Passing your National Licensing Exam
Getting licensed can open up incredible opportunities, but the exam can seem daunting. Our podcasts make passing more achievable and even fun. Dr Hutchinson and Stacy’s energy and passion for this content will get you motivated and confident.
We break things down in understandable ways - no stuffiness or complexity and focus on the critical parts you need so your valuable study time counts. You’ll come away feeling like, “I can do this!” Whether it’s nailing down diagnoses, theoretical approaches, or applying ethics in challenging situations, we help you get into a licensed mindset. Knowledge domains we cover in these podcasts include:
Professional Practice and Ethics
Intake, Assessment, & Diagnosis
Areas of Clinical Focus
Treatment Planning
Counseling Skills and Interventions
Core Counseling Attributes
And, of course, the DSM-5-TR.
If you listen, you might surprise yourself at how much you absorb and enjoy it along the way. Take that first step – you’ll gain confidence and valuable skills and feel confident getting ready for your licensing exam!
Passing your National Licensing Exam
Assessments: Subjective Units of Distress Scale (SUDS)
Feeling overwhelmed by the array of assessment tools you need to master for your licensing exam? Today's episode offers a deep dive into one of the most practical and versatile instruments available to therapists: the Subjective Units of Distress Scale (SUDS).
Dr. Linton Hutchinson breaks down this deceptively simple yet powerful clinical tool that allows therapists to quantify what seems unquantifiable – a client's subjective experience of distress. With characteristic energy (accidentally fueled by a caffeinated Starbucks mishap), Dr. Hutchinson thoroughly explains how SUDS works on a 0-10 scale, where clients rate their distress from none to maximum intensity. The beauty of SUDS lies in its accessibility and immediate feedback, making it invaluable for tracking therapeutic progress.
The episode systematically explores the four phases of SUDS implementation: establishing baselines, monitoring distress throughout sessions, regulating intervention intensity, and evaluating long-term progress. You'll discover how this framework integrates seamlessly with evidence-based treatments like Cognitive Behavioral Therapy and exposure therapy, with research supporting its effectiveness in treating anxiety disorders. Dr. Hutchinson offers practical applications for your clinical toolkit – from using SUDS during relaxation exercises to pairing it with cognitive restructuring to demonstrate the impact of thought reframing on emotional states.
Whether you're preparing for your licensing exam or looking to enhance your clinical practice, this episode delivers essential knowledge in an engaging, straightforward manner. The key takeaway? SUDS provides a structured yet flexible framework for measuring distress that works across diverse populations and therapeutic approaches. And as Dr. Hutchinson reminds us – understanding tools like this could be exactly what helps you pass your exam, even if just by one point. Ready to add this valuable assessment method to your professional repertoire? Listen now and boost both your exam confidence and clinical effectiveness.
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This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.
Hello you wonderful therapists, and welcome to the Licensure Exams Podcast. I'm Dr Linton Hutchinson and I'm excited you're joining me today. Stacey's hanging 150 feet in the air reconstructing a historic building and Eric's somewhere down in the Everglades canoeing. So it's just me. I need to issue a preemptive apology to everyone. I made a stop at Starbucks this morning and, through some cosmic barista blunder, my innocent decaf caramel macchiato was secretly replaced with the fully loaded caffeinated version. So if you notice me talking at the speed of light, gesturing like an air traffic controller on fast forward or talking about standard deviations or correlation coefficients, you'll know why this podcast might finish early, or I might accidentally invent time travel, or both. But don't worry, I'll crash spectacularly in a few hours, but I definitely would not hit Starbucks before you sit for your exam. And you're here because you're a determined therapist and I can't tell you enough how I appreciate your commitment to preparing for your national licensing exam. Today we're tackling a tool you'll your commitment to preparing for your national licensing exam. Today we're tackling a tool you'll certainly want to have in your toolkit and know about for the exam the Subjective Units of Distress Scale. You might be thinking, okay, linton, another scale to memorize, but trust me, this is straightforward and you'll be better off for knowing about it. We'll go over what it is, how it's used and why understanding it could give you an edge on your exam. Remember, you only have to pass by one point. Might as well be because you listened to this podcast on SUDS.
DR. HUTCHINSON:Knowing how to accurately assess a client's distress is a core skill, and SUDS offers a quick way to gauge what's happening for them in the moment. It's relevant for anxiety disorders, trauma and many other conditions you'll encounter both in practice and on the exam. So let's get started and explore the ins and outs of the Subjective Units of Distress Scale. So what exactly is the Subjective Units of Distress Scale? Well, it's a pretty simple yet effective tool that helps you measure the intensity of a client's distress or anxiety. It's subjective because it's based entirely on the client's perception of their feelings at that moment, rather than any objective criteria. Typically, you'll ask your client to rate their level of distress on a scale usually from 0 to 10, where 0 represents no distress and the highest number indicates the most intense distress you can imagine. It's not about comparing one person's experience to another's. It's about helping that individual quantify what's happening for them. Internally, the real strength of SUDS lies in its ease of use and the immediate feedback it provides, making it a go-to for tracking changes in distress levels during therapy.
DR. HUTCHINSON:But when you're working with clients, distress can show up in many ways and it's not always what you might expect. Some clients might become visibly agitated, fidgeting or having trouble making eye contact. Others could withdraw, becoming quiet and unresponsive, almost as if shutting down to cope with what they're feeling. You might see emotional outbursts like sudden crying or expressions of anger, even over seemingly minor things. Physical symptoms are also common. Clients could report headaches, stomach issues or muscle tension. It's also not unusual for distress to affect a client's thinking, leading to difficulty concentrating, racing thoughts or feeling overwhelmed. It's key to remember that each person experiences and shows distress uniquely, so you need to be attuned to both verbal and non-verbal cues to truly understand what's happening for them.
DR. HUTCHINSON:Now let's explore the phases you'll typically go through when using the SUDS model with a client. The first phase is all about establishing a baseline. You'll want to ask the client to rate their current level of distress before you even begin a specific intervention or therapy session. This provides a reference point. Think of it as taking a snapshot of how they're feeling at that exact moment. Next up is the distress monitoring phase. You'll use the SUDS repeatedly during a session or over a course of treatment to track how distress levels change in response to different stimuli or interventions. For instance, if you're doing exposure therapy, you'd have the client rate their distress before, during and after exposure to the feared stimulus. This helps you adjust the intensity and duration of the exposure to keep it challenging but not overwhelming. It also gives you a way to see what's working and what isn't.
DR. HUTCHINSON:The third phase involves utilizing the SUDs to regulate the intensity of interventions. You'll use the real-time feedback from your client's SUDs ratings to make adjustments on the fly. If a client's distress spikes too high, you might need to slow things down, change the focus or introduce a coping strategy. The idea here is to stay within the client's window of tolerance, where you're challenging them enough to promote growth but not pushing them so far that you cause dysregulation or re-traumatization. Finally, there's the evaluation phase. Over time you can review the SUDS ratings to assess progress. You'll look for trends. Is the client's baseline distress decreasing? Are they able to tolerate more exposure with less distress? Are you seeing quicker recovery times after a distressing event. This data provides objective evidence of the effectiveness of your work together and informs future treatment decisions. Remember, the SUDS isn't just about numbers. It's about using those numbers to deepen understanding and guide the therapeutic process. Okay, let's turn our attention to evidence-based treatments that incorporate the SUDS model.
DR. HUTCHINSON:A substantial body of research supports the use of cognitive behavioral therapy in treating anxiety disorders, and the SUDS plays a role within this framework. Studies consistently demonstrate that CBT, augmented by the SUDS model for distress monitoring, is effective in reducing symptoms of anxiety, panic and phobias. You can track a client's progress, adjusting interventions as needed to optimize results. Exposure therapy another well-supported treatment for anxiety disorders relies heavily on the SUDS model for measuring a client's distress throughout the exposure process. By quantifying anxiety levels before, during and after exposure exercises, you can carefully calibrate the intensity and duration of each exposure, ensuring that it remains therapeutic rather than overwhelming. Research supports the use of SUDS in exposure therapy to improve outcomes and reduce the likelihood of relapse.
DR. HUTCHINSON:Now let's examine some interventions that effectively use the SUDS model. One common intervention is to use SUDS as a regular part of your sessions to monitor distress levels. By asking clients to rate their distress at the beginning, middle and end of a session, you can gain immediate feedback on how you're progressing and whether adjustments are needed. This ongoing assessment can help you tailor your approach to meet the client-specific needs. Another useful intervention involves using SUDS during relaxation exercises. Before beginning a relaxation technique, such as deep breathing or progressive muscle relaxation, have the client rate their current level of distress. After completing the exercise, ask to rate it again. This allows you and your client to see the immediate impact of the relaxation technique on reducing distress. If the SUDS rating doesn't decrease significantly, you might explore alternative relaxation methods that may be more effective for the client.
DR. HUTCHINSON:Using SUDS in conjunction with cognitive restructuring is also beneficial. When a client identifies a negative thought or belief, ask them to rate the level of distress associated with that thought. After challenging and reframing the thought, have the client rate their distress again. This process can help you and your client see how cognitive restructuring can reduce emotional distress. Restructuring can reduce emotional distress.
DR. HUTCHINSON:Knowing the terms related of the subjective units of distress scale will help you remember it for your licensing exam. First, the term subjective in the SUDS model emphasizes that the rating is based on the client's personal experience and perception of distress. This means there's no objective standard. It's all about how the client feels at that moment. Next, units refer to the numerical scale used to quantify the level of distress. These units provide a standardized way for you and the client to communicate about their emotional state. It allows for tracking changes over time.
DR. HUTCHINSON:Then distress refers to the range of negative emotional states, such as anxiety, fear or discomfort, that the client is experiencing. The SUDS model is designed to measure the intensity of these feelings. And lastly, the term scale signifies the continuum on which the client rates their distress. This scale typically ranges from 0, indicating no distress, to 10 or 100, representing the worst possible distress imaginable. The scale provides a structured framework for the client to express the intensity of their emotion. Laughs. It's time for a knowledge check. Ready, here we go.
DR. HUTCHINSON:You're working with a client who has just completed an exposure exercise for a phobia. To best use the suds, you should ask the client to A Compare their distress level to others in a similar situation. B Rate their distress based on their feelings right now. C Estimate their average distress over the entire day. D Describe their distress in qualitative terms rather than using a number. The correct answer is B Rate their distress based on their feelings right now.
DR. HUTCHINSON:This SUDS is designed to capture a client's immediate subjective experience of distress at a specific moment. This real-time assessment allows you to gauge the intensity of their emotional response to the exposure exercise. To summarize, the Subjective Units of Distress Scale provides a straightforward method for quantifying a client's distress. It's a practical and immediate way to measure and work toward reducing the stress in various situations. One key takeaway is that SUDS is incredibly versatile and can be adapted for use with a wide range of ages and populations. You'll find it beneficial in sessions, research and even in self-help. Another takeaway is its utility in therapeutic settings, especially within exposure therapy. It assists you in tailoring the intensity and duration of exposures to ensure they're challenging yet manageable for your clients. Regular use of SUDS promotes self-awareness and allows clients to become more attuned to their emotional states, facilitating earlier intervention and improved self-management. It's in there.
