Understanding and Using the Subjective Units of Distress Scale (SUDS) in DBT

The Subjective Units of Distress Scale (SUDS) is a simple yet powerful tool used to measure your level of distress, anxiety, or discomfort. It’s a self-reported scale ranging from 0 to 10, where 0 represents complete calm and 10 signifies the highest level of distress or anxiety. This post will address a common misconception about the tool and show you how to use it effectively to track your progress.

‍What is SUDS?

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SUDS is particularly valuable in behavioral therapies such as Dialectical Behavior Therapy (DBT) and exposure therapy. By using the SUDS scale, therapists can monitor your progress in managing distressing thoughts or situations. Regularly checking your SUDS rating allows your therapist to assess the effectiveness of the interventions and make necessary adjustments.

‍A Common Misconception

A common misconception is that a SUDS rating of 3 feels the same for everyone. This is not true! The experience of distress or anxiety can vary significantly from person to person, even at the same SUDS level. Our perception of distress is influenced by factors such as past experiences, coping mechanisms, and personal resilience.

Examples of the Subjectivity of SUDS in Practice:

To illustrate, let’s look at how different people might experience a SUDS rating of 7:

• John: At a SUDS rating of 7, Person A feels panic, has racing thoughts, and experiences physical symptoms like a pounding heart or sweating.
• Mary: For Mary, a SUDS rating of 7 might mean feeling uneasy, worried, and experiencing mild physical discomfort.

How to Use SUDS in Your DBT Practice

1. Identify Your SUDS Levels: Throughout your day, check in with yourself and rate your level of distress on the SUDS scale. Note the thoughts, emotions, and physical sensations you experience at each level.
2. Track Your Progress: Keep a journal or use a tracking app to record your SUDS ratings and any related notes. This helps you and your therapist see patterns over time.
3. Reflect and Communicate: Reflect on your SUDS ratings and what they mean to you. Communicate these insights with your therapist. This shared understanding can help tailor your DBT interventions to better suit your needs.
4. Use SUDS During DBT Skills Practice: When practicing DBT skills like mindfulness, distress tolerance, or emotional regulation, check your SUDS rating before and after the exercise. This will help you see which skills are most effective in reducing your distress.

Understanding Your Personal Experience

To better understand your experience at different SUDS levels,  you can download a SUDS template or use the survey below. By reflecting on your thoughts, emotions, and physical sensations at each level, you can gain valuable insights into your personal experience of distress and better communicate it to your therapist or counselor.

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