SUDS & VOC Tracker (EMDR)

The SUDS & VOC Tracker is a specialized clinical tool designed for EMDR (Eye Movement Desensitization and Reprocessing) therapy. It enables therapists to systematically measure, log, and visualize a patient's emotional disturbance and positive belief strength throughout the entire EMDR protocol.

By pairing target memory management with real-time rating scales and interactive progress charts, the tracker gives clinicians a clear, longitudinal view of desensitization and cognitive reprocessing.

What you can do

• Manage Target Memories: Create, edit, and organize EMDR target memories with associated Negative Cognitions (NC) and Positive Cognitions (PC).
• Track Standardized Clinical Scales:
  • SUDS (Subjective Units of Disturbance Scale): Measure distress levels on a standard 0–10 scale.
  • VOC (Validity of Cognition): Measure positive belief validity on a standard 1–7 scale.
• Phase-Guided Recording: Automatically adjust relevant rating inputs based on the 6 standard EMDR phases (Baseline, Desensitization, Installation, Body Scan, Closure, Reevaluation).
• Track Stimulation Sets: Log set numbers sequentially during bilateral stimulation passes.
• Visualize Desensitization Curves: View real-time line charts tracking the decline of SUDS and the rise of VOC over time.
• Integrate with Bilateral Stimulation: Seamlessly track ratings directly inside live Bilateral Stimulation sessions without switching screens.
• Encrypted Clinical Records: Target details, cognitions, and clinical observations are encrypted at rest and fully audited for patient privacy and compliance.

Understanding the Scales & Phases

The Rating Scales

EMDR therapy relies on two primary subjective measurement scales to assess reprocessing progress:

EMDR Protocol Phases & Smart Rating Defaults

Different phases of the EMDR protocol focus on different measurements. When you select a phase, the tracker automatically activates the clinically relevant rating sliders while keeping non-applicable ones optional:

• Baseline (Assessment Phase): Establishes initial measurements for both disturbance and positive cognition strength. Both SUDS and VOC are enabled by default.
• Desensitization (Reprocessing Phase): Focuses on reducing emotional distress through bilateral stimulation sets. SUDS is enabled by default; VOC is excluded.
• Installation (Cognitive Restructuring Phase): Focuses on strengthening the positive cognition. VOC is enabled by default; SUDS is excluded.
• Body Scan (Somatic Processing Phase): Checks for residual physical tension or somatic distress. SUDS is enabled by default; VOC is excluded.
• Closure (Session Debriefing): Evaluates the patient's emotional state before concluding the session. Both SUDS and VOC are enabled by default.
• Reevaluation (Subsequent Sessions): Assesses memory stability and maintenance of positive gains at the start of a follow-up session. Both SUDS and VOC are enabled by default.

Note: While smart defaults are applied automatically when selecting a phase, you can manually toggle the Include rating checkbox next to SUDS or VOC at any time.

Getting Started

To use the tool, navigate to Features > Tools > SUDS & VOC Tracker.

Selecting a Patient

Because target memories and clinical readings are part of a patient's medical history, the tracker is always linked to a specific patient:

1. Search for and select the patient from the patient directory.
2. The tracker will load all target memories and past readings associated with that patient.

Managing Target Memories

A Target Memory represents a specific distressing event, image, or experience identified during treatment planning.

Creating a New Target

1. Click the + New Target button in the target selector panel.
2. Fill in the target details:
   • Target Title (Required): A clear label identifying the memory (e.g., "2024 Highway Accident").
   • Negative Cognition (NC): The irrational, negative self-belief held by the patient (e.g., "I am powerless" or "I am in danger").
   • Positive Cognition (PC): The adaptive, healthy belief the patient desires to adopt (e.g., "I am in control now" or "I am safe now").
   • Status: Choose the initial state (Active, Completed, or Archived). Defaults to Active.
   • Target Notes: Any clinical observations or relevant contextual details about the memory.
3. Click Save.

Target Statuses

Each target is assigned a status displayed with a color-coded badge:

• Active (Blue badge): Target currently being processed in ongoing therapy sessions.
• Completed (Green badge): Target has reached clinical resolution (SUDS at 0 and VOC at 7 with a clear body scan).
• Archived (Grey badge): Target kept for reference and historical records, but not actively processed.

Editing & Deleting Targets

• Edit: Click the Pencil icon next to any target in the list to update its title, cognitions, status, or notes.
• Delete: Click the Trash icon to remove a target. A confirmation dialog will appear. Deleting a target also securely removes its associated readings.

Recording Ratings (SUDS & VOC)

Once an active target is selected, you can record new clinical ratings before, during, or after stimulation sets.

How to Record a Reading

1. Select Phase: Choose the current EMDR phase from the dropdown. The relevant rating sliders will automatically adjust.
2. Set Number: Enter the bilateral stimulation set number. If you are tracking within an active session, this increments automatically.
3. Adjust Sliders:
   • SUDS Slider (Red / 0–10): Drag the slider to the patient's reported disturbance level.
   • VOC Slider (Green / 1–7): Drag the slider to the patient's reported positive cognition validity.
   • Use the Include rating checkboxes if you only want to record one of the two scales for this reading.
4. Reading Notes (Optional): Enter what the patient reported noticing during the set (e.g., emotional shifts, somatic sensations, memory associations).
5. Click Record Reading.

The reading is saved immediately with an accurate timestamp, and the notes field resets for the next pass.

Desensitization Curve & History

The Desensitization Curve provides visual confirmation of treatment efficacy, illustrating how disturbance decreases and positive beliefs take hold over successive sets and appointments.

Progress Chart

• Dual Line Graph: Plots SUDS (in red) and VOC (in green) across all recorded readings.
• Interactive Data Points: Click on any point along the curve to highlight the corresponding reading in the history list below.
• Visualizing Progress: A successful reprocessing curve typically shows the red SUDS line descending from high values (e.g., 8–10) down to 0, while the green VOC line ascends from low values (e.g., 1–2) up to 7.

History Log

Beneath the chart, a detailed history list displays all recorded readings in chronological order:

• Date and timestamp of each reading.
• Protocol phase name (e.g., Desensitization, Installation).
• Recorded SUDS, VOC, and Set Number.
• Click on any entry in the list to inspect its details.

In-Session Integration with Bilateral Stimulation

The SUDS & VOC Tracker is deeply integrated with Astral's Bilateral Stimulation (BLS) tool:

1. In the control panel of a Bilateral Stimulation session, turn on the SUDS/VOC Tracker switch.
2. During the session, the target memory selector, rating input, and desensitization curve appear below the stimulus preview. If the session has several patients, first choose who the target memory belongs to.
3. As you pause between stimulation sets, whether visual, audio, or both, you can record the patient's feedback with a single click. The set number advances automatically (Set 1, Set 2, Set 3...).
4. The patient's view remains completely clean and distraction-free, showing only the bilateral stimulus without exposing rating controls or clinical notes.

Security & Data Privacy

Therapy records and clinical notes contain sensitive mental health information. Astral safeguards EMDR target data with rigorous security standards:

• End-to-End Database Encryption: Target titles, negative cognitions, positive cognitions, target notes, and reading notes are stored in an encrypted format using AES database encryption.
• Audit Trails: Every access event and modification to target records is logged in compliance with healthcare data protection requirements.
• Strict Role & Ownership Controls: Only therapists assigned to or authorized to treat a patient can view or manage their EMDR targets and tracking data.

Related

• Bilateral Stimulation (EMDR)
• Tools Overview
• Patient Profile
• Glossary