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Understanding VOC and SUDS Scales in EMDR for Kids

Eye Movement Desensitisation and Reprocessing (EMDR) is a therapeutic approach designed to help individuals, including children, process traumatic memories and distressing experiences. A crucial part of the EMDR process involves using two specific scales: the Validity of Cognition (VOC) scale and the Subjective Units of Distress (SUDS) scale. These tools help therapists gauge a child’s progress throughout therapy, making the process more effective and tailored to their needs.

What Are the VOC and SUDS Scales?

Validity of Cognition (VOC) Scale

The VOC scale measures the credibility of a child’s belief about a negative thought or feeling associated with a traumatic experience. For instance, if a child believes "I am worthless" after a distressing event, the VOC scale helps assess how true this belief feels to them at the start and end of therapy.

The VOC scale typically ranges from 1 to 7:

• 1 indicates the belief feels completely false.
• 7 means the belief feels completely true.

By tracking changes in the VOC score, therapists can determine how much a child’s perception of their negative beliefs has shifted over the course of therapy.

Subjective Units of Distress (SUDS) Scale

The SUDS scale measures a child’s emotional distress or discomfort at any given moment. It helps quantify how severe the child feels the emotional pain associated with their trauma. This scale usually ranges from 0 to 10:

• 0 signifies no distress whatsoever.
• 10 represents the highest level of distress imaginable.

Just as with the VOC scale, observing changes in SUDS scores allows therapists to evaluate the effectiveness of the interventions used during EMDR sessions.

Why Are These Scales Important?

Utilising the VOC and SUDS scales in EMDR therapy provides several benefits:

1. Tailored Treatment: By monitoring both the child’s beliefs and emotional distress, therapists can tailor treatment interventions to effectively address specific issues.

2. Encouragement and Motivation: As children see tangible changes in their VOC and SUDS scores, it can enhance their motivation and improve their confidence throughout the healing process.

3. Objective Measurement: These scales offer a structured way to quantify subjective experiences, allowing therapists to document progress over time and adjust treatment plans accordingly.

How Do These Scales Work Together?

During an EMDR session, a therapist may begin by asking the child to identify a particular negative belief related to their trauma and to rate it using the VOC scale. Next, the therapist will determine the child’s current level of distress using the SUDS scale.

As the session progresses and the child processes their thoughts and emotions, the therapist will regularly check in with both scales. For instance, if a child starts with a VOC score of 5 (somewhat true) and a SUDS score of 8 (high distress), the therapist may guide them through specific eye movements and techniques designed to reduce those scores.

At the end of the session, re-evaluating the VOC and SUDS scores allows the child to see how their belief and distress levels have changed. Ideally, the VOC score should decrease, while the SUDS score also drops, signalling a healthier processing of the traumatic experience.

Helping Children Understand

When working with children, it’s vital to explain the VOC and SUDS scales in simple, relatable terms. Therapists can use visual aids or analogue measures, like a thermometer, to help kids grasp the concept of rating their feelings and beliefs. It encourages a sense of ownership over their emotional health and fosters a collaborative therapeutic environment.

Conclusion

The VOC and SUDS scales are invaluable tools in the EMDR therapy process for children. By helping kids articulate their distress and beliefs about themselves, these scales foster healing and resilience. They empower children to articulate their feelings, see their progress, and understand that healing from trauma is not only possible but achievable. With the right support and guidance, children can learn to navigate their emotions and move towards a more positive and fulfilling life.

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