Expanding The SUDS (Subjective Units of Distress Scale)

You may have heard Brainspotting's tagline "Where you look affects how you feel” (Grand, 2013).  This means that when we access a Brainspot; we also access the emotional, physiological, and neurological charge associated with what is being processed. Tracking intensity and activation can help clients put language and measurement to a process that might feel otherwise abstract and unexplainable.

One of the simplest tools we use to support this tracking is the Subjective Units of Distress Scale (SUDS). Originally developed to help assess anxiety levels (Wolpe, 1966), the SUDS scale has evolved across modalities; including somatic and brain-body approaches like Brainspotting. Using numbers or language to track internal sensations can help clients move from “something is wrong with me” to “something is happening in me.”  This shift supports autonomy, curiosity, and self-compassion (Ogden, Minton, & Pain, 2006).

Rather than pushing toward a “lower number,” we follow the nervous system and the client’s cues; honoring the intelligence of survival responses. But as we deepen our understanding of trauma physiology, neurodiversity, and dissociative coping, a question emerges:

How can we adapt the SUDS scale so it better reflects real nervous system states including shutdown, numbness, and disconnection?

Expanding the Scale: Making Space for Hypoarousal, Numbness, and Freeze

One example of this evolution is the SUE Scale (Subjective Units of Experience), developed in the early 2000s as part of the Modern Energy paradigm. Instead of focusing solely on distress, the SUE model expands the range to include both negative and positive energy states. This model explores a full energetic spectrum from depletion and shutdown to balance and uplift (Hartmann, 2009.).

Traditional SUDS scales only track distress from 0–10, which assumes that high sensation is the only form of activation.

But trauma isn’t always high activation.

Clients may experience:

• numbness

• flat affect

• dissociation

• shutdown

• inability to access emotion

• collapse

These experiences aren’t “nothing”. They are a different form of activation. Polyvagal Theory helps us understand this as the difference between hyperarousal (fight/flight) and hypoarousal (freeze/collapse) (Porges, 2011).

When clients fall into shutdown or dissociation, the traditional scale may read as “0,” but internally, their system is not calm. It is more likely that their system is overloaded. To support inclusivity in trauma work and Brainspotting, I like to use a modified version of the SUDS scale that ranges from –10 to +10, allowing clients to differentiate between:

Range	Meaning
+1 to +10	Hyperarousal, activation, overwhelm, anxiety, intensity
0	Regulated, grounded, present
–1 to –10	Hypoarousal, numbness, shutdown, dissociation, collapse

This expanded version:

• validates nervous system responses beyond distress

• supports dissociative, autistic, ADHD, and highly sensitive nervous systems

• reduces pressure to be “regulated” in only one direction

• normalizes freeze, fog, and disconnect as meaningful data; not symptoms to eliminate

  
  

Clients often find that naming hypoarousal helps them stay connected to the process rather than feeling shame, confusion, or like they are “doing it wrong.”

You can download an Expanded SUDS Scale resource here.

A Gentle, Consent-Based Way to Use the Scale

Rather than asking:

“What’s your SUDS number?”

We can soften the invitation:

“If it feels helpful, can you check in and estimate where your system might be right now?"

or

“Is your body feeling more activated, more shut down, or somewhere in the middle? It's ok if you're unsure.”

This language gives space for the SUDS to be a self-awareness tool that invites curiousity rather than a clinician driven assessment.

The expanded SUDS scale honors the full range of nervous system experience. Not just intensity; but also stillness, collapse, fog, fawn, or freeze. Using this approach supports:

• nervous system literacy

• trauma-informed pacing

• neurodivergent accessibility

• non-pathologizing clinical language

• deeper agency and attunement

  
  

Ultimately, the purpose of any tracking tool is not to control the process; but to meet the body where it is with curiosity, compassion, and respect.

References

Grand, D. (2013). Brainspotting: The revolutionary new therapy for rapid and effective change. Sounds True.

Hartmann, S. (2009). The SUE Scale & The Modern Energy Chart: Subjective Units of Experience (SUE) and the Modern Energy Chart (–10 to +10). Guild of Energists. https://suescale.com/sue_scale_modern_energy_chart.htm

Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. W.W. Norton & Company.

Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W.W. Norton & Company.

Wolpe, J., & Lazarus, A. A. (1966). Behavior therapy techniques: A guide to the treatment of neuroses. Pergamon Press.