How to overcome a phobia step by step: one method and five example ladders
To overcome a phobia step by step, write down exactly what you think will happen, list 8 to 10 small real-world steps towards the thing you fear, rate each one 0 to 10, and start with one you would rate about a 3. Repeat that step, without the little things you do to feel safe, until you have tested your prediction and it feels more dull than scary, then move up one. The part most guides get wrong is how to make a step smaller, because that depends on which kind of phobia you have.
The thing most guides miss
Most step-by-step guides give one set of levers for making a step easier, usually distance, time and how many people are around, and apply them to every fear. In practice the levers are not the same.
The NHS sorts the phobias that only flare up near the thing itself into three groups: animals (it names dogs, insects and snakes), situations (flying, heights, being in a small space) and bodily fluids (blood and vomit). Those groups shrink in different ways.
| Type | What makes a step smaller | What makes it bigger |
|---|---|---|
| Animals (spiders, dogs, birds) | Distance, a barrier between you, the animal staying still, someone else in control of it | Closer, no barrier, the animal moving towards you, you being the one in control |
| Situations (lifts, small rooms, deep water, heights) | Shorter time, an easy way out, company, knowing exactly when it ends | Longer, the exit harder to reach, alone, not knowing when it ends |
| Bodily fluids (blood, needles, vomit) | Pictures before real life, someone else rather than you | Real, close, your own body |
Animals
Spiders, dogs, birds
Smaller
- Further away
- A barrier between you
- It stays still
- Someone else holds it
Bigger
- Closer
- No barrier
- It moves towards you
- You are in control of it
Situations
Lifts, small rooms, deep water
Smaller
- Shorter
- Easy way out
- With someone
- You know when it ends
Bigger
- Longer
- Exit harder to reach
- Alone
- You do not know when it ends
Bodily fluids
Blood, needles, vomit
Smaller
- Pictures first
- Someone else, not you
Bigger
- Real and close
- Your own body
Ever fainted at blood or a needle? Talk to your GP before you practise.
The third group has an extra catch. Guy's and St Thomas' NHS Foundation Trust explains that in some people with needle phobia, heart rate and blood pressure go up and then "rapidly drop", which can make them faint. If you have ever fainted or nearly fainted at blood or a needle, do not practise alone. Speak to your GP first. That is why this guide's example ladders are animals and situations.
The method, worked through on a fear of spiders
1. Write down the prediction
Not "I'm scared of spiders". Write what you think will actually happen. For example: "If a spider is in the same room as me, it will run at me and I will scream and not be able to stay in the room."
That sentence is what each step tests. A vague fear cannot be tested. A prediction can.
2. List the steps, using the levers for your type
Spiders are an animal phobia, so the levers are distance, a barrier, how much it moves, and who is in control. Write 8 to 10 steps. Do not order them yet.
3. Rate each step from 0 to 10
0 is no fear at all. 10 is the worst you can imagine. Rate how you think you would feel doing it, not how the idea feels now. Then put them in order. If two neighbouring steps are more than 2 or 3 points apart, find one in between by changing one lever.
4. Start at about a 3
Low enough that you will actually do it this week. High enough that you feel something. If your lowest step is a 6, it is not a starting step. Make it smaller.
5. Do it, and rate before and after
Rate your fear just before. Do the step. Rate it again just after. Then write one line: did the thing you predicted happen?
| Date | Step | Before (0 to 10) | After (0 to 10) | Did the prediction happen? |
|---|---|---|---|---|
6. Stay long enough to test it
Older advice says stay until your fear halves. A 2014 paper by Michelle Craske and colleagues argues that the learning comes from finding out that what you expected did not happen, and lists ways to strengthen that, including dropping safety signals, varying the practice and practising in more than one place. So the rule here is simpler: stay until you have properly tested the prediction you wrote down. If you predicted you would have to leave the room, stay in the room.
7. Drop the safety behaviours
These are the small things you do so the step feels survivable: keeping the door open behind you, holding your phone with the torch on, having someone stand between you and the spider, looking away. They feel helpful. They also stop you finding out you can manage without them. Drop one at a time. Our guide to safety behaviours has a longer list.
8. Repeat, then move up
Do the same step again on another day. Move up when your before rating has dropped a few points and the step feels more boring than frightening. If you get stuck on a step for a week, there is a smaller step hiding inside it. Change one lever.
Example ladders
These are examples, ordered for a typical person. Yours will not match, which is why there are no ratings in them. Write your own numbers next to each step. Each one names the lever that moved.
Spiders
| Step | What you do | Lever |
|---|---|---|
| 1 | Look at a cartoon spider for a minute | How real |
| 2 | Look at photos of real house spiders for two minutes | How real |
| 3 | Watch a video of a spider moving | Movement |
| 4 | Look at a spider in a sealed jar across the room | Distance, barrier |
| 5 | Walk up to the jar and look at it for a minute | Distance |
| 6 | Hold the sealed jar in your hands | Distance |
| 7 | Stay in a room with a spider on the far wall for five minutes | Barrier removed |
| 8 | Catch a spider yourself with a glass and a card and put it outside | Control |
Dogs
Only with a calm dog you know and an owner who has agreed to help. Never an unknown dog.
| Step | What you do | Lever |
|---|---|---|
| 1 | Watch videos of calm dogs | How real |
| 2 | Sit in a park and watch dogs on leads from a bench far away | Distance |
| 3 | Stand across the road from a friend's dog on a lead | Distance, someone in control |
| 4 | Be in the same room as the dog while the owner holds the lead | Barrier |
| 5 | Let the dog sniff your closed hand while the owner holds the lead | Distance |
| 6 | Stroke the dog's back for ten seconds | Distance |
| 7 | Hold the lead yourself on a short walk with the owner beside you | Control |
| 8 | Be in the room with the dog off the lead | Movement |
Enclosed spaces (lifts)
| Step | What you do | Lever |
|---|---|---|
| 1 | Stand in a lift with the doors held open | Way out |
| 2 | Ride one floor with a friend | Time, company |
| 3 | Ride one floor alone | Company |
| 4 | Ride three floors alone | Time |
| 5 | Ride three floors in a busy lift | Space |
| 6 | Ride to the top floor of a tall building alone | Time |
| 7 | Ride without looking at the floor numbers | Knowing when it ends |
Deep water
Only in a lifeguarded pool. Never practise in open water or alone in water.
| Step | What you do | Lever |
|---|---|---|
| 1 | Sit on the edge of the shallow end with your feet in | How deep |
| 2 | Stand in the shallow end for five minutes | Time |
| 3 | Walk along the wall to where the floor starts to slope | How deep |
| 4 | Put your face in the water for three seconds, standing | Control |
| 5 | Hold the wall in water where you cannot stand | How deep |
| 6 | Let go of the wall for five seconds, then grab it | Way out |
| 7 | Swim a width at the deep end next to the wall | Way out, distance |
Birds (pigeons)
| Step | What you do | Lever |
|---|---|---|
| 1 | Watch videos of pigeons flapping | Movement |
| 2 | Watch pigeons through a window | Barrier |
| 3 | Sit on a bench far from a group of pigeons | Distance |
| 4 | Sit on a bench closer to them | Distance |
| 5 | Walk through a square with pigeons on the ground | Distance, movement |
| 6 | Stand still while pigeons take off around you | Movement |
| 7 | Scatter a few crumbs near your feet and stay put | Control |
The NHS also suggests checking whether zoos and airlines run sessions for people with phobias. Some do, and they give you a step you could not set up on your own.
A bad day is not a failure
Some days a step you managed last week feels like an 8. Do the step below it instead, and log that. It still counts. If every step is suddenly too much, take a day off and come back to the lowest step on the ladder.
When to see your GP instead of doing this alone
The NHS says to see a GP if you think you have a phobia and it is affecting your life. In particular, get help before you start if:
- You have fainted or nearly fainted at blood, needles or injury.
- You have a heart or breathing condition and the fear brings on strong physical reactions.
- The fear has spread so that you avoid leaving the house or large parts of normal life.
- The fear started with something traumatic, such as a serious dog attack or a near drowning.
- You feel hopeless or have thoughts of harming yourself. Call Samaritans free on 116 123, any time, or 999 if you are in danger.
The NHS also says you can refer yourself directly to its talking services without a GP referral.
If you want the ladder written for you
Conquer Fear, our app, is built around this method. You name a goal and the fear in the way of it, and it writes a ladder of small real-world steps for that exact fear, rather than picking from a fixed list. It shows you one step at a time and asks for your 0 to 10 rating before and after each attempt. Attempts are logged as completed, partial or not completed, so a step you started but did not finish still counts. If a step is too big, you can tap "Make it smaller" on it and it splits the step. There is a help chat for when you are stuck. For needles, which we left out above, there is a ladder written out on our fear of needles page.
The free tier gives you one ladder, its first three steps, 20 logged attempts and three help chats. Premium is £9.99 a month, or £49.99 a year with a 7 day free trial on the annual plan. It is on the App Store for iPhone only.
Where it is not the right choice: it is not on Android, it needs a connection, and it has no pictures, videos or VR of the thing you fear, so for the early "look at a photo" steps you find your own. It does not teach breathing, relaxation or the tensing technique for fainting. If a notebook suits you, the tables above do the same job for free.
Sources
All checked 25 October 2026.
- NHS, Phobias (types of phobia, when to see a GP, zoos and airlines, self-referral), page last reviewed 11 March 2026: https://www.nhs.uk/mental-health/conditions/phobias/
- Guy's and St Thomas' NHS Foundation Trust, Needle phobia and overcoming your fear (last reviewed May 2024): https://guysandstthomas.nhs.uk/health-information/needle-phobia-and-overcoming-your-fear
- Craske MG, Treanor M, Conway CC, Zbozinek T, Vervliet B (2014), an inhibitory learning approach to exposure, Behav Res Ther 58, 10 to 23: https://doi.org/10.1016/j.brat.2014.04.006 (abstract read via PubMed, PMID 24864005)
- Samaritans, contact page: https://www.samaritans.org/how-we-can-help/contact-samaritan/
Conquer Fear is a self-help tool inspired by exposure principles. It isn't therapy or medical care, and it is not intended to diagnose, treat, cure or prevent any disease. If fear or anxiety is affecting your daily life, check with your GP or a qualified professional.