Subjective Units of Distress Scale (SUDS)

Have you ever experienced overwhelming distress but found it difficult to articulate your emotions? In counseling and psychotherapy, that is what the Subjective Units of Distress Scale (SUDS) is for. If you have been to the hospital for a physical check-up when you were a child, you might have seen the Faces Pain Scale posted on the wall of your pediatrician’s clinic—a self-report measure that is often used to assess the level of a child’s pain. Similar to the Faces Pain Scale, the SUDS is also a self-report tool; however, it is used to rate the severity of psychological pain. This article thus discusses how the Subjective Units of Distress Scale is used in real-world settings.

What Is the Subjective Units of Distress Scale (SUDS)?

The Subjective Units of Distress Scale, or the SUDS Scale, is a rating scale that allows for the subjective measurement of severity of the distress of an individual. In this context, distress refers to negative painful emotions that lead to discomfort [*]. Originally developed by Joseph Wolpe, this self-report assessment has now become the go-to measurement for quantifying emotions.

Related Handout: Subjective Units Of Distress Scale (SUDS)

How Does the SUDS Scale Rating Work?

To use the SUDS Scale, the individual can quantify their level of distress on the scale by designating it with a number between 0 and 10 to obtain a SUDS score. However, some versions of the Subjective Units of Distress Scale can range from 0 to 100 or 0 to 8, among others. Alternatively, the SUDS Scale has variants with visual aids, such as the Feelings Thermometer [*].

The Subjective Units of Distress Scale rating can be obtained periodically. Sometimes, you can be asked to provide a SUDS score every minute [*]. Regardless of the variant of the scale being used, the overarching point to take note of is that the rating you give does not have to be precise. How accurate your measurement is inconsequential; rather, what is more important is that you are able to give broad strokes of the feelings that you are experiencing.

What Are the Typical Applications of SUDS?

Given its simplicity and ease of use, the Subjective Units of Distress Scale has been applied successfully in a variety of contexts and settings. Some areas of application are the following:

• Initial assessment. Many psychological tests are used to assess a client in counseling and psychotherapy before the treatment proper begins. One of the assessment tools used is the SUDS Scale. Clients can be evaluated for their SUDS score during the first session so that mental health professionals can establish the client’s baseline level of emotion [*]. The score obtained can thus be used as a reference for succeeding sessions.
• Therapeutic progress. The SUDS Scale is often used to gauge how a client is progressing in their treatment [*]. When the scale is used for this purpose, clients assess their distress within sessions and sometimes even between sessions. One example of a therapeutic modality that makes use of this assessment tool is exposure therapy for anxiety. In this approach, the SUDS score is obtained when the client is at their baseline mood and every now and then during an exposure task. The SUDS Scale is also used again once the exposure task has been completed [*].
• Research on treatment efficacy. Finally, the SUDS Scale can also be used for research purposes. It is worth noting that the Subjective Units of Distress Scale has proven itself applicable in assessing the efficacy of a certain treatment modality. For example, if a group of researchers want to evaluate the success rate of cognitive-behavioral therapy (CBT), they have the option of using the SUDS Scale so that they can quantify the extent to which patients receiving the therapy have improved over time.

What Are the Advantages of Using SUDS?

With all the potential that the Subjective Units of Distress Scale has to be applied in various settings, it is not surprising that using this tool comes with many advantages, a few of which are the following:

• All parties involved in therapy can communicate with one another easily. If you have ever tried to talk to someone about your feelings, then you probably have experienced failing to find the right words to express those emotions at least once or twice. In these moments, the SUDS Scale can prove to be helpful, especially when the person you need to communicate your distress to is your therapist. Clear and open communication is key in a therapeutic relationship, so being able to articulate what you feel in a language that both you and your therapist can speak and understand can facilitate mutual trust in your relationship.
• The SUDS score can reflect the severity of your emotions with ease. Not only does the Subjective Units of Distress rating help your therapist understand what you mean when you say you feel depressed or anxious or any other emotion, it also aids you in understanding how intense you feel about something or someone at a certain point in time. Although a 4 on the SUD Scale for you can mean something different to another person’s rating of a 4 on the same scale, that does not matter much when using this tool because it is not about comparing your emotions with others’. Rather, knowing your own SUDS score by itself already makes it easier for you to compare your past emotional state to your present feelings. Looking at it from this perspective, the SUDS Scale can nurture the practice of emotional self-awareness as well.

What Are the Limitations of SUDS?

Although the Subjective Units of Distress Scale has many significant advantages, it also has some drawbacks, such as the following:

• There is little research of the SUDS on its application with children. Unfortunately, according to a study that examined the applications of the SUDS Scale, there is a dearth in the research literature on whether using this assessment tool is helpful at all for children [*].
• The SUDS score cannot be used as a point for comparison. Another disadvantage to using the SUDS Scale is that you will not be able to compare your score with someone else’s. Going back to what was said earlier, if you obtained a rating of 4 on the scale, it is difficult to say with confidence that this rating means the same for another person if they obtained the same score.

How Can SUDS Be Used in Therapy?

The Subjective Units of Distress Scale can be used with different treatment modalities; regardless which approach is being used, though, the scale can serve as a tracker in therapy for both improvements and setbacks. However, for the scale to be effective in therapy, the client needs to be as honest as possible when completing the assessment so that their Subjective Units of Distress rating can be fairly accurate in reflecting the intensity of the client’s distress. Moreover, by giving an honest rating, you will be able to indicate to your mental health provider which therapy modalities work better for you and which ones do not.

How Can Individuals Use SUDS for Self-Monitoring?

When it comes to using the SUDS Scale, you don’t need to be a client or patient of therapy for it to be helpful. The Subjective Units of Distress Scale can be used to monitor your own feelings of distress at your own time and at your own pace. In other words, you can practice self-monitoring. To do this, one option is to keep a journal that could serve as your stress awareness log. Whenever you are stressed, you can log information related to your recorded feelings of distress, such as the date and time you felt that way and the place where you felt distressed.

The Bottom Line

Whether it is used in therapy or for self-monitoring, the Subjective Units of Distress Scale can help you be more mindful of your emotions, become more self-aware, and articulate your feelings in a quantifiable manner. If you do plan to practice self-monitoring, it might be helpful as well to use the SUDS Scale in conjunction with this Subjective Units of Distress Scale worksheet. However you decide to use this assessment tool, though, the SUDS score you obtain will be personally meaningful and useful, so now is as good a time as ever to take advantage of this highly convenient scale!

Feel free to browse our Feelings Worksheets or DBT Worksheets collections to find additional resources that can be applied to emotional identification and regulation alongside the SUDS scale.

References:

1. Kiyimba N & O’Reilly M. The clinical use of subjective units of distress scales (SUDs) in child mental health assessments: A thematic evaluation. 2020.
2. Benjamin CL, O’Neil KA, Crawley SA, et al. Patterns and predictors of subjective units of distress in anxious youth. 2010.
3. van den Broek EL, van der Sluis F, and Dijkstra T. Therapy progress indicator (TPI): Combining speech parameters and the subjective unit of distress. 2009.