SUDs Rating Scale for Measuring Social Anxiety

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The SUDs Rating Scale, or Subjective Units of Distress Scale (SUDs) as it is officially known, is used to measure the intensity of distress or nervousness in people with social anxiety. The SUDs is a self-assessment tool rated on a scale from 0 to 100.

The SUDs can be a subjective tool used by your therapist or healthcare provider to evaluate your progress and the success of your current treatment plan. In this way, it can be used regularly over the months of your treatment to gauge different areas of distress or disturbance that require additional work.

SUDs Rating Process

A common technique in cognitive therapy is using the SUDs tool to gauge your distress or emotional state. Guidelines for the SUDs include rating the intensity of your anxiety as it is experienced in the moment and while tightening or tensing of the body.

Below is a simplified version of the scale with different guide points:

Rating Your Distress

  • 100: Unbearably upset to the point that you cannot function and may be on the verge of a breakdown
  • 90: Extremely anxious and desperate, helpless and unable to handle it
  • 80: Worried and panicky; losing focus and feeling anxious in the body
  • 70: Discomfort dominates your thoughts and you struggle to function normally
  • 60: Moderate to strong levels of discomfort
  • 50: Upset and uncomfortable; still functional
  • 40: Mild to moderate anxiety and worry
  • 30: Worried or upset; still able to function
  • 20: A little bit sad or distressed
  • 10: No distress; alert and focused
  • 0: Peace and complete calm

Precise accuracy of measurement is not important. Rather, the SUDs is a broad guide to give your therapist an idea of what you are experiencing.

It is especially important to share this with your therapist because it reflects how you feel about your distress, rather than how anyone else judges your fears. It can be difficult to share with your therapist the intensity of what you are feeling. In this way, the SUDs gives you a simple way to express the severity of your emotions.

It is common for those with social anxiety to feel emotions and fears more intensely than others. What could be a minor incident to someone else can feel like a catastrophe to you. Social anxiety influences your perspective and how you view yourself and those around you.

SUDs and Therapy

Use of the SUDs can help you and your therapist track improvements or setbacks. Be sure to complete the scale honestly to allow your therapist to appropriately judge what is working and what is not.

Through the SUDs scale, you may realize you feel intensely distressed by something that wouldn't normally bother others. This can help you identify areas you need to work on.

As you go through the SUDs assessment, you can identify areas to work on with your therapist. Your therapist may have you work through techniques such as disputation, during which you recognize irrational thoughts and work to replace them with more rational ways of looking at situations.

This is a learned skill that you establish during therapy, but continue to develop on your own in your daily routine. You may find that working through these issues improves your SUDs rating.

A Word From Verywell

Ratings scales such as the SUDs are only useful if you complete them honestly. Try not to respond in the manner that you think your therapist wants, as this can be a trap for those with social anxiety disorder. Instead, give ratings based on how you are feeling in the moment, regardless of whether you think it is good or bad to be feeling that way.

In particular, research on the use of the SUDs with children and teens has shown that miscommunication can sometimes be a problem. If you fall into this age range, be sure to tell your therapist or doctor if you are not sure how to use the SUDs tool.

5 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  5. Kiyimba N, O'Reilly M. The clinical use of Subjective Units of Distress scales (SUDs) in child mental health assessments: a thematic evaluation. J Ment Health. 2020;29(4):418-423. doi:10.1080/09638237.2017.1340616

By Arlin Cuncic
Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety."