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

Resources