What Is a SUDS Rating?

How to Build Your Hierarchy

1. Define the broad fear or avoidance pattern Start by describing, in general terms, the theme that drives your anxiety — for example, social evaluation, contamination, or public speaking.
2. Brainstorm specific situations List as many concrete, specific scenarios related to the fear as you can. Include situations you already avoid as well as situations you manage with high distress.
3. Assign a SUDS rating to each situation Rate each scenario from 0 to 100 based on the anxiety you would expect to feel if you confronted it right now.
4. Arrange from lowest to highest Order the scenarios from the lowest SUDS rating to the highest. Aim for a spread of ratings that covers the full 0 to 100 range with items at roughly 5 to 10-point intervals.
5. Fill in gaps If there are large jumps between items (more than 15 points), brainstorm intermediate steps. Gradual progression is key to successful exposure.

Tips for an Effective Hierarchy

• Be specific Instead of writing 'talk to people,' specify 'ask a coworker about their weekend in the break room.' Specificity makes exposure exercises actionable.
• Include both imaginal and in-vivo items Lower-rated steps might involve imagining a scenario or watching a video, while higher-rated steps involve direct real-life confrontation.
• Expect ratings to change As you complete lower items, your ratings for higher items often decrease. Revisit and update your hierarchy throughout treatment.
• Collaborate with your therapist Your therapist can help you identify safety behaviors to drop, set appropriate durations, and troubleshoot items that feel overwhelming.