The Subjective Units of Distress Scale (SUDS) is a tool similar to the anger thermometer that helps individuals rate their level of distress. The scale typically ranges from 0 to 10 or 0 to 100, depending on how it is used.

Recent studies cited by the National Library of Medicine have raised questions about the reliability of SUDS and similar scales, suggesting that further research is needed. However, other organizations such as the American Psychological Association and the Centre for Clinical Psychology have found these tools to be useful in clinical practice.

In my experience, SUDS can be very helpful in assisting clients with identifying how their thoughts, emotions, and behaviors impact their level of distress. Understanding SUDS can also serve as a guide when making important decisions or navigating difficult situations. I often spend time helping clients deconstruct events and identify the factors that contribute to increases or decreases in distress. Just as important, we work together to create action plans that empower clients and help them become more proactive rather than reactive.

The SUDS Scale

Below is an example of how the SUDS scale may be used:

  • 100 – Highest distress, fear, anxiety, or discomfort you have ever felt

  • 90 – Extremely anxious or distressed

  • 80 – Very anxious or distressed, difficulty concentrating

  • 70 – Quite anxious or distressed, interference with performance

  • 60 or 50 – Moderate anxiety or distress, uncomfortable but able to continue functioning

  • 40 or 30 – Mild anxiety or distress, no interference with performance

  • 20 – Minimal anxiety or distress

  • 10 – Alert and awake, concentrating well

  • 0 – Totally relaxed

Thoughts, Emotions, and Distress

Emotions and thoughts are closely interconnected. Automatic Negative Thoughts (ANTs) can significantly increase distress levels. These thoughts are typically unhelpful and often make situations feel worse. Common ANTs include:

  • Black and white thinking

  • Mind reading

  • Catastrophizing

  • Labeling

  • Jumping to conclusions

  • Overgeneralizing

  • Using “shoulds”

  • Disqualifying the positive

  • Making assumptions

  • Mental filtering

ANTs contribute to elevated distress, which is why it is important to identify, understand, and challenge unhelpful thinking patterns. When deconstructing and reflecting on difficult experiences, it can be helpful to examine each step of the situation, particularly what occurred as SUDS levels rose and fell.

Many clients notice that their SUDS levels are higher at the start of the day or when anticipating future events. Strategies such as mindfulness, deep breathing, distraction, journaling, and using a stress or self-soothing kit can be effective ways to reduce distress.

Understanding the Subjective Units of Distress Scale (SUDS) and How It Helps Manage Stress2

Applying the SUDS Scale in Daily Life

SUDS is a tool that can help individuals identify and better understand their level of distress. Higher distress levels can impact how we make decisions and respond to others. Gaining insight into how our thoughts influence distress is especially helpful when reflecting on past events. Learning strategies to lower SUDS levels can empower clients to prepare for difficult situations and become less reactive overall.

If you are struggling with chronic stress or difficulty managing distress, it is important to seek support from a qualified mental health provider. Family Counseling Service is here to help.
Call us at 630-844-2662 or contact us online to schedule individual therapy and give yourself permission to take care of yourself.