S.U.D.s stands for Subjective Units of Distress. An important aspect of this is that it is subjective. Sometimes kids will want to be exact so I encourage my clients to not give it too much thought, just the first impression that occurs to them. I use a numerical scale of 0 – 10.
For some kids, that just doesn’t work so I switch to words that measure intensity. For younger kids I might use a whiteboard with a line that they can mark. I am attaching a handout you can use freely if you would like.
With some clients, the numbers are always high and I get a baseline with them. You cannot really compare one person to another on this sort of rating scale. The important thing to do is figure out what the client is willing to tolerate. I have had clients tell me they are 8 or 9 but it is clear they are willing and able to handle the distress. For others, that is way too high.
Virtually every client will use decimals. They will say something like 5.5. I suppose one could use a scale of 0 – 100 but kids and teens seem to like to break it down with decimals.
I think a brief explanation of why I want to use SUD scores is helpful. It is a way of comparing the starting distress with the score after practicing it. It is encouraging for someone to feel a difference during an exposure trial. However, be prepared for it to go up and down. It is important to not get too invested in a decline with every practice. If it seems to take “too long”, you might investigate if some sort of safety behavior is being used. You will only be able to judge what “too long” is with experience with your client as well as doing ERP over time. I also explain that SUD scores help me judge whether a particular step is too easy or too hard.
Below is a link to an illustrated SUDs handout that some kids may find helpful.
