Distress Intolerance Research Articles

Aversive Reactivity: A Transdiagnostic Functional Bridge Between Neuroticism and Avoidant Behavioral Coping.

Aversive reactivity to negative affect has been described as a transdiagnostic mechanism that links distal temperamental vulnerabilities to clinically relevant behaviors. However, the abundance of constructs reflecting aversive reactivity has resulted in a proliferation of models that may ultimately be redundant. We performed a circumscribed review of studies measuring associations between six constructs - anxiety sensitivity, experiential avoidance, distress intolerance, intolerance of uncertainty, thought-action fusion, and negative urgency - and ten relevant coping behaviors. Results suggested that most constructs were measured in relation to a limited number of coping behaviors. Additionally, constructs were most often measured in isolation, rather than with similar constructs. Implications and suggestions for future research and treatment are discussed.

Submissive behavior as a transdiagnostic construct: Associations with internalizing symptoms and distress intolerance.

Submissive behavior is associated with significant impairment and negative life outcomes. The goal of the present study was to determine the transdiagnostic nature of submissive behavior by observing its association with internalizing symptoms (i.e., social anxiety, depression, and worry) and distress intolerance. Additionally, we sought to determine the moderating role of gender in these relationships. We used a community sample (N = 208) to evaluate the hypothesized relationships between submissive behavior and internalizing symptoms. All three internalizing symptoms were uniquely associated with greater submissive behavior when covarying for each other. Distress intolerance was also uniquely positively related to submissive behavior respective of general distress. Moderation analyses revealed that the associations between social anxiety, worry, and distress intolerance with submissive behavior were stronger in men rather than women. The present study provides novel evidence for the relevance of submissive behavior to internalizing symptoms and distress intolerance. We discuss clinical implications and directions for future research.

The dynamics of smoking quit motivation in daily life: Associations with momentary self-regulation and nightly quit intentions

Due to prior work suggesting dynamic fluctuations in quit motivation over time, the current study used ecological momentary assessment (EMA) to examine contextual predictors of momentary quit motivation, most notably perceived self-regulation. The sample (n = 84) intentionally excluded smokers actively trying to quit and those who plan to never quit, focusing on the group of smokers who are interested in but not yet committed to quitting. Participants completed one week of EMA, where they responded to random prompts 7x/day and logged each cigarette. At each prompt, they completed measures assessing cigarette craving, affect (positive and negative), quit motivation, and perceived momentary self-regulation (i.e., willpower self-efficacy, distress intolerance, craving uncontrollability). Participants also completed a nightly prompt where they reported their quit intentions. Results revealed that the newly developed 4-item index of quit motivation had strong psychometric properties, and demonstrated fluctuations over time and across situations. Quit motivation was higher when craving was ideographically lower than usual, and when willpower was higher than usual. People with higher distress intolerance reported higher quit motivation. In addition, stronger quit motivation and less variability in quit motivation was associated with higher quit intentions. The current study suggests that quit motivation does shift dynamically and speaks to the potential importance of targeting craving and willpower self-efficacy to enhance people’s motivation to quit.

Investigating the causes of Maladjustment in marital interactions (qualitative study)

Aim: The purpose of this study is to investigate the causes of maladjustment in couple interactions. Method: This study was conducted with a qualitative method and thematic analysis method. The sampling method was purposeful and up to the point of saturation, so that 20 maladjustment couples were selected based on the entry and exit criteria and were interviewed. The research tool was semi-structured in-depth interview. Findings: The collected data were analyzed with the help of thematic analysis and MAXQDA.2018 software. After analyzing the content of the data, seven central categories were obtained, which in order of importance were the lack of communication skills (inconsistency of verbal and non-verbal behavior, weak conversation skills, vague boundaries, weak listening skills), impenetrability (lack of flexibility, lack of agreement, arrogance) lack of demarcation in the main family (triangulation, condemning, intervention), economic factors (financial problems, heavy dowry, inflation), devaluation (undervaluing, non-acceptance, judging), intolerance of distress (lack of control) Anger, acting emotionally, having hatred) and forced marriage (adherence to tribal relations, adherence to customs). Conclusion: In couple interactions, the obtained categories are the causes of marital maladjustment.

Elevated integration within the reward network underlies vulnerability to distress.

Distress tolerance (DT), the capability to persist under negative circumstances, underlies a range of psychopathologies. It has been proposed that DT may originate from the activity and connectivity in diverse neural networks integrated by the reward system. To test this hypothesis, we examined the link between DT and integration and segregation in the reward network as derived from resting-state functional connectivity data. DT was measured in 147 participants from a large community sample using the Behavioral Indicator of Resiliency to Distress task. Prior to DT evaluation, participants underwent a resting-state functional magnetic resonance imaging scan. For each participant, we constructed a whole-brain functional connectivity network and calculated the degree of reward network integration and segregation based on the extent to which reward network nodes showed functional connections within and outside their network. We found that distress-intolerant participants demonstrated heightened reward network integration relative to the distress-tolerant participants. In addition, these differences in integration were higher relative to the rest of the brain and, more specifically, the somatomotor network, which has been implicated in impulsive behavior. These findings support the notion that increased integration in large-scale brain networks may constitute a risk for distress intolerance and its psychopathological correlates.

Gendered racial microaggressions and emerging adult Black women's social and general anxiety: Distress intolerance and stress as mediators.

The purpose of this study was to examine the associations between gendered racial microaggressions stress (GRMS) and gendered racial microaggressions frequency (GRMF), and Black women's social anxiety and general anxiety symptoms. We also examined the mediating roles of distress intolerance and stress in these associations. One hundred and sixty-three Black women, between the ages of 18 and 25 years old, completed a cross-sectional survey. Regression analyses were used to examine the associations between gendered racial microaggressions and social anxiety and general anxiety, and mediation analyses examined the indirect effect of gendered racial microaggressions on the outcome variables through distress intolerance and stress. GRMS was associated with greater social and general anxiety through the mechanisms of distress intolerance and stress. GRMF was associated with reduced social anxiety and was not associated with general anxiety. Intervention efforts should be aimed to prevent the experience of gendered racial microaggressions to prevent subsequent stress and mental health outcomes for Black women.

Intolerance of Uncertainty, Acculturative Stress, Gratitude, and Distress: A Moderated Mediation Model

Based on Berry’s (1997) model of acculturation, the current study examined whether gratitude would moderate the association between intolerance of uncertainty (IU) and acculturative stress (i.e., moderation hypothesis), and mitigate the positive association between IU and psychological distress through acculturative stress (i.e., moderated mediation hypothesis). Participants were 171 international students with Chinese heritage from a Midwest public university. Results from PROCESS supported these hypotheses. First, the positive association between IU and acculturative stress was attenuated to a greater extent at higher compared to lower levels of gratitude. Second, the mediation effect of IU on psychological distress through acculturative stress was weaker among those with higher compared to lower levels of gratitude. Findings demonstrate the protective role of gratitude and the role of IU as a risk factor for psychological distress through acculturative stress. Implications for practice, training, and research are discussed.

PREDICTING PSYCHOLOGICAL DISTRESS AMONG UNIVERSITY STUDENTS: THE ROLE OF RELIGIOSITY AND INTOLERANCE OF UNCERTAINTY

The aim of the present study was to examine the effect of Intolerance of uncertainty and religiosity on psychological distress among university students. Pre-established scales of Intolerance of uncertainty, religiosity and psychological distress were adapted from existing literature with slight modifications to fit into the context. A sample of 209 university students (mean age 25.6) participated in the research study. The data collected were subjected to descriptive analysis and multiple regression analysis using SPSS. The results revealed that Intolerance of uncertainty has a significant positive effect on psychological distress. In contrast,it was observed that religiosity exerts a significant negative effect on psychological distress. Moreover, results indicateda significant difference in psychological distress between male and female students.

Alcohol use in firefighters: A network model of behaviors and transdiagnostic risk

Background and aimsFirefighters are at heightened risk for developing alcohol use disorder (AUD), possibly due to chronic stress and exposure to potentially traumatic events. Daily trauma experiences and transdiagnostic risk factors (i.e., anxiety sensitivity and distress intolerance) are related to posttraumatic stress and depressive symptoms, as well as alcohol use severity and alcohol as a coping strategy. Although alcohol use has been identified as a key target for addressing mental health in firefighters, prior research has not fully integrated transdiagnostic vulnerabilities, internalizing symptoms, posttraumatic stress symptoms, alcohol coping, and overall alcohol use into a dynamic network model. MethodsWe assessed the symptom structure of overall alcohol use in firefighters with a likely AUD and transdiagnostic risk factors in all firefighters using network analysis. ResultsFailing to meet expectations (Expected Influence [EI]: 1.32), morning dependence (EI: 1.07), and guilt about drinking (EI: 1.10) were most central to the network model developed for firefighters with a likely AUD. In a transdiagnostic model of use in firefighters overall, anxiety sensitivity cognitive concerns (EI: 1.48) and negative alterations to cognitions and mood related to trauma (EI: 1.87) had the highest influence on the network. Notable correlations were also identified between trauma arousal and overall alcohol use, between depression and alcohol coping motives, and between trauma avoidance and alcohol coping motives. ConclusionsAlcohol use behaviors may follow a unique etiologic pathway in firefighters and intervention strategies should target factors found to be more central to symptom networks.

Mood symptoms predict COVID-19 pandemic distress but not vice versa: An 18-month longitudinal study.

The COVID-19 pandemic has had medical, economic and behavioral implications on a global scale, with research emerging to indicate that it negatively impacted the population's mental health as well. The current study utilizes longitudinal data to assess whether the pandemic led to an increase in depression and anxiety across participants or whether a diathesis-stress model would be more appropriate. An international group of 218 participants completed measures of depression, anxiety, rumination and distress intolerance at two baselines six months apart as well as during the onset of the COVID-19 pandemic exactly 12 months later. Contrary to expectations, depression, rumination, and distress intolerance were at equivalent levels during the pandemic as they were at baseline. Anxiety was reduced by a trivial degree (d = .10). Furthermore, a comparison of quantitative explanatory models indicated that symptom severity and pandemic-related environmental stressors predicted pandemic-related distress. Pandemic-related distress did not predict symptom severity. These findings underscore the necessity of longitudinal designs and diathesis-stress models in the study of mental health during the COVID-19 pandemic. They also emphasize that individuals with higher rates of baseline psychopathology are as particularly at risk for higher levels of distress in response to disaster-related stressors.

Hoarding: Ownership Gone Awry

Hoarding: Ownership Gone Awry

Supplemental Material for Who Disengages From Emotion and When? An EMA Study of How Urgency and Distress Intolerance Relate to Daily Emotion Regulation

Supplemental Material for Who Disengages From Emotion and When? An EMA Study of How Urgency and Distress Intolerance Relate to Daily Emotion Regulation

Brief adjunctive mindfulness-based cognitive therapy via Telehealth for anxiety during the COVID-19 pandemic

ABSTRACT Background and Objectives While cognitive–behavioral therapy is a highly efficacious treatment for anxiety, additional research is needed to identify adjunctive interventions that may augment treatment outcome. Design In response to the COVID-19 pandemic, we conducted an open feasibility trial of brief (i.e., four 75- to 90-minute sessions) mindfulness-based cognitive therapy (MBCT) for anxiety via telehealth for patients (N = 23) receiving individual CBT at an outpatient specialty clinic. Methods Self-report measures of home practice compliance (weekly), intervention acceptability (post-intervention), mindfulness and self-compassion, anxiety and depressive symptoms, and transdiagnostic processes (pre- and post-intervention) were administered as part of routine clinical practice. Results Results indicated good retention and attendance rates, few technical difficulties, good home practice compliance, and high levels of perceived importance. Participants indicated that they would highly recommend the group to others and also recommended extending the group beyond four sessions. There were significant improvements in mindfulness and self-compassion and reductions in intolerance of uncertainty, anxiety sensitivity, distress intolerance, emotion dysregulation, and anxiety symptoms from pre- to post-intervention. Conclusions Brief MBCT as an adjunctive treatment for anxiety via telehealth is feasible and acceptable, and shows promise in terms of engaging treatment targets and transdiagnostic processes and reducing anxiety symptoms.

Relationship of depression, impulsivity, distress intolerance and coping styles with maladaptive eating patterns in bariatric candidates.

The study aimed to investigate the problematic eating patterns and understand their relationship to psychological constructs, including stress intolerance, coping mechanisms and impulsivity, and psychiatric symptoms among bariatric surgery candidates. The bariatric candidates were evaluated by psychiatric interview and standard scales assessing maladaptive eating behaviors (Eating Attitudes Test (EAT), Bulimia Investigatory Test-Edinburgh (BITE), Dutch Eating Behavior Questionnaire (DEBQ)), depression (Beck Depression Inventory (BDI)), psychiatric symptoms (Brief Symptom Inventory (BSI)), and psychological constructs (Distress Intolerance Index (DSI), Coping Styles Scale (CSS), UPPS Impulsive Behavior Scale(UPPS)). More than half (57.8%) had maladaptive eating behaviors, and 23.6% had binge-eating behavior. Depression and anxiety predicted EAT, BITE, and DEBQ emotional and external eating sub-scale scores; distress intolerance, helpless coping style, and impulsivity predicted maladaptive eating behaviors in bariatric candidates. Maladaptive eating patterns play an essential role in the failure to lose weight and regain weight and are predicted by depression, anxiety, and psychological constructs in this study. Evaluation of pathological trait characteristics besides discrete psychiatric syndromes should be recommended in the pre-operation process to plan relevant interventions in the long-term management of weight. Level III, evidence obtained from well-designed cohort analytic studies.

Psychological variables associated with quality of life in patients with head and neck cancer: the role of body image distress

ObjectiveThe aim of this cross-sectional study was to explore the relationship between quality of life (QoL) and body image distress in patients with head and neck cancer (HNC), considering relevant psychological variables (i.e., coping strategies, social anxiety symptoms, self-esteem, intolerance of uncertainty, pain, and distress). We also aimed to explore gender differences in patients with HNC in terms of relevant psychological variables in HNC.MethodsFifty-one HNC patients (37 males and 14 females) completed self-report questionnaires to assess body image distress, physical and mental QoL, and relevant psychological variables in HNC (coping strategies, social anxiety symptoms, self-esteem, intolerance of uncertainty, pain, and distress) before undergoing treatment. Pearson’s correlations and four-step hierarchical regressions were performed to assess the relationship between body image distress, QoL, and the abovementioned psychological variables, while one-way analyses of variance and one-way analysis of covariance were employed to assess gender differences.ResultsPhysical QoL was associated with body image distress above and beyond disease duration, distress, coping strategies, pain, mental QoL, and self-esteem, while mental QoL was associated with pain above and beyond distress, coping strategies, physical QoL, self-esteem, and body image distress. Concerning gender differences, females scored higher than males on most of the explored psychological variables, except for physical QoL and intolerance of uncertainty, and showed lower mental QoL and self-esteem than males.ConclusionBody image distress and pain emerged as negatively associated with QoL, and almost all the explored psychological variables differed among genders. Psychological interventions targeting body image distress and pain should be promoted in patients with HNC to increase their QoL, while keeping gender differences in mind.

The effectiveness of transdiagnostic treatment on pain anxiety, distress intolerance and sleep disorders in psychosomatic patients who suffer from migraine

Introduction: Migraine headache is a common, painful, severe and debilitating in chronic conditions which can be characterized by recurrent and unilateral moderate to severe attacks. Aim: The aim of this study was to determine the effectiveness of transdiagnostic treatment on pain anxiety, distress intolerance and sleep disorders in psychosomatic patients who suffer from migraine. Method: The present study was a quasi-experimental study that benefited from a pretest-posttest design with a control group. The statistical population included patients with migraine referred to a psychiatrist in Urmia in the second half of 2020, who were randomly divided into control and experimental groups with 15 patients in each group. Measurement tools included Distress Intolerance Questionnaire (Simmons & Gaher, 2005), Pain Anxiety Scale (McCracken & et al, 1992) and Sleep Disorders Questionnaire (Mohammadi & et al, 2009). Data were analyzed using multivariate analysis of covariance in SPSS-26 software. Results: The results showed that considering ETA squares, there was a statistically significant difference between the control and experimental groups (p<0.001). Therefore; it can be claimed that changes and improvements in about 92% of pain anxiety, 91.6% of distress intolerance and 82.1% of sleep disorders have been due to the effectiveness of transdiagnostic treatment intervention. Conclusion: The results showed that transdiagnostic treatment can be used in conjunction with drug interventions for migraine patients who can also be effective in reducing emotional symptoms, pain anxiety, distress intolerance and sleep disorders in these individuals.

Relationships between Intolerance of Uncertainty, Worry, Rumination, and Distress in College Students During the Coronavirus Pandemic: the Role of COVID-19 Threat Appraisals.

BackgroundIn two conditional process models, we examined whether intolerance of uncertainty (IU) had both direct and indirect effects on coronavirus anxiety (through worry) and depressive symptoms (through rumination) among college students; these associations were hypothesized to be more likely among students who appraised COVID-19 as highly threatening.MethodData were collected during the COVID-19 pandemic from September 2020 to November 2020 in the USA. Participants (n = 134) completed measures of IU, COVID-19 specific threat appraisal, rumination, worry, coronavirus anxiety, and depressive symptoms. The PROCESS macro (Model 8) was used for analyses with gender as a covariate.ResultsIU had a direct positive effect on coronavirus anxiety and the effect was strongest among students who perceived COVID-19 as more threatening. Threat appraisal did not moderate the IU–depressive symptoms relationship. IU had an indirect effect on depressive symptoms through rumination at all levels of threat appraisal. Unexpectedly, this indirect effect was strongest among students who perceived the pandemic as less threatening.ConclusionResults may inform interventions that address IU, threat appraisals, and repetitive negative thinking to mitigate symptoms of coronavirus anxiety and depression.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12529-022-10116-3.

Distress intolerance and pain catastrophizing as mediating variables in PTSD and chronic noncancer pain comorbidity.

Several studies have demonstrated posttraumatic stress disorder (PTSD) and chronic pain comorbidity. However, there is a lack of research on the psychological variables that might explain their co-occurrence. We investigated the mediating role of distress intolerance and pain catastrophizing in this relationship. A moderated mediation model was tested. The sample comprised 114 individuals with chronic noncancer pain (90 women and 24 men; mean age, of 60.04years [SD=9.76]). Catastrophizing had a significant effect on PTSD. Distress intolerance mediated catastrophizing and PTSD, and pain intensity moderated this relationship. New insights are provided into the psychological variables that may explain PTSD and chronic noncancer pain comorbidity.

Does the network structure of obsessive-compulsive symptoms at treatment admission identify patients at risk for non-response?

Exposure and response prevention is the gold-standard treatment for obsessive compulsive disorder (OCD), yet up to half of patients do not adequately respond. Thus, different approaches to identifying and intervening with non-responders are badly needed. One approach would be to better understand the functional connections among aspects of OCD symptoms and, ultimately, how to target those associations in treatment. In a large sample of patients who completed intensive treatment for OCD and related disorders (N = 1343), we examined whether differences in network structure of OCD symptom aspects existed at baseline between treatment responders versus non-responders. A network comparison test indicated a significant difference between OCD network structure for responders versus non-responders (M = 0.19, p = .02). Consistent differences emerged between responders and non-responders in how they responded to emotional distress. This pattern of associations suggests that non-responders may have been more reactive to their distress by performing compulsions, thereby worsening their functioning. By examining the association between baseline distress intolerance with other symptom aspects that presumably maintain the disorder (e.g., ritualizing), clinicians can more effectively target those associations in treatment.

An examination of the effects of distress intolerance and rating of perceived exertion on changes in mood and anxiety following aerobic exercise among treatment-seeking smokers

ABSTRACT Aerobic exercise is frequently used as an intervention for depression and smoking cessation because of its antidepressant and anxiolytic effects. Distress intolerance (DI) is a proposed individual difference factor that, coupled with a higher rating of perceived exertion during exercise, may significantly impact the acute mood and anxiolytic effects of exercise. The current study examined the interactive effect of maximum rating of perceived exertion (RPE) and DI on change in mood and anxiety. Treatment-seeking smokers (M age = 45.32; 72% female) with elevated depressive symptoms completed a 1-mile treadmill walk at their preferred intensity and self-reported their RPE during the test. Analyses were conducted to examine whether there was an interactive effect of maximum RPE and DI on change in self-reported mood and anxiety from before to after the walk test. Findings indicate a significant moderating effect of RPE at lower ratings. Individuals reporting a low maximum RPE and higher DI exhibit a greater change in mood over the course of an exercise session, whereas individuals reporting a low maximum RPE and a lower DI exhibit smaller changes in mood. These results indicate that the subjective effects of exercise within a population of cigarette smokers could be improved by tailoring exercise intensity to individual characteristics. Mild to moderate-intensity exercise, as compared to high-intensity exercise, may result in greater changes in mood for individuals endorsing difficulty tolerating affective and physical distress.