Have you ever used SUDS? No, I'm not talking about your bubble bath! I am actually referring to Subjective Unit(s) of Discomfort. It works similar to a pain rating scale, only it is an anxiety rating scale. Some people use a scale of 1 to 10, while others use a scale of 1 to 100. My psychologist suggested using the 1 to 100 scale so that I could be more precise with my feelings of anxiety. I agreed with her, so that is the scale I use. You could probably use any scale you want, as long as you are consistent with using the same one all the time.
Something very low on the scale, say around a 20, means you are experiencing very little anxiety, and something around a 100 means that you are completely overwhelmed with anxiety. Jonathan Grayson, in his book, "Freedom From Obsessive Compulsive Disorder," states, "When using 100, try to remember that this means there is no greater anxiety you can feel-or, in other words, don't use ratings of 110" (page 66).
To me, the important word is "subjective." Basically, the anxiety sufferer is the one who decides where on the scale his or her anxiety sits. Sometimes, that is difficult for me. Especially because it is subjective and I have no outside proof of what I am feeling. Often, I struggle with what "number" I am. "Am I a 55 or a 65 on the scale? Oh, no, what if I'm totally wrong about what number I am?" If I let it, attempting to find my number can itself become an obsessive and compulsive activity. I fight that urge, however, and usually just try to settle near to whatever number I first came up with instinctively. On a scale of 1 to 100, if I'm off by 10 or 15 points, I don't think it's a very big deal. I try to look at it as a rough guide. Again, we can take Dr. Grayson's advice: "With regard to the accuracy of your SUDS rating, don't worry. The ratings are meant to generally measure what feels mildly distressing to severely distressing" (page 66). There is no perfection allowed in OCD treatment and recovery!
Why is the SUDS scale helpful? The scale is invaluable when creating a hierarchy of exposures (more on that in another post). It can also guide us on how to proceed with an exposure. My doctor always recommended working on ERPs that were about a 60 or 70 on the SUDS scale. At this level, things are certainly uncomfortable and painful, but they are not completely out of my ability to tackle them. Additionally, the SUDS scale is helpful when looping ERPs. Moreover, during in-office exposures, my psychologist would often ask me, "What's your SUDS level?" so she could decide on how to proceed with the ERP.
If you have never used SUDS, you may want to start keeping track of your anxiety levels, so that you can get an idea of what is a really difficult exposure and what is easier for you to work on. I do think it's important to remember that this is just another tool to help us in the battle against OCD. So, what's your SUDS level?