The Role of Emotional Distress Tolerance on Fear Responding in a Heights-Fearful Sample: Perceived Versus Actual Behavior

Emotional distress tolerance (EDT)—or the ability to withstand negative emotional states—is considered a transdiagnostic risk factor for psychopathology. Although EDT is theorized to play a role in anxiety development and maintenance, research aiming to delineate the relationship between anxiety and EDT is lacking. The current study tested whether self-reported EDT predicted self-reported and actual avoidance in the presence of feared stimuli using a heights-fearful sample. Moreover, the study tested whether EDT predicted other in-the-moment fear responses, such as peak anxiety, anxious cognitions, and bodily sensations. Participants (N = 128) completed questionnaires assessing fear of heights, negative affect, anxious cognitions, and bodily sensations, as well as two heights behavioral avoidance tasks (BATs). Results demonstrated that EDT did not predict actual avoidance or other in-the-moment fear responses, except for peak anxiety in one BAT. However, EDT predicted self-reported avoidance of heights beyond fear of heights and negative affect. Taken together, results suggest that perception of ability to tolerate emotional distress predicts perception of avoidance of heights, but not actual avoidance of heights or reactions to heights (with the exception of peak anxiety in one BAT). Given these findings, self-reported EDT may not adequately predict how individuals react in anxiety-provoking situations.     

Striving Towards Empowerment and Medication Adherence (STEP-AD): A Tailored Cognitive Behavioral Treatment Approach for Black Women Living With HIV

In the U.S. Black women with HIV face numerous psychosocial challenges, particularly trauma, racism, HIV-related discrimination, and gender role expectations, that are associated with negative HIV health outcomes and low medical treatment adherence. Yet many of these factors are unaddressed in traditional cognitive behavioral approaches. This study presents a case series of a tailored cognitive behavioral treatment approach for Black women living with HIV. Striving Towards EmPowerment and Medication Adherence (STEP-AD) is a 10-session treatment aimed at improving medication adherence for Black women with HIV by combining established cognitive behavioral strategies for trauma symptom reduction, strategies for coping with race- and HIV-related discrimination, gender empowerment, problem-solving techniques for medication adherence, and resilient coping. A case series study of five Black women with HIV was conducted to evaluate the preliminary acceptability and feasibility of the treatment and illustrate the approach. Findings support the potential promise of this treatment in helping to improve HIV medication adherence and decrease trauma symptoms. Areas for refinement in the treatment as well as structural barriers (e.g., housing) in the lives of the women that impacted their ability to fully benefit from the treatment are also noted.     

The Effect of a Brief Mindfulness Training on Distress Tolerance and Stress Reactivity

Poor distress tolerance (DT) is considered an underlying facet of anxiety, depression, and a number of other psychological disorders. Mindfulness may help to increase DT by fostering an attitude of acceptance or nonjudgment toward distressing experiences. Accordingly, the present study examined the effects of a brief mindfulness training on tolerance of different types of distress, and tested whether trait mindfulness moderates the effect of such training. Undergraduates (n = 107) naïve to mindfulness completed a measure of trait mindfulness and underwent a series of stress tasks (cold pressor, hyperventilation challenge, neutralization task) before and after completing a 15-minute mindfulness training or a no-instruction control in which participants listened to relaxing music. Participants in the mindfulness condition demonstrated greater task persistence on the hyperventilation task compared to the control group, as well as a decreased urge to neutralize the effects of writing an upsetting sentence. No effect on distress ratings during the tasks were found. Overall trait mindfulness did not significantly moderate task persistence, but those with lower scores on the act with awareness facet of mindfulness demonstrated greater relative benefit of mindfulness training on the hyperventilation challenge. Mediation analyses revealed significant indirect effects of mindfulness training on cold pressor task persistence and urges to neutralize through the use of the nonjudge and nonreact facets of mindfulness. These results suggest that a brief mindfulness training can increase DT without affecting the subjective experience of distress.     

Negative Interpretations of Interpersonal Situations and the Relation Between Low Perceived Support and Psychological Distress Among Divorced Adults1

This research tested hypotheses for a mechanism by which low perceived support may lead to psychological distress. According to social‐cognitive models, perceived support guides the interpretation of interpersonal situations. People with low perceived support interpret these situations more negatively than do people with high perceived support, and these negative interpretations lead to psychological distress. This mechanism is hypothesized to be distinct from similar mechanisms involving other social‐cognitive constructs, such as dysfunctional attitudes. These hypotheses were tested in 2 samples of adults adjusting to divorce. The data were consistent with predictions. Implications for understanding low perceived support's relation to distress and adults' adjustment to divorce were discussed.     

The Links Among Perceived Adherence to the System of Care Philosophy,Consumer Satisfaction,and Improvements in Child Functioning

The present study investigated the associations among perceived adherence to the system of care philosophy, changes in internalizing and externalizing behaviors, and consumer satisfaction with services. Participants included 98 families, interviewed at two time points across a one-year period. Hierarchical multiple regressions indicated that the more a child and family perceived services to be consistent with the system of care philosophy, the greater their level of satisfaction with services and the fewer internalizing and externalizing behaviors they reported one year after receiving services (controlling for initial levels of problem behaviors). Implications for children’s mental health service delivery are offered.     

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.     

Adherence to antiretroviral therapy for pediatric HIV infection: review of the literature and recommendations for research

This review described and compared empirical investigations of adherence to pediatric antiretroviral therapy (ART) and predictors/correlates of adherence with regard to methodology and outcome. Thirteen empirical studies of children's adherence to ART, conducted between the years 1981 and 2002 were identified. Investigations varied by age of participant, drug therapy regimen, method of adherence assessment, and by the reporting of predictors/correlates of adherence. Conclusions from the literature are limited by the lack of common sample characteristics and adherence assessment methodologies. Nevertheless, consistent with much of the pediatric adherence literature, adherence to antiretroviral medications among children and adolescents appears to be frequently suboptimal. Few investigations identified predictors/correlates of adherence, but these appear generally similar to those found in adult samples. Recommendations for future investigations are proposed.     

Distress Tolerance and Anxiety Sensitivity Cognitive Concerns: Testing the Incremental Contributions of Affect Dysregulation Constructs on Suicidal Ideation and Suicide Attempt

Empirical work has suggested relationships among suicide-related outcomes and several constructs related to affect dysregulation, notably anxiety sensitivity (AS) and distress tolerance (DT). However, important questions remain, including the relative contributions of these affect regulation variables as well as the direct contribution of DT on suicidal ideation and prior attempts. The current study sought to better elucidate the nature of these relationships by examining AS, DT, and suicidal ideation and attempt in a clinical sample (N = 192). Consistent with prior work and prediction, findings revealed a significant relationship between the AS cognitive concerns subfactor and suicidal ideation and suicide attempt history after accounting for the effects of DT, gender, and depressive symptoms. In addition, depressive symptoms significantly moderated the relationship between the AS cognitive concerns subfactor and suicidal ideation. After accounting for the influence of AS, analyses revealed that DT approached significance in predicting suicidal ideation, but did not significantly predict suicide attempt history. These results suggest that elevated AS cognitive concerns are particularly relevant to suicide in the context of depressive symptoms. Clinicians may benefit from implementing AS reduction strategies with individuals who endorse elevated suicide risk as well as elevated AS cognitive concerns.     

Utility of the Millon Behavioral Medicine Diagnostic (MBMD) to Predict Adherence to Highly Active Antiretroviral Therapy (HAART) Medication Regimens Among HIV-Positive Men and Women

Trait loyalty has received virtually no attention from researchers; consequently, the basic goal of this research was to create a measure of interpersonal loyalty. Principal factor analyses of an initial pool of items revealed 2 factors: Individual Loyalty (e.g., “I stand by my friends, even when they make mistakes”) and Group Loyalty (e.g., “I am loyal to my country”). Analyses of a revised item pool identified the same 2 factors in a second sample. Scales based on these factors were internally consistent and only moderately related to one another. Additional analyses indicated that both scales (a) were stable over time; (b) showed moderate to strong self-peer agreement; (c) positively correlated with conscientiousness, agreeableness, altruism, and positive emotionality; and (d) negatively related to an avoidant attachment style. However, these associations all were moderate in magnitude (in fact, none was as high as |.40|), indicating that the Individual and Group Loyalty Scales tap unique variance that is not captured by existing instruments.     

Use of Multisystemic Therapy to Improve Regimen Adherence Among Adolescents with Type 1 Diabetes in Poor Metabolic Control: A Pilot Investigation

The purpose of the current study was to conduct a pilot investigation to determine the effectiveness of Multisystemic Therapy (MST) for improving regimen adherence and metabolic control among adolescents with poorly controlled Type 1 diabetes. Thirty-one adolescents were randomly assigned to either MST or a control condition. MST treatment lasted approximately six months. Data were collected at study entry and at a six-month posttest. Twenty-five adolescents completed the study. Adolescents who received MST had significantly improved adherence to blood glucose testing and metabolic control from study entry to the six-month posttest, whereas controls did not. Adolescents receiving MST also had a decreased number of inpatient admissions at the six-month posttest. Improvements in metabolic control were related to improvements in parent report of adolescent adherence. Results suggest that MST holds promise as an intervention for improving adherence behavior and health outcomes among adolescents in poor metabolic control.     

The Illness Perceptions and Treatment Beliefs of Individuals with Severe Haemophilia and their Role in Adherence to Home Treatment

The majority of individuals in the UK with severe haemophilia treat themselves at home with clotting factor. The aim of this study was to examine patient's beliefs about their haemophilia, their beliefs regarding treatment with clotting factor and to assess whether relationships existed between these factors and adherence to home treatment. Patient beliefs were assessed by posting individuals with severe haemophilia A and B ( n = 104) the Illness Perceptions Questionnaire (IPQ) and the Beliefs about Medicines Questionnaire (BMQ). The final analysis was based on 65 questionnaires yielding a response rate of 63%. Adherence to the frequency and to the amount of each clotting factor dose was assessed for individuals treating prophylactically and the amount of each clotting factor dose for those only treating 'on-demand'. Adherence scores were calculated by comparing individual patient treatment records with recommended regimens. Regression analysis indicated that perceptions of illness identity and treatment necessity explained a significant amount of the variance in adherence to frequency of prophylactic infusions and that illness identity was associated with the adherence to the amount of each prophylactic dose. Further regression analysis also showed that the amount of each dose of clotting factor administered on-demand was associated with perceptions regarding the necessity of treatment. Analysis with a combined measure of adherence to dose amount indicated that patients treating on-demand or with prophylaxis who under treated, recorded significantly lower perceptions of illness consequence than individuals who were fully adherent or who over-treated. The results suggest that assessing illness perceptions, especially beliefs regarding identity , consequence and necessity of treatment, may play a valuable role in identifying which individuals are least likely to adhere to treatment.     

Main and Interactive Effects of Distress Tolerance and Negative Affect Intensity in Relation to PTSD Symptoms among Trauma-Exposed Adults

The present investigation evaluated the main and interactive effects of distress tolerance and negative affect intensity in relation to posttraumatic stress disorder (PTSD) symptom severity and symptom cluster severity. Participants were 190 trauma-exposed adults (52.6 % women; M _age?=?25.3 years, SD?=?11.4) recruited from the community. Distress tolerance (i.e., perceived ability to withstand distressing emotional states) demonstrated significant incremental associations with global PTSD symptom severity as well as Re-Experiencing, Emotional Numbing, and Hyperarousal symptom cluster severity. Negative affect intensity (i.e., perceived intensity of negative emotional responses) demonstrated significant incremental associations with each of the PTSD symptom outcomes. Moreover, the incremental interactive effect of distress tolerance and negative affect intensity was significantly associated with PTSD symptom severity as well as PTSD—Emotional Numbing symptom cluster severity. These incremental effects were evident after accounting for the variance explained by anxiety sensitivity (i.e., fear of anxiety-related sensations). Post hoc probing analyses supported the moderating role of negative affect intensity in the association between distress tolerance and PTSD symptom severity, such that low levels of distress tolerance, in the context of elevated levels of negative affect intensity, were associated with the greatest levels of PTSD symptoms.     

A Cognitive-Behavioral Standpoint on the Perceived Consequences of a Major Seismic Event in Relation to Optimism and Pre-hazard Emotional Distress

The study examined a circumscribed class of cognitions (i.e., dispositional optimism and perceived consequences) in connection to the emotional distress experienced in anticipation of a major seismic event (i.e., pre-hazard emotional distress). Grounded on cognitive-behavioral theory, it was argued that dispositional optimism exerts distal influence on distress, while the perceived consequences of a major seismic event are proximal to distress and, therefore, interpose the optimism-distress relationship. The hypothesis was tested via a cross-sectional study on a sample of 189 volunteers located in areas of high seismic hazard. Participants reported their level of pre-hazard emotional distress, their dispositional optimism, and their perceived consequences of a major seismic hazard. The results showed that there was a partial indirect effect from dispositional optimism to emotional distress via perceived consequences, indirect effect = ?0.190, SE = 0.114, 95 % CI [?0.487; ?0.021], k² = 0.051. These findings could inform future prevention programs targeting emotional distress in anticipation of a natural hazard with impact on post-disaster recovery.     

Faculty Stressors, Job Satisfaction, and Psychological Distress Among University Teachers in Hong Kong: The Role of Locus of Control

The study aimed at identifying the sources of stress, and investigating their effects on job satisfaction and psychological distress among 106 university teachers (86 males, 20 females) from four tertiary institutes in Hong Kong. Another purpose of the study was to examine the moderating effect of locus of control on stressor-strain relationships. A factor analysis of the faculty stressors revealed six factors: recognition, perceived organizational practices, factors intrinsic to teaching, financial inadequacy, home/work interface, and new challenge. A series of stepwise multiple regressions demonstrated that recognition, perceived organizational practices, and financial inadequacy were best predictors of job satisfaction, whereas perceived organizational practices and home/work interface were the best predictors of psychological distress. Further, external locus of control was associated with low job satisfaction and psychological distress. A series of hierarchical moderated regressions demonstrated a moderating effect of locus of control on some of the stressor-strain relationships.     

Differential Effects of Anxiety Sensitivity Components in the Relation Between Emotional Non-Acceptance and Post-traumatic Stress Symptoms Among Trauma-Exposed Treatment-Seeking Smokers

Anxiety sensitivity (AS), defined as the extent to which individuals believe anxiety and anxiety-related sensations have harmful consequences, may play an important explanatory role in the relation between emotional non-acceptance and the expression of traumatic stress symptoms among trauma-exposed smokers. This investigation examined whether lower-order dimensions of AS (cognitive, physical, and social concerns) differentially explain the relation between emotional non-acceptance and post-traumatic stress (PTS) symptom clusters (re-experiencing, avoidance, hyperarousal) among trauma-exposed daily smokers (N = 169, 46% female; M_age = 41, SD = 12.3). AS and its lower-order facets of cognitive and social concerns were found to mediate the relations between emotional non-acceptance and avoidance and hyperarousal PTS symptoms. Using a multiple mediation model, the mediational effect of AS cognitive concerns for the relation between emotional non-acceptance and post-traumatic avoidance symptoms was found to be uniquely evident relative to social and physical concerns. All observed AS effects were evident above and beyond the variance accounted for by gender, number of traumatic event exposure types, negative affectivity, number of cigarettes smoked per day, and alcohol use problems. The present findings suggest cognitive-based AS concerns may play a mechanistic role in the relation between emotional non-acceptance and certain PTS symptoms among trauma-exposed daily smokers.     

Family Processes and Treatment Outcome in the MTA: Negative/Ineffective Parenting Practices in Relation to Multimodal Treatment

To elucidate processes underlying therapeutic change in a large-scale randomized clinical trial, we examined whether alterations in self-reported parenting practices were associated with the effects of behavioral, medication, or combination treatments on teacher-reported outcomes (disruptive behavior, social skills, internalizing symptoms) in children with attention-deficit hyperactivity disorder (ADHD). Participants were 579 children with Combined-type ADHD, aged 7–9.9 years, in the Multimodal Treatment Study of Children with ADHD (MTA). We uncovered 2 second-order factors of parenting practices, entitled Positive Involvement and Negative/Ineffective Discipline. Although Positive Involvement was not associated with amelioration of the school-based outcome measures, reductions in Negative/Ineffective Discipline mediated improvement in children's social skills at school. For families showing the greatest reductions in Negative/Ineffective Discipline, effects of combined medication plus behavioral treatment were pronounced in relation to regular community care. Furthermore, only in combination treatment (and not in behavioral treatment alone) was decreased Negative/Ineffective Discipline associated with reduction in children's disruptive behavior at school. Here, children in families receiving combination treatment who showed the greatest reductions in Negative/Ineffective Discipline had teacher-reported disruptive behavior that was essentially normalized. Overall, the success of combination treatment for important school-related outcomes appears related to reductions in negative and ineffective parenting practices at home; we discuss problems in interpreting the temporal sequencing of such process-outcome linkages and the means by which multimodal treatment may be mediated by psychosocial processes related to parenting.     

Moderating Effects of Religious/Spiritual Coping in the Relation Between Perceived Stress and Psychological Well-Being

Although the relationship between stress and depressive symptoms is well documented, less is known about the role of coping strategies, in particular strategies for coping via religious or spiritual means. To investigate the relationships among these factors, data was collected with questionnaires completed by 127 MSW students at a northeastern university in 2003. Significant Stress×Religious/Spiritual Coping buffer interactions were found in the relationship between stress and depression. EQS 6.1 and hierarchical moderated regression analysis showed that religious/spiritual coping reduced the impact of stress on depression. Implications for practice are discussed.     

Temporal Associations Between Posttraumatic Stress Symptoms and Depression in Response to Online Expressive Writing Interventions in a Hispanic Sample

Some expressive writing (EW) interventions targeting posttraumatic stress symptoms (PTSS) may reduce both PTSS and comorbid depression symptoms. The temporal associations between PTSS and depression symptom levels in response to EW interventions are unknown. This study examined the directionality of PTSS and depression symptom levels from baseline to 1-week, 1-month, and 3-month follow-ups of two online EW interventions in a Hispanic sample with diverse trauma experiences. Participants (n = 70) completed either emotion-focused or fact-focused writing for 3 consecutive days online. A manifest autoregressive model with cross-lagged effects and treatment condition was analyzed. All but one first-order autoregressive path were statistically significant, with later PTSS and depression scores significantly predicted by those scores at preceding time points. The cross-lagged effects findings suggest that earlier PTSS levels influenced later depression levels, but earlier depression did not influence later PTSS, demonstrating a unidirectional temporal association. Severe PTSS may hinder EW treatment gains in depression. Superior outcomes for emotion-focused writing relative to fact-focused writing were also found.