Teaching Intensity Ratings: What Clinicians Can Learn from New Research
When someone says their pain is “a 7,” what does that actually mean? For many learners, rating internal sensations on a number scale is surprisingly difficult—and the way we teach it matters. A recent study explored whether adults could learn to assign consistent numbers to sensations they couldn’t see, offering practical insights for clinicians who help people communicate about pain, discomfort, and other private experiences.
What is the research question being asked and why does it matter?
The study asked a simple question: Can adults learn to assign a number on a 0–10 scale to the intensity of a touch sensation, when the helper cannot observe what the person is feeling?
The researchers focused on three types of touch: roughness, heaviness, and temperature. This matters because many real-life sensations—pain, nausea, dizziness, “too loud”—are private. Others must rely on what the person says.
In clinics, schools, and hospitals, people are often asked to rate pain or discomfort using a number scale. But many struggle to do so consistently, or use the scale differently than others expect. Teaching “level words” for intensity in a careful way may help some learners communicate their needs sooner and more clearly.
Still, this study is only a first step. It used safe, non-painful materials in a controlled setting—not real pain or real medical visits.
What did the researchers do to answer that question?
Two neurotypical adults participated. They sat at a table while the experimenter presented touch stimuli the participants could feel but not see.
For roughness and temperature, materials were placed inside a box with a hand hole. Participants reached in and touched them with their eyes closed. For heaviness, they lifted items kept out of sight in a consistent location.
Each sensation type had five intensity levels (1 to 5), but the rating scale ran from 0 to 10. Before many sessions, the experimenter let the person feel a “level 3” item once as a reference point.
During baseline, participants rated sensations without help or feedback. During teaching, the experimenter first stated the correct number while the person felt the item, then shifted to asking for responses and providing feedback—”Yes, that’s a 1″ or “No, that’s actually a 2.”
After participants learned two target levels for a sensation (for example, levels 1 and 2, or 4 and 5), the researchers tested for generalization. They checked whether participants could apply the same numbers to new materials that felt similar, different body parts (like arm instead of hand), and intensity levels that were never directly taught. They also ran a “no-comparison” check where participants rated all five levels without first feeling the level 3 anchor.
How you can use this in your day-to-day clinical practice
Be clear about what you’re teaching. This is a shared way to communicate, not a test of whether the learner is “right” about their body. In this study, “correct” meant “matches the program’s agreed-upon label”—not “this is the true intensity.” Your goal is usually functional communication that helps the learner get support, make choices, and be understood. Plan from the start how the rating will improve care or comfort, not question the learner’s report.
Control what the learner can see. The key feature was hiding visual cues—how an item looks, its size, any labels. If you’re teaching intensity for sensations that can be seen (an ice pack, vibration toy, or textured item), you may need to block sight, cover the item, or position it so the learner can’t use visual shortcuts. Without this control, you may teach “guessing based on looks” instead of “labeling based on feeling,” and the skill may not transfer.
Anchor the scale with simple, consistent reference points. The study used a “level 3” comparison item before many sessions. This can help learners who do better with a known middle point.
But the exact question you ask can change how the learner uses the scale. One participant rated cold as “high intensity” because the instruction was to rate “temperature intensity”—which could mean “very cold is very intense.” When the instruction changed to “How hot does it feel?” the scale aligned better with the intended direction.
Pick your direction and stick with it. Say “How hot?” if higher numbers mean hotter. Say “How cold?” if higher numbers mean colder. Avoid vague words like “How intense?” unless you’ve taught what that means for that learner.
Teach only part of the scale at first. Don’t assume the learner will fill in the rest on their own. Both adults quickly learned the two taught numbers with prompts and feedback, but generalization to untaught levels was mixed. One participant generalized better than the other, and even when “percent correct” was low, both became more consistent in their responses.
The takeaway: plan extra teaching if you need the learner to use many points on the scale. If the real goal is “low, medium, high” reporting, consider a smaller scale or teach category labels first, rather than jumping to 0–10.
Separate the kinds of generalization you care about. The researchers checked at least four different things: new materials, new body parts, untaught intensity levels, and combinations of those. That’s a good clinical mindset.
A learner might use “2” correctly for a light backpack but not for a light squeeze. They might label roughness on fingertips but not on their arm. When you write goals, specify what “generalization” means. If your client needs to report “pressure” during dental care, it’s not enough that they can rate a heavy jug at a table. Probe in situations that resemble the real setting, while keeping it safe and respectful.
Expect some learners to use the scale differently than you planned. One participant responded as if the full 0–10 scale was in play, even though only levels 1–5 were presented. This happens in real practice too. If you teach “this is a 5” but the learner thinks “5 means middle because the scale goes to 10,” you can get stable, consistent ratings that still don’t match your target numbers.
If your main goal is communication, consider whether you can accept a wider “correct” range tied to a reference point. For example, if the learner feels the anchor and then reports anything higher than the anchor for a stronger stimulus, that might be “good enough” for clinical decisions—as long as everyone on the team uses the same rules.
Build in choice, stop rules, and dignity protections from the start. Even when stimuli are meant to be mild, make opt-out options visible in your plan. The researchers capped intensity to avoid pain and told participants they could stop at any time.
In clinical practice, do the same. Include a clear opt-out response the learner can use without penalty. Avoid turning sensation work into compliance training. If the learner says “stop” or shows discomfort, stopping should be reinforced—not debated.
Be cautious about who this applies to. These were two neurotypical adults with strong language skills, short sessions, and tight experimental control. Don’t assume the same outcomes for autistic learners, learners with limited vocal speech, or learners with high sensory sensitivity.
If you adapt this approach, consider prerequisites: basic tacting, understanding “more/less,” tolerating brief contact with materials, and having a safe way to refuse. Also consider that biological factors and day-to-day changes (sleep, stress, illness) may affect how sensations are felt and labeled.
Treat intensity ratings as one tool, not the truth. A good next step is to pair ratings with observable context and coping options. If a learner reports “7,” you can teach what supports are available at “7”—a break, activity change, asking for help, getting a sensory tool, requesting a medical check—instead of using the number to argue about whether the learner “should” be okay.
The practical value is better, faster communication and better response from the team, as long as the scale is taught carefully and used with respect.
Works Cited
Rajagopal, S., Nicholson, K., Hernandez, M., & Odume, B. (2025). Using concealed public accompaniments to teach individuals to tact intensity. The Analysis of Verbal Behavior, 41, 235–261. https://doi.org/10.1007/s40616-025-00222-0
