Subjective Units of Distress (SUDs)
EMDR Concept
A 0-to-10 self-report scale used in EMDR and many wellness practices to track how distressing a memory, thought, or feeling is in the moment — and how that distress changes as you process it.
Also known as: SUD, SUDS, SUD scale, distress rating
The Subjective Units of Distress scale (SUDs) is a simple number between 0 and 10 that you give your own distress in the moment. Zero is neutral — no disturbance at all. Ten is the most distress you can imagine feeling. Every number in between is a reading of how much charge a memory, thought, body sensation, or belief carries right now, from your own perspective.
SUDs was developed in the 1960s by psychiatrist Joseph Wolpe and has since been adopted across many wellness and clinical practices, including EMDR. It is deliberately subjective: there is no “correct” number. The value of SUDs is not in comparing your rating to anyone else’s — it’s in watching how your own number shifts over time.
How SUDs is used in self-guided practice
- Before processing. Bring the target memory or feeling to mind. Notice a number between 0 and 10 that reflects how disturbing it feels right now. Write it down.
- During processing. After each round of bilateral stimulation, re-check the number. Don’t force it one way or the other. Just notice.
- After a session. A meaningful drop — even 8 → 5 — is a real shift. A session that ends at 2 or below usually means the material has integrated enough to close for now.
Why the scale matters
SUDs gives self-guided practice something EMDR clinicians rely on every session: a feedback signal. Without it, it is easy to lose track of whether the work is moving. With it, small shifts become visible — and the work becomes a conversation with your own nervous system instead of a leap of faith.
The complementary measurement for positive belief, rather than distress, is VoC.