Subjective Units of Distress Are a Staple in Mental Health Treatment, but What Are They?
The Subjective Units of Distress Scale (SUDs) is a rating tool used during treatment to measure a patient’s level of distress or anxiety.
SUDs (not to be confused with Substance Use Disorder) are a self-assessment tool that helps patients convey their progress during treatment. At EHN Canada, our patients use SUDs in therapies such as Dialectical Behaviour Therapy (DBT) and Exposure Therapy to express their emotions more clearly to clinicians.
How SUDs Work
SUDs capture how a patient feels at a particular moment during treatment. They help patients quantify their levels of stress using a 0-10 scale, or 0-100 for more detailed assessments.
For some patients, identifying their feelings is difficult. SUDs provide a simple way to express them. As therapy moves towards more Measurement-Based Care practices, SUDs allow patients to be more involved in their treatment through self-reporting their emotions and working with their clinician on a solution.
SUDs can also be used in daily life by journaling SUD scores throughout the day. These scores help individuals recognize when to use self-soothing and relaxation techniques. Many EHN Canada alumni have told us that they continue using the SUDs scale post-treatment to support their emotional management throughout recovery.
A study from the Journal of Anxiety Disorders showed that SUDs are highly effective in therapies like Exposure Therapy for patients who are diagnosed with Obsessive-Compulsive Disorder. The study highlighted that patients who used SUDs consistently experienced a significant reduction in symptoms compared to those who did not.
What Does an SUD Look Like?
There are several different kinds of SUDs that are used in clinical settings. Here is an example of one.
This is what the different levels of the SUD scale may represent. This is a simplified version using the 0-100 rating scale and would be used by a patient in real-time to show a clinician how they are feeling.
- Distress Intensity: None
- Physical Signs: At peace or completely calm. Lacking any form of anxiety
- Behaviours: There are no outward signs of distress
- Distress Intensity: Low
- Physical Signs: Slight increase in muscle tension. Breathing starts to change
- Behaviours : There is a slight outward change in behaviour and others may notice if they are paying close attention
- Distress Intensity: Moderate
- Physical Signs: Increased heart rate, muscle tension in the jaw, neck, shoulders etc. Sweating
- Behaviours: There is some difficulty concentrating at this point. Difficulty communicating, jaw clenching, and looking agitated, but still able to cope somewhat
- Distress Intensity: High
- Physical Signs: Headaches, back pain, shaking, difficulty breathing
- Behaviours: At this point an individual may be panicking or trying to escape the situation. Others can see visible distress on their face and body.
- Distress Intensity: Severe
- Physical Signs: Erratic heartbeat, extreme trouble breathing, sweating, vomiting
- Behaviours: The individual is extremely uncomfortable at this point. They are actively trying to or already escaping the situation. This is also the stage where they may go into fight or flight mode.
- Distress Intensity: Maximum
- Physical Signs: Severe shaking, vomiting, severe sweating, headaches
- Behaviours: This could be described as the worst anxiety a person has ever felt. Completely unable to communicate, nervous breakdown, inconsolable. A 911 call may be necessary at this point
Remember, this scale is subjective and the specific number is less important than the overall feeling the patient is experiencing. The scale might not mean the same for everyone. What one might consider a 50 could be completely different than a 50 for someone else, and this is where clinical discernment comes into play.
This subjectivity helps capture the client’s experience of distress, making it useful for tracking progress and adjusting treatment as needed.
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