Validation of Self-Report Measures of Emotional and Physical Distress Tolerance

The Distress Tolerance Scale (DTS) and Discomfort Intolerance Scale (DIS) are self-report measures developed for the assessment of emotional and physical distress tolerance, respectively. However, little evidence exists for their construct and specifically criterion-related validity. The current study examined the associations of these self-report measures with lab-based assessments of perceived emotional tolerance and physical discomfort tolerance. Undergraduate participants (N?=?166) were administered four film clips intended to induce sadness, disgust, fear, and anger, and a handgrip persistence task intended to elicit physical discomfort. The DTS, but not the DIS, was significantly associated with self-reported emotional tolerance and perceived threat associated with each film after controlling for emotional intensity. Among DTS subscales, the absorption subscale was the only subscale incrementally predictive of negative perceptions of the sad film, the appraisal subscale was incrementally predictive of negative perceptions of the other three films, and little support for the incremental validity of the tolerance and regulation subscales was found. The DTS also incrementally predicted tolerance and perceived threat of film-elicited emotions across films after controlling for anxiety sensitivity. The DIS was only marginally predictive of handgrip task persistence and was unrelated to emotional film perceptions. Overall, these findings uniquely add to the empirical literature on the construct and criterion-related validity of the DTS and DIS.     

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.     

Exploring the unique and interactive roles of distress tolerance and negative urgency in obsessions

Recent research has implicated relationships between emotion dysregulation and obsessions. Evidence suggests low distress tolerance and greater tendency to act impulsively in the face of negative affect (or negative urgency) are strongly related to obsessions. The current study sought to examine the unique and interactive roles of distress tolerance and negative urgency in the prediction of obsessions. A large non-clinical sample (N = 238) was administered a range of self-report measures. Results revealed that both poor distress tolerance and greater negative urgency were uniquely associated with obsessions but not other obsessive-compulsive symptoms, even when controlling for gender, depression, anxiety, and generalized anxiety disorder symptoms. Additionally, low distress tolerance and high negative urgency interacted with each other in the prediction of greater obsession symptoms. Overall, the findings help clarify the emerging literature linking emotion dysregulation to obsessions.     

Changes in Risk Factors During the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents

This study aimed to assess whether changes in potentially modifiable risk factors associated with the construct of neuroticism and common to emotional disorders (i.e., poor distress tolerance and heightened avoidance) occur in concordance with the administration of different treatment components of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) and with reductions in emotional disorder symptoms (i.e., anxiety and depressive symptoms) overall. Using single-case analytic strategies, including multiple-baseline design and modeling techniques, the authors treated 8 adolescents with emotional disorder diagnoses and evaluated trajectories of change in distress tolerance and experiential avoidance as well as in the sequencing of such change in regard to change in anxiety and depressive symptoms. Clinical outcomes were favorable based on parent, adolescent, and clinician-rated measures. Treatment-based change was demonstrated, at both group and individual levels, and at expected points in treatment, in regard to facets of neuroticism. Overall, self-reported change in experiential avoidance and distress tolerance tended to occur simultaneously to reductions in emotional disorder symptoms. This study helps to clarify the course of expected change in variables believed to be common among a range of emotional disorders during a transdiagnostic treatment and provides initial information regarding tailoring the UP-A for individuals with different clinical profiles.     

Cognitive reappraisal attenuates the association between depressive symptoms and emotional response to stress during adolescence

Depression is associated with increased emotional response to stress. This is especially the case during the developmental period of adolescence. Cognitive reappraisal is an effective emotion regulation strategy that has been shown to reduce the impact of emotional response on psychopathology. However, less is known about whether cognitive reappraisal impacts the relationship between depressive symptoms and emotional responses, and whether its effects are specific to emotional reactivity or emotional recovery. The current study examined whether cognitive reappraisal moderated the relationship between depressive symptoms and trait or state measures of emotional reactivity and recovery. A community sample of 127 adolescents (M-age?=?15.28; 49% female, 47% Caucasian), at an age of risk for depression, completed self-report measures of trait emotional responding and depressive symptoms. In addition, they completed an in vivo social stress task and were assessed on state emotional reactivity and recovery from the stressor. Findings suggested that cognitive reappraisal was associated with an attenuated impact of depressive symptoms on trait and state emotional recovery. These results provide evidence that cognitive reappraisal may be an effective strategy for improving some aspects of emotional responding in relation to depressive symptoms among adolescents.     

The Association between Symptom Accommodation and Emotional Coregulation in Couples with Binge Eating Disorder

Intense negative emotions and maladaptive behavioral strategies to reduce emotional distress occur not only in patients with various forms of psychopathology but also in their committed partners. One common strategy to reduce distress is for partners to accommodate to the symptoms of the disorder, which reduces distress short term but maintains symptoms long term. Accommodation is believed to be motivated by the partner reacting behaviorally to the patient's emotions, but the emotions of the partner in this context have yet to be examined. This pilot study examined how partner accommodation related to specific patterns of emotional coregulation between patients with binge eating disorder (BED) and their partners, before and after a couple‐based intervention for BED. Vocally encoded emotional arousal was measured during couples’ (n = 11) conversations about BED. As predicted, partners’ emotional reactivity to patients’ emotional arousal was associated with high accommodation before treatment. Thus, partners may use accommodation as a strategy to reduce both the patients’ and their own distress. After treatment, partners’ arousal was no longer associated with the patients’ emotional arousal; instead, partners showed greater emotional stability over time, specifically when accommodation was low. Additionally, patients were less emotionally aroused after treatment. Therefore, treatment may have decreased overall emotionality of patients and altered the association between accommodation and partners’ emotional reactivity. If replicated, this understanding of the emotional context associated with accommodation in BED can inform couple‐based treatment by targeting specific emotional precipitants of behaviors that maintain symptoms.     

Trait Versus Task-Induced Emotional Reactivity and Distress Intolerance in Hoarding Disorder: Transdiagnostic Implications

Evidence from analogue samples suggests that deficits in emotional functioning, namely elevated emotional reactivity and distress intolerance, are implicated in the development and maintenance of hoarding disorder. We aimed to extend previous research in this area by investigating emotional reactivity and distress intolerance in a sample of individuals diagnosed with hoarding disorder (n = 24) in comparison to clinical controls (n = 21) and nonclinical community controls (n = 26) using a combination of self-report, physiological, and behavioral measures. We found that trait distress intolerance was significantly and independently associated with greater hoarding severity. The hoarding and clinical control groups reported more trait emotional reactivity and distress intolerance than the community control group, but did not differ from each other on these traits. The hoarding group reported more subjective distress before beginning a frustrating behavioral task, but did not evidence more physiological arousal. Moreover, the hoarding group experienced similar increases in distress during the task and did not differ from either group in regard to time persisting on this task. The clinical control group, however, terminated the frustrating task significantly faster than the community control group, who tended to persist until the task timed out. Lastly, trait distress intolerance evidenced a small-to-moderate but nonstatistically significant independent relationship with task persistence time. Given the desynchrony between subjective distress and physiological arousal, we encourage researchers to utilize multimodal assessment in the future. We also suggest that clinicians start to use behavioral experiments, as has been done with other psychological disorders, to improve distress intolerance among persons who experience hoarding disorder.     

Positive emotional attention bias in young children with symptoms of ADHD

Children with attention-deficit/hyperactivity disorder (ADHD) often experience emotional dysregulation. Dysregulation can arise from heightened attention to emotional stimuli. Emotional attention biases are associated with a number of adverse socioemotional outcomes including reward sensitivity and externalizing behaviors. As reward sensitivity and externalizing behaviors are common in children with ADHD, the aim of the current study was to determine whether emotional attention biases are evident in young children with clinically significant ADHD symptoms. To test this, children with (n = 18) and without (n = 15) symptoms of ADHD were tested on a Dot Probe task. Provided recent evidence that emotional attention biases are attenuated by sleep, the task was performed before and after overnight sleep. Children with ADHD symptoms displayed positive, but not negative, attention biases at both time points, whereas typically developing children did not preferentially attend toward or away from positive or negative stimuli. Sleep did not alter attention biases in either group. Collectively, these results indicate that children with ADHD symptoms have stable, positive attention biases.     

A Multifaceted Assessment of Emotional Tolerance and Intensity in Hoarding

Hoarding is characterized by emotionally reinforced saving behaviors, which often combine with excessive acquisition to give rise to clutter, distress, and impairment. Despite the central role emotional processes are thought to play in hoarding, very little research has directly examined this topic. There is suggestive evidence linking hoarding with several facets of emotional intolerance and avoidance, though one key limitation of this past research has been the exclusive reliance on self-report questionnaires. The aim of the current study was to conduct a multimethod investigation of the relationship between hoarding and perceptions of, and cognitions about, negative emotional states. A large unselected sample of nonclinical young adults (N = 213) completed questionnaires, behavioral tasks, and a series of negative mood inductions to assess distress tolerance (DT), appraisals of negative emotions, and emotional intensity and tolerance. Hoarding symptoms were associated with lowered tolerance of negative emotions, as well as perceiving negative emotions as more threatening. Individuals high in hoarding symptoms also experienced more intense emotions during the mood inductions than individuals low in hoarding symptoms, though there was no association with poorer performance on a behavioral index of DT. Across measures, hoarding was consistently associated with experiencing negative emotions more intensely and reporting lower tolerance of them. This relationship was particularly pronounced for the difficulty discarding and acquiring facets of hoarding. Our results offer initial support for the important role of emotional processes in the cognitive-behavioral model of hoarding. A better understanding of emotional dysfunction may play a crucial role in developing more effective treatments for hoarding.     

Emotional flexibility and recovery from pain

This study aimed to investigate the relationship between two aspects of emotional flexibility (EF, i.e. flexible emotional responsiveness and affective flexibility) and tolerance for, and recovery from, experimentally-induced pain. Fifty-two adults completed a flexible emotional responsiveness task in which emotional responses on multiple dimensions were registered while watching positive and negative pictures. Affective flexibility was measured using a switching task with positive and negative pictures. Pain tolerance was assessed as the time participants endured an ischemic pain task and total time until recovery in terms of pain intensity and pain unpleasantness was registered. Flexible emotional responsiveness—reflected in divergent corrugator responses to positive and negative stimuli—was associated with faster recovery from pain unpleasantness. Affective flexibility was associated with recovery in terms of pain intensity, with faster switches from neutral towards affective aspects of positive stimuli being predictive of faster recovery. Results did not provide evidence for an association between EF and pain tolerance. The findings suggest that EF may protect against pain persistence.

     

The role of distress tolerance in the relationship between depressive symptoms and problematic alcohol use

Empirical evidence and theory implicate the role of distress tolerance in the relationship between negative affect and alcohol use. However, limited research has been conducted to explore these relationships. As such, the purpose of this study was to examine whether distress tolerance moderates the relationship between current depressive symptoms and problematic alcohol use in a community sample of adults. Participants included 150 adults, primarily female, recruited from the local community. Problematic alcohol use was measured using the Alcohol Use Disorders Identification Test (AUDIT) total score, which is a composite measure of harmful and hazardous patterns of alcohol use and several current alcohol dependence symptoms. Distress tolerance was measured using a computerized behavioral distress tolerance task, the Computerized Paced Auditory Serial Addition Task (PASAT-C). Tobit regression analyses indicated a significant interaction between distress tolerance and depressive symptoms in predicting alcohol problems, such that depressive symptoms were significantly associated with problematic alcohol use among adults with low, but not high, distress tolerance. Thus, alcohol use interventions with a focus on distress tolerance skills in the context of depressive symptoms may be particularly effective. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Who benefits from emotional expression? An examination of personality differences among gynaecological cancer patients participating in a randomized controlled emotional disclosure intervention trial

The present study examined the role of neuroticism and extraversion in the effects of written emotional disclosure in patients diagnosed with gynaecological cancer. It was hypothesized that high levels of neuroticism would be associated with an increase in distress after emotional disclosure as mediated by heightened negative affect and avoidance post-disclosure. Conversely, we expected high extraversion to be associated with decreased distress as mediated by heightened positive moods and a decrease in avoidance. Eighty-eight participants were randomly assigned to participate in an expressive writing task versus a control writing task. Distress and avoidance were assessed at baseline and 6 months post-writing. Negative and positive mood were assessed immediately following writing. Multiple regression confirmed that neuroticism but not extraversion moderates the effects of emotional disclosure on distress, however no significant mediating relationships were found.     

The anger–distress model of temper tantrums: associations with emotional reactivity and emotional competence

The goals of this investigation were (a) to assess the structural validity of the anger–distress model of temper tantrums, and (b) to examine the associations among temper tantrums, emotional reactivity and emotional competence in a community sample of preschoolers. A parent‐report measure, the Temper Tantrum Grid, was used to measure the frequency of common tantrum behaviours. Laboratory and parent‐report measures of emotional reactivity and emotional competence were administered. Confirmatory factor analysis supported the proposal that anger and distress are separate but overlapping tantrum processes. Correlation analyses showed that temper tantrum anger and distress were related to emotional reactivity and emotional competence. There was no evidence to support the notion that emotional competence moderated the effect of emotional reactivity on temper tantrums. In contrast, emotional competence was a significant mediator of the association between emotional reactivity and temper tantrums. Overall, the results support the anger–distress model of temper tantrums. The findings suggest that children's temper tantrums are systematically related to the overall organization of emotion and behaviour in preschool children. Copyright © 2010 John Wiley & Sons, Ltd.     

Tolerating Distress After Trauma: Differential Associations Between Distress Tolerance and Posttraumatic Stress Symptoms

Distress tolerance has been implicated in disorders of emotional regulation, such as eating disorders and borderline personality disorder; however, much less attention has been given to distress tolerance in the context of posttraumatic stress (PTS). Several conceptual linkages between distress tolerance and PTS exist. Low distress tolerance may increase negative appraisals, reducing an individual’s propensity to deal with distressing mental symptoms immediately after a trauma. Relatedly, a perceived inability to cope with the distress brought on by trauma-related memories and cues may engender maladaptive coping strategies. The few published studies examining the relationship between distress tolerance and PTS have demonstrated that lower distress tolerance was associated with increased PTS symptomatology, including increased avoidance, hyperarousal, and re-experiencing. The current study sought to replicate and extend the emerging empirical base by examining the relationship between distress tolerance and the four distinct PTS symptom clusters, while controlling for time since the index trauma and depressive symptoms. Results indicated that distress tolerance accounted for significant unique variance in re-experiencing and avoidance but not negative emotionality and hyperarousal symptoms. There was also a strong positive association between the number of traumas endorsed by participants, depression, and PTS symptoms. Findings suggest that distress tolerance is associated with PTS, lending further support to the putative relationship between PTS and distress tolerance. Accordingly, developing treatment protocols designed to increase distress tolerance in individuals affected by PTS may reduce symptom severity and increase coping abilities.     

Factor structure and initial validation of a brief measure of perceived emotional and physical distress tolerance in post-9/11 US Veterans

Distress tolerance (i.e., perceived or actual capacity to tolerate aversive internal states) has received considerable research attention as a transdiagnostic risk-factor underlying the development and maintenance of psychopathology. Lower levels of emotional distress tolerance have been linked to psychopathology (e.g. Posttraumatic Stress Disorder) within Military populations; however, the association of physical distress tolerance to psychopathology in this population has been under-researched. This research gap may be due in part to a paucity of comprehensive, temporally stable and brief measures of distress tolerance that have been validated within Military populations, which may hinder further examination and refinement of the construct. Addressing this problem, the current study evaluates the psychometric properties of a novel and brief measure of emotional and physical distress tolerance in a sample of United States post-9/11 Veterans. Participants were 307 Veterans (M_age = 38.9, 67.7% male) who completed the 10-item Distress Tolerance Inventory at baseline and annual follow-up. Exploratory structural equation modeling was used to examine the optimal latent factor structure and longitudinal invariance of the DTI measurement model, along with correlational analyses to examine the convergent properties of the DTI subscales. The DTI reflected a longitudinally invariant two-factor structure (emotional and physical distress tolerance), with excellent internal consistency and preliminary evidence of convergent validity. Thus, the DTI represents a brief, reliable and temporally stable measure of physical and emotional distress tolerance.     

Profile Analysis of Psychological Symptoms Associated With Misophonia: A Community Sample

Misophonia is characterized by extreme aversive reactions to certain classes of sounds. It has recently been recognized as a condition associated with significant disability. Research has begun to evaluate psychopathological correlates of misophonia. This study sought to identify profiles of psychopathology that characterize misophonia in a large community sample. A total of N = 628 adult participants completed a battery of measures assessing anxiety and anxiety sensitivity, depression, stress responses, anger, dissociative experiences, obsessive-compulsive symptoms and beliefs, distress tolerance, bodily perceptions, as well as misophonia severity. Profile Analysis via Multidimensional Scaling (PAMS) was employed to evaluate profiles associated with elevated misophonia and those without symptoms. Three profiles were extracted. The first two accounted for 70% total variance and did not show distinctions between groups. The third profile accounted for 11% total variance, and showed that misophonia is associated with lower obsessive-compulsive symptoms for neutralizing, obsessions generally, and washing compared to those not endorsing misophonia, and higher levels of obsessive-compulsive symptoms associated with ordering and harm avoidance. This third profile extracted also showed significant differences between those with and without misophonia on the scale assessing physical concerns (that is, sensitivity to interoceptive sensations) as assessed with the ASI-3. Further research is called for involving diagnostic interviewing and experimental methods to clarify these putative mechanisms associated with misophonia.     

The role of fear of emotion in distress, arousal, and cognitive interference following an emotional stimulus

Diverse theories of psychopathology suggest that reactions to internal experiences, such as emotion, are important in the development and maintenance of psychological distress and symptomatology. This study examines the relationships between one type of reaction to emotion, fear of emotion, and reactivity to, recovery from, and interference of emotional material. As predicted, fear of emotion was related to greater increases in distress, negative affect, and skin conductance in reaction to an emotional film clip, and to greater interference of film-related material in a modified emotional Stroop task. These relationships remained when variance contributed by general negative affect was removed. Findings provide preliminary evidence that fear of emotion may be related to emotional distress and physiological arousal, and that this relationship may exist beyond shared variance due to self-report response style and general negative affectivity.     

Suppression of emotional and neutral material

Previous studies have indicated that suppression of a thought results in an immediate increase of the frequency of this thought and/or in a rebound effect, i.e. in a heightened frequency of this thought later on. The present study (n = 53) examined the relationship between suppression and emotionality of the to-be-suppressed material. More specifically, it was investigated whether suppression of an emotional story results in stronger immediate enhancement or thought rebounds than suppression of a neutral story. There was a clear initial enhancement effect in the group suppressing a neutral story: subjects who tried to suppress experienced more target thoughts than subjects who did not try to suppress. In the neutral-story conditions, no rebound effect occurred. In the groups exposed to an emotional story, there was neither evidence of initial enhancement nor of a rebound. As most obsessions are related to emotional themes, the present findings cast doubt on the claim that the rebound phenomenon represents a valid laboratory model for clinical obsessions.     

Preliminary evidence of attenuated blood pressure reactivity to acute stress in adults following a recent marital separation

Objective: This study explores cardiovascular reactivity during an acute-stress task in a sample of recently separated adults.

Design: In a cross-sectional design, we examined the association between adults’ subjective separation-related distress and changes in heart rate and blood pressure across the acute-stress laboratory paradigm in a sample of 133 (n = 49 men) recently separated adults.

Main outcome measures: Heart rate (HR) and Blood pressure (BP) were recorded across a resting baseline period, a math stressor task, and a recovery period.

Results: Multilevel analyses revealed that adults who reported greater separation-related distress exhibited higher initial BP and a slower linear increase in BP across the study period. In addition, adults reporting greater separation-related distress evidenced significantly slower declines in diastolic blood pressure (DBP) following the acute-stress task. HR reactivity was not moderated by separation-related distress.

Conclusions: In recently separated adults, preliminary evidence suggests that the context of the stressors may reveal differential patterns of problematic reactivity (exaggerated or blunted responding). Greater emotional intrusion and hyperactivity symptoms may index increased risk for blunted cardiovascular reactivity to general stressors. This pattern of reactivity is consistent with models of allostatic load that emphasise the deleterious effect of hyporesponsivity to environmental demands.     

Mother–infant interaction and maternal postnatal psychological distress are associated with negative emotional reactivity among infants and toddlers— A FinnBrain Birth Cohort study

Studies have reported mixed findings regarding the effects of mother-infant interaction and maternal distress on children’s negative emotional reactivity. In the current study (N = 134 and 107), we examined the effects of maternal Emotional Availability (sensitivity, structuring, non-intrusiveness and non-hostility) and maternal psychological distress on negative reactivity among children in the FinnBrain birth cohort study. In addition, the possible moderating effect of mother-infant interaction on the associations between maternal psychological distress and children's negative reactivity was examined. We used questionnaires to asses maternal psychological distress, observations of mother-infant interaction and observations as well maternal reports of child temperament to overcome the key limitations of many studies relying on single-method assessments. Our results showed that higher maternal sensitivity and structuring at 8 months of child’s age were associated with lower mother-reported negative reactivity among children at 24 months. Higher maternal postnatal distress associated with higher parent-reported negative reactivity in children at 12 and 24 months of age when the effects of prenatal distress and the quality of mother-infant interaction were controlled for. Mother-infant interaction and maternal psychological distress did not associate with observations of child negative reactivity. We found no moderation effects of mother-infant interaction regarding the associations between maternal distress and children’s negative emotional reactivity. Our findings reflect the importance of developing interventions to reduce the maternal distress symptoms while enhancing maternal sensitivity and structuring to prevent the possible harmful effects of these on child negative reactivity.