Often when people are asked to rate the levels of anxiety that their obsessive thoughts may cause them, they may be unable to assign a number. The anxiety may feel too high and it may be difficult to ascertain just how bad it is in the moment. For this purpose, the Subjective Units of Distress Scale (SUDS) may be used. The SUDS is used to assess the level of distress in a systematic manner (Matheson, 2014). The SUDS is a simple analogue scale used to measure the subjective strength of the distress experienced (Benjamin et al., 2010). It starts from 0, which is no anxiety, and goes up to 10, which is unbearable anxiety. 

For your recovery, so far you have listed down all your triggers, and obsessions. These obsessions will need to be ranked on the extent of distress they may cause you if you are not allowed to do the associated compulsions. For example, if you obsess about your partner’s poor sense of dressing, the distress may be 7 on 10. But if you think your partner may be cheating on you, the anxiety associated may be 9 on 10. For smaller obsessions, the anxiety may be 5 on 10. Using the SUDS, it may be a little simpler to get an understanding of how to grade your fears. The SUDS has been provided for reference in table 4.81.

Table 4.8.1: Subjective Units of Distress Scale

0: Peace and complete calm.
1: No distress; alert and focused.
2: A little bit sad or distressed.
3: Worried or upset; still able to function.
4: Mild to moderate anxiety and worry.
5: Upset and uncomfortable; still functional.
6: Moderate to strong levels of discomfort.
7: Discomfort dominates your thoughts and you struggle to function normally.
8: Worried and panicky; losing focus and feeling anxious in the body.
9: Extremely anxious and desperate, helpless and unable to handle it.
10: Unbearably upset to the point that you cannot function and may be on the verge of a breakdown.

Remember that two different entries may have the same SUDS score and some SUDS scores may not feature at all in your list. It is not necessary that every entry will have a different SUDS score and it is also not necessary that one SUDS score can appear only once. Thus, multiple entries may have the SUDS score of 8, and none of them may have the SUDS score of 1 or 2. It is all fine, and correct. You will need to complete the exercise of ranking your fears in the Anxiety Hierarchy Worksheet when we fill that. In the next chapter, we shall look at how your compulsions need to be identified.