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).     

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.     

Dimensions of distress tolerance and the moderating effects on mindfulness-based stress reduction

Background and Objectives: This study examined the relationship between distress tolerance and psychosocial changes among individuals participating in Mindfulness-Based Stress Reduction (MBSR). The objective of the analysis was to discern whether individuals with lower distress tolerance measured before MBSR showed larger reductions in perceived stress following MBSR. Design and Methods: Data were collected from a sample of convenience (n?=?372) using a quasi-experimental design. Participants completed self-report measures immediately prior to course enrollment and following course completion. Results: Perceived stress, distress tolerance, and mood states showed favorable changes from pre- to post-MBSR in the current study. Baseline distress tolerance significantly moderated reductions on perceived stress, supporting the primary hypothesis that individuals with lower baseline distress tolerance evidenced a greater decline in perceived stress following MBSR. For a one-unit increase on the self-reported baseline Distress Tolerance Scale, reported perceived stress scores decreased by 2.5 units (p?Conclusions: The finding that individuals with lower baseline distress tolerance evidenced a greater decline in perceived stress may offer hints about who is most likely to benefit from MBSR and other mindfulness-based treatments. Identifying moderators of treatment outcomes may yield important benefits in matching individuals to treatments that are most likely to work for them.     

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.     

Time Doesn’t Change Everything: The Longitudinal Course of Distress Tolerance and its Relationship with Externalizing and Internalizing Symptoms During Early Adolescence

Although distress tolerance is an emerging construct of empirical interest, we know little about its temporal change, developmental trajectory, and prospective relationships with maladaptive behaviors. The current study examined the developmental trajectory (mean- and individual-level change, and rank-order stability) of distress tolerance in an adolescent sample of boys and girls (N?=?277) followed over a four-year period. Next we examined if distress tolerance influenced change in Externalizing (EXT) and Internalizing (INT) symptoms, and if EXT and INT symptoms in turn influenced change in distress tolerance. Finally, we examined if any of these trends differed by gender. Results indicated that distress tolerance is temporally stable, with little mean- or individual-level change. Latent growth models reported that level of distress tolerance is cross-sectionally associated with both EXT and INT symptoms, yet longitudinally, only associated with EXT symptoms. These results suggest that distress tolerance should be a focus of research on etiology and intervention.     

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.     

Unique roles of antisocial personality disorder and psychopathic traits in distress tolerance

Previous research indicates that individuals with antisocial personality disorder (ASPD) evidence low distress tolerance, which signifies impaired ability to persist in goal-directed behavior during an aversive situation, and is associated with a variety of poor interpersonal and drug use outcomes. Based on theory and research indicating that psychopathic traits are associated with hypo-reactivity in emotional responding, a unique hypothesis emerges where psychopathic traits should have the opposite effect of ASPD and be related to high levels of distress tolerance. In a sample of 107 substance-dependent patients in an inner-city substance use residential treatment facility, this hypothesis was supported. ASPD was related to lower distress tolerance, while psychopathic traits were related to higher distress tolerance, with each contributing unique variance. Findings are discussed in relation to different presentations of distress tolerance as a function of psychopathic traits among those with an ASPD diagnosis.     

A multi-modal investigation of the roles of distress tolerance and emotional reactivity in obsessive-compulsive symptoms

Emerging evidence implicates important roles of poor distress tolerance and heightened emotional reactivity in obsessive-compulsive disorder. To date, investigations have relied mostly on self-report measures, and we sought to extend the literature by examining the relationship between OC symptoms and distress tolerance, as well as emotional reactivity, using three laboratory assessments. Nonclinical participants (N=167) viewed emotional films associated with four different negative emotions and also completed mirror tracing and handgrip persistence tasks. Greater obsessions scores were predictive of poorer emotional tolerance for a sad film and shorter persistence on the mirror tracing task. Among men only, obsessions were negatively correlated with persistence on the handgrip task. Associations between increased emotional reactivity and washing symptoms also emerged. These findings provide further evidence for the role of poor distress tolerance in obsessions and suggest heightened emotional reactivity may play a role in compulsive washing.     

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.     

Distress tolerance and experiential avoidance in compulsive acquisition behaviours

Compulsive buying (CB) is not only associated with impulse control disorders and specific domains of impulsivity, but is also highly comorbid with negative affect and depression, making it a candidate disorder to be characterised by poor emotion regulation. Despite emerging research supporting an association between distress tolerance and disorders of dysregulated behaviour, no study has investigated distress tolerance in the context of CB. The aim of the current study was to explore the relationship between CB and four specific domains of distress tolerance (appraisal, tolerance, absorption, regulation) and experiential avoidance. In a community‐recruited sample of compulsive buyers (n = 47) and healthy controls (n = 38), CB was significantly associated with each of the domains of distress tolerance (Distress Tolerance Scale). Furthermore, CB was associated with greater experiential avoidance (Acceptance and Action Questionnaire), which was in turn associated with each domain of distress tolerance. Analysis of variance demonstrated significant group differences in all measures. Nonparametric bootstrapping analysis revealed that general psychopathology, impulsivity, and experiential avoidance could not fully account for the relationship between distress tolerance and CB severity. Results suggest that distress tolerance and experiential avoidance may represent therapeutic targets in CB. Limitations and future directions are discussed.     

Does distress tolerance moderate the impact of major life events on psychosocial variables and behaviors important in the management of HIV?

Living with HIV involves management of multiple stressful disease-related and other life events. Distress tolerance may provide a functional, individual-based context for qualifying the established relationships between major life events and psychosocial variables important in the management of HIV. The present study provided a preliminary test of the hypothesis that distress tolerance moderates the impact of major life events on these predictors of disease progression. HIV-positive patients (n=116) completed psychosocial and medical questionnaires. Results indicated that major life events interacted with distress tolerance such that lower distress tolerance and higher life events were associated with significantly higher levels of depressive symptoms, substance use coping, alcohol and cocaine use, and medication adherence. In addition, distress tolerance was directly related to self-reported HIV-related symptoms. These results suggest that low distress tolerance, particularly in the face of major life events, may present significant challenges to adaptive management of HIV. Distress tolerance assessment may help to specify targets for cognitive-behavioral and stress management treatments for people living with HIV.     

A Multimodal Study of Childhood Trauma and Distress Tolerance in Young Adulthood

Individuals with a history of childhood trauma experience deficits in emotion regulation. However, few studies have investigated childhood trauma and both perceived (i.e., self-report) and behavioral measures of distress tolerance. The current study evaluated associations between childhood trauma (i.e., physical abuse, sexual abuse, and witnessing family violence) and measures of perceived (Distress Tolerance Scale) and behavioral distress tolerance (i.e., Paced Auditory Serial Addition Test, breath-holding). Participants were 320 undergraduate students with a history of interpersonal trauma (e.g., sexual/physical assault). Structural equation modeling was used to evaluate associations between frequency of childhood trauma type and distress tolerance. Greater childhood physical abuse was associated with higher perceived distress tolerance. Greater levels of witnessing family violence were associated with lower behavioral distress tolerance on the breath-holding task. No significant effects were found for Paced Auditory Serial Addition Test performance. Associations between childhood trauma and emotion regulation likely are complex and warrant further study.     

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.     

Distress tolerance but not impulsivity predicts outcome in concurrent treatment for posttraumatic stress disorder and substance use disorder

Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) commonly co-occur. Emerging research suggests that both distress tolerance and impulsivity may underlie this comorbidity. However, to our knowledge no studies have examined whether these 2 constructs predict outcome in PTSD-SUD treatment. The current study investigated whether pretreatment distress tolerance and impulsivity predicted posttreatment PTSD and cravings severity in a sample of 70 Veterans receiving concurrent treatment for PTSD and SUD in a residential day treatment program. Veterans completed measures of symptom severity before and after treatment. Results demonstrated that pretreatment distress tolerance predicted posttreatment PTSD severity while controlling for pretreatment PTSD. By contrast, pretreatment impulsivity was not predictive of posttreatment PTSD while controlling for pretreatment values. Neither distress tolerance nor impulsivity predicted posttreatment cravings severity. The findings support the notion that distress tolerance may help to explain the co-occurrence of PTSD and SUD and suggest that targeting this construct in PTSD-SUD treatment may be important for successful outcomes.     

The moderating role of proactive coping on the relationship between distress tolerance and elevated blood pressure

This study investigated the moderating role of proactive coping on the relationship between distress tolerance and elevated blood pressure (BP) among Nigerian adults with heart disease. Two hundred and forty hypertensive patients were recruited from the cardiology unit of a university teaching hospital (females = 56.2%%; mean age = 41.09 years, SD = 9.11 years). The participants responded to two self-reported measure including the Proactive Coping Inventory (PCI) and the Distress Tolerance Scale (DTS). Following moderated regression analysis, the results showed that proactive coping moderated the relationship between distress tolerance and elevated BP. The slope of the moderation analysis indicated that the relationship between distress tolerance and mean artery pressure was significantly higher for individuals with low proactive coping, as compared to individuals with higher proactive coping. Unlike reactive ways of coping, which addressed already existing stress, interventions aimed at increasing peoples’ proactive coping could be more efficacious in the management of people with high BP.     

The relationship between distress tolerance and antisocial personality disorder among male inner-city treatment seeking substance users

There is currently limited research on the potential mechanisms underlying the development of antisocial personality disorder (ASPD). One such mechanism, distress tolerance (defined as an individual's behavioral persistence in the face of emotional distress) may underlie the development of ASPD and its associated behavioral difficulties. It was hypothesized that substance users with ASPD would evidence significantly lower levels of distress tolerance than substance users without ASPD. To test this relationship, we assessed 127 inner-city males receiving residential substance abuse treatment with two computerized laboratory measures of distress tolerance. The mean age of the sample was 40.1 years (SD = 9.8) and 88.2% were African American. As expected, multiple logistic regression analyses indicated that distress intolerance significantly predicted the presence of an ASPD diagnosis, above and beyond key covariates including substance use frequency and associated Axis I and II psychopathology. Findings suggest that distress tolerance may be a key factor in understanding the development of ASPD, setting the stage for future studies expanding on the nature of this relationship, as well as the development of appropriate interventions for this at-risk group.     

Parental Distress Tolerance in Three Periods of Child Development: The Moderating Role of Child Temperament

Emotion regulation (ER) is essential to everyday, normative functioning. One aspect of ER is distress tolerance—the ability to persist in goal-directed activities when experiencing aversive states. Despite an assumption that ER improves with age, very little is known about ER across parenthood. Emotion regulation may be taxed by parenthood with implications for negativity in the family environment. The purpose of the current study was to describe levels of distress tolerance across periods of parenthood and to evaluate child temperament as a moderator of the relationship between child’s age and parents’ distress tolerance. A total of 602 parents (66.3% female, M _age ? =?32.31 years, SD?=?7.07) whose eldest child belonged to one of three developmental periods (i.e., infancy, n?=?187; early childhood, n?=?214; late childhood, n?=?201) completed an online survey. While we found no evidence for a main effect of child’s age on parent distress tolerance, children’s negative affectivity moderated the association between period of parenthood and parent distress tolerance. Specifically, children who were higher in negative affectivity had parents who reported less distress tolerance between the developmental periods. The implications of the current study are discussed in the context of current and future research on emotional regulation among parents.     

Depression Mediates the Relationship Between Distress Tolerance and Nonsuicidal Self‐Injury Among Adolescents: One‐Year Follow‐Up

Through a one‐year follow‐up design, this study examined whether distress tolerance would increase the risk for nonsuicidal self‐injury (NSSI), mediated through depression in a representative sample of adolescents. Participants (N  = 2,170) were recruited from senior high schools throughout Taiwan using both stratified and cluster sampling in time 1 (T1), and 1,832 students were followed‐up one year later (T2). Structure equation modeling results revealed that after controlling NSSI measured at T1, NSSI (T2) was significantly predicted by distress tolerance (T1) and fully mediated through depression (T2). The mediating role of depression in the relationship between distress tolerance and NSSI are discussed.     

Parental reflective functioning is associated with tolerance of infant distress but not general distress: Evidence for a specific relationship using a simulated baby paradigm

Parental reflective functioning represents the capacity of a parent to think about their own and their child's mental states and how these mental states may influence behavior. Here we examined whether this capacity as measured by the Parental Reflective Functioning Questionnaire relates to tolerance of infant distress by asking mothers (N = 21) to soothe a life-like baby simulator (BSIM) that was inconsolable, crying for a fixed time period unless the mother chose to stop the interaction. Increasing maternal interest and curiosity in their child's mental states, a key feature of parental reflective functioning, was associated with longer persistence times with the BSIM. Importantly, on a non-parent distress tolerance task, parental reflective functioning was not related to persistence times. These findings suggest that parental reflective functioning may be related to tolerance of infant distress, but not distress tolerance more generally, and thus may reflect specificity to persistence behaviors in parenting contexts.     

Distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility

A large percentage of individuals who enter residential substance abuse treatment drop out before completing treatment. Given that early treatment dropout places individuals at an increased risk for relapse, identifying the mechanisms underlying treatment dropout would have several important theoretical and clinical implications. In the current study, the authors examined levels of psychological and physical distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility. In a sample of 122 individuals entering a residential substance abuse treatment facility, level of psychological distress tolerance was predictive of early treatment dropout above and beyond relevant self-report variables. There was no relationship between physical distress tolerance and early treatment dropout. Implications for future studies and treatment development or modification are discussed.