Section 349 of 440

Complete canonical tutorial. This reader section contains the same teaching body as PWR-167 · Fear extinction and courage. Open the Power dossier.

PWR-167 · SUPERVISED full tutorial

Learn a clinician-planned approach step while keeping danger and fear separate

This lesson teaches the full method used in a licensed-clinician-led fear-learning plan: verify real safety, define a chosen function, build a graded step, predict fear channels, approach without flooding, stay for the agreed learning window, record what happened and test context only when approved. Fear is relearned, not erased, and courage can include leaving danger.

What you will produceIn a clinician-approved plan, the learner completes one agreed low-level approach step, records fear channels and safety behaviour, and follows the stop and review rules.

Method8 numbered Power-specific steps

Practice authorityFull method with qualified supervision where stated

Start step by step Open research dossier

1 · Permission and limits

Know exactly what you may do

You may

Under a licensed clinician, complete one preselected low hierarchy step with written dose and exit conditions.
Record predicted and observed fear channels, outcome and safety behaviour without turning the exercise into a bravery test.
Use the stop signal freely and end at the planned withdrawal point.

Qualified help is required for

The clinician distinguishes fear from real danger and approves hierarchy step, context, proximity, duration and repetition.
Only the clinician may alter a dose feature, introduce a new context or progress to another hierarchy item.

Never do this from the page alone

Confront real danger, an abusive person, unsafe animal, traffic, height, substance or medical risk as “exposure.”
Flood, surprise, shame or physically prevent the learner from leaving.
Remove medication, mobility, communication or safety aids without clinical authority.

2 · Get ready

Gather what you need and check the starting conditions

What you need

a licensed-clinician-led exposure or fear-learning plan.
Written hierarchy, real-danger screen, consent/stop signal, clinician contact and emergency plan.
A trial sheet for prediction, subjective fear, body response, approach, safety behaviours, learning and later context.

Before you start

Prepare a licensed-clinician-led exposure or fear-learning plan using one low-level step selected from an individual hierarchy
Before the first fear extinction and courage attempt, write the exact result you will score: Safe chosen approach and function across contexts with fear channels recorded.
The licensed clinician assesses diagnosis, trauma, medical risk, dissociation, suicidality, current safety and whether exposure is indicated.
The learner chooses the functional goal and may pause or withdraw; no flooding or surprise cue.

3 · The method

Follow these steps in order

Separate fear from real danger
Use the clinician’s screen to identify actual hazards, consent limits and emergency needs. Cancel the exercise if the situation is not objectively safe.
Why: Fear reduction is never the goal when protective action is needed.
Check: Learner and clinician agree the cue is safe enough and the emergency route remains available.
Name the chosen function
Write what the learner wants to do despite fear, such as stand near a closed lift for one minute, and why it matters.
Why: A values-linked function is a better target than a zero-fear score.
Check: The goal is concrete, chosen and achievable without entering danger.
Select one graded step
Choose a low-level hierarchy step within the clinician-set range and define start, duration, distance and stop conditions.
Why: A precise dose prevents an approach from turning into flooding.
Check: All four dose features are written before exposure.
Predict separate channels
Before approaching, predict subjective fear, body activation, urge to escape and ability to complete the step.
Why: Fear channels can change differently and prediction error can support learning.
Check: Four predictions are recorded without requiring a low number.
Approach at the agreed pace
Begin only on the learner’s signal. Move to the declared position and keep normal safety supports unless the clinician explicitly plans otherwise.
Why: Voluntary, graded approach preserves control and valid learning.
Check: The learner reaches the planned point without surprise escalation.
Stay for the learning window
Remain for the agreed interval while naming present facts and allowing fear. Do not extend to force fear to fall.
Why: New learning can occur even if self-reported fear stays high.
Check: The interval ends as planned with orientation and consent intact.
Record outcome, not bravery
Afterward, record actual fear channels, completion, safety behaviours and what was learned about the prediction.
Why: Observed outcome and function matter more than a courage label.
Check: The note compares prediction with outcome and avoids moral judgement.
Plan context only with clinician
Repeat the same step or vary one context feature only after review. Expect fear may return in a new place and keep the safety screen.
Why: Extinction learning is context-dependent and return of fear is not failure.
Check: Any context change is pre-approved and logged as a new condition.

4 · Worked example

See the whole method used once

Scenario

A licensed therapist works with a learner whose agreed low-level step is standing two metres from a stationary, closed lift for one minute without entering it.

Walkthrough

They confirm the lift area is safe, accessible and not needed for emergency evacuation.
The learner states the function: eventually visit an upstairs public office, and chooses the one-minute step.
Predictions are fear 7, body 6, escape urge 8 and completion ability 4.
On the learner’s signal they stand at the mark for one minute, remain oriented and keep the agreed support person nearby.
Outcome is fear 7, body 5, urge 6 and completion achieved; learning is “fear stayed but I completed the step.” The therapist repeats the same context rather than escalating.

Result

Chosen approach occurs without danger or flooding even though fear remains. The method treats return of fear and context dependence as expected.

5 · Right and wrong

Compare correct or safer execution with the common wrong version

Right and wrong comparison
Moment	Right / safer	Wrong / riskier	Why it matters
Separate fear from real danger	Use the clinician’s screen to identify actual hazards, consent limits and emergency needs. Cancel the exercise if the situation is not objectively safe.	Use a feared situation without checking whether danger is real.	Fear reduction is never the goal when protective action is needed.
Name the chosen function	Write what the learner wants to do despite fear, such as stand near a closed lift for one minute, and why it matters.	Set “feel no fear” as the only goal.	A values-linked function is a better target than a zero-fear score.
Select one graded step	Choose a low-level hierarchy step within the clinician-set range and define start, duration, distance and stop conditions.	Jump from avoidance to the hardest hierarchy item.	A precise dose prevents an approach from turning into flooding.
Predict separate channels	Before approaching, predict subjective fear, body activation, urge to escape and ability to complete the step.	Record only a total fear number and omit urge or function.	Fear channels can change differently and prediction error can support learning.
Approach at the agreed pace	Begin only on the learner’s signal. Move to the declared position and keep normal safety supports unless the clinician explicitly plans otherwise.	Approach because the clinician surprises or pressures the learner.	Voluntary, graded approach preserves control and valid learning.

6 · Common mistakes

Spot the error and apply the correction

Common mistakes and corrections
Mistake	Fix
Use a feared situation without checking whether danger is real.	Use the clinician’s screen to identify actual hazards, consent limits and emergency needs. Cancel the exercise if the situation is not objectively safe.
Set “feel no fear” as the only goal.	Write what the learner wants to do despite fear, such as stand near a closed lift for one minute, and why it matters.
Jump from avoidance to the hardest hierarchy item.	Choose a low-level hierarchy step within the clinician-set range and define start, duration, distance and stop conditions.
Record only a total fear number and omit urge or function.	Before approaching, predict subjective fear, body activation, urge to escape and ability to complete the step.
Approach because the clinician surprises or pressures the learner.	Begin only on the learner’s signal. Move to the declared position and keep normal safety supports unless the clinician explicitly plans otherwise.

7 · Practice

Turn the steps into a usable skill

First session

Licensed clinician separates feared cue from objective danger & confirms an exit route. Learner names one chosen function that fear limits, then selects a low hierarchy step whose place, duration, proximity & repetition are all written before approach.
Record predictions for fear, body activation, action urge & expected outcome. Also list safety behaviour to observe, such as repeated reassurance or escape scanning; exercise does not require discarding a genuine safety measure.
Approach agreed cue at planned pace while clinician tracks dose. Learner may use stop signal at any time. Neither courage language nor a lower-than-expected rating is used to pressure a longer or closer exposure.
Stay for specified learning window if safety remains intact, noticing whether predicted outcome occurs & whether urge or activation changes. Aim is new information about cue & choice, not compulsory relaxation or emotional exhaustion.
After withdrawing as planned, record actual outcome, fear channels, safety behaviour, context & support. Compare prediction with observation in concrete terms; completing step is not proof that a harder setting is safe.
Clinician decides whether to repeat same dose, change one feature or retire step. Close with ordinary recovery & a delayed symptom check, without an unscheduled second exposure or a leap to next hierarchy item.

Repeat plan

Repeat same hierarchy step only on clinician's schedule until prediction–outcome learning is interpretable across sessions. A later step changes one dose feature at a time & keeps emergency route. Generalisation to a new place, person or cue requires a separate clinician-approved plan.

Progress when

In a clinician-approved plan, learner completes one agreed low-level approach step, records fear channels & safety behaviour & follows stop & review rules.
All four dose features are written before exposure.
Interval ends as planned with orientation & consent intact.
Any context change is pre-approved & logged as a new condition.

Do not progress when

Do not progress when real danger has not been excluded or exposure dose is not written in place, time, proximity & repetition terms.
Stop for panic escalation beyond care plan, severe dissociation, inability to use signal, new medical symptoms or an unavailable exit route.
Do not skip hierarchy levels because one trial ended with a low fear rating or was described as brave.

8 · Check the result

Measure what changed

Safe chosen approach and function across contexts with fear channels recorded

How: For Fear extinction and courage, measure Safe chosen approach and function across contexts with fear channels recorded. Keep the fear extinction and courage fixture stable. Target: In a clinician-approved plan, the learner completes one agreed low-level approach step, records fear channels and safety behaviour, and follows the stop and review rules. Log fear extinction and courage errors, prompts, burden and stops.

Good result: All four dose features are written before exposure. Interval ends as planned with orientation & consent intact. Any context change is pre-approved & logged as a new condition.

This does not prove: Fear ratings and safety behaviours are context-dependent; learning supported by one clinician, cue and place may not persist after any of them changes.

Self-check

Starting check — Learner and clinician agree the cue is safe enough and the emergency route remains available.
Can you show this before continuing? The goal is concrete, chosen and achievable without entering danger.
If you catch this mistake — Use a feared situation without checking whether danger is real. — use this correction: Use the clinician’s screen to identify actual hazards, consent limits and emergency needs. Cancel the exercise if the situation is not objectively safe.
What this result does not prove: Fear ratings and safety behaviours are context-dependent; learning supported by one clinician, cue and place may not persist after any of them changes.

9 · Stop, adapt or get help

Keep the safety boundary practical

Stop and get help

Stop for real danger, loss of consent, dissociation, flashback, medical symptoms, self-harm or harm urges, inability to orient or clinician command.
End the approach and use urgent help if the fear cue proves dangerous, self-harm risk appears or orientation or consent is lost.
Do not progress when real danger has not been excluded or exposure dose is not written in place, time, proximity & repetition terms.
Stop for panic escalation beyond care plan, severe dissociation, inability to use signal, new medical symptoms or an unavailable exit route.
Do not skip hierarchy levels because one trial ended with a low fear rating or was described as brave.

Accessibility and adaptations

Keep usual aids for Fear extinction and courage; record each support inside the fear extinction and courage setup.
Accessible opening check for Fear extinction and courage: Learner and clinician agree the cue is safe enough and the emergency route remains available.
Use remote imagery only if clinician-approved, mobility/access supports, visual hierarchy, AAC, support person and smaller distance or duration; never remove necessary safety aids to raise difficulty.

10 · Evidence and limits

Why these instructions are here

primary research
Human extinction memory was context-modulated, supporting explicit context tracking and caution about return of fear.
Context modulation of memory for fear extinction in humans
official guidance
Official PTSD guidance places exposure-based trauma treatment with appropriately trained practitioners and does not support DIY flooding.
Post-traumatic stress disorder — recommendations

Limits

Human fear returned when context changed, and affect labeling changed physiology more clearly than self-reported fear.
One completed step does not erase fear, prove courage, predict behaviour in danger or authorise unsupervised exposure.
Fear ratings and safety behaviours are context-dependent; learning supported by one clinician, cue and place may not persist after any of them changes.

Open the complete canonical research register

Primary empirical supportLimiting / contrary
Context modulation of memory for fear extinction in humans
M R Milad; S P Orr; R K Pitman; S L Rauch · 2005 · Primary research
Primary empirical supportLimiting / contrary
Feelings into words: contributions of language to exposure therapy
K Kircanski; M D Lieberman; M G Craske · 2012 · Primary research
Limiting / contraryOfficial boundary context
Post-traumatic stress disorder — recommendations
National Institute for Health and Care Excellence · 2018 · Official guidance

Read the complete evidence interpretation on the Power dossier.

Tutorial delivery controls

Learn, adapt, troubleshoot and resume

Estimated timeEstimated 13 min reading; practical time is provider-set

DifficultyIntermediate

EquipmentBasic stationery or digital tools

SpaceDesk / seated

Method qualityComprehensive10 of 10 structural checks present. Automated method-readiness band; human editorial sign-off is separate.

Evidence contextG4; Focused research depthScientific support is evaluated separately from teaching-method structure.

Editorial reviewPending manual sign-offNo human approval is claimed until reviewer, date and content hash are recorded.

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Step-by-step learner mode

Each activity includes its success check, a nearby accessible alternative and an “I’m stuck” correction path. Alternatives preserve the target where possible; when they change the task, Titan labels them as related rather than equivalent.

Separate fear from real danger

Use the clinician’s screen to identify actual hazards, consent limits and emergency needs. Cancel the exercise if the situation is not objectively safe.

Why this step exists

Fear reduction is never the goal when protective action is needed.

Success check

Learner and clinician agree the cue is safe enough and the emergency route remains available.

I’m stuck on this step

Reset: Re-read this authored instruction — “Use the clinician’s screen to identify actual hazards, consent limits and emergency needs. Cancel the exercise if the situation is not objectively safe.” — and its success check, then attempt only this step.

Possible snag: Use a feared situation without checking whether danger is real.
Correction: Use the clinician’s screen to identify actual hazards, consent limits and emergency needs. Cancel the exercise if the situation is not objectively safe.

Stop / get help: Stop for real danger, loss of consent, dissociation, flashback, medical symptoms, self-harm or harm urges, inability to orient or clinician command.

Mark step 1 complete

Name the chosen function

Write what the learner wants to do despite fear, such as stand near a closed lift for one minute, and why it matters.

Why this step exists

A values-linked function is a better target than a zero-fear score.

Success check

The goal is concrete, chosen and achievable without entering danger.

I’m stuck on this step

Reset: Re-read this authored instruction — “Write what the learner wants to do despite fear, such as stand near a closed lift for one minute, and why it matters.” — and its success check, then attempt only this step.

Possible snag: Set “feel no fear” as the only goal.
Correction: Write what the learner wants to do despite fear, such as stand near a closed lift for one minute, and why it matters.

Stop / get help: Stop for real danger, loss of consent, dissociation, flashback, medical symptoms, self-harm or harm urges, inability to orient or clinician command.

Mark step 2 complete

Select one graded step

Choose a low-level hierarchy step within the clinician-set range and define start, duration, distance and stop conditions.

Why this step exists

A precise dose prevents an approach from turning into flooding.

Success check

All four dose features are written before exposure.

I’m stuck on this step

Reset: Re-read this authored instruction — “Choose a low-level hierarchy step within the clinician-set range and define start, duration, distance and stop conditions.” — and its success check, then attempt only this step.

Possible snag: Jump from avoidance to the hardest hierarchy item.
Correction: Choose a low-level hierarchy step within the clinician-set range and define start, duration, distance and stop conditions.

Stop / get help: Stop for real danger, loss of consent, dissociation, flashback, medical symptoms, self-harm or harm urges, inability to orient or clinician command.

Mark step 3 complete

Predict separate channels

Before approaching, predict subjective fear, body activation, urge to escape and ability to complete the step.

Why this step exists

Fear channels can change differently and prediction error can support learning.

Success check

Four predictions are recorded without requiring a low number.

I’m stuck on this step

Reset: Re-read this authored instruction — “Before approaching, predict subjective fear, body activation, urge to escape and ability to complete the step.” — and its success check, then attempt only this step.

Possible snag: Record only a total fear number and omit urge or function.
Correction: Before approaching, predict subjective fear, body activation, urge to escape and ability to complete the step.

Stop / get help: Stop for real danger, loss of consent, dissociation, flashback, medical symptoms, self-harm or harm urges, inability to orient or clinician command.

Mark step 4 complete

Approach at the agreed pace

Begin only on the learner’s signal. Move to the declared position and keep normal safety supports unless the clinician explicitly plans otherwise.

Why this step exists

Voluntary, graded approach preserves control and valid learning.

Success check

The learner reaches the planned point without surprise escalation.

I’m stuck on this step

Reset: Re-read this authored instruction — “Begin only on the learner’s signal. Move to the declared position and keep normal safety supports unless the clinician explicitly plans otherwise.” — and its success check, then attempt only this step.

Possible snag: Approach because the clinician surprises or pressures the learner.
Correction: Begin only on the learner’s signal. Move to the declared position and keep normal safety supports unless the clinician explicitly plans otherwise.

Stop / get help: Stop for real danger, loss of consent, dissociation, flashback, medical symptoms, self-harm or harm urges, inability to orient or clinician command.

Mark step 5 complete

Stay for the learning window

Remain for the agreed interval while naming present facts and allowing fear. Do not extend to force fear to fall.

Why this step exists

New learning can occur even if self-reported fear stays high.

Success check

The interval ends as planned with orientation and consent intact.

I’m stuck on this step

Reset: Re-read this authored instruction — “Remain for the agreed interval while naming present facts and allowing fear. Do not extend to force fear to fall.” — and its success check, then attempt only this step.

Possible snag: The result from “Remain for the agreed interval while naming present facts and allowing fear. Do not extend to force fear to fall.” does not yet meet this declared check: The interval ends as planned with orientation and consent intact.
Correction: Return to the start of “Stay for the learning window”, reduce complexity or pace, and repeat only the part needed to satisfy: “The interval ends as planned with orientation and consent intact.”

Stop / get help: Stop for real danger, loss of consent, dissociation, flashback, medical symptoms, self-harm or harm urges, inability to orient or clinician command.

Mark step 6 complete

Record outcome, not bravery

Afterward, record actual fear channels, completion, safety behaviours and what was learned about the prediction.

Why this step exists

Observed outcome and function matter more than a courage label.

Success check

The note compares prediction with outcome and avoids moral judgement.

I’m stuck on this step

Reset: Re-read this authored instruction — “Afterward, record actual fear channels, completion, safety behaviours and what was learned about the prediction.” — and its success check, then attempt only this step.

Possible snag: The result from “Afterward, record actual fear channels, completion, safety behaviours and what was learned about the prediction.” does not yet meet this declared check: The note compares prediction with outcome and avoids moral judgement.
Correction: Return to the start of “Record outcome, not bravery”, reduce complexity or pace, and repeat only the part needed to satisfy: “The note compares prediction with outcome and avoids moral judgement.”

Stop / get help: Stop for real danger, loss of consent, dissociation, flashback, medical symptoms, self-harm or harm urges, inability to orient or clinician command.

Mark step 7 complete

Plan context only with clinician

Repeat the same step or vary one context feature only after review. Expect fear may return in a new place and keep the safety screen.

Why this step exists

Extinction learning is context-dependent and return of fear is not failure.

Success check

Any context change is pre-approved and logged as a new condition.

I’m stuck on this step

Reset: Re-read this authored instruction — “Repeat the same step or vary one context feature only after review. Expect fear may return in a new place and keep the safety screen.” — and its success check, then attempt only this step.

Possible snag: The result from “Repeat the same step or vary one context feature only after review. Expect fear may return in a new place and keep the safety screen.” does not yet meet this declared check: Any context change is pre-approved and logged as a new condition.
Correction: Return to the start of “Plan context only with clinician”, reduce complexity or pace, and repeat only the part needed to satisfy: “Any context change is pre-approved and logged as a new condition.”

Stop / get help: Stop for real danger, loss of consent, dissociation, flashback, medical symptoms, self-harm or harm urges, inability to orient or clinician command.

Mark step 8 complete

Correct versus incorrect execution

These accessible process diagrams are built from the tutorial’s own right/wrong teaching. They are not anatomical illustrations and do not add technique beyond the canonical tutorial.

Separate fear from real danger — Fear reduction is never the goal when protective action is needed.

Correct / safer

Use the clinician’s screen to identify actual hazards, consent limits and emergency needs. Cancel the exercise if the situation is not objectively safe.

Wrong / riskier

Use a feared situation without checking whether danger is real.

Name the chosen function — A values-linked function is a better target than a zero-fear score.

Correct / safer

Write what the learner wants to do despite fear, such as stand near a closed lift for one minute, and why it matters.

Wrong / riskier

Set “feel no fear” as the only goal.

Select one graded step — A precise dose prevents an approach from turning into flooding.

Correct / safer

Choose a low-level hierarchy step within the clinician-set range and define start, duration, distance and stop conditions.

Wrong / riskier

Jump from avoidance to the hardest hierarchy item.

Predict separate channels — Fear channels can change differently and prediction error can support learning.

Correct / safer

Before approaching, predict subjective fear, body activation, urge to escape and ability to complete the step.

Wrong / riskier

Record only a total fear number and omit urge or function.

Approach at the agreed pace — Voluntary, graded approach preserves control and valid learning.

Correct / safer

Begin only on the learner’s signal. Move to the declared position and keep normal safety supports unless the clinician explicitly plans otherwise.

Wrong / riskier

Approach because the clinician surprises or pressures the learner.

Method-structure checklist

10 of 10 structural checks present

Ordered, Power-specific instructions — present
Every activity has a success check — present
Materials or supplied records are declared — present
Measurement or assessment rule is present — present
Tutorial-specific troubleshooting is present — present
Stopping or escalation boundary is present — present
Every activity has an adjacent alternative — present
Correct-versus-incorrect comparison is present — present
Evidence context is bound to the Power record — present
Planning metadata is present — present

The method-readiness band and presence checklist assess tutorial presentation and are separate from evidence quality for the underlying Power. They are automated editorial aids, not human approval.

Manual editorial sign-off: Pending. This tutorial must not display a human-approved state until an identified editor signs the exact content hash.