How to Track SUD and VOC Scores in Remote EMDR

SUD and VOC ratings are the two numbers that steer an EMDR session — they tell you how much distress a target still carries and how true the client's preferred belief feels. On a video call, spoken ratings work exactly as they do in the room, but a few small habits make them easier to track and act on. Here's a practical rundown.

Where the scales come from

The Subjective Units of Disturbance scale, usually shortened to SUD, wasn’t invented for EMDR. It originated with Joseph Wolpe and Arnold Lazarus in 1966 as a general tool for rating anxiety, originally on a 0–100 range (Mattera & Zaboski, 2025, Clinics and Practice). EMDR adopted a compressed 0–10 version of the same idea: 0 means no disturbance at all, 10 means the worst disturbance the client can imagine.

The Validity of Cognition scale, or VOC, is specific to EMDR and comes from Francine Shapiro’s original protocol. It runs from 1 (completely false) to 7 (completely true) and measures how true a positive, preferred belief feels to the client — not how true they know it to be intellectually, but how true it feels in the moment. According to EMDRIA’s own description of the eight phases, reprocessing during desensitization continues until SUD comes down to 0 or 1, and installation continues until the positive cognition’s VOC reaches 7 (EMDR International Association).

Why the numbers matter beyond the moment

SUD and VOC aren’t just session bookkeeping. A SUD that refuses to drop, or a VOC that won’t climb, is often the first sign that reprocessing has stalled — the same pattern covered in our guide to blocked processing. Ratings that move steadily set the pace for the whole session, telling you when it’s safe to end a set, when to check in more closely, and when a target is genuinely complete versus just quiet.

Tracking ratings on a remote call

The mechanics of asking for a number out loud don’t change over video. What changes is how easy it is to lose track of a fast-moving sequence of numbers when you’re also watching the screen, running the dot, and reading the client’s face. A few habits help:

• Keep a running log, even a simple one. A plain notes document with a timestamp, the SUD or VOC number, and a two-word note on what shifted is enough to reconstruct the session afterward and to document by session’s end. Full clinical documentation is a separate task, but a live log makes it far faster.
• Ask for the number before you ask “what’s coming up.” Getting the rating first, before the client starts describing content, keeps the number itself clean and un-anchored to whatever they say next.
• Watch for a mismatch between the number and the tone. A client who reports “SUD 3” in a shaky voice may be minimizing, and a client who reports “SUD 7” flatly may be intellectualizing. The number is a starting point for a check-in, not the final word.
• Say the scale anchors out loud if it’s been a while. For clients who haven’t done EMDR recently, a quick “zero is no disturbance, ten is the worst you can imagine” re-anchors the scale before you ask for a number, especially useful if you can’t hold up a printed scale for them to see on camera.

Using the numbers to decide what’s next

A dropping SUD and climbing VOC across sets is the signal to keep going with the current pacing. A flat SUD across two or more sets, or a VOC that won’t move even though the client can state the positive belief intellectually, is the cue to slow down, check the target, or introduce an intervention like a cognitive interweave. Either way, the numbers — not just your read of the room — should be driving that decision, since affect and self-report don’t always move together, especially on a screen where some nonverbal cues are harder to catch.

At the end of a session, whatever the final SUD and VOC land on, log them clearly. They’re your baseline for picking the target back up next time, and they’re often the clearest evidence in your notes of what actually happened in a session.

What to do with an incomplete session

Not every session ends with SUD at 0 or 1 and VOC at 7 — plenty end mid-set, especially once you account for the time it takes to settle in and close out safely over video. When that happens, your last recorded numbers become the plan for the next session: you know exactly where the target stood and roughly how much work remains, rather than having to reconstruct it from memory or a client’s vague sense of “it went okay.” That’s a small thing, but it’s the difference between picking up a thread cleanly and re-litigating where you left off.

It’s also worth noting the numbers alongside the client’s presentation that day. A client who arrives already elevated will likely start and end a set at higher SUD than usual, and reading that in context — rather than comparing it flatly to last week’s numbers — keeps you from misreading a rough day as a lack of progress.