Appendix g: suds – Subjective Units of Distress Scale

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APPENDIX G: SUDS – Subjective Units of Distress Scale

Before discussing the process of exposure (used in the treatment of trauma), it is important to explain the concept of SUDS, since this is central to the conduct of any exposure procedure. You as the client will need to understand and be able to use SUDS during the anxiety management phase and need to be thoroughly familiar with the concept to be best supported in addressing your trauma memory.

Try to get used to rating your anxiety or discomfort on a scale of 0 – 100. Imagine you have a "fear thermometer" to measure your anxiety according to the following scale. Notice how your level of anxiety changes over time and in different situations.

SUDS: The Fear Thermometer

100 Highest anxiety/distress that you have ever felt

90 Extremely anxious/distressed

80 Very anxious/distressed, unable to concentrate

70 Quite anxious/distressed, interfering with performance


50 Moderate anxiety/distress, uncomfortable but can continue to perform


30 Mild anxiety/distress, no interference on performance

20 Minimal anxiety/distress

10 Alert and awake, concentrating well

0 Totally relaxed

The SUDS is simply a means of rating the severity of current distress (or anxiety), thereby allowing you and your counsellor to monitor changes over time, for example, following the teaching of an anxiety management strategy or during exposure to a feared stimulus.

As you start to confront your memories, it is useful to have a means of both measuring your level of anxiety and distress, and reporting it to your counsellor in a short-hand way. You use a SUDS scale ranging from 0 to 100 – a kind of fear thermometer – where 0 is feeling perfectly relaxed and 100 is the worst anxiety and distress you can imagine. It is useful to get into the habit of rating your anxiety. That way, you become more in touch with your feelings and have a better chance of controlling them. Without some kind of measure, people tend to think in black and white terms - either you are anxious or relaxed – when, in reality, there are many shades of grey. Using the SUDS scale will help you to keep your distress level in perspective; for example, you may be feeling anxious, but it's only 40 – you can handle that.

(Acknowledgment: The Australian Centre for Post-Traumatic Mental Health.}

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