> ## 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.
# The SUDS scale
> Wolpe's 0–10 Subjective Units of Distress — how Rivet captures it between sets, where it lives, and how it renders in the session arc.
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.
## 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.
## 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.
### 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.
### 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.
### 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
The SUDS card pops **automatically** at each of these points — baseline,
between sets, and end. You don't have to open a separate panel; the
Workspace transitions through the state on its own.
## 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.
## 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](/emdr/the-session-arc).
## 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.
## 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.
## 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](/clinical-templates/index).
## 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.
## Related articles
How the SUDS trajectory renders at the end of the session, the stats
tiles, and the Copy button.
Spacebar start, pause, end, and how the between-sets card flows.
Wolpe's original SUDS, Shapiro's EMDR adoption, and the WHO/NICE
guidance.