Subjective Units of Distress Scale (SUDS) Worksheets


Subjective units of distress scales (SUDS) can be a useful way for individuals to express to their clinicians their experience of distress in anticipation of, during, or after a distressing situation or exposure exercise. SUDS worksheets help individuals create their unique SUDS by creating anchors for the scale (e.g., identifying a meaningful experience that represents a 0, 25, 50, 75, and 100). It is recommended to coach the individual to choose anchors that are past experiences of distress vs general situations that cause them distress so that the anchors do not change as one becomes less distressed with general situations through exposure therapy.

It's important to note that some have argued to move away from using SUDS during exposure therapy as it can place an unhelpful focus on the decrease of anxiety as a goal for an exposure exercise. Having decreasing anxiety seen as the primary goal for an exposure exercise can interfere with the acceptance of and willingness to bring on the anxiety and let it "run its course." Therefore, clinicians might consider minimizing their focus on the use of SUDS during exposures and using SUDS more during the exposure exercise design and processing phases.

Additionally, partly driven by inconsistent findings and the updated thinking about the mechanisms of exposure therapy (inhibitory learning model; Craske et al., 2008), some have also argued to move away from using SUDS as a marker of exposure therapy success. While some clinicians continue to find SUDS as a useful measure for determining when to end or move on to the next exposure exercise, clinicians are encouraged to compliment SUDS with other assessments that can index the targeted therapeutic learning (Smits et al., 2019). For example, a complementary assessment in the treatment of fear-based disorders would be measuring the shift from danger appraisals to safety appraisals.