Social Anxiety and SUDs Ratings

The SUDs Rating is an Essential Tool in Treating Social Anxiety

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The Subjective Units of Distress Scale (SUDs) is a scale used for those with social anxiety to measure the intensity of distress or nervousness you experience. It is a self-assessment tool with a scale of 0 to 100. It can be a subjective tool used by your therapist or healthcare provider to evaluate your progress and the success of your current treatment plan. It can be taken regularly over the months of your treatment to gauge different areas of disturbance that require additional work.


The SUDs Scale

A common technique in cognitive therapy is using the SUDs tool to gauge your distress or emotional state. Guidelines for the SUDs rating include the intensity as it is experienced in the moment and tightening or tensing of the body. Below is a simplified version of the scale with different guide marks:

  • 0: Peace and complete calm
  • 1: No real distress but perhaps a slight feeling of unpleasantness
  • 2: A little bit sad or off
  • 3: Worried or upset
  • 4: Upset to the point where negative thoughts begin to impact you
  • 5: Upset and uncomfortable
  • 6: Discomfort to the point where you feel a change is needed
  • 7: Discomfort dominates your thoughts and you struggle not to show it
  • 8: Panic takes hold. 
  • 9: Feeling desperate, helpless and unable to handle it
  • 10: Unbearably upset to the point where you cannot function and may be on the break of a breakdown

Accuracy is not exactly important; it is just a broad guide to give your therapist an idea of what you are experiencing.

It is especially important because it is how you feel about your distress, not how anyone else judges your fears. It can be difficult to share with your therapist the intensity of what you are feeling. The SUDs scale 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 harms your perspective and impacts how you view yourself and those around you. 

It can help you and your therapist notice any improvements or setbacks. That make sit important to fill out the scale honestly 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 bother others. This can help you identify areas you need to work on. 

SUDs and Therapy

As you go through the SUDs assignment, you can work with your therapist on those areas that cause you the most emotional distress. Your therapist may then work you through techniques like disputation, where you recognize the areas of anxiety and irrational reactions and work to replace them with rational, positive thoughts. 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. 


Tanner, B. "Validity of Global and Physical and Emotional SUDs". Applied Psychophysiological Biofeedback, 31-34, 2012. 

Wolpe, J. The Practice of Behavior Therapy, 1969. 

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