958. Foa formalized exposure logging for PE in 2007. The before/peak/end triplet has become standard across PE, ERP, and modern exposure-based CBT.

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What it captures

Six fields, single-exposure entry:

• What you faced — the situation (textarea)
• How distressing you expected it to be — 0-10 predicted SUDS
• Highest it actually got — 0-10 peak SUDS
• Where it ended — 0-10 end SUDS
• How long, in minutes — duration
• What you noticed (optional) — context, thoughts during, what helped

No total score — the clinical signal is the comparison: predicted vs peak vs end across a series of entries.

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The three SUDS readings each do different work

• Predicted vs peak. The gap between what the client expected and what actually happened is the expectancy-violation data that drives inhibitory-learning models of exposure. Predictions that systematically exceed peaks are the cognitive shift exposure produces.
• Peak vs end. Within-session habituation — the within-trial drop from peak to end. This is the data point most clients track intuitively (“it got easier the longer I stayed in it”).
• End across exposures. Between-session habituation — the end-SUDS trajectory across repeated exposures to the same item. Each successive end-SUDS that’s lower than the last is the durable reduction.

The Inhibitory Learning model (Craske 2014) downweights peak-to-end habituation as the mechanism and emphasizes expectancy violation. Rivet’s log captures both — the practitioner reads whichever pattern matches the treatment model in use.

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When to use it

• Every exposure attempt. In PE for PTSD, in ERP for OCD, in graded exposure for panic, social, GAD — every time the client did the exposure, it gets logged immediately after.
• In-session in-vivo work. When you’re doing the exposure in the session (a panic interoceptive exposure, an in-vivo OCD trigger), the log is filled in real time.
• Reviewed weekly. You look at the spread of predictions, peaks, and ends across the week, identify the patterns, and adjust the hierarchy.

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In-session mechanics

Templates → Exposure log, the renderer opens with all six fields visible on one screen. The three SUDS sliders sit on top of each other so the comparison is visual. For a between-session log being reviewed in the next session, you fill the fields from what the client tells you. For in-session in-vivo work, the predicted-SUDS goes in before the exposure starts, peak and end during and after.

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Citation

Wolpe, J. (1958). Psychotherapy by Reciprocal Inhibition. Stanford University Press. Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences. Oxford University Press. Foa, E. B., Yadin, E., & Lichner, T. K. (2012). Exposure and Response (Ritual) Prevention for Obsessive-Compulsive Disorder: Therapist Guide (2nd ed.). Oxford University Press. Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). “Maximizing exposure therapy: An inhibitory learning approach.” Behaviour Research and Therapy, 58: 10-23. The SUDS-rated exposure structure is published clinical method since 1958 and is uncopyrightable. All field labels are original. VA MIRECC Prolonged Exposure materials (US Federal, public domain) used as a paraphrase reference only.

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When not to use it

• Trauma processing without a PE or ERP framework. Exposure for PTSD outside a manualized protocol (PE, NET, EMDR phase 4) can re-traumatize. The log is a tool inside an exposure-based treatment, not a standalone intervention.
• Acute crisis or destabilization. Exposure work is contraindicated when the client is in active suicidal crisis, recently psychotic, or unable to tolerate within-session distress without leaving the room.
• Dissociation patterns that block engagement. PTSD clients who dissociate during exposure aren’t accessing the trauma memory at the somatic level needed for processing. Stabilization work (grounding, resourcing, calm place) comes first.

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