Step 1: Create Awareness

Rating your SUDS

Being aware of our own anxiety is a simple and underrated, but essential first step. Why? Well, for one thing, it’s pretty hard to do something about your anxiety if you don’t even know that you’re experiencing it. Beyond that, understanding and being aware of how strong our anxiety currently is and which symptoms we’re experiencing can help us take a targeted approach for managing our anxiety (more on this below).

There are a variety of ways to create awareness, but we’re going to use the simple approach of rating our SUDS. SUDS stands for Subjective Units of Distress Scale and is widely used in clinical science interventions. [3, 4]

You’ll notice that the SUDS is on a 0 to 10 scale. You can think about 0-1 as being your “no anxiety” range, 2-3 as the “mild anxiety” range, 4-6 as your “moderate anxiety” range, and 7-10 as your “high anxiety” range.

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Let's Practice!

Go ahead and rate your SUDS right now using the scale below:

10	Highest anxiety/distress that you have ever felt
9	Extremely anxious/distressed
8	Very anxious/distressed; can’t concentrate. Physiological signs present (e.g. racing heart, sweating, stomach distress, shortness of breath).
7	Quite anxious/distressed; interfering with functioning. Physiological signs may be present (e.g. racing heart, sweating, stomach distress, shortness of breath).
6	Moderate-to-strong anxiety or distress
5	Moderate anxiety/distress; uncomfortable, but can continue to function
4	Mild-to-moderate anxiety or distress
3	Mild anxiety/distress; no interference with functioning
2	Minimal anxiety/distress
1	Alert and awake; concentrating well
0	No distress; total relaxation

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Using the SUDS

Remember when we said that creating awareness helps us take a targeted approach? Well, in the future, you can use your SUDS to decide which step of the toolkit we want to take next: reduce physiological arousal, challenge biased thinking, or proactively engage (see Figure 2).

Figure 2. Decision tree for toolkit steps

Let’s break this down a bit more:

• When your SUDS is a 7 or higher, you’re likely experiencing some pretty intense physiological symptoms that make it hard to concentrate. In these cases, you may want to reduce your physiological arousal first, so that you can concentrate a bit better when challenging your biased thoughts and proactively engaging.

• When your SUDS is between 3 and 6, you’re likely experiencing anxiety, but still able to concentrate. In these cases, you may not need to address your physiological arousal, and can instead jump ahead to challenging your biased thoughts, before proactively engaging.

• Finally, when your SUDS is below 3, you’re likely experiencing no to low anxiety. In these cases, you might skip reducing physiological arousal and challenging your biased thoughts and jump right into proactively engaging.

Since we are still learning about each of the steps though, let’s go through each of the steps.