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The SUDs Rating Scale, or Subjective Units of Distress Scale (SUDs) as it is officially known, is used to measure the intensity of distress or nervousness in people withsocial anxiety. The SUDs is a self-assessment tool rated on a scale from 0 to 100.

SUDs Rating Process

A common technique incognitive therapyis using the SUDs tool to gauge distress or emotional state. Guidelines for the SUDs include rating the intensity of your anxiety as it is experienced in the moment verus while tightening or tensing of the body.

Below is a simplified version of the scale with different guide points:

Rating Your Distress100: Unbearably upset to the point that you cannot function and may be on the verge of a breakdown90: Extremely anxious and desperate; helpless and unable to handle it80: Worried and panicky; losing focus and feeling anxious in your body70: Discomfort dominates your thoughts and you struggle to function normally60: Moderate to strong levels of discomfort50: Upset and uncomfortable; still functional40: Mild to moderate anxiety and worry30: Worried or upset; still able to function20: A little bit sad or distressed10: No distress; alert and focused0: Peaceful and complete calm

Rating Your Distress

100: Unbearably upset to the point that you cannot function and may be on the verge of a breakdown90: Extremely anxious and desperate; helpless and unable to handle it80: Worried and panicky; losing focus and feeling anxious in your body70: Discomfort dominates your thoughts and you struggle to function normally60: Moderate to strong levels of discomfort50: Upset and uncomfortable; still functional40: Mild to moderate anxiety and worry30: Worried or upset; still able to function20: A little bit sad or distressed10: No distress; alert and focused0: Peaceful and complete calm

Precise accuracy of measurement is not important. Rather, the SUDs is a broad guide to give your therapist an idea of what you are experiencing.

The 6 Types of Basic Emotions

For many, it can be difficult to share the intensity of what you are feeling. In this way, the SUDs give you a simple way to express the severity of your emotions. It is especially important to share your SUDs scale rating with your therapist because it reflects how you feel, rather than how someone else interprets your fear or anxiety.

It is common for those with social anxietyto feel emotions and fears more intensely than others.What could be a minor incident to someone else can feel like a catastrophe to you. Social anxiety influences your perspective and how you view yourself and those around you. Sharing how you feel based on the SUDs can help therapists and healthcare providers better understand how social anxiety may be affecting you.

Things to Start Doing If You Have SAD

SUDs and Therapy

Use of the SUDs can help you and your therapist track improvements or setbacks intreatment. Be sure to complete the scale honestly to allow your therapist to appropriately judge which treatment methods are working and which are not.

Based on your SUDs assessment, your therapist may have you work through techniques such as disputation, during which you recognize irrational thoughts and work to replace them with more rational ways of looking at situations.

This and other cognitive skills are learned in therapy, but continue to develop as you begin to apply them to your daily routine. You may find that working through issues with cognitive strategies improves your SUDs rating.

What Is Disputation?

A Word From Verywell

Rating scales such as the SUDs are only useful if you complete them honestly. Try not to respond in the manner you think your therapist wants, as this can be a trap for those with social anxiety disorder. Instead, give ratings based on how you are feeling in the moment, regardless of whether you think it is good or bad to be feeling that way.

Research on the use of SUDs with children and teens has shown that miscommunication can sometimes be a problem.If you or your child fall into this age range, be sure to tell yourtherapistor doctor if you are concerned about the use of the SUDs tool.

CBT Coping Skills and Strategies

5 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Benjamin CL, O’Neil KA, Crawley SA, Beidas RS, Coles M, Kendall PC.Patterns and Predictors of Subjective Units of Distress in Anxious Youth.Behav Cogn Psychother. 2010;38(4):497-504. doi:10.1017/S1352465810000287Tanner BA.Validity of Global Physical and Emotional SUDS.Appl Psychophysiol Biofeedback. 2012;37(1):31-34. doi:10.1007/s10484-011-9174-xFarmer AS, Kashdan TB.Stress sensitivity and stress generation in social anxiety disorder: A temporal process approach.J Abnorm Psychol. 2015;124(1):102-114. doi:10.1037/abn0000036Clément C, Lin J, Stangier U.Efficacy of Behavioral Experiments in Cognitive Therapy for Social Anxiety Disorder: Study protocol for a randomized controlled trial.Trials. 2019;20(1):748. doi:10.1186/s13063-019-3905-3Kiyimba N, O’Reilly M.The clinical use of Subjective Units of Distress scales (SUDs) in child mental health assessments: a thematic evaluation.J Ment Health. 2020;29(4):418-423. doi:10.1080/09638237.2017.1340616

5 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Benjamin CL, O’Neil KA, Crawley SA, Beidas RS, Coles M, Kendall PC.Patterns and Predictors of Subjective Units of Distress in Anxious Youth.Behav Cogn Psychother. 2010;38(4):497-504. doi:10.1017/S1352465810000287Tanner BA.Validity of Global Physical and Emotional SUDS.Appl Psychophysiol Biofeedback. 2012;37(1):31-34. doi:10.1007/s10484-011-9174-xFarmer AS, Kashdan TB.Stress sensitivity and stress generation in social anxiety disorder: A temporal process approach.J Abnorm Psychol. 2015;124(1):102-114. doi:10.1037/abn0000036Clément C, Lin J, Stangier U.Efficacy of Behavioral Experiments in Cognitive Therapy for Social Anxiety Disorder: Study protocol for a randomized controlled trial.Trials. 2019;20(1):748. doi:10.1186/s13063-019-3905-3Kiyimba N, O’Reilly M.The clinical use of Subjective Units of Distress scales (SUDs) in child mental health assessments: a thematic evaluation.J Ment Health. 2020;29(4):418-423. doi:10.1080/09638237.2017.1340616

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Benjamin CL, O’Neil KA, Crawley SA, Beidas RS, Coles M, Kendall PC.Patterns and Predictors of Subjective Units of Distress in Anxious Youth.Behav Cogn Psychother. 2010;38(4):497-504. doi:10.1017/S1352465810000287Tanner BA.Validity of Global Physical and Emotional SUDS.Appl Psychophysiol Biofeedback. 2012;37(1):31-34. doi:10.1007/s10484-011-9174-xFarmer AS, Kashdan TB.Stress sensitivity and stress generation in social anxiety disorder: A temporal process approach.J Abnorm Psychol. 2015;124(1):102-114. doi:10.1037/abn0000036Clément C, Lin J, Stangier U.Efficacy of Behavioral Experiments in Cognitive Therapy for Social Anxiety Disorder: Study protocol for a randomized controlled trial.Trials. 2019;20(1):748. doi:10.1186/s13063-019-3905-3Kiyimba N, O’Reilly M.The clinical use of Subjective Units of Distress scales (SUDs) in child mental health assessments: a thematic evaluation.J Ment Health. 2020;29(4):418-423. doi:10.1080/09638237.2017.1340616

Benjamin CL, O’Neil KA, Crawley SA, Beidas RS, Coles M, Kendall PC.Patterns and Predictors of Subjective Units of Distress in Anxious Youth.Behav Cogn Psychother. 2010;38(4):497-504. doi:10.1017/S1352465810000287

Tanner BA.Validity of Global Physical and Emotional SUDS.Appl Psychophysiol Biofeedback. 2012;37(1):31-34. doi:10.1007/s10484-011-9174-x

Farmer AS, Kashdan TB.Stress sensitivity and stress generation in social anxiety disorder: A temporal process approach.J Abnorm Psychol. 2015;124(1):102-114. doi:10.1037/abn0000036

Clément C, Lin J, Stangier U.Efficacy of Behavioral Experiments in Cognitive Therapy for Social Anxiety Disorder: Study protocol for a randomized controlled trial.Trials. 2019;20(1):748. doi:10.1186/s13063-019-3905-3

Kiyimba N, O’Reilly M.The clinical use of Subjective Units of Distress scales (SUDs) in child mental health assessments: a thematic evaluation.J Ment Health. 2020;29(4):418-423. doi:10.1080/09638237.2017.1340616

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