The SUDS scale

The SUDS scale — Subjective Units of Distress — is how EMDR captures the client’s experienced distress at each point in a reprocessing session. It’s the single most important data point in the Phase 4 → Phase 7 work, and Rivet’s Workspace is designed around capturing it cleanly.

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The scale

Wolpe, J. (1969). The Practice of Behavior Therapy. Pergamon Press. (Earlier appearance in Wolpe, 1958, Psychotherapy by Reciprocal Inhibition.)

Wolpe’s original scale ran 0 to 100. EMDR convention is 0 to 10. Rivet uses 0–10 to match EMDR practice and to reduce the perceived precision the client has to commit to in the moment. The Workspace surfaces these anchors:

• 0 — calm — no distress
• 5 — moderate
• 10 — worst imaginable

The narrative interpretation in between (1–4 light, 6–9 high) is clinical judgment territory. Rivet doesn’t surface band labels for the intermediate numbers because the published convention varies and the clinical use depends on the client’s reference frame, not a software label.

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SUD check-ins follow your protocol

Rivet doesn’t force one check-in rhythm on every session. A SUD check-ins control in the Configure modal lets you match how you’d run the protocol on paper:

• Every set — a SUDS card pops after each set, the EMDR 2.0 default. This is the tightest read on trajectory, set by set.
• Baseline + end — the Classic default. A SUDS card opens before Set 1 to capture where the client is starting from, then again after the final set. Between sets, the card is quiet by default — you keep moving without a forced rating every time — but a small Capture SUD link is there if you want an on-demand reading (a return-to-target check, for example).

Switching modes (EMDR 2.0 ↔ Classic) resets SUD check-ins to that mode’s default; you can override it either way before you start. When baseline-first check-ins are on, the Start button reads “Start — baseline first” so the first card in the session is never a surprise.

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Baseline

If your session is set to baseline + end, the Workspace opens a SUDS card before any bilateral stimulation runs — pretitle “Baseline — before we begin.” Ask the client for their rating, capture it, and tap Begin Set 1 to start the first set. This is the Phase 3 assessment rating, captured in the same flow as everything else, and it becomes the first point on the session arc.

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Between sets

On every-set check-ins, the card behaves exactly as it always has: a question, a scale, a Continue button, after every set. On baseline + end check-ins, the between-sets card is quieter — “Set complete,” a sparkline, and Continue to Set N+1. If you want a reading at that point, tap Capture SUD to reveal the scale, rate it, then continue. Skip it and nothing is recorded for that set — the choice is yours, set by set.

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End of session

Whichever check-in style the session uses, the last card is always the end-of-session reading — pretitle “End of session,” button “Finish.” This closes the SUD history for the session and opens the session arc. The card shows:

• The question (“How distressing now?” or the baseline/end variant)
• A gradient horizontal scale track with a draggable marker (starts at 5)
• A legend showing the three anchors: 0 · calm, 5 · moderate, 10 · worst
• A sparkline of the session’s SUDS history so far

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Optional VOC capture

At baseline and at the end of a session using baseline + end check-ins, the card shows a second, smaller row under the SUD scale — “Belief feels true (VOC),” the Validity of Cognition scale, 1 (completely false) to 7 (completely true). Tap a number to capture it, or leave it — nothing is selected by default and nothing is required. VOC pairs with the SUD reading the way it does in the standard protocol: SUD tracks distress coming down, VOC tracks the positive belief going up. When both a baseline and end VOC are captured, the session arc and the Copy output show the shift.

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Where the SUDS values live

During the session, SUDS values are held in your browser’s session storage — available to the Workspace for the duration of the session, so the sparkline rehydrates if you reload the page mid-session. At the end of the session, the full SUDS trajectory saves to the client’s chart automatically, alongside the VOC readings, sets, duration, and modalities — the same session arc data shown on the closing card. That only happens for a session linked to a client who checked in by name and number; an unlinked session has nowhere on a chart to save to, and the Workspace tells you that plainly. The Copy button on the session arc card is still there any time you want the plain-text summary on your clipboard too — for an EHR note or a session log you keep yourself. See The session arc.

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The optional note field

The SUDS modal on the practitioner panel surfaces an optional one-line note field where you can capture context — a body sensation the client mentioned, an image they reported, a shift in their narrative (“less heavy in chest”). The note is stored alongside the SUDS value and renders in the Copy session summary. The field is capped at 120 characters. Skip if you don’t want it.

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The session sparkline

Inside the between-sets card, a small sparkline renders the SUDS history so far. After Set 1 it’s a single dot; after Set 4 it’s a 4-point line. The sparkline gives you a quick read on trajectory without having to remember the previous SUDS values. If the line is descending steadily, the reprocessing is doing its work. If the line flatlines or rises, that’s a clinical signal — adjust pace, switch dual-task prompt category, check the target, or close the session early.

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What SUDS isn’t

• Not validated for the practitioner to set. Only the client can rate their own distress. The slider is on your screen because you’re driving the controls, but the value reflects the client’s verbal report.
• Not a forced choice. A client who can’t or won’t rate can skip the capture — the practitioner panel surfaces a Skip button. The skipped set won’t render a dot on the sparkline.
• Not part of the EMDR diagnosis. SUDS is a process measure inside the protocol, not a clinical assessment tool. Pair with a validated PTSD measure (PCL-5) for diagnostic and outcome tracking — see the Clinical templates library.

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Capturing SUDS in Phase 3 vs Phase 4

Strictly speaking, the first SUDS in an EMDR session is captured in Phase 3 (assessment) before any BLS runs — the baseline rating with the target activated. If your session uses baseline + end check-ins, Rivet captures that reading directly in the Workspace, before Set 1 — it’s the first point on the session arc curve, no extra step in your notes. If your session uses every-set check-ins instead (the EMDR 2.0 default), the first captured point is still the post-Set-1 reading, matching the convention of measuring after activation. Switch a session to baseline + end check-ins from the Configure modal any time you want that Phase 3 anchor on the curve.

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