Why "71º & Sunny?"

I consider 71º to be the perfect temperature. Not too cold and not too hot. I also love perfect sunny days. The vast majority of days are not 71º & Sunny and yet, all days were created by God's hand and they are still gifts, even if they don't fit my ridiculous definition of perfection. My struggle with OCD has at times imprisoned me in an impossible attempt to achieve perfection. I'm now learning to love all kinds of days that don't even come close to 71º & Sunny.

Please leave me a comment below. I really want to know what you are thinking!

Wednesday, October 24, 2012

SUDS

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?

17 comments:

  1. Thanks for explaining about SUDS. Actually I had someone use the idea of scale before but I don't think she used the terms "SUDS." My anxiety levels are generally WAY down from what they used to be. Have to remember that when I feel frustrated with what I feel like is lack of progress. I am not at 9 or 10 anymore. (I'll use 1-10.) Most of the time if I have anxiety, it is probably around the 1-3 range.

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    1. My pleasure, Kristina! I'm so glad to hear that your anxiety levels are down significantly. You're right - it is a good measure of your progress. My day to day levels of anxiety are also down quite a bit, so I know how good that feels. Congrats!

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  2. Thanks for this helpful post, Sunny. You explained SUDS very well! I experienced some anxiety as I created my hierarchies, afraid that I wasn't writing down the "right" number (I'm using 1-100). I had to remind myself of what Dr. Grayson said about not trying to be perfect!

    I am generally pretty anxious, sometimes at a 50 on just a "normal" day. But I'm learning that the OCD is affecting me even when I don't have active compulsions going on. And the GAD, too, I guess. I'm hoping the ERPs I'm doing will help lower all that to a nice 10 to 20.

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    1. Tina, I really struggled with my hierarchies too. Oh, was it frustrating for me. Even my psychologist acknowledged that for some reason, ranking stuff was something I always struggled with.

      That's a good point you make that OCD affects your general anxiety level, even when you don't have an active compulsion. I found that to be true as well. When I walked into my doc's office in the Fall of 2009, I think my basic daily anxiety level was around a 70 or 80 (believe it or not!). Seriously, I felt like I could explode into a million pieces at any minute. Once the OCD started to get under control, my base level also dropped. Most days now I'm probably around a 25 to 30 - many days even less, some days a bit more. I hope you find that your overall level drops as well. I certainly wish you well with that!

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  3. Sunny I am Vivian (Viv) and just found your blog off of Janet's blog. I recently started blogging and have many health issues including OCD as one. I am pure O as they call it and do more Obcessing than having compulsions but either way it is hard. I have heard of rating anxiety but not par-say SUDS!! This was really interesting and I always have trouble with putting a number to myself even on the chronic pain chart of 1-10 I have a problem wondering if I picked the right number. It was interesting that Dr. Grayson pointed out not to worry about them just be general. I am going to mention to my doctor about the scale I think this might help him and me both understand how anxious I feel at times. Like it is 3 a.m. here in TN. and I am up because I could not shut my thoughts down from running away and feel very anxious this morning because I am tired yet sleep would not come. I would say I am about a 60 at the moment. So glad to find your blog and read this. Thank you very much and it is nice to meet you.

    Hugs and Blessings,
    Viv

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  4. I do not know why it shows me as unknown I blog under vivspecialthoughts sorry about it not showing who I am..

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    1. Hey Viv! Welcome!! I suspect it's really common for those of us with OCD to struggle putting a number on anything, unfortunately. I'm sure that's why Grayson mentioned not worrying about it - I think he knows us pretty well!

      I'm so very sorry that you struggle with so many health issues. It must be an incredible challenge for you. I understand about not being able to sleep. When my anxiety was at its worst, it seemed like it would really spike in the middle of the night. I don't know, I guess it was the idea that everyone else was sleeping and it was so dark out. It always makes me sad to hear that others are going through that too because I know how bad it can be.

      I did check out your blog really briefly (I'll definitely be back to read more) and it's a very pretty design. I'm glad you started blogging. Hopefully you will receive the same kind of great online support that I have received.

      Sometimes Blogger and Wordpress don't talk real nicely with each other so that's probably why your previous comment came up with "Anonymous" and not your name.

      Come back and visit again. So nice to have met you too! Hugs.

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  5. Sunny, thank you once again for the information. Appreciate it very much. Hugs to you!

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  6. I've never heard of SUDS (except for the ones that form up in the kitchen sink).

    I am a person who would say something like 110 if I feel my anxiety is a maximum over load. But I really like how the author explained what 100 meant and therefore making a number of 110 doesn't really exist.

    I've been on such a good medication combination and I'm thankful to say that my number would probably fall around 20-25.

    Blessings to you Sunny!

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    1. Hi Deanna! I'm so glad to hear that your anxiety is on the lower side and that your medications are working for you. Life really does look differently when it's not completely colored by anxiety, doesn't it? Continued good health to you! : )

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  7. Great explanation of SUDS, Sunny. Thank you. I know when I go with my mom to the doctor it is so much easier for her to use a pain scale (1-10) to let her doctors know how she is feeling rather than trying to describe it. Such a simple idea, yet so helpful,as you say.

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    1. Thanks for your kind words, Janet. Actually, you make a really good point - the nice thing about a scale such as this is that it would make it easy for anyone (even a child) to express how they are feeling. I've seen pain charts that use smiley or crying faces instead of numbers to help people describe their pain. Perhaps we should use something similar - a "10" could be someone sitting peacefully and a "100" could be a picture of someone pulling their hair out or something! OK - I'm being silly again - but I do remember when my anxiety was near to a 100. It sure felt like I wanted to pull all my hair out and run around the room in circles while screaming. Horrible, horrible feeling.

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  8. I have learned so many things from you Sunny. I have rather informally rated my anxiety level at times, like before doing an ERP, usually on a scale from 1-10. Since I have been doing the whole laundry room ERP's, I have gone from a total 10 just standing in the laundry room and not touching anything to about a 2-3. Today I was in there taking clothes out of the dryer and my granddaughter shot this Nerf toy with a suction cup over the wash machine where it stuck on the wall and I actually leaned over to get it for her and gave it to her without any handwashing or anxiety which is a complete miracle. I could never have done that a month ago with stage 10 anxiety.
    I think once I get home I am going to do as you suggest and start writing a SUDS list and get some more work done. Thanks for sharing!

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    1. Oh, Krystal Lynn - I cannot tell you how thrilled I am for you!! Truly incredible!! You have worked so hard and I'm so excited for the progress you have made. I wish I was there in person with you because I would do a happy dance with you!! ha ha ha I'm really proud of you. I know this has not been easy but you have been such an example and inspiration to all of us. You've faced your fears and you're knocking them out, one by one. Look out OCD, here comes Krystal Lynn! CONGRATULATIONS!!!!

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  9. My counselor likes to promote 1 - 10 instead of 1 - 100 because she's seen how we like to go for in between numbers (i.e. 73.5) or being really exact. So I use 1 - 10, but occasionally give in to putting a .5 on the end. :) I'm afraid to ever use a 10, because it might not be accurate, and I want to save it in case I ever really really need it (and yes, I think that smells of OCD). For depression, though, I've named 7 as starting to vaguely think about suicide, 8 means I'm thinking about it and starting to believe it, and 9 means I'm really starting to believe it and very close to needing immediate help if not already needing it. Only, feeling suicidal is not the only symptom of severe depression, so that wouldn't always apply.

    But back to anxiety, today's exposure was maybe 8 (or 80), so that was on the higher end of what I should try. Only making a hierarchy seems too hard, so I haven't done that yet. :)

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    1. Hey Abigail! Yep, I agree - smells like OCD! ha ha But I sure get it, been there, done that.

      Actually, I never thought of using a "depression" scale, but I think that could be very helpful. I like the idea of giving people other ways to express their pain. Sometimes, it's so hard to articulate how you are feeling.

      Wow, that's amazing that you did an 80 ERP! I'm sure that took tremendous courage. You should really be proud of yourself. I'm sure proud of you! Really, really great job!

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