Assessments: Subjective Units of Distress Scale (SUDS)

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Feeling overwhelmed by the array of assessment tools you need to master for your licensing exam? Today's episode offers a deep dive into one of the most practical and versatile instruments available to therapists: the Subjective Units of Distress Scale (SUDS).

Dr. Linton Hutchinson breaks down this deceptively simple yet powerful clinical tool that allows therapists to quantify what seems unquantifiable – a client's subjective experience of distress. With characteristic energy (accidentally fueled by a caffeinated Starbucks mishap), Dr. Hutchinson thoroughly explains how SUDS works on a 0-10 scale, where clients rate their distress from none to maximum intensity. The beauty of SUDS lies in its accessibility and immediate feedback, making it invaluable for tracking therapeutic progress.

The episode systematically explores the four phases of SUDS implementation: establishing baselines, monitoring distress throughout sessions, regulating intervention intensity, and evaluating long-term progress. You'll discover how this framework integrates seamlessly with evidence-based treatments like Cognitive Behavioral Therapy and exposure therapy, with research supporting its effectiveness in treating anxiety disorders. Dr. Hutchinson offers practical applications for your clinical toolkit – from using SUDS during relaxation exercises to pairing it with cognitive restructuring to demonstrate the impact of thought reframing on emotional states.

Whether you're preparing for your licensing exam or looking to enhance your clinical practice, this episode delivers essential knowledge in an engaging, straightforward manner. The key takeaway? SUDS provides a structured yet flexible framework for measuring distress that works across diverse populations and therapeutic approaches. And as Dr. Hutchinson reminds us – understanding tools like this could be exactly what helps you pass your exam, even if just by one point. Ready to add this valuable assessment method to your professional repertoire? Listen now and boost both your exam confidence and clinical effectiveness.

If you need to study for your national licensing exam, try the free samplers at: LicensureExams


This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.

Episode Transcript

DR. HUTCHINSON (00:00):
Hello you wonderful therapists, and
welcome to the Licensure ExamsPodcast.
I'm Dr Linton Hutchinson andI'm excited you're joining me
today.
Stacey's hanging 150 feet inthe air reconstructing a
historic building and Eric'ssomewhere down in the Everglades
canoeing.
So it's just me.
I need to issue a preemptiveapology to everyone.
I made a stop at Starbucks thismorning and, through some

(00:22):
cosmic barista blunder, myinnocent decaf caramel macchiato
was secretly replaced with thefully loaded caffeinated version
.
So if you notice me talking atthe speed of light, gesturing
like an air traffic controlleron fast forward or talking about
standard deviations orcorrelation coefficients, you'll
know why this podcast mightfinish early, or I might

(00:44):
accidentally invent time travel,or both.
But don't worry, I'll crashspectacularly in a few hours,
but I definitely would not hitStarbucks before you sit for
your exam.
And you're here because you'rea determined therapist and I
can't tell you enough how Iappreciate your commitment to
preparing for your nationallicensing exam.

(01:04):
Today we're tackling a toolyou'll your commitment to
preparing for your nationallicensing exam.
Today we're tackling a toolyou'll certainly want to have in
your toolkit and know about forthe exam the Subjective Units
of Distress Scale.
You might be thinking, okay,linton, another scale to
memorize, but trust me, this isstraightforward and you'll be
better off for knowing about it.
We'll go over what it is, howit's used and why understanding

(01:27):
it could give you an edge onyour exam.
Remember, you only have to passby one point.
Might as well be because youlistened to this podcast on SUDS
.
Knowing how to accurately assessa client's distress is a core
skill, and SUDS offers a quickway to gauge what's happening
for them in the moment.
It's relevant for anxietydisorders, trauma and many other

(01:48):
conditions you'll encounterboth in practice and on the exam
.
So let's get started andexplore the ins and outs of the
Subjective Units of DistressScale.
So what exactly is theSubjective Units of Distress
Scale?
Well, it's a pretty simple yeteffective tool that helps you
measure the intensity of aclient's distress or anxiety.
It's subjective because it'sbased entirely on the client's

(02:11):
perception of their feelings atthat moment, rather than any
objective criteria.
Typically, you'll ask yourclient to rate their level of
distress on a scale usually from0 to 10, where 0 represents no
distress and the highest numberindicates the most intense
distress you can imagine.
It's not about comparing oneperson's experience to another's

(02:31):
.
It's about helping thatindividual quantify what's
happening for them.
Internally, the real strengthof SUDS lies in its ease of use
and the immediate feedback itprovides, making it a go-to for
tracking changes in distresslevels during therapy.
But when you're working withclients, distress can show up in
many ways and it's not alwayswhat you might expect.

(02:52):
Some clients might becomevisibly agitated, fidgeting or
having trouble making eyecontact.
Others could withdraw, becomingquiet and unresponsive, almost
as if shutting down to cope withwhat they're feeling.
You might see emotionaloutbursts like sudden crying or
expressions of anger, even overseemingly minor things.

(03:14):
Physical symptoms are alsocommon.
Clients could report headaches,stomach issues or muscle
tension.
It's also not unusual fordistress to affect a client's
thinking, leading to difficultyconcentrating, racing thoughts
or feeling overwhelmed.
It's key to remember that eachperson experiences and shows

(03:34):
distress uniquely, so you needto be attuned to both verbal and
non-verbal cues to trulyunderstand what's happening for
them.
Now let's explore the phasesyou'll typically go through when
using the SUDS model with aclient.
The first phase is all aboutestablishing a baseline.
You'll want to ask the clientto rate their current level of

(03:55):
distress before you even begin aspecific intervention or
therapy session.
This provides a reference point.
Think of it as taking asnapshot of how they're feeling
at that exact moment.
Next up is the distressmonitoring phase.
You'll use the SUDS repeatedlyduring a session or over a
course of treatment to track howdistress levels change in

(04:15):
response to different stimuli orinterventions.
For instance, if you're doingexposure therapy, you'd have the
client rate their distressbefore, during and after
exposure to the feared stimulus.
This helps you adjust theintensity and duration of the
exposure to keep it challengingbut not overwhelming.
It also gives you a way to seewhat's working and what isn't.

(04:39):
The third phase involvesutilizing the SUDs to regulate
the intensity of interventions.
You'll use the real-timefeedback from your client's SUDs
ratings to make adjustments onthe fly.
If a client's distress spikestoo high, you might need to slow
things down, change the focusor introduce a coping strategy.
The idea here is to stay withinthe client's window of

(05:00):
tolerance, where you'rechallenging them enough to
promote growth but not pushingthem so far that you cause
dysregulation orre-traumatization.
Finally, there's the evaluationphase.
Over time you can review theSUDS ratings to assess progress.
You'll look for trends.
Is the client's baselinedistress decreasing?
Are they able to tolerate moreexposure with less distress?

(05:24):
Are you seeing quicker recoverytimes after a distressing event
.
This data provides objectiveevidence of the effectiveness of
your work together and informsfuture treatment decisions.
Remember, the SUDS isn't justabout numbers.
It's about using those numbersto deepen understanding and
guide the therapeutic process.
Okay, let's turn our attentionto evidence-based treatments

(05:47):
that incorporate the SUDS model.
A substantial body of researchsupports the use of cognitive
behavioral therapy in treatinganxiety disorders, and the SUDS
plays a role within thisframework.
Studies consistentlydemonstrate that CBT, augmented
by the SUDS model for distressmonitoring, is effective in
reducing symptoms of anxiety,panic and phobias.

(06:09):
You can track a client'sprogress, adjusting
interventions as needed tooptimize results.
Exposure therapy anotherwell-supported treatment for
anxiety disorders relies heavilyon the SUDS model for measuring
a client's distress throughoutthe exposure process.
By quantifying anxiety levelsbefore, during and after
exposure exercises, you cancarefully calibrate the

(06:31):
intensity and duration of eachexposure, ensuring that it
remains therapeutic rather thanoverwhelming.
Research supports the use ofSUDS in exposure therapy to
improve outcomes and reduce thelikelihood of relapse.
Now let's examine someinterventions that effectively
use the SUDS model.
One common intervention is touse SUDS as a regular part of

(06:54):
your sessions to monitordistress levels.
By asking clients to rate theirdistress at the beginning,
middle and end of a session, youcan gain immediate feedback on
how you're progressing andwhether adjustments are needed.
This ongoing assessment canhelp you tailor your approach to
meet the client-specific needs.
Another useful interventioninvolves using SUDS during

(07:15):
relaxation exercises.
Before beginning a relaxationtechnique, such as deep
breathing or progressive musclerelaxation, have the client rate
their current level of distress.
After completing the exercise,ask to rate it again.
This allows you and your clientto see the immediate impact of
the relaxation technique onreducing distress.

(07:36):
If the SUDS rating doesn'tdecrease significantly, you
might explore alternativerelaxation methods that may be
more effective for the client.
Using SUDS in conjunction withcognitive restructuring is also
beneficial.
When a client identifies anegative thought or belief, ask
them to rate the level ofdistress associated with that

(07:59):
thought.
After challenging and reframingthe thought, have the client
rate their distress again.
This process can help you andyour client see how cognitive
restructuring can reduceemotional distress.
Restructuring can reduceemotional distress.
Knowing the terms related of thesubjective units of distress
scale will help you remember itfor your licensing exam.
First, the term subjective inthe SUDS model emphasizes that

(08:23):
the rating is based on theclient's personal experience and
perception of distress.
This means there's no objectivestandard.
It's all about how the clientfeels at that moment.
Next, units refer to thenumerical scale used to quantify
the level of distress.
These units provide astandardized way for you and the
client to communicate abouttheir emotional state.
It allows for tracking changesover time.

(08:45):
Then distress refers to therange of negative emotional
states, such as anxiety, fear ordiscomfort, that the client is
experiencing.
The SUDS model is designed tomeasure the intensity of these
feelings.
And lastly, the term scalesignifies the continuum on which
the client rates their distress.
This scale typically rangesfrom 0, indicating no distress,

(09:09):
to 10 or 100, representing theworst possible distress
imaginable.
The scale provides a structuredframework for the client to
express the intensity of theiremotion.
Laughs.
It's time for a knowledge check.
Ready, here we go.
You're working with a client whohas just completed an exposure

(09:30):
exercise for a phobia.
To best use the suds, youshould ask the client to A
Compare their distress level toothers in a similar situation.
B Rate their distress based ontheir feelings right now.
C Estimate their averagedistress over the entire day.
D Describe their distress inqualitative terms rather than

(09:51):
using a number.
The correct answer is B Ratetheir distress based on their
feelings right now.
This SUDS is designed to capturea client's immediate subjective
experience of distress at aspecific moment.
This real-time assessmentallows you to gauge the
intensity of their emotionalresponse to the exposure

(10:12):
exercise.
To summarize, the SubjectiveUnits of Distress Scale provides
a straightforward method forquantifying a client's distress.
It's a practical and immediateway to measure and work toward
reducing the stress in varioussituations.
One key takeaway is that SUDSis incredibly versatile and can

(10:33):
be adapted for use with a widerange of ages and populations.
You'll find it beneficial insessions, research and even in
self-help.
Another takeaway is its utilityin therapeutic settings,
especially within exposuretherapy.
It assists you in tailoring theintensity and duration of
exposures to ensure they'rechallenging yet manageable for

(10:53):
your clients.
Regular use of SUDS promotesself-awareness and allows
clients to become more attunedto their emotional states,
facilitating earlierintervention and improved
self-management.
It's in there.