Behavioral Measure Of Distress Tolerance Research Articles

Distress tolerance and emotional regulation in individuals with alcohol use disorder.

Previous research suggests that low distress tolerance may be associated with poor emotion regulation, contribute to drinking to cope motives, and predict alcohol-related problems in non-clinical populations. However, little is known about the ability to tolerate distress among individuals with alcohol use disorder (AUD) and its association with emotional dysregulation. The aim of this study was to examine the link between emotional dysregulation and a behavioral measure of distress tolerance among individuals with AUD. The sample consisted of 227 individuals with AUD enrolled in an 8-week abstinence-based inpatient treatment program. Behavioral distress tolerance was assessed using a test of ischemic pain tolerance and the Difficulties in Emotion Regulation Scale (DERS) was used to assess emotion dysregulation. Distress tolerance was significantly associated with emotional dysregulation even when accounting for alexithymia, depressive symptomatology, age, and biological sex. The current study provides preliminary support for an association between low distress tolerance and emotion dysregulation in a clinical group of patients with AUD.

Distress Tolerance as a Mechanism Linking Violence Exposure to Problematic Alcohol use in Adolescence.

Adolescents exposed to violence are at elevated risk of developing most forms of psychopathology, including depression, anxiety, and alcohol abuse. Prior research has identified emotional reactivity and difficulties with emotion regulation as core mechanisms linking violence exposure with psychopathology. Scant research has examined behavioral responses to distress as a mechanism in this association. This study examined the association of violence exposure with distress tolerance-the ability to persist in the face of distress-and whether lower distress tolerance linked violence exposure with subsequent increases in depression, anxiety, and alcohol abuse problems during adolescence. Data were collected prospectively in a sample of 287 adolescents aged 16-17 (44.3% male; 40.8% White). At Time 1, participants provided self-report of demographics, violence exposure, and psychopathology, and completed a behavioral measure of distress tolerance, the Paced Auditory Serial AdditionTask. Four months later, participants (n = 237) repeated the psychopathology assessments. Violence exposure was associated with lower distress tolerance (β = -.21 p = .009), and elevated concurrent psychopathology (β = .16-.45, p = .001-.004). Low distress tolerance was prospectively associated with greater likelihood of abusing alcohol over time (OR = .63, p = .021), and mediated the association between violence exposure and greater levels (β = .02, 95% CI [.001, .063]) and likelihood (OR = .03, 95% CI [.006, .065]) of alcohol use over time. In contrast, low distress tolerance was not associated concurrently or prospectively with internalizing symptoms. Results persisted after controlling forsocio-economic status. Findings suggest that distress tolerance is shaped by early experiences of threat and plays a role in the association between violence exposure and development of problematic alcohol use in adolescence.

Examining Relationships between Gender, Opioid Dependence, and Distress Tolerance among Patients in Substance Use Disorder Treatment

Background: Opioid abuse/dependence is associated with multiple negative outcomes relative to other forms of substance abuse/dependence, including relapse. Research identifying modifiable characteristics associated with opioid dependence and associated negative outcomes may inform the development of targeted interventions for this high-risk population. One factor warranting investigation is low distress tolerance (DT). Purpose/Objectives: In a sample of patients in substance use disorder (SUD) treatment, the present study examined DT levels among patients with current opioid dependence versus no history of opioid dependence, as well as the moderating role of gender. We predicted that patients with opioid dependence would exhibit lower DT than those without a history of opioid dependence, and that women with opioid dependence would exhibit lower levels of DT than men with opioid dependence. Methods: A sample of 203 patients in residential SUD treatment were administered a series of diagnostic interviews and a behavioral measure of DT. Results: DT did not differ significantly as a function of opioid dependence. However, there was a significant opioid dependence by gender interaction, such that men with current opioid dependence exhibited significantly lower levels of DT than women with opioid dependence and men without a history of opioid dependence. Conclusions/Importance: Findings highlight a modifiable characteristic associated with opioid dependence among men that may be targeted in interventions.

The Nomological Network of a Behavioral Distress Tolerance Task in Veterans.

There is a relative lack of research on distress tolerance (DT) in veteran samples. The aims of the study were to (a) evaluate convergent and discriminant validity of a behavioral measure of DT compared to theoretically similar (i.e., self-report DT, negative urgency) and dissimilar (i.e., risk-taking) constructs and (b) evaluate the concurrent validity of DT in relation to posttraumatic stress disorder (PTSD) and depressive symptoms in a veteran sample. A sample of U.S. veterans who served after the September 11, 2001 terror attacks (N = 306, 89.9% male; M age 30.2 years, SD = 4.5, range: 21-40 years) completed self-report and behavioral measures of DT, risk-taking, impulsivity, and depressive symptoms, and completed a clinical interview for PTSD. Results of a multitrait-multimethod matrix found significant yet minimal shared variance, r2 = .01-.03, ps = .002-.055, between the self-report and behavioral measures of DT. We used a series of multiple regressions to examine the relative contribution of the behavioral and self-report DT measures in the prediction of PTSD and depressive symptoms. Self-reported, but not behavioral, DT accounted for unique variance in PTSD, r2 = .12, p < .001, and depressive symptoms, r2 = .23, p < .001. Participants with PTSD or higher scores on measures of depression were more likely to report greater increases in frustration and irritability after completing the behavioral task. Results indicate that DT is not a unidimensional construct and must be considered in the context of specific emotions (e.g., tolerance of irritability vs. fear) and contexts (e.g., behavioral, affective).

The relationship between emotional clarity and suicidal ideation among trauma-exposed adolescents in inpatient psychiatric care: does distress tolerance matter?

ABSTRACTThe present investigation examined associations between low emotional clarity (the extent to which individuals are confused about the specific emotions they are experiencing) and suicidal ideation in a diverse sample of trauma-exposed inpatient adolescents, as well as the moderating role of distress tolerance (DT) in this association. Participants (N = 50; 52.0% female; M = 15.1 years, SD = .51; 44% White) completed measures of emotion dysregulation, posttraumatic stress disorder (PTSD), and suicidal ideation/attempts, as well as a behavioral measure of DT. Controlling for age, gender, presence of mood disorder, and past history of attempts, results revealed a significant interaction between DT and low emotional clarity in relation to suicidal ideation. Specifically, lower emotional clarity was related to suicidal ideation at higher, but not lower, levels of DT. Findings suggest that presence of suicidal ideation among traumatized youth with low emotion clarity is most likely when these emotional deficits are coupled with a high tolerance for cognitive/psychological distress. Given that the ability to withstand distress is arguably a key factor in transitioning individuals from ideation to lethal suicidal behavior, attention to the presence of this construct in the context of clinical practice may be warranted.

A Multimodal Study of Childhood Trauma and Distress Tolerance in Young Adulthood

ABSTRACTIndividuals with a history of childhood trauma experience deficits in emotion regulation. However, few studies have investigated childhood trauma and both perceived (i.e., self-report) and behavioral measures of distress tolerance. The current study evaluated associations between childhood trauma (i.e., physical abuse, sexual abuse, and witnessing family violence) and measures of perceived (Distress Tolerance Scale) and behavioral distress tolerance (i.e., Paced Auditory Serial Addition Test, breath-holding). Participants were 320 undergraduate students with a history of interpersonal trauma (e.g., sexual/physical assault). Structural equation modeling was used to evaluate associations between frequency of childhood trauma type and distress tolerance. Greater childhood physical abuse was associated with higher perceived distress tolerance. Greater levels of witnessing family violence were associated with lower behavioral distress tolerance on the breath-holding task. No significant effects were found for Paced Auditory Serial Addition Test performance. Associations between childhood trauma and emotion regulation likely are complex and warrant further study.

Emotion Regulation in Borderline Personality Disorder: An Experimental Investigation of the Effects of Instructed Acceptance and Suppression

Difficulties with emotion regulation are central to borderline personality disorder (BPD). Recent research suggests that avoidance of emotions in general, and emotion suppression specifically, may be commonly used among those who meet criteria for the disorder. Contemporary behavioral interventions for BPD incorporate cognitive and behavioral skills to increase emotional experiencing and acceptance while decreasing behaviors that function to escape or avoid from emotions. Few studies, however, have experimentally examined the effects of instructed emotion suppression and acceptance in BPD. The present study examined the effects of instructed use of different emotion regulation strategies on emotions, psychophysiology, and behavior in BPD. Participants with BPD, major depressive disorder (MDD), and nonpsychiatric controls (N = 193) were randomly assigned to either suppress or accept emotions during an audio recording of a social rejection scenario, and completed a behavioral measure of distress tolerance. BPD participants exhibited greater heart rate variability in the acceptance (vs. suppression) condition; this pattern was not evident within the other groups. These results suggest that deliberate use of acceptance-based emotion regulation strategies may have unique physiological effects among individuals with BPD.

A Brief Report on the Assessment of Distress Tolerance: Are We Measuring the Same Construct?

Distress tolerance (DT) refers to an individual’s capacity to cope with aversive internal (e.g., physical, cognitive, emotional) states. A growing body of evidence suggests that there is a relationship between DT and the development and maintenance of problematic behavioral patterns. Despite emerging evidence for such associations, a number of issues remain unresolved. The results of recent studies suggest problems with the convergent validity of the primary measures used to assess DT, despite the fact that these measures are used interchangeably in the DT literature. In order to further examine the relationships among DT assessments, we evaluated intercorrelations among various self-report and behavioral measures of DT in an unselected undergraduate sample (n = 83). Results indicate that two self-report measures of DT were highly correlated with one another, but that neither measure was significantly correlated with the behavioral measures. The relationships among the behavioral measures and between self-report and behavioral measures were weak and non-significant. Correlations between self-report measures only were strong. The findings partially replicate prior research indicating weak correlations between certain, commonly used measures of DT, and raise questions about the current conceptualization of the construct.

Distress tolerance in social versus solitary college student drinkers

Low distress tolerance has been an inconsistent predictor of alcohol-related consequences in college students, but its relationships to depression and coping motives for alcohol have received stronger support. Research on college students who drink heavily in isolation suggests that this population is more likely to have a greater number and severity of alcohol-related problems, depression, and coping motives. Solitary heavy drinkers were therefore hypothesized to have lower distress tolerance than other drinkers. This study examined differences in self-reported and behavioral distress tolerance across two groups of university students: those who endorsed heavy solitary drinking (20.1%) versus those who endorsed other types of drinking. Students completed a self-report measure (Distress Intolerance Self-Report, or DISR) and behavioral measure of distress tolerance (Paced Auditory Serial Addition Test, or PASAT). Students who reported drinking heavily in isolation differed from other students on the DISR, F(1, 132)=4.645, p=.033, η2=.034, but not on the PASAT, F(1, 132)=0.056, p=.813. These students also endorsed more coping motives for alcohol. Distress tolerance did not predict drinking consequences directly, yet a mediation model linking distress tolerance to consequences through coping motives supports previous findings of distress tolerance as a distal, indirect predictor of drinking problems. The unique characteristics of solitary binge drinkers and the significance of distress tolerance as an indirect predictor of alcohol-related consequences are discussed.

The Nomological Network of Self-Reported Distress Tolerance.

Distress tolerance (DT), or the ability to withstand psychological distress, is a popular construct in the psychological literature. However, research has not specified the nomological network of DT across self-report measures. The purpose of the current investigation was to understand what personality features, environmental stressors, current affective states, and behaviors contribute to DT in two different samples: college students and those in residential substance use treatment. Correlations revealed that self-reported DT was most strongly associated with trait negative emotionality, state negative affect, impulsivity, and perceived stress. In comparisons across samples, self-harm exhibited a stronger relationship with self-reported DT in the drug treatment than in the student sample, whereas perceived stress had a stronger association in the student sample. Correlations between self-report and behavioral measures of DT were nonsignificant. To understand this lack of associations, associations of outcomes with behavioral measures were assessed. In contrast to self-reported DT, behavioral DT was more closely related to achievement orientation, state negative affect, and state positive affect, but was not significantly related to psychopathology and maladaptive behaviors. It is necessary to continue investigating the construct validity of behavioral DT measures via the use of incremental utility analyses and experimental approaches.

Maternal and adolescent distress tolerance: the moderating role of gender.

Distress tolerance is defined behaviorally as the ability to maintain goal-directed behavior while experiencing physical or psychological distress. Distress tolerance is closely related to emotion regulation and is a clinically relevant construct contributing to psychopathology across adults and adolescents, yet limited research has examined the development of this construct. A number of studies suggest the importance of parenting in the emergence of emotion regulation capacities in childhood and adolescence. In the current study, we utilize a behavioral measure of distress tolerance to examine whether maternal distress tolerance is related to adolescent distress tolerance, and whether this association differs as a function of gender. We also examine the influence of family emotional climate, namely maternal response to adolescent distress and adolescent attachment. Results indicate a significant maternal distress tolerance by adolescent gender interaction, such that maternal distress tolerance predicts adolescent distress tolerance in daughters, but not sons. The family emotional climate variables were unrelated to maternal or adolescent distress tolerance. Taken together, data indicate that maternal distress tolerance is significantly related to the distress tolerance of adolescent daughters and indicates the potential utility of addressing maternal distress tolerance in clinical work with adolescents.

Adolescent friendships in the context of dual risk: the roles of low adolescent distress tolerance and harsh parental response to adolescent distress.

Given extensive evidence about the importance of relationships with friends during development, a large body of research has examined the correlates of these significant social experiences. Most of this research, however, has examined either individual characteristics (e.g., behavior, personality) or contextual factors (e.g., family), and most of the work has studied relationships during childhood. The present study extended previous research by examining how both an individual factor (adolescent distress tolerance) and a contextual factor (parental response to adolescent distress) are linked to adolescents' friendships. Adolescents (N = 161) completed two behavioral measures of distress tolerance, and parents reported about their responses to adolescent distress. Although distress tolerance and parental responses to distress were not directly associated with adolescents' positive or negative friendship experiences, for adolescents with low distress tolerance, harsh parental responses were negatively associated with adolescents' positive friendship quality. Further, for adolescents whose parents used harsh responses to distress, distress tolerance was negatively associated with adolescents' positive friendship quality. Results highlight the importance of studying both individual and familial factors related to adolescents' social functioning.

An investigation of experiential avoidance, emotion dysregulation, and distress tolerance in young adult outpatients with borderline personality disorder symptoms.

In this study we investigated 3 domains of emotional functioning--emotion dysregulation, distress tolerance, and experiential avoidance--in young adult outpatients with borderline personality disorder (BPD) symptoms. Participants were 40 young adult outpatients at a university counseling center who reported current suicidal ideation and met diagnostic criteria for BPD or experienced subthreshold BPD symptoms (i.e., met diagnostic criteria for 3 or 4 symptoms). Participants completed 3 self-report measures of emotional functioning-experiential avoidance (Acceptance and Action Questionnaire-2; Bond et al., 2011; Hayes et al., 2004), emotion dysregulation (Difficulties in Emotion Regulation Scale; Gratz & Roemer, 2004), and distress tolerance (Distress Tolerance Scale; Simons & Gaher, 2005)-and a behavioral measure of distress tolerance (Paced Auditory Serial Addition Task-Computerized; Lejuez, Kahler, & Brown, 2003), in addition to self-report measures of depression and BPD symptom severity. Partial correlations demonstrated that both emotion dysregulation and experiential avoidance were significantly associated with BPD symptom severity after accounting for depression. However, neither the self-report nor behavioral measure of distress tolerance were related to BPD symptom severity. A regression analysis with emotion dysregulation and experiential avoidance as independent variables revealed that only experiential avoidance was significantly associated with BPD symptom severity after controlling for depression symptoms. The current findings suggest that experiential avoidance may be a central process in BPD symptom severity. Future research directions are discussed.

Ruminative and mindful self-focused attention in borderline personality disorder.

The current study investigated the short-term effects of mindful and ruminative forms of self-focused attention on a behavioral measure of distress tolerance in individuals with borderline personality disorder (BPD) who had completed an angry mood induction. Participants included 40 individuals who met criteria for BPD and were currently involved in mental health treatment. Each completed an individual 1-hr session. Following an angry mood induction, each participant was randomly assigned to engage in ruminative or mindful self-focus for several minutes. All participants then completed the computerized Paced Auditory Serial Addition Test (PASAT-C), a behavioral measure of willingness to tolerate distress in the service of goal-directed behavior. The mindfulness group persisted significantly longer than the rumination group on the distress tolerance task and reported significantly lower levels of anger following the self-focus period. Results are consistent with previous studies in suggesting that distinct forms of self-focused attention have distinct outcomes and that, for people with BPD, mindful self-observation is an adaptive alternative to rumination when feeling angry.

The Roles of Emotional Reactivity and Tolerance in Generalized, Social, and Health Anxiety: A Multimethod Exploration

Emotion regulation difficulties have been implicated in the maintenance of many anxiety disorders. However, existing research has relied mostly on self-report measures of emotion regulation or one type of mood induction. The present study examined the relationships between anxiety symptoms and emotional reactivity and tolerance using multiple assessment methodologies. Participants (N=122) completed measures of generalized, social, and health anxiety symptoms and reported tolerance of and reactivity to negative emotions (sadness, fear, anger, disgust) elicited by 4 film clips. Participants also completed a mirror-tracing persistence task, a behavioral measure of distress tolerance. Social anxiety symptoms predicted unique variance in tolerance of film-elicited emotions, whereas generalized anxiety symptoms predicted unique variance in total peak reactivity to film-elicited emotions. Health anxiety was not related to tolerance or peak reactivity, but it was predictive of greater anxiety following the mirror-tracing task. The results of this study suggest heightened emotional reactivity is a salient feature of generalized anxiety symptoms, whereas emotional tolerance is more strongly related to social anxiety symptoms. The unique association between health anxiety and anxious response to the distress tolerance task represents a novel finding that warrants further investigation.

Behaviorally-indexed distress tolerance and suicidality

Research indicates that distress tolerance exhibits a complicated relationship with risk factors for suicidal behavior. Specifically, low self-reported distress tolerance has been linked to perceived burdensomeness and thwarted belongingness. Contrastingly, high self-reported distress tolerance has been linked to the acquired capability for suicide. Given the frequently discrepant findings between self-report and behavioral indices of distress tolerance, we sought to expand upon prior findings by testing these relationships utilizing a behavioral measure of distress tolerance. Additionally, in an effort to further clarify the role of distress tolerance relative to painful and/or provocative experiences in the acquired capability, we examined whether distress tolerance serves as a moderator. Results revealed no significant associations between distress tolerance and burdensomeness or belongingness; however, distress tolerance was positively associated with the acquired capability. Furthermore, the interaction of distress tolerance and painful and/or provocative experiences significantly predicted the acquired capability, with the strength of the association increasing at higher levels of distress tolerance. Results highlight the potential importance of perceived versus actual ability to tolerate distress with respect to suicidal desire. In contrast, the results reflect the importance of actual persistence in the acquired capability.

Smoking in Response to Negative Mood in Men Versus Women as a Function of Distress Tolerance

Negative mood situations often increase smoking behavior and reward, effects that may be greater among women and smokers low in tolerance for distress. Adult dependent smokers (N = 164; 86 men, 78 women) first completed measures of distress tolerance via self-report and by mirror-tracing and breath-holding tasks. They then participated in 2 virtually identical laboratory sessions, involving induction of negative versus neutral mood (control) via pictorial slides and music. They rated negative affect (NA) before and during mood induction and smoked their preferred brand ad libitum during the last 14 min of mood induction. Our aim was to examine mood effects on NA, smoking reward ("liking"), and smoking intake (puff volume and number) as a function of sex and distress tolerance. Negative mood induction increased NA, as planned, and smoking reward and intake compared with neutral mood. Increases in NA and puff volume due to negative mood were greater in women compared with men, as hypothesized, but no main effects of the self-report or behavioral distress tolerance measures were seen in responses to mood induction. However, unexpectedly, lower self-reported distress tolerance was associated with greater smoking intake due to negative (but not neutral) mood in men and generally due to neutral (but not negative) mood in women. Negative mood may increase smoking intake more in women compared with men. Yet, low distress tolerance may enhance smoking intake due to negative versus neutral mood differentially between women and men, suggesting that sex and distress tolerance may interact to influence smoking responses to negative mood.

Evaluating Distress Tolerance Measures: Interrelations and Associations with Impulsive Behaviors

Prior studies have utilized a variety of self-report and behavioral measures of distress tolerance to predict dysregulated behaviors and other problematic outcomes. However, few studies have examined the concurrent associations among these various measures, which may be assessing distinct constructs. The purpose of the present study was to evaluate the concurrent utility of several self-report and behavioral distress tolerance measures in predicting two clinically-relevant outcomes: bulimic symptoms and general impulsive behaviors. Results of hierarchical multiple regression analyses revealed that whereas only self-reported emotional distress tolerance was significantly associated with bulimic symptom severity, self-reported emotional and physical distress tolerance, as well as a behavioral measure of psychological distress tolerance, were significantly associated with impulsive behaviors in general. These findings highlight the need for further explication of the conceptualization and operationalization of the distress tolerance construct, as well as research examining the convergent and discriminant validity of various distress tolerance assessments.

Multi-Method Evaluation of Distress Tolerance Measures and Construct(s): Concurrent Relations to Mood and Anxiety Psychopathology and Quality of Life

Despite the growing theoretical and clinical interest in distress tolerance (DT) and its role(s) in psychopathology vulnerability, we lack knowledge regarding the: (1) nature and degree of associations between putatively related measures of DT, and (2) universal/differential nature of associations between these DT measures and psychopathological syndromes. Accordingly, the purpose of the current multi-method study was thus to investigate the relations between and among various self-report and behavioral DT measures, as well as to examine the measures' differential relations to multiple forms of mood and anxiety psychopathology and quality of life. Participants were 149 adults (61.3% women; Mage = 23.4, SD = 8.8) who completed self-report [Distress Tolerance Scale (DTS; Simons &amp; Gaher, 2005), Discomfort Intolerance Scale (DIS; Schmidt, Richey, &amp; Fitzpatrick, 2006)] and behavioral (mirror-tracing, breath-holding, and CO2-enriched air tolerance tasks) measures of DT, as well as a structured clinical interview and quality of life measure. As hypothesized, the self-report DT measures were significantly related to one another and the behavioral DT measures were significantly related to one another, though the self-report and behavioral DT measures were orthogonal. Furthermore, DTS scores evidenced significant transdiagnostic relations to psychopathology and quality of life; lower levels of perceived tolerance of emotional distress were related to mood and anxiety disorder diagnostic status, greater levels of co/multi-morbidity, and poorer quality of life. In contrast, the behavioral DT measures were not related to any of the clinical outcomes studied. Implications of the present study for conceptualizing the nature of individual differences in DT construct(s), and the role(s) of these individual differences for psychopathology vulnerability, are discussed.

Interrelating Behavioral Measures of Distress Tolerance with Self-Reported Experiential Avoidance

Experiential avoidance and distress intolerance play a central role in novel behavior therapies, yet they appear to overlap considerably the REBT concept of low frustration tolerance. Using baseline data from 100 adult cigarette smokers enrolled in a clinical trial of smoking cessation therapies, the present study evaluated the convergent validity of common questionnaire measures of experiential avoidance (Acceptance and Action Questionnaire; AAQ; Hayes et al. 2004, and Avoidance and Inflexibility Scale: AIS; Gifford et al. 2004) and behavioral measures of distress tolerance (computerized Mirror Tracing Persistence Task: MTPT-C: Strong et al. 2003; computerized Paced Auditory Serial Addition Task; PASAT-C; Lejuez et al. 2003). The distress tolerance measures correlated significantly (r = .29) with one another. However, the questionnaire measures of experiential avoidance did not correlate with each other, nor with the behavioral measures. Further research is needed on the validity of measuring experiential avoidance by self-report and of the overlap versus distinctiveness of seemingly similar constructs such as experiential avoidance, distress tolerance, and frustration tolerance.