Mirror Tracing Persistence Task Research Articles

Suicidality, perceived chronic stress, and stress-induced cortisol changes of individuals with schizophrenia.

The associations of suicidality with stress are poorly studied in schizophrenia. The study aimed to determine whether suicidality was correlated with perceived chronic stress and the cortisol fluctuations under stress tasks in schizophrenia. High suicidality was defined as a lifetime history of suicide attempts or suicidal ideation in the past 2weeks. Individuals with schizophrenia and high suicidality (SZ-HS, n=59), with low suicidality (SZ-LS, n=207), and healthy controls (HC, n=196) finished the Perceived Stress Scale. Then, they participated in an experiment that induced stress using the Paced Auditory Serial Addition Task and the Mirror Tracing Persistence Task. Negative affect was measured at baseline and after finishing each task. The salivary cortisol was collected before-, after 20min, and after 40min of the tasks. SZ-HS had elevated perceived stress than SZ-LS and HC. Mixed effect models showed that stress tasks induced cortisol changes in all groups; cortisol of SZ-LS was reduced more than HC, but SZ-HS and SZ-LS did not differ in cortisol fluctuations. SZ-HS and SZ-LS experienced similar negative affect changes during tasks and the difference in withdrawal rates was nonsignificant. SZ-HS had an increased error rate than SZ-LS. In conclusion, suicidality was correlated with high-level perceived stress but did not result in differences in cortisol reactivities under stress tasks. It suggests the inconsistency between appraisal of stress and biological stress system disturbance among SZ-HS compared to SZ-LS.

Frustration Response and Regulation Among Irritable Children: Contributions of Chronic Irritability, Internalizing, and Externalizing Symptoms

ABSTRACT Objective The need to understand and treat childhood chronic irritability (CI; i.e. frequent temper loss and angry/irritable mood) is imperative. CI predicts impairment across development and complex comorbidities with both internalizing and externalizing disorders. Research has emphasized frustration reactivity as a key mechanism of CI. However, there are understudied components of frustrative non-reward, particularly regulation-oriented frustration recovery, frustration tolerance, and cognitive control, that may further explain impairments specific to CI beyond comorbid symptoms. Method Sixty-three community children (N = 25 CI/38 non-CI) and a parent completed surveys and the computerized Frustration Go/No-Go (FGNG) and Mirror Tracing Persistence Task (MTPT). Analyses compared task performance and self-rated affect across youth with or without CI, with further comparison based on negative/positive screen for ADHD (N = 45-/18+). Results In mixed effects models assessing change across task, the CI group did not demonstrate more intense frustration on the MTPT or rigged FGNG block but exhibited persisting frustration and inhibitory control difficulties into the FGNG recovery period; the CI+ADHD subgroup drove recovery effects. In GEE and logistic regression models including dimensional symptom clusters, only internalizing symptoms predicted child frustration intolerance and reactivity across tasks. ADHD severity was also associated with higher MTPT frustration reactivity, while oppositional behavior predicted lower frustration. Better frustration recovery was associated with lower irritability, but higher internalizing symptoms. Conclusions Co-occurring symptoms may better explain some frustration-related difficulties among youth with CI. Difficulties with postfrustration affect and inhibitory control recovery suggest the importance of characterizing CI by self-regulation impairments.

Abnormal cortisol profile during psychosocial stress among patients with schizophrenia in a Chinese population

Accumulating evidence suggests that hypothalamic-pituitary-adrenal axis dysfunction might play an important role in the pathophysiology of schizophrenia. The aim of this study was to explore the cortisol response to psychological stress in patients with schizophrenia. In this study, patients with schizophrenia (n = 104) and healthy volunteers (n = 59) were asked to complete psychological stress challenge tasks, which included the Paced Auditory Serial Addition Task and Mirror-Tracing Persistence Task, and pre- and post-task saliva samples were collected to measure cortisol levels. Emotions and psychopathology were assessed by the Positive and Negative Affect Schedule and Positive and Negative Syndrome Scale. The results showed (1) that the cortisol response and negative emotions in patients with schizophrenia differed significantly from those in healthy volunteers, (2) there were significant interactions between the sampling time and diagnosis for saliva cortisol levels, (3) there were significant interactions between the scoring time and diagnosis for the negative affect score of the PANAS, and (4) the changes in salivary cortisol levels and negative affect scores before and after the psychological stress challenge tasks were not correlated with clinical symptoms in patients with schizophrenia. These findings indicated an abnormal cortisol profile in patients with schizophrenia, which might be a biological characteristic of the disease.

Distress tolerance: prospective associations with cognitive-behavioral therapy outcomes in adults with posttraumatic stress and substance use disorders

ABSTRACT 74Distress tolerance (DT; perceived or actual ability to tolerate aversive physical or emotional states) is related to both posttraumatic stress disorder (PTSD) symptoms and substance use disorders (SUD). This investigation evaluates self-report and behavioral measures of DT as potential predictors of PTSD and SUD cognitive-behavioral therapy outcomes. Participants included 41 treatment-seeking adults (53.7% women; 73.2% African American; M age = 44.90, SD = 9.68) who met at least four symptoms of DSM-5 PTSD and DSM-IV substance dependence, assessed via structured interviews. At baseline (pre-treatment), participants completed the Distress Tolerance Scale (DTS), Mirror-Tracing Persistence Task (MTPT), Breath Holding task, and Paced Auditory Serial Addition Task. The Clinician-Administered PTSD Scale for DSM-5 severity scores and percent days of primary substance use, measured via Timeline Follow-back, were used as indicators of PTSD symptoms and substance use, respectively. Covariates included treatment condition, baseline PTSD symptom severity, and baseline substance use. Lower perceived DT at baseline (DTS total score) was associated with higher PTSD symptom severity at end-of-treatment. Lower behavioral DT at baseline (MTPT duration) was associated with higher substance use at the conclusion of treatment (i.e. proportion of number of use days to total number of days between two final treatment sessions).

Maladaptive Emotional Schemas and Emotional Functioning: Evaluation of an Integrated Model Across Two Independent Samples

Recent advancements in emotion theory propose that emotional schemas—individualized conceptualizations and beliefs about emotions—serve a fundamental function in guiding emotional processes. To critically assess the validity of this suggestion, the current research proposed and evaluated an integrative model of emotional functioning. Two studies were completed using a combination of behavioral (Mirror Tracing Persistence Task), performance-based (Perception of Affect Task), and self-report (Leahy Emotional Schema Scale-II, Cognitive-Behavioral Avoidance Scale, Generalized Expectancy for Negative Mood Regulation Scale, UPPS-P Impulsive Behavior Scale) measures of maladaptive emotional schemas and emotional functioning. Results supported the model and suggested complex interrelations between maladaptive emotional schemas, emotion-processing deficits, avoidant coping, emotion-regulation ineffectiveness, and behavioral dysregulation, with emotional schemas playing a key role in guiding emotional experience and functioning. Given the centrality of beliefs about emotion and emotional functioning in empirically supported therapies, the proposed model may inform future research on mechanisms of change in these treatments.

Distress tolerance trajectories following substance use treatment.

Distress tolerance (DT), the ability to withstand aversive internal states, represents an important risk factor for substance use relapse and a potential treatment target. Neurobiological research in substance using populations suggests that continued substance use could erode DT, whereas abstinence could bolster it. The current study characterized trajectories of behavioral and self-reported indices of DT and examined the prospective effect of substance use on DT trajectories among those seeking treatment for substance use. Individuals (N = 263, Mage = 42.68, SD = 11.8, 70.7% male, 94.7% African American) in residential substance use treatment completed subjective (Distress Tolerance Scale) and behavioral (Mirror Tracing Persistence Task-computerized version) DT measures, as well as report of daily substance use (timeline follow-back) over 5 assessment time-points from pretreatment to 12 months posttreatment. Latent curve modeling estimated DT trajectories and their associations with substance use behavior, including abstinence duration (days until first use) and substance use frequency (percentage of substance use days between assessments). Self-reported and behavioral DT indicators both exhibited positive, nonlinear change over time (standardized slope parameter estimates: Distress Tolerance Scale β = 0.61, p < .01; Mirror Tracing Persistence Task β = 0.34, p < .01). Abstinence duration was associated with greater improvement in behavioral (β = .20, p = .03) DT specifically. Frequency of use was statistically significantly associated with attenuated behavioral DT at 6-month (β = -.12, p = .03) and 12-month follow-ups (β = -.08, p = .045). DT appears to improve appreciably posttreatment, and return to substance use may shape the degree of this improvement. Collectively, these findings support the conceptualization of DT as a malleable treatment target and emphasize the benefit of abstinence on improvement in DT. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Distress tolerance: Associations with trauma and substance cue reactivity in low-income, inner-city adults with substance use disorders and posttraumatic stress.

Cue reactivity has great potential to advance our understanding of posttraumatic stress disorder (PTSD), substance use disorder (SUD), and PTSD/SUD comorbidity. The present investigation examined distress tolerance (DT) with regard to trauma and substance cue reactivity. Participants included 58 low-income, inner-city adults (49.1% women; Mage = 45.73, SD = 10.00) with substance dependence and at least 4 symptoms of PTSD. A script-driven cue reactivity paradigm was utilized. Four DT measures were administered, including the Distress Tolerance Scale (DTS), Mirror-Tracing Persistence Task (MTPT), Breath-Holding Task (BH), and Paced Auditory Serial Addition Task (PASAT). Lower DT, as indexed by MTPT duration, was significantly predictive of greater levels of self-reported substance cravings/urges in response to trauma cues, above and beyond covariates. Lower DTS scores predicted lower levels of self-reported control/safety ratings in response to substance cues. None of the DT indices was significantly predictive of heart rate variability. Clinical and research implications are discussed. (PsycINFO Database Record

Multimodal Examination of Distress Tolerance and Suicidality in Acute-Care Psychiatric Inpatients

The present investigation examined associations between distress tolerance, examined multimodally via self-report and behavioral indices, and suicidality. Participants were 102 psychiatric inpatients (44.1% women; Mage=33.9, SD=10.8). Distress tolerance was measured via the Distress Tolerance Scale (DTS), Mirror-Tracing Persistence Task (MTPT), and Breath-Holding Task. Suicidality was defined as: number of past suicide attempts, self-reported suicidal ideation severity, and suicidality as reason for the current hospital admission. When DT indices were examined concurrently, only MTPT was negatively associated with number of past suicide attempts; perceived DT (DTS) was negatively associated with suicidal ideation severity and suicidality as the reason for current admission.

The Use of the Mirror Tracing Persistence Task as a Measure of Distress Tolerance in Generalized Anxiety Disorder

Behavioral tasks offer an objective index of processes associated with psychopathology. The mirror tracing persistence task (MTPT) has been used as a measure of distress tolerance, or the ability to endure negative internal states. In generalized anxiety disorder (GAD), a poor ability to tolerate aversive internal states may relate to the inability to adaptively regulate emotion. This study examined if those with GAD exhibit lower distress tolerance compared to controls as evidenced by length of time persisting on the MTPT. Participants underwent diagnostic interviews to determine the presence of absence of GAD and following group assignment, completed the MTPT. Results demonstrated that the groups differed significantly in time spent persisting on the task, with controls persisting longer than those with GAD, supporting the hypothesis that individuals with GAD exhibit lower distress tolerance than controls. These results provide support for the use of behavioral assessments as potential markers of distress tolerance.

Multimodal examination of distress tolerance and posttraumatic stress disorder symptoms in acute-care psychiatric inpatients

Distress tolerance (DT), the actual or perceived capacity to withstand negative internal states, has received increasing scholarly attention due to its theoretical and clinical relevance to posttraumatic stress disorder (PTSD). Past studies have indicated that lower self-reported – but not behaviorally observed – DT is associated with greater PTSD symptoms; however, studies in racially and socioeconomically diverse clinical samples are lacking. The current study evaluated associations between multiple measures of DT (self-report and behavioral) and PTSD symptoms in an urban, racially and socioeconomically diverse, acute-care psychiatric inpatient sample. It was hypothesized that lower self-reported DT (Distress Tolerance Scale [DTS]), but not behavioral DT (breath-holding task [BH]; mirror-tracing persistence task [MT]), would be associated with greater PTSD symptoms, above and beyond the variance contributed by trauma load, substance use, gender, race/ethnicity, and subjective social status. Participants were 103 (41.7% women, Mage=33.5) acute-care psychiatric inpatients who endorsed exposure to potentially traumatic events consistent with DSM-5 PTSD Criterion A. Results of hierarchical regression analyses indicated that DTS was negatively associated with PTSD symptom severity (PCL-5 Total) as well as with each of the four DSM-5 PTSD symptom clusters (p’s<0.001), contributing between 5.0%–11.1% of unique variance in PTSD symptoms across models. BH duration was positively associated with PTSD arousal symptom severity (p<0.05). Covariates contributed between 21.3%–40.0% of significant variance to the models. Associations between DT and PTSD in this sample of acute-care psychiatric inpatients are largely consistent with those observed in community samples.

Frustration Tolerance in Youth With ADHD

Objective: The objective of this study was to compare children with ADHD with children without ADHD on frustration tolerance and to examine the role of oppositional defiant disorder (ODD) in frustration tolerance within the sample. Method: Participants included 67 children ages 10 to 14 years-old with (n = 37) and without (n = 30) Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) ADHD who completed the Mirror Tracing Persistence Task (MTPT), a validated computerized behavioral measure of frustration tolerance. Results: Children with ADHD were more likely to quit this task than children without ADHD, demonstrating lower levels of frustration tolerance. There were no differences in frustration tolerance between children with ADHD + ODD and those with ADHD – ODD. Moreover, ODD did not moderate the relationship between ADHD and frustration tolerance. Conclusion: Our results suggest that low frustration tolerance is directly linked to ADHD and not better accounted for by ODD. This research highlights specific behavioral correlates of frustration in children with ADHD.

(530) Distress intolerance and prescription opioid misuse among patients with chronic pain

A substantial proportion of chronic pain patients who are on long-term opioid therapy will misuse their medication, leading to a variety of adverse events and consequences. Understanding the risk factors for developing opioid misuse behaviors is crucial for intervention and prevention of future cases. Distress intolerance is an important vulnerability factor in substance use disorders, but has not been widely investigated in chronic pain. The primary aim of this study was to examine whether distress intolerance was associated with opioid misuse among individuals with chronic pain receiving long-term opioid treatment. After completing questionnaires, participants underwent Quantitative Sensory Testing (including mechanical pain thresholds, mechanical temporal summation, and repeated cold pressor tasks) and the Computerized Mirror Tracing Persistence Task (MTPT) in a randomized order. Distress intolerance was measured behaviorally using the MTPT and a self-report Distress Intolerance Index (DII). Opioid misuse was assessed by the Current Opioid Misuse Measure (COMM) and the Addiction Behaviors Checklist. The DII and MTPT were modestly, but significantly correlated (r = -0.31, p = .03). There was a significant association between the DII and both opioid misuse status (p= .04), and COMM scores (r = .52, p < .001), suggesting that higher levels of distress intolerance were associated with more frequent and more severe opioid misuse. The DII was modestly associated with elevated pain rating during the cold pressor test (p = .03), and with anxiety ratings during psychophysical testing. These findings highlight the relevance of distress intolerance in shaping opioid misuse behaviors. Collectively, enhancing our ability to identify patients at greater risk for opioid misuse would allow for closer monitoring of this subgroup, and may provide targets for intervention to reduce medication misuse.

The prospective effects of perceived and laboratory indices of distress tolerance on cannabis use following a self-guided quit attempt.

The majority of individuals who attempt to quit using cannabis do not seek formalized treatment. To better understand which malleable factors contribute to cannabis use following a self-guided quit attempt, we concurrently examined 2 measures of distress tolerance (DT) as prospective predictors of cannabis use post quit attempt. We hypothesized that veterans with higher in relation to lower levels of DT would be less likely to use cannabis following a self-guided quit attempt. In this study, we included 103 cannabis-dependent veterans (Mage = 50, 95% male, 37% White, 36% Black, 14% Hispanic, 14% other) who reported being motivated to quit using cannabis. Veterans completed 2 measures of DT, the Distress Tolerance Scale (perceived distress tolerance) and the Mirror-Tracing Persistence Task (laboratory analogue of distress tolerance). Findings indicated that veterans with greater perceived distress tolerance used less cannabis over the quit period than did veterans with less perceived distress tolerance. However, contrary to expectations, baseline performance on a laboratory analogue of distress tolerance was not related to cannabis use over the quit period. Results suggest that veterans' perceived ability to tolerate distress is an important predictor of cannabis use following a self-guided quit attempt. Thus, the Distress Tolerance Scale could serve as an important tool for helping to identify veterans at risk for cannabis use postquit.

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.

Is dysphoria about being red and blue? Potentiation of anger and reduced distress tolerance among dysphoric individuals

Emotion dysregulation has been implicated in a variety of psychopathologies including depression. However, few empirical studies with depressed samples have been completed, particularly involving negative emotions such as anger. The current study explored two aspects of emotion regulation by testing dysphoric individuals' emotional reactivity and ability to tolerate distress. Specifically, stably dysphoric (n=28) and non-dysphoric (n=35) individuals participated in two distressing laboratory tasks, the Paced Auditory Serial Addition Task (PASAT) and the Mirror Tracing Persistence Task (MTPT). The dysphoric group reported greater anger following each task and displayed less distress tolerance on the MTPT than the non-dysphoric group. Findings suggest that sad mood can potentiate anger and reduce distress tolerance. Results are consistent with the idea that difficulty regulating negative emotional states may contribute to the maintenance of dysphoria.