Anxiety sensitivity and panic symptoms: the moderating influence of distress tolerance

Undergraduate students are at particular risk for greater alcohol use, which is linked to anxiety disorders among a variety of other negative consequences. Understanding transdiagnostic factors underlying alcohol use problems and other disorders, such as anxiety and mood disorders, can help identify potential targets for intervention. The present study (N = 208 undergraduates; 76.9% female) tested relations between self-reported anxiety sensitivity, panic symptoms, alcohol use and problems, and two different measures of distress tolerance (DT). Specifically, the DT measures assessed 1) perceived ability to handle negative emotion states (emotional DT), measured via self-report, and 2) behavioral ability to tolerate discomforting physical sensations (physical DT), measured via a breath-holding duration task. Consistent with expectations, anxiety sensitivity was associated with greater panic symptoms, which in turn was associated with greater alcohol use problems, for individuals with low but not high levels of physical DT. Contrary to expectations, there was no evidence that panic symptoms explained the relation between anxiety sensitivity and alcohol use and problems at either low or high levels of emotional DT. Taken together, these results suggest that a possible target to decrease alcohol use problems is to increase capacity to withstand or engage with discomforting physiological and panic sensations (i.e., to cultivate greater physical DT).

This study examined relations of two affective vulnerabilities, high anxiety sensitivity (AS) and low distress tolerance (DT), with tobacco dependence, withdrawal, smoking cessation, and pharmacotherapy response. Smokers interested in quitting (N = 1067; 52.2% female, 28.1% African American) were randomized to 12 weeks of nicotine patch, nicotine patch plus nicotine lozenge, or varenicline. Baseline questionnaires assessed AS, DT, negative affect, anxiety, and dependence. Withdrawal was assessed the first-week post-quit via ecological momentary assessment. DT, but not AS, predicted biochemically confirmed point-prevalence abstinence at multiple endpoints: weeks 4, 12, 26, and 52 post-quit (ps < .05); relations remained after controlling for pharmacotherapy treatment, AS, baseline negative affect, anxiety, and anxiety disorder history (ps < .05). Additional exploratory analyses examining week 4 abstinence showed DT predicted abstinence (p = .004) even after controlling for baseline dependence, post-quit withdrawal (craving and negative affect), and treatment. DT moderated treatment effects on abstinence in exploratory analyses (interaction p = .025); those with high DT were especially likely to be abstinent at week 4 with patch plus lozenge versus patch alone. DT, but not AS, predicted abstinence over 1 year post-quit (higher DT was associated with higher quit rates), with little overlap with other affective measures. DT also predicted early abstinence independent of dependence and withdrawal symptoms. Results suggest low DT may play a meaningful role in motivation to use tobacco and constitute an additional affective risk factor for tobacco cessation failure beyond negative affect or clinical affective disorders. People in a stop-smoking study who reported a greater ability to tolerate distress were more likely to quit smoking and remain smoke-free 1 year later. Smokers with high DT were more likely to be smoke-free 4 weeks after their target quit day if they received nicotine patch plus nicotine lozenge rather than nicotine patch alone. NCT01553084.

Cardiovascular risk as a moderator of associations among anxiety sensitivity, distress tolerance, PTSD and depression symptoms among trauma-exposed firefighters

Black individuals who smoke in the United States experience significant tobacco-related disparities. Although prior work has established that smoking abstinence expectancies play an important role in smoking-related outcomes, few studies have examined potential individual difference factors that may be relevant to smoking abstinence expectancies among Black individuals who smoke. The present study investigated anxiety sensitivity and distress tolerance in relation to smoking abstinence expectancies among a sample of Black individuals who smoke. Participants were 86 Black adults who smoke cigarettes daily (M age = 46.07 years, SD = 10.37; 26.7% female). Four separate linear regression analyses were conducted to evaluate the relation between anxiety sensitivity, distress tolerance, and their interaction with each of the four smoking abstinence expectancies (i.e., somatic symptoms, positive consequences, harmful consequences, and negative mood). Results indicated that higher anxiety sensitivity was related to higher somatic symptoms, harmful consequences, and negative mood abstinence expectancies, whereas distress tolerance was related to higher positive consequences. Further, anxiety sensitivity and distress tolerance interacted to confer greater expectancies for the positive consequences of quitting. The current findings are among the first to document that anxiety sensitivity and distress tolerance are clinically relevant factors to consider when tailoring smoking cessation treatments for Black individuals who smoke. Future research is needed to examine distress tolerance and anxiety sensitivity as longitudinal predictors of smoking abstinence expectancies among Black individuals who smoke.

Emotion regulation (ER) and distress tolerance (DT) are considered transdiagnostic risk factors for a range of anxiety disorders. This study investigated the relationship between anxiety sensitivity (AS) and health anxiety (HA) in the general population, focusing on the mediating roles of DT and ER. The study was conducted as a cross-sectional survey from October to December 2023 in Tehran Province, Iran. A total of 971 individuals participated in this study (52.8% female; mean age 39.04 years, SD=10.64). Participants completed self-report questionnaires to assess HA (The Short Health Anxiety Inventory), AS (The Anxiety Sensitivity Index-3), DT (The 15-item Distress Tolerance Scale) and ER (The 10-item Emotion Regulation Questionnaire). We used structural equation modeling (SEM) to examine the hypothesis that DT and ER would mediate the relationship between AS and the HA. AS was modestly related to all measures (r from -0.40 to 0.55). According to the SEM analysis, AS (β = 0.45, 95%CI [0.34, 0.56]) had a significant direct effect on HA. However, the analysis of the indirect effects revealed that both DT (β = 0.10, 95% CI [0.06, 0.16]) and emotion regulation strategies-cognitive reappraisal (β = 0.06, 95% CI [0.01, 0.11]) and expressive suppression (β = 0.11, 95% CI [0.06, 0.18])-act as partial mediators in the relationship between AS and HA. AS plays a crucial role in predisposing individuals to HA. The mediating roles of DT and ER provide insight into the link between AS and HA. Nevertheless, the study's cross-sectional design and reliance on a non-clinical sample limit the applicability of the results. Further research involving different samples and intervention studies is needed to validate and expand upon these findings.

Anxiety Symptomatology: The Association With Distress Tolerance and Anxiety Sensitivity

Distress tolerance, the degree to which one is able to cope with and endure negative emotional states, has been broadly applied to understand and treat a variety of health (including behavioral) problems, but little is known about its role in oral health care and specifically dental care-related fear and anxiety, making it a novel construct in the oral health care literature. This cross-sectional study examined distress tolerance as a possible predictor of dental fear and anxiety among a sample of adults with and without diagnoses of dental phobia, investigated possible differences in levels of distress tolerance between adults with and without dental phobia, and determined possible associations between distress tolerance and fear of pain, anxiety sensitivity, and depression. Using 52 volunteers (n = 31, dental phobia group; n = 21, healthy comparison group), this investigation used self-report measures of distress tolerance, fear of pain, anxiety sensitivity, dental fear, and depression. The Anxiety Disorders Interview Schedule, a semi-structured interview, was used to assess for dental phobia and other psychological disorders. Distress tolerance significantly predicted dental fear and anxiety, even after controlling for age, sex, fear of pain, anxiety sensitivity, and depression. In addition, the dental phobia group had lower distress tolerance than the healthy comparison group. Distress tolerance was significantly associated with fear of pain, anxiety sensitivity, and depression. Findings indicate that low distress tolerance plays a unique and distinct role as a possible mechanism in the genesis of dental care-related fear and anxiety and phobia and may exacerbate the experience of other states, including fear of pain and anxiety sensitivity. Knowledge Transfer Statement: Results indicate that patients who have a lower ability to tolerate emotional and physical distress may have higher levels of dental care-related fear and anxiety and even dental phobia, as well as associated sequelae (e.g., avoidance of dental care). Treatment of highly fearful dental patients may helpfully include a focus on increasing distress tolerance.

Evaluating emotional sensitivity and tolerance factors in the prediction of panic-relevant responding to a biological challenge

Distress tolerance (DT) is defined as the ability to persist in challenging goal-directed behavior in the face of stress, and individuals with low DT exhibit heightened drug-seeking behavior. However, no preclinical studies have examined the neurobiology underlying this phenomenon. To assess this, in vivo electrophysiology was used in Long Evans male and female rats during a DT task to record neural activity in the prelimbic cortex (PrL), a brain region implicated in drug-seeking. Rats were first assessed for DT, defined as the amount of time elapsed before rats quit seeking reward in an increasingly difficult operant task. Subsequently, rats underwent 2 weeks of self-administration for either water/saline or cocaine for 6 h/day. Animals then began a 1 month period of experimenter-imposed abstinence to induce heightened drug-seeking behavior. On day 28 of abstinence, DT and neural activity were reassessed; and on day 30, cocaine-seeking behavior was examined under extinction. Males had significantly higher DT than females and exhibited significantly more phasic PrL activity during the DT task. Furthermore, in male rats with a history of cocaine, PrL activity shifted to track DT; and this change in activity significantly correlated with the change in DT. Additionally, male (but not female) rats with low DT after 28 d of abstinence had significantly heightened drug-seeking behavior. Finally, PrL activity during the DT task predicted cocaine-seeking behavior. Collectively, these data demonstrate an important role for the PrL in DT in males, and link this neural activity and behavior to drug-seeking, particularly in males.SIGNIFICANCE STATEMENT Distress tolerance (DT) is defined as the ability to persist in challenging goal-directed behavior in the face of stress, and individuals with low DT exhibit heightened drug-seeking. Here, we investigated the role of the prelimbic cortex (PrL) in DT and its relationship to cocaine-seeking in male and female rats. We found that males had significantly higher DT than females and exhibited significantly more PrL activity during the DT task. Furthermore, male (but not female) rats with low DT after 28 d of abstinence had significantly heightened drug-seeking behavior. Finally, PrL activity during the DT task predicted cocaine-seeking. These data demonstrate an important role for the PrL in DT and link this neural activity and behavior to drug-seeking in males.

Evaluating competing models of distress tolerance via structural equation modeling

Understanding the associations among anxiety sensitivity, distress tolerance, and discomfort intolerance: A comparison of three models

The present investigation examined the main and interactive effects of a nonclinical panic attack history and two different measures of distress tolerance (DT)—perceived (self-report) and behavioral (breath-holding duration)—in relation to the global and lower-order factors of anxiety sensitivity (AS). Results indicated that lower levels of perceived DT were significantly related to greater levels of global as well as all lower-order AS factors (physical, cognitive, and social concerns); however, lower levels of behavioral DT were not significantly related to the global or lower-order AS factors at the main effect level. The interaction between a nonclinical panic attack history and perceived DT was only significantly related to the AS-cognitive factor. Moreover, the interaction between a nonclinical panic attack history and behavioral DT was only significantly related to the AS-physical factor. The present findings suggest that DT may be an important factor to target among panic-vulnerable populations.

Introduction Individuals who smoke cigarettes and experience affective vulnerabilities report more severe smoking patterns. Prior work has identified several transdiagnostic risk factors associated with perceived barriers for smoking cessation, including distress tolerance, anxiety sensitivity, and emotion dysregulation. However, no work has explored the unique effect of these constructs on dimensions of perceived barriers for smoking cessation while controlling for the shared variance across these affective vulnerabilities. Objectives The present study aimed to investigate the effect of anxiety sensitivity, distress tolerance, and emotion dysregulation on perceived barriers for smoking cessation related to addiction, external, and internal domains when controlling for the shared variance across the identified affective vulnerabilities. Methods Participants included 154 adults who reported daily cigarette smoking and low distress tolerance (Mage = 29.6 years; SD = 7.49; 31% female). Results Results indicate that higher anxiety sensitivity is related to greater external perceived barriers for smoking cessation whereas lower distress tolerance is related to greater internal and addiction perceived barriers for smoking cessation. Conclusion The current findings suggest anxiety sensitivity and distress tolerance are important to better understanding perceived barriers for smoking cessation in the context of one another and emotion dysregulation.

Anxiety sensitivity, distress tolerance, and discomfort intolerance in relation to coping and conformity motives for alcohol use and alcohol use problems among young adult drinkers

The present investigation evaluated the moderating role of distress tolerance (DT) in the relation between the physical concerns (PC) dimension of anxiety sensitivity (AS–PC) and panic and posttraumatic stress disorder (PTSD)-related re-experiencing symptoms in a nonclinical, undergraduate sample (n = 416; 300 females; M age=20.3 years, SD = 4.8). Consistent with prediction, there was a significant interactive effect between AS–PC and DT in regard to panic symptoms, such that greater AS–PC and low DT was associated with greater panic symptoms after controlling for the variance accounted for by negative affectivity and the respective main effects. However, contrary to prediction, AS–PC and DT did not significantly interact to predict PTSD-related re-experiencing symptoms. Also consistent with prediction, there was no interactive effect apparent for symptoms of depression or general anxiety, suggesting that the interaction between AS–PC and DT is specific to panic psychopathology.