Subjective Units of Disturbance Scale (SUDS)

Understanding the Subjective Units of Disturbance Scale (SUDS) for Assessing Nervous System Activation

The Subjective Units of Disturbance Scale (SUDS) is a widely used tool in self-help, psychology and therapy to assess the level of distress or activation in an individual's nervous system. Developed by Joseph Wolpe in 1969, SUDS is a self-report rating scale that helps individuals subjectively evaluate their emotional &/or physiological distress on a scale of 0 to 10, with 0 being no distress and 10 being extreme distress.

Here is a brief overview of the 10-point SUDS scale, along with examples of each rating — but please note that this scale is entirely subjective and rarely used where objective measures are necessary.

0 - No distress

The individual feels calm and relaxed, with no noticeable activation in their nervous system. They may describe feeling at ease, content, and in a state of emotional stability.

1 - Minimal distress

The individual experiences slight discomfort or agitation, minimal body tension or very slight unease — but it does not significantly impact their functioning or well-being. They may describe feeling mildly anxious, irritable, or uneasy.

2 - Mild distress

The individual's distress increases slightly, and they may become more aware of physiological sensations such as increased heart rate or shallow breathing. They may describe feeling moderately anxious, worried, or upset.

3 - Moderate distress

The individual's distress becomes more noticeable, and it may start to interfere with their ability to concentrate or engage in daily activities. Physical signs might include notable muscle tension. They may describe feeling moderately anxious, stressed. Concerned, but not yet overwhelmed.

4 - Moderate to severe distress

The individual's distress intensifies, and they may start to feel a sense of panic or unease. They may notice their increased heart rate, and may start sweating. They may describe feeling highly anxious, agitated, or distressed, with physiological sensations becoming more pronounced.

5 - Severe distress

The individual's distress becomes more notable, perhaps overwhelming, and they may have difficulty managing their emotions or thoughts. Their heart may be racing, they may be tense or short of breath. They may describe feeling highly anxious, scared, or on the brink of losing control.

6 - Very severe distress

The individual's distress reaches a critical level, they're very agitated, unable to think or concentrate and it may be difficult for them to function or communicate effectively. They may describe feeling extremely anxious, panicked, or overwhelmed, with physiological symptoms becoming more severe. High muscle tension, short breathing, muscles being knotted, stomach discomfort.

7 - Extremely severe distress

The individual's distress becomes unbearable, and they may feel completely overwhelmed or dissociated from their surroundings. They may describe feeling in a state of extreme distress, terror, or emotional pain. They may experience intense muscle tension, rapid heart rate, difficulty breathing, trembling.

8 - Near maximum distress

The individual's distress reaches a critical level, and they may feel on the verge of losing control or experiencing a crisis. They may describe feeling in a state of extreme distress, agitation, or desperation. They may have severe muscle tension, palpitations, shallow breathing, or dizziness.

9 - Maximum distress

The individual's distress becomes intolerable, and they may feel completely overwhelmed or unable to cope. They may describe feeling in a state of extreme distress, terror, or despair, with physiological symptoms reaching a peak. Physical symptoms may include extreme muscle tension, pounding heart, difficulty breathing, nausea.

10 - Overwhelming distress

The individual's distress becomes all-encompassing, and they may feel completely incapacitated or unable to function. They may describe feeling in a state of extreme distress, terror, or hopelessness, with physiological symptoms at their highest intensity. They may have overwhelming physical symptoms, such as chest pain, racing heart, difficulty breathing, or feeling faint. Generally at or before this point, people may seek medical attention for fear of their life.

It's important to note that the SUDS scale is subjective and thus what any given rating means may vary from person to person. It is intended to help individuals assess and communicate their distress levels to their therapist or mental health professional, and can be used as a useful tool in therapy, particularly in approaches such as exposure therapy or desensitization.

Using the SUDS Scale for Hypoarousal Symptoms

In addition to assessing anxiety or distress levels, the Subjective Units of Disturbance Scale (SUDS) can also be used to evaluate hypoarousal symptoms, which are associated with decreased energy, motivation, and engagement. Hypoarousal can manifest as the "flop" response or as depression, and it's important to recognize and address these symptoms in therapy or self-help practices.

Here's a list of SUDS ratings that can be used to assess hypoarousal symptoms, but as usual it's entirely up to the person doing the ratings to decide what their own personal symptom rating is:

• 0 - No signs of hypoarousal or depression
• 1 - Mild decrease in energy or motivation
• 2 - Noticeable decrease in energy or motivation
• 3 - Feeling sluggish or lethargic
• 4 - Difficulty initiating or completing tasks
• 5 - Significant decrease in energy or motivation, feeling numb or disconnected
• 6 - Feeling emotionally flat or empty
• 7 - Loss of interest or pleasure in activities
• 8 - Feeling detached or dissociated from oneself or surroundings
• 9 - Overwhelming feelings of hopelessness or despair
• 10 - Severe depression, inability to function, complete emotional shutdown

Using the SUDS scale for hypoarousal symptoms can help individuals identify and track changes in their energy levels and motivation, and determine the effectiveness of interventions or strategies aimed at addressing hypoarousal symptoms. It's important to remember that hypoarousal symptoms may require different approaches than anxiety symptoms, and working with a qualified therapist or mental health professional can be beneficial in developing effective strategies for managing hypoarousal.

Example of SUDS in use

One practical application of the SUDS scale is in conjunction with trauma work techniques. We'll use Emotional Freedom Technique New (EFT) to illustrate how SUDS is used to gauge the effectiveness of the intervention — but it can be used with other tools & techniques as well. The SUDS scale provides a before-and-after subjective rating that helps the client and their helper track changes in distress levels during a trauma work session.

The SUDS scale can be used before, during, and after each round of tapping to assess the changes in distress levels. Here's an example of how the SUDS scale can be integrated into an EFT session:

1. Before starting the EFT session, the individual rates their current distress level using the SUDS scale, with 0 indicating no distress and 10 indicating extreme distress. This serves as the baseline measurement.
2. The individual begins the first round of tapping while focusing on the specific issue or emotion they want to address. After completing the first round, they pause and re-assess their distress level using the SUDS scale.
3. During the session, the individual may repeat multiple rounds of tapping, checking in with their distress level using the SUDS scale after each round. They may notice changes in their distress level, which can be recorded and tracked.
4. At the end of the EFT session, the individual rates their distress level again using the SUDS scale to determine the post-session measurement.
5. The individual and the therapist can then compare the baseline distress level with the post-session distress level to assess the effectiveness of the EFT intervention. If there is a significant reduction in distress level, it may indicate progress in addressing the targeted issue or emotion.

Illustrated Example

Let's consider an example of an individual using the SUDS scale in conjunction with EFT to address their fear of public speaking. Before starting the EFT session, the individual rates their distress level as 8 on the SUDS scale, indicating a high level of distress. After the first round of tapping, they re-assess their distress level and find it has decreased to 5. They continue with additional rounds of tapping and after the session, their distress level has further reduced to 2 on the SUDS scale. This significant reduction in distress level suggests that the EFT intervention has been effective in reducing their fear of public speaking.

Expanding SUDS with UNSAFE

In some cases it's very helpful to jot down UNSAFE New feelings along with SUDS scores, to help track the signs or symptoms that might be lowered during trauma work attempts. When we're tapping into how intensely we're activated (0-10) we can also jot down how we feel UNSAFE at the moment — all the feelings, sensations, triggers that our body has stored up about the trauma we're processing.

Some examples are embedded in the SUDS descriptions above. One might ask "Why am I saying it's a 4 and not a 3…?" "I'm sweating…"

• unmet needs ("I need to run away, but I'm stuck")
• noticed perceptions ("A voice is saying go away")
• story ("I'm a loser")
• age ("I feel really small…")
• feelings ("I'm tensed and anxious")
• emotions ("I feel angry and sad")

…and any other similar reactions or feelings you think are relevant.

Verification

A drop in SUDS score is usually a sign of desirable change. To verify, however, we would also go back to the thoughts, feelings, body sensations, intrusions, and so on that were in play before we started our work.

If trauma work is successful and given the examples feelings above, we might ask ourself "Am I still a loser?" and find we no longer connect with that belief. The nausea may have vanished, and instead of anger, now there's mild grief. The feeling of wanting to run away may be gone now.

A week later, we might check back and see whether our SUDS is still low to none on that topic — and also check whether the undesirable feelings have been resolved: "I haven't had a headache in a week. I no longer hear someone saying 'Go Away!' and I feel free — I'm not trapped anymore."

When seeking memory reconsolidation New, it can be very helpful to do verification work after trying an intervention.

Conclusion

The Subjective Units of Disturbance Scale (SUDS) is a valuable tool in assessing and tracking changes in distress levels during therapy or interventions such as EFT. By using the SUDS scale before, during, and after an intervention, individuals and therapists can gain insight into the effectiveness of the intervention in reducing distress and promoting emotional well-being.

Article created by The Crisses with massive boost by ChatGPT.

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