> ## 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. # SUDS check-in > Before and after distress rating across a single in-session intervention — 30 seconds total to fill. 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. ## What it captures Two sections, paired sliders. ### Before * **How strong is the feeling right now?** — 0-10 slider (none → worst) * **What you noticed (optional)** — short text ### 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. ## 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](/clinical-templates/emdr/calm-place), [Container](/clinical-templates/emdr/container)) before the session ends. ## 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](/clinical-templates/cbt/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. ## 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](/clinical-templates/cbt/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. ## In-session mechanics Open **SUDS check-in** from the top-right corner (**Clinical templates ▾**). 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. ## 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. ## 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](/clinical-templates/screening/phq-9), [GAD-7](/clinical-templates/screening/gad-7), or [PCL-5](/clinical-templates/screening/pcl-5) for weekly outcome monitoring. * **As an EMDR Phase 3 target SUDS baseline.** The Phase 3 baseline goes on the [target identification](/clinical-templates/cbt/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](/clinical-templates/cbt/exposure-log), which captures predicted SUDS, peak SUDS, end SUDS, and duration in one entry. ## Related articles When the SUDS data is part of a structured exposure attempt. The EMDR Phase 3 worksheet that holds the baseline SUDS for the target. How SUDS works specifically inside the EMDR 8-phase protocol.