Self-reported Distress Tolerance Research Articles

Transdiagnostic Risk Factors for Reasons for Smoking: Evaluating the Concurrent Role of Distress Tolerance and Anxiety Sensitivity.

Although rates of cigarette smoking have declined in the US, many individuals report experiencing significant barriers to quitting smoking, including poor mental health. Two prominent affective vulnerability factors that independently underlie both smoking behavior and processes and mental health include distress tolerance and anxiety sensitivity. However, limited work has examined the concurrent role of these factors on motivational reasons for smoking. The current study is a secondary analysis of baseline data from a nationally recruited sample of individuals (N = 156; Mage = 29.74, SD = 7.72; 69.2% female) interested in participating in a digitally delivered intervention for comorbid smoking and low distress tolerance. Two-step hierarchical linear regression was used to examine the unique role of self-reported distress tolerance and anxiety sensitivity in relation to reasons for smoking (i.e., habitual, negative affect reduction, addictive, pleasurable/relaxation, stimulation, and sensorimotor manipulation). Results indicated that lower levels of distress tolerance and greater levels of anxiety sensitivity were associated with greater sensorimotor manipulation reasons for smoking. Only distress tolerance was related to addictive, negative affect reduction, and stimulation reasons for smoking, whereas only anxiety sensitivity was related to habitual reasons for smoking. The current findings suggest that there is an explanatory utility for unique and multi-risk effects for distress tolerance and anxiety sensitivity for understanding smoking motives.

Examining the structure of distress tolerance: Are behavioral and self-report indicators assessing the same construct?

Distress tolerance, or the ability to tolerate physically and emotionally aversive experiences, is a target of psychological intervention in contextual behavioral science. It has been conceptualized as a self-reported ability, as well as a behavioral tendency, and operationalized with a wide variety of questionnaires and behavioral tasks. The current study aimed to investigate whether behavioral tasks and self-report assessments of distress tolerance measure the same underlying dimension, two correlated dimensions, or whether method factors accounted for covariation above and beyond a general content dimension. A university student sample (N = 288) completed behavioral tasks associated with distress tolerance and self-report distress tolerance measures. Confirmatory factor analysis indicated that behavioral and self-report assessments of distress tolerance do not comprise a single dimension of distress tolerance, or two correlated dimensions of self-report or behavioral distress tolerance. Results also failed to support a bifactor conceptualization with a general distress tolerance dimension and domain-specific method dimensions for behavioral and self-report assessments. Findings suggest that more precision and attention to contextual factors are required in the operationalization and conceptualization of distress tolerance.

Assessing distress tolerance using a modified version of the Emotional Image Tolerance task

The Emotional Image Tolerance (EIT) task assesses tolerance of negative emotion induced by negatively valenced images. We made several minor modifications to the task (Study 1) and adapted the task to include positive and neutral images in order to assess whether individuals respond to the valence or the intensity of the image content (Study 2). In both studies, we assessed subjective distress, gender differences in task responses, and associations between behavioral and self-reported distress tolerance, and related constructs. Across both studies, the EIT successfully induced distress and gender differences were observed, with females generally indicating more distress than males. In Study 2, responses on the adapted EIT task were correlated with self-reported distress tolerance, rumination, and emotion reactivity. The EIT successfully induces distress and the correlations in Study 2 provide promising evidence of validity.

Evaluating cognitive control training on symptoms of depression over time: Three potential mechanisms

Abstract Background Cognitive Control Training (CCT) may reduce symptoms of depression. The mechanisms behind CCT are unclear, however. This study examined the adaptive Paced Auditory Serial Addition Task's (aPASAT) effect on depressive symptoms, while examining potential mechanisms by which changes may occur. Methods Seventy-two participants were randomly assigned to 1 of 3 conditions: the aPASAT, an active control condition, and a no training control. Participants in the aPASAT and active control conditions each practiced a cognitive task over a 2-week period. The aPASAT is paced and time-pressured, whereas the active control was self-paced and developed to be less stressful. Results Linear trend analysis revealed that, when accounting for age, CCT decreased depressive symptoms as the stress involved in the training task increased, as predicted. Against prediction, self-reported distress tolerance was unrelated to this pattern. Limitations This study did not include data to evaluate performance on the training tasks. Additionally, though the task in the active control condition was developed to be less stressful, participant stress was not directly measured. Conclusions Findings suggest that cognitive control training may reduce depressive symptoms and that the stressful component of the aPASAT may be important in that reduction.

Measurement invariance of the distress tolerance scale among university students with and without a history of non-suicidal self-injury.

Non-suicidal self-injury (NSSI) is the intentional damage to one’s body tissue in the absence of suicidal intent. NSSI primarily serves an emotion regulation function, with individuals engaging in self-injury to escape intense or unwanted emotion. Low distress tolerance has been identified as a mechanism that underlies self-injury, and is commonly assessed using the self-report Distress Tolerance Scale. There are mixed findings regarding the factor structure of the Distress Tolerance Scale, with some researchers utilising a higher-order distress tolerance score (derived from the scores on the four lower-order subscales) and other researchers using the four subscales as unique predictors of psychological outcomes. Neither of these factor structures have been assessed among individuals with a history of self-injury. Of note, an inability to tolerate distress (thought to underlie NSSI) may limit an individual’s capacity to accurately observe and report specific thoughts and emotions experienced in a state of heightened distress, which may impact the validity of scores on the Distress Tolerance Scale. Therefore, measurement invariance should be established before attributing NSSI-related differences on the scale to true differences in distress tolerance. We compared the Distress Tolerance Scale higher-order model with the lower-order four factor model among university students with and without a history of NSSI. Our results indicated that the lower-order four factor model was a significantly better fit to the data than the higher-order model. We then tested the measurement invariance of this lower-order factor model among individuals with and without a history of NSSI, and established configural and full metric invariance, followed by partial scalar and full residual error invariance. These results suggest the four subscales of the Distress Tolerance Scale can be used to confidently discern NSSI-related differences in distress tolerance.

Distress tolerance among emergency department patients in acute pain: Associations with substance use treatment.

Managing acute pain in individuals with a history of substance use disorders (SUD) is complex. Distress tolerance (DT) (e.g., the ability to handle uncomfortable sensations) may serve as an ideal non-pharmacological intervention target in this population. Among 293 emergency department (ED) patients seeking treatment for pain (Mage =41; 42% Female; 43% Black), we examined rates of SUD treatment and DT, whether an objective DT task is feasible to conduct in the ED, and relationships between DT and SUD. Patients completed a self-report DT survey, an objective DT task, and brief surveys of pain, drug use, current or past SUD treatment, and depression/anxiety. Average DT was 18.50 (SD=9.4) out of 50; patients with past or current SUD treatment (n=43; 14.7%) reported lower DT than patients with no SUD treatment history (n=250; 85.3%). Controlling for demographics, depression/anxiety, and pain severity, lower subjective DT (adjusted odds ratio [aOR]=1.05) and objective DT (aOR=1.02) was associated a current or past history or SUD treatment. Assessing subjective and objective DT in ED patients with acute pain is feasible; interventions aimed at boosting DT may improve outcomes among patients with acute pain and SUD.

Validation and Clinical Correlates of the Behavioral Indicator of Resiliency to Distress Task (BIRD) in a University- and Community-Based Sample of Youth with Emotional Disorders

Distress tolerance (DT) is a transdiagnostic risk factor for psychopathology. The Behavioral Indicator of Resiliency to Distress (BIRD) task assesses DT by measuring task persistence in the face of distress. BIRD task performance has been associated with internalizing and externalizing symptoms in nonclinical youth, but these relationships have not been explored in clinical youth. Validating this task in a clinical sample would clarify its utility as a more objective indicator of DT. We aimed to investigate the correlates and predictors of BIRD task performance in a clinical sample of 348 youth assessed at pretreatment in community mental health clinics (CMHC; n = 209; ages 12–18; 66.8% female) or at a university-based research clinic (RC; n = 139; ages 10–18; 49.6% female). We aimed to evaluate the concurrent validity of the BIRD task by examining the associations between quitting the task and pre-task subjective units of distress (SUDs) and youth- and parent-reported anxiety, depressive, and externalizing symptoms, as well as youth-reported DT. Youth who reported greater subjective units of distress (SUDS) prior to the task reported greater anxiety and depressive symptoms, externalizing symptoms, and poorer DT. Those who quit the task early reported greater parent-reported school and separation anxiety. Surprisingly, fewer participants quit the task in this study compared with previous studies. The current results provide evidence that the BIRD may not be measuring the same construct as self-reported DT. Whereas a self-report measure captures one’s perceived ability to handle negative emotions, the BIRD captures one’s actual ability to persist in the face of frustration. These results suggest that youth’s perception of their ability to handle negative emotions may be distinct from their actual persistence when faced with distress. Assessing both perceived and actual DT may have clinical utility for youth with internalizing symptoms.

Outcome of CBT for Problematic Hoarding in a Naturalistic Setting: Impact on Symptoms and Distress Tolerance

AbstractCognitive behavioural therapy (CBT) for problematic hoarding is an effective treatment, but further research in diverse, naturalistic settings is needed to see whether this treatment is effective across settings and in smaller doses. The current study investigated the outcome of a 12-session group CBT for hoarding offered in an outpatient hospital setting. Sixty-four participants completed therapy, and 38 participants completed posttreatment assessments. Results demonstrated statistically significant improvements in hoarding symptom severity, saving cognitions, and self-reported distress tolerance. Effect sizes for changes in saving cognitions were generally large. However, effect sizes were modest for most other outcome variables, and only 4 of 38 participants achieved clinically significant change in hoarding symptom severity. These results suggest that 12 sessions of group CBT for hoarding is associated with significant change in saving cognitions, but less meaningful change in other indicators of symptom severity.

Multi-method assessment of distress tolerance and smoking-related factors among adult daily smokers.

Although distress tolerance (DT) is associated with smoking lapse and relapse outcomes, few studies have conducted a rigorous assessment of DT across domain and method in the context of acute abstinence. In a human laboratory-based study of 106 adult daily smokers, we examined between multiple indices of DT and smoking lapse, withdrawal processes, and motivation to quit. We expected that low DT would be associated with shorter latency to smoke, greater withdrawal severity, and lower motivation to quit. Following a smoking abstinence period (≥ 6 hr deprived), participants completed an assessment battery including both behavioral (mirror-tracing, serial addition, cold pressor, and breath-holding tasks) and self-report measures of DT (general and smoking-specific), withdrawal processes (craving, negative affect, and positive affect), and motivation to quit. Latency to smoke (range = 0-50 min) was assessed in a laboratory analogue task in which delaying smoking was monetarily rewarded. Behavioral and self-report DT indices displayed only modest intercorrelations, indicating different facets of this construct by domain and method of assessment. Tolerance of physical pain was uniquely associated with smoking choice. Both self-report DT measures were associated with abstinence-induced increases in negative affect, while only smoking-specific DT was positively associated with craving. Results are discussed within the context of guiding targeted behavioral interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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).

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.

A Preliminary Pilot Study Comparing Dialectical Behavior Therapy Emotion Regulation Skills with Interpersonal Effectiveness Skills and a Control Group Treatment

This pilot study examined the effects of dialectical behavior therapy (DBT) emotion regulation (ER) skills training for borderline personality disorder (BPD). To date, studies have yet to reveal whether specific DBT skill modules uniquely improve ER problems - one of the putative factors considered to underlie clinical problems in BPD. This preliminary examination aimed to characterize the effect sizes of DBT-ER compared to DBT interpersonal effectiveness (DBT-IE) skills training. Women with BPD (N = 19) were randomized to 6-weeks of DBT-ER, DBT-IE, or a control group. BPD symptoms, emotion regulation, and other BPD-relevant outcomes were assessed using self-report and laboratory-based measures. The DBT-ER group demonstrated large effect sizes for improved self-reported reactivity to an emotional stressor, generation of active rather than passive solutions to interpersonal problems, as well as self-reported distress tolerance, mindfulness, and BPD symptoms following treatment. At follow-up, DBT-ER training was also associated with large improvements in ER, social problem solving, and depression. Similarly large effect sizes, however, were sometimes also achieved in the DBT-IE and control condition. Significant condition x time interactions were detected for non-suicidal self-injury and mindfulness, with significant improvements occurring only in the DBT-ER group, whereas such interactions were not detected for other outcomes. These findings, although preliminary, can stimulate future research examining the specificity of DBT skills.

Sleep and affective functioning: Examining the association between sleep quality and distress tolerance among veterans

Poor sleep quality is common among veterans, and associated with numerous negative consequences. Although sleep may play a critical role in next-day emotion regulation functioning, it is currently unclear how sleep quality relates to distress tolerance. As such, the current study cross-sectionally examined the association between sleep quality and distress tolerance (measured behaviorally and via self-report) among 94 military veterans with cannabis use disorder. Results indicated that Perceived Sleep Quality was associated with self-reported distress tolerance and increased frustration on a distressing task, after accounting for covariates. The current study's findings should be replicated utilizing prospective designs, but are initially consistent with theoretical models suggesting that sufficient sleep quality is necessary for appropriate affective functioning, and have clinical implications given the negative effects of poor sleep quality on general psychological functioning.

The Effects of a Hatha Yoga Intervention on Facets of Distress Tolerance

Individuals with low distress tolerance (DT) experience negative emotion as particularly threatening and are highly motivated to reduce or avoid such affective experiences. Consequently, these individuals have difficulty regulating emotions and tend to engage in maladaptive strategies, such as overeating, as a means to reduce or avoid distress. Hatha yoga encourages one to implement present-centered awareness and non-reaction in the face of physical and psychological discomfort and, thus, emerges as a potential strategy for increasing DT. To test whether a hatha yoga intervention can enhance DT, a transdiagnostic risk and maintenance factor, this study randomly assigned females high in emotional eating in response to stress (N = 52) either to an 8-week, twice-weekly hatha (Bikram) yoga intervention or to a waitlist control condition. Self-reported DT and emotional eating were measured at baseline, weekly during treatment, and 1-week post-treatment. Consistent with prediction, participants in the yoga condition reported greater increases in DT over the course of the intervention relative to waitlist participants (Cohen's d = .82). Also consistent with prediction, the reduction in emotional eating was greater for the yoga condition than the waitlist condition (Cohen's d = .92). Importantly, reductions distress absorption, a specific sub-facet of DT, accounted for 15% of the variance in emotional eating, a hallmark behavior of eating pathology and risk factor for obesity.

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.

Differential Associations Between Perceived and Objective Measurement of Distress Tolerance in Relation to Antiretroviral Treatment Adherence and Response Among HIV-Positive Individuals

The present study sought to extend prior work, showing an association between self-reported distress tolerance and self-reported antiretroviral treatment (ART) adherence, by conducting a multimethod test of the association between distress tolerance and objective measures of ART adherence among a sample of 140 individuals (23.6% female) with human immunodeficiency virus (HIV). Findings indicated that, after accounting for negative affectivity and ART side-effect severity, distress tolerance was significantly associated with pill count adherence as well as viral load. Specifically, a differential association was observed whereby self-reported distress tolerance was associated with pill count adherence, whereas behavioral distress tolerance was associated with viral load. Importantly, no associations were observed between either measure of distress tolerance and CD4 count. Findings are discussed in terms of the importance of both behavioral and perceived distress tolerance assessment among patients with HIV as well as potential clinical implications related to the integration of distress tolerance-focused treatments into existing interventions for individuals with HIV.

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.

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.