> ## Documentation Index
> Fetch the complete documentation index at: https://docs.getrivet.ca/llms.txt
> Use this file to discover all available pages before exploring further.

# Exposure log

> Single-exposure SUDS triplet — predicted, peak, and end — plus duration and notes.

The exposure log is the unit of exposure-based therapy. The client faced
something they normally avoid; you log what they faced, how distressing
they expected it to be, how high the distress actually got, and where it
ended. Over a series of these, the patterns (predictions getting more
accurate, peaks getting lower, ends getting closer to baseline) become the
client's evidence that exposure works.

Wolpe introduced the SUDS scale in 1958. Foa formalized exposure logging for
PE in 2007. The before/peak/end triplet has become standard across PE, ERP,
and modern exposure-based CBT.

## What it captures

Six fields, single-exposure entry:

* **What you faced** — the situation (textarea)
* **How distressing you expected it to be** — 0-10 predicted SUDS
* **Highest it actually got** — 0-10 peak SUDS
* **Where it ended** — 0-10 end SUDS
* **How long, in minutes** — duration
* **What you noticed (optional)** — context, thoughts during, what helped

No total score — the clinical signal is the comparison: predicted vs peak
vs end across a series of entries.

## The three SUDS readings each do different work

* **Predicted vs peak.** The gap between what the client expected and what
  actually happened is the expectancy-violation data that drives
  inhibitory-learning models of exposure. Predictions that systematically
  exceed peaks are the cognitive shift exposure produces.
* **Peak vs end.** Within-session habituation — the within-trial drop from
  peak to end. This is the data point most clients track intuitively
  ("it got easier the longer I stayed in it").
* **End across exposures.** Between-session habituation — the end-SUDS
  trajectory across repeated exposures to the same item. Each successive
  end-SUDS that's lower than the last is the durable reduction.

The Inhibitory Learning model (Craske 2014) downweights peak-to-end
habituation as the mechanism and emphasizes expectancy violation. Rivet's
log captures both — the practitioner reads whichever pattern matches the
treatment model in use.

## When to use it

* **Every exposure attempt.** In PE for PTSD, in ERP for OCD, in graded
  exposure for panic, social, GAD — every time the client did the exposure,
  it gets logged immediately after.
* **In-session in-vivo work.** When you're doing the exposure in the
  session (a panic interoceptive exposure, an in-vivo OCD trigger),
  the log is filled in real time.
* **Reviewed weekly.** You look at the spread of predictions, peaks, and
  ends across the week, identify the patterns, and adjust the hierarchy.

## In-session mechanics

Open **Exposure log** from the top-right corner (**Clinical templates ▾**). The three SUDS sliders
sit on top of each other so the comparison is visual.

For a between-session log being reviewed in the next session, you fill the
fields from what the client tells you. For in-session in-vivo work, the
predicted-SUDS goes in before the exposure starts, peak and end during and
after.

## Citation

Wolpe, J. (1958). *Psychotherapy by Reciprocal Inhibition.* Stanford
University Press.

Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). *Prolonged Exposure
Therapy for PTSD: Emotional Processing of Traumatic Experiences.* Oxford
University Press.

Foa, E. B., Yadin, E., & Lichner, T. K. (2012). *Exposure and Response
(Ritual) Prevention for Obsessive-Compulsive Disorder: Therapist Guide*
(2nd ed.). Oxford University Press.

Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B.
(2014). "Maximizing exposure therapy: An inhibitory learning approach."
*Behaviour Research and Therapy,* 58: 10-23.

The SUDS-rated exposure structure is published clinical method since 1958
and is uncopyrightable. All field labels are original. VA MIRECC Prolonged
Exposure materials (US Federal, public domain) used as a paraphrase
reference only.

## When not to use it

* **Trauma processing without a PE or ERP framework.** Exposure for PTSD
  outside a manualized protocol (PE, NET, EMDR phase 4) can re-traumatize.
  The log is a tool inside an exposure-based treatment, not a standalone
  intervention.
* **Acute crisis or destabilization.** Exposure work is contraindicated
  when the client is in active suicidal crisis, recently psychotic, or
  unable to tolerate within-session distress without leaving the room.
* **Dissociation patterns that block engagement.** PTSD clients who
  dissociate during exposure aren't accessing the trauma memory at the
  somatic level needed for processing. Stabilization work (grounding,
  resourcing, [calm place](/clinical-templates/emdr/calm-place)) comes
  first.

## Related articles

<CardGroup cols={2}>
  <Card title="SUDS check-in" icon="gauge" href="/clinical-templates/cbt/suds-check-in">
    The standalone SUDS pair when you're not running a formal exposure.
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  <Card title="Behavioral experiment" icon="flask" href="/clinical-templates/cbt/behavioral-experiment">
    When the work is testing a prediction rather than habituating to distress.
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  <Card title="PCL-5" icon="clipboard-list" href="/clinical-templates/screening/pcl-5">
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</CardGroup>
