SUDS- SUBJECTIVE UNITS OF DISTRESS SCALE The Subjective Units of Distress Scale (SUDS) is a metric that gives the therapist an individual-specific evaluation. It provides the current subjective intensity of distress experienced by the individual undergoing an exposure therapy. The SUDS is an 11-point scale, 0-10, that expresses the degree of distress where 10 is severe distress and 0 is no distress whatsoever. It was developed by Joseph Wolpe in 1969 (Wolpe, Joseph. The Practice of Behavior Therapy. Pergamon Press, 1969) for his investigations of systematic desensitization therapy. The following discussion is a guideline for the use of the SUD. It is just a guideline based on clinical experience. Applying Havening requires you to apply your own clinical experience. The SUDS is richer in information then it appears on first view. Below is a list of issues that the SUDS raise. Information gleaned from initial level of distress Rate of decrement Getting stuck Going up Fractional differences Going to 0 Firstly, it is interesting that an individual can provide a number. I have asked many individuals and they tell me that the number appears to them in their mind. This is the subconscious at work. It is surprising how often recall of a traumatic event produces a 9 or 10 SUD. (10 = Feels unbearably bad, beside yourself, out of control. 9 = Feeling desperate, losing control over your emotions.) The implication is that the individual is experiencing the event as if it happening at the time of the encoding moment. If the number is in the mid-range one should attempt to Haven this to 0 and then continue history taking. It is likely that the event just havened might be a later subsequent event, after the sentinel event, and it is important to uncover the earlier moment. If the number is low 1-2 then one needs to seek out other events. It may be instructive to Haven this event to see what is uncovered but often a Transpirational Havening should be done next. What happens after one round of Havening next is of utmost importance. 1. The SUD does not move- Implies that the landscape is not permissive for Havening. The individual needs to have other aspects of the event or other events Havened first or an emotion transpirationally Havened before one can tackle this particular event. 2. The SUD goes down a little- Implies that this is not the critical event and that it is unlikely that you will get to an SUD of 0 during subsequent rounds. It is a call for further history taking when the SUD no longer diminishes with subsequent rounds. 3. The SUD goes down a lot- If after the first round the SUD drops to 2-3 it is likely that this memory will be successfully treated and that you achieve a 0 SUD It is not an uncommon occurrence to see the SUD get stuck at a number during Havening. If it gets stuck at a relatively high number (6 or more) then the critical event has not yet been discovered and further history is needed. If it gets stuck at a low number (3 or less) then consider Transpirational Havening for any remaining emotions. Getting stuck is not a failure! Rather it is a call for further investigation. There are instances where the SUD seems to be decrementing nicely and all of a sudden it goes up after a round. Here, a new event or another aspect of the event being Havened is brought to conscious awareness. It is important to stop and ask what came into mind. This will guide you to the next experience to be Havened. Sometimes the client will use fractions for the SUD. They will state that they are for example at a 2 ½. It is unlikely that you will be able to bring this to 0. Often they will go ‘halfway to the goal of 0’ e.g., 2 ½ 1 ¼ and may decrement a little from there. Try to get it as low as possible and then step back and take more history. If you achieve a 0 SUD it is of utmost importance to debrief the client on subsequent attempt on recall. It is not unusual to see other aspects of the event become uncovered and a lower number (SUD of 4-6) appear. This needs to be Havened and it will occur rapidly. Then re-debrief to make sure nothing is left. Again, these are simple guidelines meant to encourage you to look at the SUD in a more detailed way. Nothing here is written in stone as this information is just based on clinical experience. Ronald A. Ruden, M.D., Ph.D.
Posted on: Sat, 15 Jun 2013 14:12:46 +0000
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