Mattera Elizabeth, Zaboski Brian
Yale School of Medicine, Department of Psychiatry, Yale University, New Haven, CT 06510, USA.
Clin Pract. 2025 Jun 29;15(7):123. doi: 10.3390/clinpract15070123.
The Subjective Units of Distress Scale (SUDS) is a widely used self-report measure clinicians rely on during exposure and response prevention (ERP) to monitor progress, guide exposure pacing, and assess intervention efficacy. However, despite its ubiquity in clinical and research settings, foundational investigations of its psychometrics are often atheoretical, fail to evaluate its longitudinal properties, and lack a rigorous construct validation framework. This paper addresses these shortcomings by evaluating the SUDS as a measure of state negative affective intensity using the Strong Program of Construct Validation. Our evaluation demonstrates that the SUDS suffers from significant psychometric weaknesses, including construct underrepresentation, construct irrelevance, poorly defined measurement occasions, and structural limitations, challenging its validity as a precise measure of subjective distress. These limitations have crucial implications for clinical practice, potentially leading to misinterpretations of patient distress and compromising treatment decisions. We discuss these clinical implications, highlight them with a brief clinical vignette, outline a research roadmap for potential improvement using modern psychometric methods, and provide practical recommendations for clinicians currently using the SUDS. Given these validity concerns, caution is warranted when interpreting SUDS scores in both clinical and research contexts until its psychometric properties are more robustly established and understood.
痛苦程度主观量表（SUDS）是一种广泛使用的自我报告测量工具，临床医生在暴露与反应阻止疗法（ERP）过程中依靠它来监测进展、指导暴露节奏并评估干预效果。然而，尽管它在临床和研究环境中无处不在，但其心理测量学的基础研究往往缺乏理论依据，未能评估其纵向特性，也缺乏严格的结构效度验证框架。本文通过使用结构效度验证的强程序将SUDS评估为一种状态负性情感强度的测量工具，来解决这些缺点。我们的评估表明，SUDS存在显著的心理测量学弱点，包括结构代表性不足、结构不相关、测量时机定义不清以及结构限制，这对其作为主观痛苦精确测量工具的有效性提出了挑战。这些限制对临床实践具有关键影响，可能导致对患者痛苦的误解并影响治疗决策。我们讨论了这些临床意义，通过一个简短的临床案例进行说明，概述了使用现代心理测量方法进行潜在改进的研究路线图，并为目前使用SUDS的临床医生提供了实用建议。鉴于这些效度问题，在临床和研究背景下解释SUDS分数时都应谨慎，直到其心理测量特性得到更有力的确立和理解。
