Subjective Distress Scale
Rate the level and duration of exposure
Full Name
*
First Name
Last Initial
E-mail
Exposure Name:
Rate the anticipatory distress level
1
2
3
4
5
Minimal (if any)
Severe
1 is Minimal (if any), 5 is Severe
Rate the exposure distress level
1
2
3
4
5
Minimal (if any)
Severe
1 is Minimal (if any), 5 is Severe
Approximate Duration of Exposure (number of minutes)
Rate the post exposure distress level
1
2
3
4
5
Minimal (if any)
Severe
1 is Minimal (if any), 5 is Severe
Submit
Should be Empty: