Home / Learn / Rating steps 0 to 10 without overthinking it
Rating steps 0 to 10 without overthinking it
The 0 to 10 distress rating is the engine of an exposure hierarchy. How to take a rating that is actually useful.
Every rung on a hierarchy carries a number: how much distress this would cause, right now, from 0 to 10. Clinicians call it SUDS, for Subjective Units of Distress, and it has been the working unit of exposure therapy since Wolpe introduced it in 1958.
What the numbers mean
0 is complete calm. 10 is the worst distress the person can imagine. In the middle, 3 is noticeable but easy to carry, 5 is uncomfortable and hard to ignore, 7 is where avoidance starts to feel necessary, and 9 is barely tolerable. Those anchors matter more than precision: the difference between a 6 and a 7 is noise, but the difference between a 3 and an 8 is the whole plan.
Rate the situation you would actually be in
The most common rating error is rating an idealised version. "Eat in a restaurant" is a 4 with a friend on a quiet Tuesday and an 8 alone on a Saturday night. Write the rung so it is unambiguous, then rate that.
Do not average across a week
Rate it as it feels today. Ratings drift as the work goes on, and that drift is the evidence that the ladder is working. A rung that was an 8 in March and a 4 in May is the clearest signal a person will get, and it disappears if the number is a rolling average.
Let the person who has to do it rate it
This is the one rule worth being strict about with children. A parent's estimate of how hard the school gate feels is not the same measurement, and a ladder built on the parent's numbers is usually too steep at the bottom and too flat at the top. Ask, write the answer down as given, and resist correcting it.
Re-rate after the practice, not only before
Taking a rating at the start of an exposure and again at the end gives the two numbers that show whether anything happened. What you are looking for over repeated practices is the peak coming down and arriving later.
Build the ladder
Name the fear and Bia suggests the rungs. Free, and nothing about you is sent.