SUDS Scale Tracker: Rate Distress 0 to 100 During Exposure

Rate your distress from 0 to 100 during an exposure. A gentle reminder chimes every 1 or 2 minutes and your curve draws as you go. Includes an EMDR mode for SUD and VoC between sets.

AdultsTeensTrauma & EMDRCBT
10–45 minutesIn person and on video
Free interactive tool
Designed by Michael Thompson, MSc

Link copied – paste it to your client

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Use with care

Exposure should follow a plan made with a trained clinician, especially for trauma.

More

The EMDR mode is only for trained EMDR clinicians and records ratings, not memory content. Stop and use your coping plan if you feel unsafe; distress on its own is not danger.

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How to play

  1. Optional: write what you're facing and what you predict will happen.
  2. Tap Start and rate now (0 is totally calm, 100 the worst you can imagine).
  3. Rate again each time the reminder chimes. Your curve draws as you go.
  4. End when your planned time is up, whatever the number, and write what you learned.

About the technique

The Subjective Units of Distress Scale (SUDS) asks a person to rate their distress from 0 to 100, where 0 is completely calm and 100 is the worst they can imagine. Joseph Wolpe introduced it in behavior therapy to build fear hierarchies and monitor desensitization (Wolpe, 1969), and it remains the usual way to track distress during exposure work. EMDR uses a 0 to 10 version, the SUD, alongside the Validity of Cognition (VoC) scale, which rates from 1 to 7 how true a positive belief feels (Shapiro, 2018).

Ratings give a shared, moment-to-moment picture of an exposure, but how to read the curve has changed. The inhibitory learning approach argues that distress does not need to fall within a session for learning to occur: the aim is to learn that feared outcomes do not happen and distress can be tolerated, not to wait for the number to drop (Craske et al., 2014). The treatments the scale supports are well established; prolonged exposure, for example, shows large effects for PTSD in meta-analysis (Powers et al., 2010). In EMDR, SUD ratings have shown good psychometric properties, tracking depression and anxiety at the start and clinical improvement at the end (Kim et al., 2008).

It suits adults and teens doing planned exposure or ERP, and the EMDR form is for trained EMDR clinicians. The scale is a measure, not a treatment. Exposure should follow a plan made with a trained clinician, especially for trauma. Distress is not danger; agree in advance what the client will do if they feel unsafe between sessions.

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For therapists: how to run it

Goal

See how distress actually moves during an exposure, and compare what you predicted with what happened.

In session

  1. Plan the exposure step together first (for example from the fear ladder). Ask for a prediction and an expected peak.
  2. Share your screen or send the client link. Tick Share tab audio so the client hears the reminder chime.
  3. Prompt for a rating at each chime; the curve is a shared record, not a target.
  4. Afterward, compare prediction and outcome and ask what they learned. For EMDR, switch to the EMDR mode and log SUD and VoC between sets.

As homework

  1. Only do exposures you planned with your therapist.
  2. Rate at the start and each time it chimes. You don't need the number to drop before you stop.
  3. Write what happened and what you learned, then tap See my exposure. Tap Copy on the result card, then paste it into your therapist's secure messaging (client portal) or bring it to your next session. Nothing is saved, so copy before closing.
Good to know

The live mode never tells the client to keep going until the number drops: ending at the planned time is framed as fine, in line with inhibitory learning. The EMDR mode logs baseline SUD and VoC, checks between sets, body scan and closure, and records the final ratings as they were; whether reprocessing is complete stays the clinician's judgment.

Worksheets that pair with this tool

Fear Ladder Worksheet

Fear Ladder Worksheet

Free PDF with a five-step grid pairing each feared situation with an anxiety rating from 1 to 10, for graded exposure work.Adults and teensAnxietyBehavioralCBTExposure and ERP+2Free PDF 1 pageExposure Tracking Log Worksheet

Exposure Tracking Log Worksheet

Log date, intensity before and after, length and reflections for each exposure on one page.Adults and teensAnxietyOCDBehavioralCBTExposure and ERP+3Free PDF 1 pageCycle Of Anxiety Worksheet

Cycle Of Anxiety Worksheet

Map the four-step loop from anxiety to avoidance, short-term relief and long-term anxiety growth.Adults and teensAnxietyCBTExposure and ERPPsychoeducational+2Free PDF 3 pages

Sources & credibility

Method
Subjective Units of Distress Scale (SUDS) during exposure; SUD and Validity of Cognition (VoC) in EMDR
Developed by
Joseph Wolpe (SUDS); Edna Foa (prolonged exposure); Francine Shapiro (EMDR SUD and VoC)
First described
1969; 1991; 1989
Approach
Behavior therapy, CBT, ERP, EMDR
Evidence
Supported by studiesExposure-based treatments such as prolonged exposure and exposure and response prevention are well supported, and SUDS ratings are their standard way of tracking distress. Current inhibitory-learning guidance says the goal is to learn you can cope, not to wait for the number to fall. The scale tracks distress; it is not a treatment on its own.

References

  1. Powers M. B., Halpern J. M., Ferenschak M. P., Gillihan S. J. & Foa E. B. (2010). A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clinical Psychology Review, 30(6), 635–641. Source
  2. Craske M. G. et al. (2014). Maximizing exposure therapy: an inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. Source
  3. Kim D., Bae H. & Park Y. C. (2008). Validity of the Subjective Units of Disturbance Scale in EMDR. Journal of EMDR Practice and Research, 2(1), 57–62. Source
  4. Shapiro F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures (3rd ed.). Guilford Press.
  5. Wolpe, J. (1969). The practice of behavior therapy. Pergamon Press. Source
  6. Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences. Therapist Guide. Oxford University Press. Source

How it was made

Built by the Mentalyc team from the original method and the published sources listed here. Nothing you enter is stored.

Questions people ask

What is the SUDS scale?

The Subjective Units of Distress Scale, developed by Joseph Wolpe, is a 0 to 100 self-rating of how upset or anxious you feel right now: 0 is completely calm and 100 is the worst distress you can imagine.

How is SUDS used in exposure therapy?

You rate SUDS at the start of an exposure and every few minutes during it. The ratings show how distress actually rises and falls, and help you and your therapist plan the next step.

Do I have to wait for my SUDS to go down before stopping?

Not necessarily. Current inhibitory-learning approaches focus on learning that you can tolerate the feeling and that the feared outcome doesn't happen. Ending at the planned time is fine; follow your therapist's plan.

What are SUD and VoC in EMDR?

In EMDR, SUD is rated 0 to 10 for how disturbing a memory feels now, and the Validity of Cognition (VoC) is rated 1 to 7 for how true a positive belief feels. The EMDR mode lets a trained clinician log both between sets.

How do you rate SUDS during in vivo exposure?

Ask for a 0 to 100 rating before the exposure, every few minutes during it and at the end. Plotting the ratings shows the client that distress can rise and fall without escape, though in inhibitory learning the aim is tolerating distress, not waiting for it to drop.

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Michael Thompson

Michael Thompson, MSc

Michael's background combines doctoral training in clinical psychology with research on motivation, learning, and emotional regulation.

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Table Of Contents
  1. About the technique
  2. For therapists: how to run it
  3. Worksheets that pair with this tool
  4. Sources & credibility
  5. Questions people ask
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