SUDS check-in

The SUDS check-in is the simplest worksheet in the library. You ran an intervention — a grounding exercise, a thought record, a self-compassion break, an EMDR set — and you want to know whether it moved the needle. The client rates Subjective Units of Distress on a 0-10 scale before, runs the intervention, then rates again after. Wolpe introduced the SUDS scale in 1969 (with earlier appearance in 1958). It’s the most reusable single concept in the clinical-template library — every modality uses some variant.

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What it captures

Two sections, paired sliders.

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Before

• How strong is the feeling right now? — 0-10 slider (none → worst)
• What you noticed (optional) — short text

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After

• Where is it now? — 0-10 slider (none → worst)
• What shifted (optional) — short text

The whole worksheet takes 30 seconds total to fill — sub-twenty before the intervention, sub-twenty after.

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Reading the change

The clinical signal is the delta between before and after, plus what the client said in the two optional notes. A rough interpretive frame:

• No change (0 delta). The intervention didn’t shift anything for this client at this moment. Worth exploring why in the session: was the intervention engaged with? Was the target SUDS already too low to meaningfully drop? Is the client dissociating?
• Small drop (1-2 points). Typical for a single brief intervention, especially in early treatment. Continued repetition often compounds.
• Large drop (3+ points). Meaningful single-session shift. Worth noting in the session record for treatment planning.
• Increase in SUDS. The intervention may have surfaced previously unprocessed material. Common in EMDR Phase 4 mid-processing. Consider closure techniques (Calm place, Container) before the session ends.

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EMDR session-arc tracking

In an EMDR processing session, the SUDS check-in is often the worksheet that frames the whole session. You record the baseline SUDS on the target identification worksheet at Phase 3, run desensitization sets through Phase 4, and use SUDS check-ins between sets (or at session start and session end) to track the arc. The standard EMDR protocol wants SUDS down to 0 or 1 by end of Phase 4 for the target. The SUDS check-in is the lightweight surface for that between-set tracking when you don’t want to reopen the whole target identification worksheet.

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When to use it

• Before and after any discrete in-session intervention. Grounding exercises, breathing work, brief cognitive restructuring, self-compassion exercises, EMDR sets.
• As a session-arc bracket. At session start and session end, to capture the overall arc of the session.
• For in-vivo exposure when you want the SUDS data but don’t need the full exposure log structure.

It’s rarely homework. SUDS tracking between sessions doesn’t have the same clinical signal as the in-session pre/post pair.

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In-session mechanics

Templates → SUDS check-in. Before/After section structure with two sliders each. You fill the Before section, run the intervention, then come back to fill After. The whole exchange takes well under a minute on each side. The worksheet copies to clipboard for paste into session notes. The before/after numbers plus the two optional notes are a useful piece of session documentation for tracking what interventions are landing.

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Citation

Wolpe, J. (1969). The Practice of Behavior Therapy. Pergamon Press. Earlier appearance: Wolpe, J. (1958). Psychotherapy by Reciprocal Inhibition. Stanford University Press. Joseph Wolpe introduced the SUDS scale in his work on systematic desensitization. The numeric scale (0 = no distress, 10 = worst distress imaginable) is the clinical concept; the concept itself is uncopyrightable under the idea/expression dichotomy. EMDR uses 0-10 specifically; exposure work historically used 0-100. Rivet uses 0-10. All field labels are original to Rivet. VA MIRECC Prolonged Exposure materials (US Federal, public domain) used as a paraphrase reference only.

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When not to use it

• As a substitute for a validated symptom measure. SUDS captures in-the-moment distress, not symptom severity. Use the PHQ-9, GAD-7, or PCL-5 for weekly outcome monitoring.
• As an EMDR Phase 3 target SUDS baseline. The Phase 3 baseline goes on the target identification worksheet (which has its own SUDS field), not here.
• As a structured exposure-attempt log. Multi-trial exposure tracking benefits from the exposure log, which captures predicted SUDS, peak SUDS, end SUDS, and duration in one entry.

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