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To test the psychometric properties of the Subjective Units of Disturbance Scale (SUDS), this study analyzed the data from 61 patients treated with EMDR. The pretreatment self-reported questionnaires, the in- session records of EMDR, and the Clinical Global Impression-Change (CGI-C) scale at the termination of EMDR were reviewed. The initial score of the SUDS at the first session was significantly correlated with the patient's level of depression, the state anxiety, and distress from the impact of events. The final score of the SUDS at the first session was significantly correlated with the CGI-C score at termination. Consequently, this study confirmed that the SUDS in EMDR sessions has good psychometric properties.
Keywords: EMDR; Subjective Units Disturbance Scale (SUDS); validity
Assessing the level of subjective anxiety is an important procedural element in behavior therapy. A simple check enables clinicians to anchor clients' self-rated discomfort at baseline, to monitor any change of their status, and also to evaluate the progress of therapy (Ciminero, Nelson, & Lipinski, 1977; Sloan & Mizes, 1999; Wolpe, 1990). For this reason, the behavioral therapist Joseph Wolpe (1969) developed and introduced the Subjective Units of Disturbance Scale (SUDS). Since then, this instrument has been extensively used in the realm of behavior treatment, and is sometimes referred to as the Subjective Units of Distress Scale.
The SUDS is a one-item 11-point Likert-type subjective anxiety scale. Originally, it was defined as the self-rated current anxiety between 0 (a state of absolute calmness) and 100 (the worst anxiety ever experienced; Wolpe, 1969). Later, Wolpe (1990) also proposed the use of a more compact scale ranging from 0 to 10. The SUDS was not only used for measuring anxiety in exposure-based therapies (e.g., prolonged exposure; Foa & Rothbaum, 1998) but also adapted for describing subjective alcohol urges (Hodgson & Rankin, 1976) and even the subjective level of sexual arousal (Farkas, Sine, & Evans, 1979).
Francine Shapiro (1995), the originator and developer of eye movement desensitization and reprocessing (EMDR), incorporated the SUDS into the standard treatment protocol. Additionally, the range of emotion that the scale covers was expanded from subjective anxiety alone to any emotional disturbance or negative feelings. In EMDR, the SUDS is designed to measure the level of distress before and after target memory processing....