SUDs (Subjective Units of Distress)

A scale for measuring and communicating your level of emotional distress.

SUDs (Subjective Units of Distress) is a simple 0–10 scale for rating how distressed you feel right now. It gives you and your therapist a shared language for talking about emotional intensity.

The Scale

  • 0 — No distress. Completely calm and at peace.
  • 1–2 — Minimal distress. Slight unease, easily manageable.
  • 3–4 — Mild distress. Noticeable discomfort but you can still function well.
  • 5 — Moderate distress. Uncomfortable. Harder to concentrate. Skills are needed.
  • 6–7 — High distress. Significant suffering. Functioning is impaired. Strong urges may be present.
  • 8–9 — Severe distress. Overwhelming. Crisis skills needed. Difficult to think clearly.
  • 10 — Worst possible distress. Completely overwhelmed. In crisis.

When to Use SUDs

  • Daily on your diary card
  • Before and after practicing a skill (to measure effectiveness)
  • In session with your therapist
  • When deciding which skills to use — higher SUDs may call for crisis survival skills (TIP, ACCEPTS) before emotion regulation skills
There's no 'right' answer. A 5 for you might look different from a 5 for someone else. What matters is that your ratings are consistent for you over time.

SUDs and Skill Selection

A rough guide for matching distress level to skill type:

  • SUDs 1–3: Mindfulness, Emotion Regulation skills, preventive coping
  • SUDs 4–6: Opposite Action, Check the Facts, PLEASE, interpersonal skills
  • SUDs 7–8: Distress Tolerance skills (ACCEPTS, Radical Acceptance)
  • SUDs 9–10: Crisis survival skills (TIP, STOP) — change body chemistry first, then use other skills

Real-Life Examples

Scenario: Your therapist asks "How anxious are you?" and you say "Very." But you said "very" last week too, and you're not sure if it's actually the same or different. Skill in action: You start using SUDs (Subjective Units of Distress): today's anxiety is a 6/10. Last week's was an 8/10. You're actually improving — you just couldn't see it without a number to compare. The scale gives you precision where vague words fail.
Scenario: You're in the middle of a conflict and trying to decide whether to use a crisis skill (TIPP) or an emotion regulation skill (Check the Facts). You're not sure how distressed you actually are. Skill in action: You do a quick SUDs check: "Where am I on a 0-10 scale right now?" You're at a 7. Your rule of thumb: above 7 = crisis skills (TIPP, ACCEPTS). Below 7 = regulation skills (Check the Facts, Opposite Action). The number helps you pick the right tool instead of guessing.
Scenario: You're doing exposure therapy for social anxiety. After talking to a stranger, you feel like it was "horrible" and want to quit. Skill in action: You rate your SUDs: before the conversation you were at 9, during it you peaked at 8, and 5 minutes later you're at a 4. The number tells you something your emotions obscure: your anxiety actually went DOWN after the exposure, not up. Without the scale, you'd only remember the peak fear and miss the drop — which is the whole point of exposure.

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