Enhanced Anger Reactivity and Reduced Distress Tolerance in Major Depressive Disorder

Effect of Dialectical Behavior Therapy on Negative Affect, and Symptoms of Depression and Anxiety in Individuals with Borderline Personality Disorder during COVID-19 Pandemic

Background: This study investigated the effectiveness of dialectical behavior therapy (DBT) in patients with borderline personality disorder (BPD) during the COVID-19 pandemic, assessing negative affect, depression, and anxiety levels as indicators of health. Methods: A total of 287 participants were recruited, including BPD patients at different stages of treatment and the general population without a diagnosis of BPD. Questionnaires were used to assess the fear of COVID-19 and the referenced health indicators. Results: No differences were observed between groups in levels of fear of COVID-19, but there were differences in the health indicators studied. BPD patients in long-term treatment showed levels of negative affect similar to those of the general population, while those in early treatment stages exhibited significantly higher levels. However, no significant improvements were observed in levels of depression and anxiety in the long-term treatment group compared to those who underwent the initial treatment phase. Conclusions: These findings underscore the importance of effectively intervening in BPD, especially in stress-inducing situations such as the pandemic, and suggest the need to explore complementary approaches to addressing depression and anxiety in this clinical context.

Childhood bullying victimization, emotion regulation, rumination, distress tolerance, and depressive symptoms: A cross-national examination among young adults in seven countries

Existing research suggests a robust association between childhood bullying victimization and depressive symptoms in adulthood, but less is known about potential mediators of this link. Furthermore, there is limited cross-national research evaluating similarities and differences in bullying victimization and its associations with mental health. The current study addressed gaps in the literature by evaluating cognitive and affective responses to stress (i.e., emotion regulation, rumination, and distress tolerance) as potential mediators of the link between recalled bullying victimization and current depressive symptoms among 5909 (70.6% female) college students from seven countries. Results revealed specific indirect associations of bullying victimization through distress tolerance and three out of four facets of rumination, as well as a persistent direct association of childhood bullying on adulthood depression. Emotion regulation strategies were not significantly associated with bullying victimization and did not mediate its association with depressive symptoms. Constrained multigroup models indicated that results were invariant across country and gender. Findings provide evidence of statistical mediation in a cross-sectional sample and await replication in prospective studies. Rumination and distress tolerance may be promising targets for resilience-promoting interventions among children experiencing peer victimization. Ongoing research is needed to clarify cross-national patterns in childhood bullying, identify additional mediators accounting for the remaining direct association, and evaluate emotion regulation as a potential moderator of associations between bullying victimization and adult mental health.

Transdiagnostic Approach and Obsessive Compulsive Disorder

The categorical approach of traditional psychiatric nosology has been a forceful approach for a very long time for explaining psychological disorders which are defined by symptom based diagnostic categories. However, in recent years, the importance of the "transdiagnostic" approach which is a new classification system is increasing. The transdiagnostic approach aims to examine dimensionally the common cognitive, behavioral, interpersonal and biological processes underlying many psychopathologies away from the categorical approach that classifies psychopathologies according to observable symptoms. This approach intends to treat the disorders through the common underlying processes and risk factors, thus heterogeneous and comorbid symptoms are better addressed and diagnostic categories that may change during treatment are avoided. In this review study, the current problems in diagnosing based on classification and gaps in the field were examined, and the approach itself was proposed as a solution. RDoC (Research Domain Criteria) which is a new classification system for psychiatric disorders within the scope of the approach, has created a new structure using modern research approaches in genetics, neuroscience and behavioral sciences. In the present study, the definition and emergence of the transdiagnostic approach, obsessive compulsive disorder and RDoC in the context of transdiagnostic approach and transdiagnostic treatment are explained. This review is intended to be a resource for both basic psychopathology research and the development of treatment methods within the framework of a transdiagnostic approach.

Understanding the benefits of extrinsic emotion regulation in depression

Depression is a serious psychiatric illness that negatively affects people's feelings, thoughts, and actions. Providing emotion regulation support to others, also termed Extrinsic Emotion Regulation (EER), reduces depressive symptoms such as perseverative thinking and negative mood. In this conceptual review paper, we argue that EER may be especially beneficial for individuals with depression because it enhances the cognitive and affective processes known to be impaired in depression. Behavioral studies have shown that EER recruits processes related to cognitive empathy, intrinsic emotion regulation (IER), and reward, all impaired in depression. Neuroimaging data support these findings by showing that EER recruits brain regions related to these three processes, such as the ventrolateral prefrontal cortex which is associated with IER, the ventral striatum, which is associated with reward-related processes, and medial frontal regions related to cognitive empathy. This conceptual review paper sheds light on the mechanisms underlying the effectiveness of EER for individuals with depression and therefore offers novel avenues for treatment.

Challenges for Artificial Intelligence in Recognizing Mental Disorders

Artificial Intelligence (AI) appears to be making important advances in the prediction and diagnosis of mental disorders. Researchers have used visual, acoustic, verbal, and physiological features to train models to predict or aid in the diagnosis, with some success. However, such systems are rarely applied in clinical practice, mainly because of the many challenges that currently exist. First, mental disorders such as depression are highly subjective, with complex symptoms, individual differences, and strong socio-cultural ties, meaning that their diagnosis requires comprehensive consideration. Second, there are many problems with the current samples, such as artificiality, poor ecological validity, small sample size, and mandatory category simplification. In addition, annotations may be too subjective to meet the requirements of professional clinicians. Moreover, multimodal information does not solve the current challenges, and within-group variations are greater than between-group characteristics, also posing significant challenges for recognition. In conclusion, current AI is still far from effectively recognizing mental disorders and cannot replace clinicians' diagnoses in the near future. The real challenge for AI-based mental disorder diagnosis is not a technical one, nor is it wholly about data, but rather our overall understanding of mental disorders in general.

Testing the Feasibility and Acceptability of an Acceptance and Commitment Therapy Intervention to Increase Physical Activity among Individuals with Depression: A Protocol Paper

Background

Engaging in regular physical activity (PA) is particularly important among individuals with depression, who are at heightened risk for a host of negative health outcomes. However, people with depression are 50% less likely to meet national guidelines for PA and face unique barriers to PA adherence, including lower distress tolerance and motivation for exercise. Acceptance and Commitment Therapy (ACT) may offer promise for increasing PA among adults with depressive symptoms due to its effects on distress tolerance and motivation. Therefore, we developed ACTivity, an ACT-based intervention designed to promote PA among low-active adults with elevated depressive symptoms. Prior to testing the efficacy of ACTivity in an RCT, an important first step is to conduct a preliminary trial to establish feasibility of study procedures for the ACTivity and comparison intervention programs, as well as to establish the credibility/acceptability of the intervention. The purpose of this paper is to describe the ACTivity intervention and the design of this feasibility trial.

Method/Design

We will conduct a feasibility RCT with two parallel groups and a 1:1 allocation ratio comparing ACTivity to a comparison intervention (relaxation training + PA promotion) among 60 low-active adults with elevated depressive symptoms. All study procedures will be conducted remotely.

Discussion

Results of this feasibility study will inform a subsequent RCT designed to test the efficacy of ACTivity. If shown to be efficacious, ACTivity will provide a treatment that can be widely disseminated to increase PA among adults with depressive symptoms and thereby decrease their risk for chronic disease.

Predicting Different Types of Intimate Partner Aggression Perpetration: The Roles of Problem Alcohol Use and Distress Tolerance

Intimate partner aggression (IPA) victimization and substance use have been well established as risk factors for IPA perpetration (Leonard, 2005; Sprunger et al., 2015). Recent research has identified a negative association between distress tolerance and physical and psychological IPA perpetration, specifically in males in substance use treatment (Shorey et al., 2017). Research examining the interplay of problem substance use, distress tolerance, and other forms of IPA (i.e., sexual coercion, controlling behaviors) in non-clinical samples is limited. The present analysis aimed to examine the potential moderating effect of distress tolerance on problem alcohol use and four types of IPA perpetration (physical assault, psychological aggression, sexual coercion, and controlling behaviors) in a diverse, national sample (N = 323; 44.3% female; 52.9% sexual minority; age M = 33.61 years, SD = 8.71). Results showed that alcohol use and distress tolerance had differing influences on each IPA perpetration type. In line with hypotheses, distress tolerance significantly moderated the relationship between problem alcohol use and two forms of IPA (physical assault and controlling behaviors); this relationship was stronger for individuals with low levels of distress tolerance. Significant interaction effects did not emerge for psychological aggression or sexual coercion. Findings suggest that treatment strategies that focus specifically on increasing distress tolerance may be effective in reducing alcohol-facilitated IPA perpetration involving physical assault and controlling behaviors.

Relations between emotion regulation strategies and affect in daily life: A systematic review and meta-analysis of studies using ecological momentary assessments

Emotion regulation (ER) is a central target in the study of psychological and neurobiological processes of emotions for numerous psychological disorders. Ecological momentary assessments, overcoming retrospective self-reports, allow a better understanding of the relation between the use of ER strategies and daily life affective experiences. A systematic review and meta-analyses of studies testing these relations through experience sampling methods (ESM) and daily diaries were conducted. ESM studies showed significant large effect sizes in contemporaneous relations between negative affect (NA) and rumination, suppression, and worry, and in both contemporaneous and prospective relations between positive affect (PA) and reappraisal; medium effect sizes in prospective relations between NA and rumination, and PA and distraction; and a small effect size in the prospective relation between NA and suppression. Daily diary studies showed significant large effect sizes in contemporaneous relations between NA and rumination and suppression, and in both contemporaneous and prospective relations between PA and reappraisal; medium effect sizes in contemporaneous relations between PA and acceptance, and problem-solving; and a small effect size in the prospective relation between NA and reappraisal. These findings shed light on the temporal relations between the use of ER strategies and affective experiences and highlight conceptual and methodological limitations in the field.

Emotion Reactivity and Suicide Ideation Among Chinese Adolescents: A Longitudinal Serial Mediation Model

OBJECTIVE

Previous studies have indicated that emotion reactivity is an important predictive factor for suicide ideation. However, the mechanism underlying their association has remained largely unexplored. The current study aims to investigate a serial mediation model to examine the potential mechanism in the relationship between emotion reactivity and suicide ideation.

METHOD

A total of 5,423 Chinese adolescents (52.7% females, M_age = 14.63 years, SD = 1.25) completed self-report questionnaires regarding emotion reactivity, suicide ideation, distress intolerance, and depressive symptoms. Assessment was conducted for two waves, 6 months apart.

RESULTS

In descriptive analyses, the prevalence of suicide ideation in this study was 15.3% for Wave 1 and 14.3% for Wave 2. Emotion reactivity, distress intolerance, and depressive symptoms were positively related to suicide ideation. In serial mediation analyses, there was a significant total effect of emotion reactivity on suicide ideation. After controlling for baseline variables, distress intolerance and depressive symptoms played serial mediating roles in the relation between emotion reactivity and suicide ideation, with emotion reactivity influencing suicide ideation through three mediation pathways.

CONCLUSIONS

This study demonstrates a potential mechanism underlying the path from emotion reactivity to suicide ideation. Interventions that target emotion reactivity may be an effective way to reduce the risk of developing suicide ideation. HIGHLIGHTSEmotion reactivity was positively related to suicide ideation.Distress intolerance and depressive symptoms mediated the relationship between emotion reactivity and suicide ideation.Emotion reactivity also exerted an influence on suicide ideation through serial mediation of distress intolerance and depressive symptoms, after controlling for baseline variables.

An evaluation of mental health and emotion regulation experienced by undergraduate nursing students in China during the COVID-19 pandemic: A cross-sectional study

The COVID-19 outbreak negatively impacted the mental health and emotions of many individuals. The study presented here explores the mental health and emotion regulation experienced by undergraduate nursing students in China during the pandemic. Potential risk factors related to negative mental health symptoms were identified in this study. An online cross-sectional study including 342 respondents was performed from March 6, 2020, to April 1, 2020, at a University in China. A Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Emotion Regulation Questionnaire (ERQ) were used to evaluate mental health and emotions. The statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 22. The prevalence of anxiety, depression, or comorbid anxiety and depression were 55.0%, 56.4%, and 31.6%, respectively. The mean score of cognitive reappraisal and expressive suppression was 29.36 ± 8.00 and 15.55 ± 5.14. Lower scores for cognitive reappraisal and higher scores for expressive suppression were susceptible to symptoms of anxiety, depression, or comorbid anxiety and depression. Issues with mental health occurred in nursing students during the COVID-19 pandemic. Findings from this study provide a better understanding of the association between mental health and emotion regulation, which will help direct psychological intervention that relieves these issues during the pandemic.

Distinguishing veterans with suicidal ideation from suicide attempt history: The role of emotion reactivity

INTRODUCTION

Growing evidence suggests emotion reactivity-sensitivity and intensity of emotional experience-may represent a diathesis for suicide risk. However, our understanding of its ability to differentiate risk for suicidal ideation (SI) from suicide attempt (SA) is limited.

METHOD

This study compares Veterans with SI (n = 81) to Veterans with SA (n = 177) history on factors relevant to emotion reactivity to determine which variable(s) best differentiate groups. Variables examined are multimodal: (a) self-report: childhood trauma, combat exposure; (b) clinician-assessed: non-suicidal self-injury (NSSI), structured diagnostic interview of psychopathology; and (c) psychophysiological: affect-modulated startle (AMS; proxy for amygdala reactivity and emotion reactivity) to unpleasant pictures was examined in a subset (n = 90).

RESULTS

SA history was independently predicted by NSSI history, MDD, PTSD, and SUD diagnosis. Childhood trauma and combat exposure did not differentiate groups. The composite risk index demonstrated good accuracy (AUC=0.71, sensitivity=0.90, specificity=0.49). Only AMS independently predicted SA history when added to the model and accuracy was improved (AUC=0.82, sensitivity=0.85, specificity=0.56).

CONCLUSION

NSSI history, MDD, PTSD, and SUD diagnosis may be salient risk factors for this population. However, emotion reactivity is a more parsimonious predictor of SA history among Veterans suggesting it is an important treatment target among Veterans with SI.

Assessing Physical Pain Perception and Psychological Distress Tolerance through the MMPI-2-RF: A Comparison of Multimethod Measures

While transdiagnostic factors are important domains in clinical assessment and treatment, there is little research to link such constructs to widely accepted and utilized broadband assessments such as the Minnesota Multiphasic Personality Inventory, 2nd edition - Restructured Form (MMPI-2-RF). A handful of studies suggest the ability of the MMPI-2-RF scales to capture variance in transdiagnostic constructs; however, this literature relies solely on self-report criterion measures, despite evidence that self-report and behaviorally-indexed correlates of psychopathology may measure varied aspects of the intended construct and can often yield differing results. The current study investigated MMPI-2-RF scales' ability to assess two widely examined transdiagnostic constructs, distress tolerance and pain perception, across both self-report and behavioral indicators. The sample included 115 undergraduate students who completed a valid MMPI-2-RF and multimethod measures of pain perception and distress tolerance. The results aligned with prior research in areas of internalizing symptoms, psychopathy, and suicide risk factors in self-report, but not behaviorally-based, assessment. Implications of this inconsistency, the association between clinical assessment and transdiagnostic constructs, and the heterogeneity of the distress tolerance and pain perception constructs are discussed.

Influences on childhood depressive symptoms: The effects of trauma and distress tolerance across age and sex groups

BACKGROUND

Depression affects many children and adolescents, leading to poor academic performance, impaired psychosocial functioning, and an increased frequency of suicidal behavior. Depression has also been notably associated with trauma and distress tolerance. Our study sought to understand the relationships of these variables across age and sex categories in youth and adolescents.

METHODS

The current study examined data from a total of 324 participants between the ages of 7 and 17 years-old who were a part of a larger study. Data related to age, sex, depression, trauma, and distress tolerance were examined.

RESULTS

A multiple regression revealed a significant interaction between age and sex on depression severity. Further, trauma and age by sex categories significantly predicted depression score, as well as distress tolerance predicting depression score. Lastly, a regression analysis, including trauma, distress tolerance, and age by sex categories were significant predictors of depression.

LIMITATIONS

The results are limited by the cross-sectional design.

CONCLUSION

Clinicians should consider age by sex effects when treating childhood depression. Future research should further the understanding of depression across age and sex groups, as well as among children with extensive trauma experiences. Future research should also seek to further understand the implications of distress tolerance therapy on childhood depression.

Brief psychological intervention for distress tolerance in an adult secondary care community mental health service: an evaluation

Distress intolerance has been suggested to be a maintaining factor in several mental health conditions. Distress tolerance skills training has been found to be beneficial in emotionally unstable personality disorder (EUPD) and post-traumatic stress disorder (PTSD). Short-term targeted interventions are increasingly being implemented in response to demand. This study investigates the efficacy of a distress tolerance brief psychological intervention (DT BPI) delivered by non-psychologists within an adult secondary care mental health service. Questionnaire data (pre and post) are reported from 43 participants who completed the intervention. Results suggest that the intervention was associated with significant improvements in distress tolerance, mood, anxiety and wellbeing. This indicates that a DT BPI can be effective when delivered by non-psychologists to real-world adult secondary care clients. The findings offer promising evidence that DT BPI could be a beneficial, cost-effective intervention and warrants further large-scale investigation.

Key learning aims

(1)

Distress Tolerance as a Familial Vulnerability for Distress-Misery Disorders

Low perceived distress tolerance (DT), a trait-like individual difference factor reflecting one's perceived ability to withstand aversive affective states, has been linked with current internalizing and substance use disorders (SUDs). However, perceived DT has not been systematically evaluated as a familial, transdiagnostic vulnerability factor for internalizing and SUDs. The current study tested whether perceived DT runs in families and whether it is reduced among individuals with versus without remitted internalizing/SUD psychopathology. Perceived DT and internalizing/SUDs were measured in 638 individuals (nested within 256 families). Analyses also adjusted for the effects of neuroticism to test whether DT was a specific vulnerability factor independent of temperamental negative affect. Analyses revealed that perceived DT was lower in individuals with remitted distress (i.e., major depression, generalized anxiety disorder, posttraumatic stress disorder) but not fear disorders (i.e., panic disorder, social anxiety disorder, specific phobia, obsessive-compulsive spectrum disorders) relative to healthy controls, and the effect of distress-misery disorder history remained significant when adjusting for neuroticism. Perceived DT was not significantly different among individuals with versus without a remitted SUD. There were no effects for comorbid SUD and distress-misery disorders. Finally, perceived DT was also significantly correlated within families, suggesting that it runs in families. Overall, results suggest that independent of neuroticism, low perceived DT is a familial vulnerability for distress (but not fear or substance use) disorders.

Confirming the Factor Structure and Validity of the Distress Tolerance Scale (DTS) in Youth

Distress tolerance (DT) is an individual's ability to handle uncomfortable emotion states or sensations (Simons and Gaher in Motiv Emot 29(2): 83-102, 2005). DT is associated with heightened risk for psychopathology, including internalizing symptoms. However, little research has examined the feasibility of assessing DT via youth self-report. The purpose of this investigation was to assess the psychometric properties of the Distress Tolerance Scale (DTS) (Simons and Gaher in Motiv Emot 29(2): 83-102, 2005) in community (n = 117; ages 10-19; 56.4% female) and clinical samples (n = 165; ages 10-18, 52.7% female) of youth. Predictors of DT and its association with internalizing symptoms were investigated. The majority of fit indices confirmed a four-factor hierarchical structure for the clinical sample data. Females reported lower DT than males and DT was associated with internalizing symptoms. Validation of the factor structure of the DTS allows for investigation of child and adolescent-reported perceptions of DT as a risk factor for psychopathology in youth.

Regulation of Craving and Negative Emotion in Alcohol Use Disorder

BACKGROUND

Alcohol use disorder (AUD) is a chronic, relapsing condition with poor treatment outcomes. Both alcohol craving and negative affect increase alcohol drinking, and-in healthy adults-can be attenuated using cognitive strategies, which rely on the prefrontal cortex (PFC). However, AUD is associated with cognitive impairments and PFC disruptions. Thus, we tested whether individuals with AUD can successfully recruit the PFC to effectively regulate craving and negative emotions, whether neural mechanisms are shared between the two types of regulation, and whether individual differences influence regulation success.

METHODS

During functional magnetic resonance imaging, participants with AUD completed the regulation of craving task (n = 17) that compares a cue-induced craving condition with an instructed regulation condition. They also completed the emotion regulation task (n = 15) that compares a negative affect condition with an instructed regulation condition. Regulation strategies were drawn from cognitive behavioral therapy treatments for AUD. Self-reported craving and negative affect were collected on each trial.

RESULTS

Individuals with AUD effectively regulated their craving and negative affect when instructed to do so using cognitive behavioral therapy-based strategies. Regulation was associated with recruitment of both common and distinct PFC regions across tasks, as well as with reduced activity in regions associated with craving and negative affect (e.g., ventral striatum, amygdala). Effective regulation of craving was associated with negative alcohol expectancies.

CONCLUSIONS

Both common and distinct regulatory systems underlie regulation of craving and negative emotions in AUD, with notable individual differences. This has important implications for AUD treatment.

Why Do People With Depression Use Faulty Emotion Regulation Strategies?

Why do people with psychopathology use less adaptive and more maladaptive strategies for negative emotions if such usage has self-destructive consequences? Although researchers have examined the reasons for people’s engagement in maladaptive “behaviors,” such as nonsuicidal self-injury, surprisingly little attention has been paid to the reasons why people might endorse maladaptive emotion regulation (ER) strategies. This article addresses this question, focusing on the case of depression, evaluating an array of 10 possible explanations. After considering the existing evidence, we provide a blueprint to help the field reach stronger conclusions about depression and other forms of psychopathology. Better understanding of the origins of healthy/unhealthy ER has implications for clinical science, clinical practice, as well as their integration.

Interrelations Among Biologically Relevant Personality Traits, Emotion Regulation Strategies, and Clinical Symptoms

Biologically relevant personality traits of weak inhibitory control (disinhibition) and threat sensitivity confer vulnerability to various clinical problems. Difficulties with emotion regulation have also been studied extensively in relation to risk for and maintenance of psychopathology. However, it remains unclear how emotion regulation strategies interface with dispositional vulnerabilities in affecting clinical symptomatology. The current study provided an initial examination of the roles of disinhibition, threat sensitivity, and use of key emotion regulation strategies (cognitive reappraisal, expressive suppression) in the occurrence of distress-related symptoms (i.e., depressivity, anxiousness, and borderline personality features). Analyses revealed that trait disinhibition and lowered use of cognitive reappraisal were related to each form of distress symptomatology, with the predictive relationship for disinhibition accounting entirely for that of reappraisal. This finding suggests that deficient top-down control capacity (i.e., disinhibition) is integral to failures in the use of an adaptive but cognitively demanding regulation strategy (i.e., reappraisal). By contrast, threat sensitivity was related both to anxiousness and use of expressive suppression, with the latter two variables unrelated to one another. Anxious individuals may avoid emotionally evocative situations, negating the downstream need to engage in the maladaptive strategy of expressive suppression. Despite certain study limitations (a cross-sectional, self-report design; modest sample size), the current study yielded evidence in line with study hypotheses, indicating a pivotal role for dispositional traits in associations between cognitive-behavioral processes and clinical problems.

Military hazing and suicidal ideation among active duty military personnel: Serial mediation effects of anger and depressive symptoms

BACKGROUND

Military hazing is one of most serious problems affecting suicidal ideation (SI) among active duty personnel, but has received limited research attention. Studies on hazing and SI indicate anger and depressive symptoms as mediators for SI.

METHODS

A sample of active duty military personnel (N = 944) completed an offline survey, consisting of the revised Conflict Tactics Scale-2, Composite International Diagnostic Interview Screening Scale, and revised Columbia Suicide Severity Rating Scale. Frequency, bivariate correlation, and serial mediation analyses were conducted to assess the serial effects of military hazing on SI, mediated via anger and depressive symptoms.

RESULTS

Military hazing, anger, depressive symptoms, and SI were positively related to each other in bivariate analyses. In serial mediation analyses, hazing was found to be a significant predictor of higher levels of anger, consequently triggering depressive symptoms, which, in turn, were associated with greater SI.

LIMITATIONS

Study limitations included the use of cross-sectional data with the use of retrospective self-report.

CONCLUSION

Hazing in the military is prevalent (17.6%), and SI is associated with serial effects of hazing, anger, and depressive symptoms with full mediation path. Findings suggest that policies that address reducing hazing and implementing clinical interventions specifically focused on symptoms of anger and depression may be important for decreasing SI in military personnel.

Cross-Domain Assessment of Distress Intolerance: Associations With Borderline Personality Disorder Features

Distress tolerance (DT) is central to major etiological theories of, and popular treatments for, borderline personality disorder (PD), but empirical evidence for the connection between DT and borderline PD is inconclusive. Such inconsistency is partly due to limited concordance across DT indices from different measurement domains (e.g., behavioral, physiological). In a student sample (N = 267), we assessed subjective perceptions of DT capabilities, task performance on a distressing laboratory challenge, and borderline pathology. Subjective and behavioral indices of DT were largely unrelated. Further, borderline PD features were moderately associated with self-perceived DT (r = -.53); in contrast, they were weakly related to performance on the DT task (r = -.09). We conclude that there is mixed evidence for an association between borderline pathology and DT. Further, we propose a systematic approach to examining the construct validity of DT in multimethod, multimeasure research that might resolve the equivocal results from prior work.

An Examination of the Association Between Emotion Reactivity and Distress Tolerance Among College Students

The goal of the present investigation was to examine associations between emotion reactivity in global and specific distress tolerance domains. Participants were 113 undergraduates (65.5% female, 82.3% Caucasian; Mage = 20.0, SD = 4.02, range = 18-45 years) who completed a battery of self-report measures. As hypothesized, the results indicate that, after controlling for sex and negative affectivity, greater levels of emotion reactivity were significantly associated with lower levels of global distress tolerance (12.5% unique variance) and the four specific distress tolerance domains: tolerance (8.6% unique variance), absorption (11.4% unique variance), appraisal (8% unique variance), and regulation (8.1% unique variance). These findings suggest that individuals who tend to react more strongly to their emotions have greater difficulty tolerating emotional distress, and interventions that target emotion reactivity may be an effective way to improve distress tolerance and reduce the risk of developing psychopathology among undergraduates.

Unique and Interactive Relations among Posttraumatic Stress, Distress Tolerance, and Anger Responding to Traumatic Event Cues

Experimental and clinical studies have demonstrated an association between posttraumatic stress symptoms (PTSS) and anger. Expanding upon past research, the current study examined the interactive associations among PTSS, distress tolerance (DT), and anger responding among a sample of 95 trauma-exposed adults. This study used a personalized script-driven imagery procedure to gauge emotional responses. Results from a hierarchical linear regression demonstrated a main effect of PTSS and an interaction between PTSS and DT. Simple slope analyses indicated that PTSS level was unrelated to anger responding among traumatic event-exposed people relatively low in DT, while anger responses were positively correlated with levels of PTSS among those relatively higher in DT. These findings highlight the need for future research to consider distress tolerance as well as other emotional vulnerability factors in assessing PTSD-related anger.

Anxiety Sensitivity and Distress Tolerance Typologies and Relations to Posttraumatic Stress Disorder: A Cluster Analytic Approach

A growing literature suggests a relationship between a high anxiety sensitivity (AS; the fear of anxiety and its related consequences)/low distress tolerance (DT; the capacity tolerate internal negative states) profile and posttraumatic stress disorder (PTSD) symptoms. However, specific profiles have not been identified or examined specifically in veteran samples. Thus, the aims of the present study were to establish empirically derived profiles created from response patterns on the Anxiety Sensitivity Index and Distress Tolerance Scale and to examine associations with PTSD symptom clusters among a sample of combat-exposed veterans (N = 250). A cluster analytic approach was utilized to identify AS/DT profiles, and a series of MANOVAs with post hoc analyses was conducted to examine the relationship between each AS/DT profile and each PTSD symptom cluster. Results indicated a three-cluster solution including a high AS/low DT "at risk" profile, a low AS/high DT "resilient" profile, and an average AS/DT "intermediate" profile. The at-risk profile was associated with significantly greater symptoms in each PTSD cluster (i.e., hyperarousal, avoidance, re-experiencing) when compared to the other two profiles. The at-risk profile was also associated with greater depressive symptoms and lower self-reported resilience. These findings extend the previous literature by identifying a high AS/low DT "at risk" profile and its associations with PTSD symptoms, underscoring the potential utility in targeting these affect-regulation constructs for clinical intervention.

Is distress tolerance an approach behavior? An examination of frontal alpha asymmetry and distress tolerance in adolescents

Frontal EEG asymmetry, relatively greater left-than-right frontal activity (rLFA), has been associated with mood symptoms and approach versus withdrawal behaviors. Distress tolerance (DT), a transdiagnostic behavior, has yet to be examined as an approach behavior using rLFA. Adolescents (N = 20; M age = 14.53, SD = 2.09) completed a frustrating mirror-tracing task which provided an index of DT. Higher resting rLFA was associated with lower DT. The results are the first to identify a relationship between cortical activation and distress tolerance in adolescents. rLFA appears to be a neurophysiological index of behaviors associated with approach motivation and escape from punishment or aversive situations.

Metacognitions or distress intolerance: The mediating role in the relationship between emotional dysregulation and problematic internet use

OBJECTIVE

Given the relevance of problematic Internet use (PIU) to everyday life, its relationship to emotional dysregulation and the importance of metacognitions and distress intolerance in process and intermediaries research, this study examined which of metacognitions and distress intolerance acts as an intermediary between emotional dysregulation and PIU.

METHODS

In the current study, 413 undergraduate students from the University of Tehran, Iran (202 females; mean age = 20.13) voluntarily completed a questionnaire package which included the Internet Addiction Test (IAT), Difficulties in Emotion Regulation Scale (DERS), Metacognitions Questionnaire 30 (MCQ-30(, and Distress Tolerance Scale (DTS). The data were then analyzed using structural equation modeling by LISREL software.

RESULTS

Significant correlations were found between PIU and emotional dysregulation and both distress intolerance and metacognitions (P < 0.001). Structural equation modeling and path analysis results fit well to the data (χ2/df = 1.73; p < 0.001; RMSEA = 0.05; SRMR = 0.04; CFI = 0.97; NFI = 0.95). The results of the mediational model indicated that emotional dysregulation has an indirect impact via metacognition (β = 0.31; SE = 0.02) and distress tolerance (β = - 0.60; SE = 0.03) on PIU. The analysis also revealed a significant direct impact of emotional dysregulation on PIU, although this impact is much less than the indirect impact. The variables in this model accounted for 62% of the variance in participants' PIU levels.

CONCLUSION

The results of this study provide evidence for the impact of emotional dysregulation on PIU through metacognitions and distress intolerance. Also, these findings emphasize that distress intolerance has a more significant mediating role than metacognition in the relationship between emotional dysregulation and PIU.

The developmental trajectory of perceived stress mediates the relations between distress tolerance and internalizing symptoms among youth

The current study examines the relation between distress tolerance, perceived stress, and internalizing symptoms across adolescence. Participants included 331 youth, ages 10 to 14 at the first wave of the study, assessed annually over 5 years. A latent growth curve approach was used to test three research questions, including whether perceived stress would increase across adolescence, whether distress tolerance (as measured by a behavioral task) would predict changes in perceived stress, and whether changes in perceived stress would mediate the relation between distress tolerance and internalizing symptoms. Results suggest that, consistent with previous findings, rates of perceived stress do increase across adolescence. Further, findings indicate that distress intolerance at baseline predicted increases in perceived stress, which in turn drove increases in internalizing symptoms. These findings point to the critical role of distress tolerance in bringing about changes in depression and anxiety symptoms and suggest support for utilizing a negative reinforcement framework to understand the emergence of internalizing symptomology.

Transdiagnostic emotional vulnerabilities linking obsessive-compulsive and depressive symptoms in a community-based sample of adolescents

BACKGROUND

Transdiagnostic emotional vulnerabilities are suspected to underlie psychopathologic comorbidity but have received little attention in adolescent emotional pathology literature. We examined distress tolerance, anxiety sensitivity, and anhedonia as concomitant transdiagnostic mechanisms that account for (i.e., statistically mediate) the covariance between adolescent obsessive-compulsive disorder (OCD) and major depressive disorder (MDD) symptoms.

METHOD

Data on MDD, OCD, and the three aforementioned transdiagnostic vulnerabilities were collected from a community-based sample of 3,094 ninth graders in a large metropolitan area and analyzed using mixed effects modeling to evaluate mediation effects.

RESULTS

Individually and when controlling for each other, all three transdiagnostic vulnerabilities mediated the relation between OCD and MDD symptoms both before and after adjusting for demographics.

CONCLUSIONS

Distress tolerance, anxiety sensitivity, and anhedonia may be unique mechanisms accounting for comorbidity between OCD and MDD symptoms in youth. Longitudinal evaluation of these candidate transdiagnostic emotional vulnerabilities in adolescent OCD-MDD comorbidity is warranted.

Distress intolerance in the parents of substance dependent patients

The purpose of this study was to determine levels of Distress Tolerance (DT) and to compare levels of DT, depression, and anxiety in the parents of substance dependent patients. This sample included 40 parents of inpatients undergoing treatment for substance dependence (SDPP) in the Balıklı Rum Hospital, Istanbul, Turkey. A healthy control group was recruited of 40 individuals with no Axis I diagnoses that were counterbalanced with the SDPP group in terms of age and sex. All study participants completed a sociodemographic data form and the Beck Depression Inventory, the Beck Anxiety Inventory, the State & Trait Anxiety Inventory, and the Distress Tolerance Scale. DSM-IV-TR Axis I diagnoses were evaluated by psychiatrists through face to face interviews in which a Structured Clinical Interview (SCID I) was administered. We found a statistically significant lower level of distress tolerance (DT) in our SDPP group. A negative relationship was found between levels of DT, depression and anxiety. The results of our study suggested that negative emotional symptoms such as depression, anxiety, and distress tolerance were frequently seen in parents of substance dependent patients. Limitations and future research directions are also discussed.

Distress intolerance as a moderator of the relationship between daily stressors and affective symptoms: Tests of incremental and prospective relationships

BACKGROUND

Distress intolerance (DI) is conceptualized as an individual difference reflective of the ability to tolerate aversive psychological states. Although high DI has demonstrated cross-sectional associations with multiple forms of psychopathology, few studies have tested key facets of its theoretical conceptualization. Specifically, little research has been conducted on DI's theorized role as an incrementally valid prospective moderator of the relationship between daily stressful events and affective symptoms reflective of preoccupation with aversive internal (e.g., depression, worry) rather than external stimuli (e.g., social anxiety).

METHOD

A non-clinical sample (N = 147; 77% female; M age = 19.32) in which high DI individuals were oversampled was recruited. Participants completed baseline measures of DI and trait negative affect followed by six diary entries over a two-week period in which participants reported on daily stressors, negative affect, worry, depressive, and social anxiety symptoms.

RESULTS

Hierarchical linear models revealed that DI positively predicted depressive and worry, but not social anxiety symptoms, independent of daily stressors and negative affect. Further, a significant interaction effect was found such that the positive association between daily stressor(s) occurrence and daily worry was significant at high, but not low DI, and a similar trend-level interaction effect was observed for depressive symptoms. The interaction for social anxiety symptoms was non-significant LIMITATIONS: Utilization of a non-clinical sample precludes generalization of results to clinical samples. Only self-reported DI was assessed, limiting conclusions to perceived as opposed to behaviorally-indexed DI.

CONCLUSIONS

Results largely supported DI's theoretical conceptualization as an incrementally valid moderator of stress responding with relevance to particular affective symptoms.

The effects of respiratory sinus arrhythmia on anger reactivity and persistence in major depression

The experience of anger during a depressive episode has recently been identified as a poor prognostic indicator of illness course. Given the clinical implications of anger in major depressive disorder (MDD), understanding the mechanisms involved in anger reactivity and persistence is critical for improved intervention. Biological processes involved in emotion regulation during stress, such as respiratory sinus arrhythmia (RSA), may play a role in maintaining negative moods. Clinically depressed (MDD; n = 49) and nondepressed (non-MDD; n = 50) individuals were challenged with a stressful computer task shown to increase anger, while RSA (high frequency range 0.15-0.4 Hz) was collected. RSA predicted future anger, but was unrelated to current anger. That is, across participants, low baseline RSA predicted anger reactivity during the task, and in depressed individuals, those with low RSA during the task had a greater likelihood of anger persistence during a recovery period. These results suggest that low RSA may be a psychophysiological process involved in anger regulation in depression. Low RSA may contribute to sustained illness course by diminishing the repair of angry moods.

Reading under the skin: physiological activation during reading in children with dyslexia and typical readers

The aim of this study was to investigate physiological activation during reading and control tasks in children with dyslexia and typical readers. Skin conductance response (SCR) recorded during four tasks involving reading aloud, reading silently, and describing illustrated stories aloud and silently was compared for children with dyslexia (n = 16) and a control group of typical readers (n = 16). Children's school wellness was measured through self- and parent-proxy reports. Significantly lower SCR was found for dyslexic children in the reading-aloud task, compared to the control group, whereas all participants showed similar physiological reactions to the other experimental conditions. SCR registered during reading tasks correlated with "Child's emotional difficulties," as reported by parents. Possible interpretations of the lower activation during reading aloud in dyslexic children are discussed.

Dispositional Mindfulness Uncouples Physiological and Emotional Reactivity to a Laboratory Stressor and Emotional Reactivity to Executive Functioning Lapses in Daily Life

Both dispositional mindfulness and mindfulness training may help to uncouple the degree to which distress is experienced in response to aversive internal experience and external events. Because emotional reactivity is a transdiagnostic process implicated in numerous psychological disorders, dispositional mindfulness and mindfulness training could exert mental health benefits, in part, by buffering emotional reactivity. The present studies examine whether dispositional mindfulness moderates two understudied processes in stress reactivity research: the degree of concordance between subjective and physiological reactivity to a laboratory stressor (Study 1); and the degree of dysphoric mood reactivity to lapses in executive functioning in daily life (Study 2). In both studies, lower emotional reactivity to aversive experiences was observed among individuals scoring higher in mindfulness, particularly non-judging, relative to those scoring lower in mindfulness. These findings support the hypothesis that higher dispositional mindfulness fosters lower emotional reactivity. Results are discussed in terms of implications for applying mindfulness-based interventions to a range of psychological disorders in which people have difficulty regulating emotional reactions to stress.

Characterizing emotional dysfunction in borderline personality, major depression, and their co-occurrence

This research aimed to characterize patterns of emotional reactivity and dysregulation in borderline personality, depression, and their co-occurrence. In study 1, 488 young adult women from the community were categorized into four groups based on self-reported major depressive disorder (MDD) and borderline personality disorder (BPD) symptoms (Low BPD/Low MDD; Low BPD/High MDD; High BPD/Low MDD; High BPD/High MDD). Immediate and prolonged subjective emotional reactivity to a laboratory stressor were assessed, and participants completed self-report and behavioral measures of emotion dysregulation. Study 2 extended these findings, examining emotional reactivity and dysregulation in a clinical population of 176 substance dependent patients with diagnoses of BPD and MDD and including a biological index of emotional reactivity. Results revealed greater prolonged fear reactivity in the High BPD/High MDD (vs. Low BPD/Low MDD) group in study 1, and greater prolonged anxiety and negative affect reactivity in both High BPD groups (vs. Low BPD/Low MDD and Low BPD/High MDD groups) in study 2 (but no differences in cortisol reactivity). Results also demonstrated greater subjective (but not behavioral) emotion dysregulation in the High BPD/High MDD (vs. Low BPD/Low MDD) group in study 1 and both High BPD groups (vs. both Low BPD groups) in study 2. Finally, the High BPD/High MDD group reported greater difficulties controlling impulsive behaviors compared with all other groups in study 1 and the Low BPD groups in study 2. Findings suggest that BPD pathology (but not MDD pathology alone) is characterized by greater prolonged emotional (especially anxiety/fear-related) reactivity and heightened emotion dysregulation.

Distress Tolerance and Pathological Worry: Tests of Incremental and Prospective Relationships

Pathological worry and generalized anxiety disorder (GAD) have been linked with low distress tolerance (DT), although questions remain including whether this association exists independent of depression and comorbidity, the directionality of the relationship between worry and DT, and DT's nonredundancy with other worry-relevant variables (i.e., emotional reactivity, stressful life events). Further, it is unclear whether DT is merely a correlate of excessive worry or acts as a risk factor for its development. Two independent studies were completed to evaluate these questions. In Study 1, DT was examined in patients with GAD and healthy controls. In Study 2, a nonclinical sample completed baseline measures of DT, negative affect, and worry, as well as daily assessments of these constructs and stressors for 1month. In Study 1, lower DT was associated with GAD diagnosis and greater worry symptoms independent of extent of comorbidity and depressive symptoms. In Study 2, lower baseline DT predicted unique variance in daily worry and increases in worry over time, whereas baseline worry did not predict daily DT or decreases in DT 1month later. Findings suggest that low DT plays a role in excessive worry independent of relevant covariates (i.e., comorbidity, emotional reactivity, stressful life events) and that this relationship is unidirectional. Further, preliminary evidence indicates that low DT may be an overall risk factor for the development of worry, particularly during periods of romantic stress, although further research and replication is required.

Depressive symptoms affect changes in nicotine withdrawal and smoking urges throughout smoking cessation treatment: Preliminary results

BACKGROUND

Individuals who report more depressive symptoms consistently demonstrate higher rates of nicotine dependence and less successful smoking cessation than do individuals who report fewer depressive symptoms. Nicotine withdrawal and smoking urges are two potential factors that may account for the differences observed between these two groups. This study assessed whether elevated depression symptoms among nicotine dependent smokers are associated with changes in withdrawal and urges to smoke when undergoing smoking cessation treatment.

METHOD

Data on 81 nicotine dependent smokers were collected as part of a smoking cessation randomized trial that compared standard and contingency management treatment across one baseline week and four treatment weeks. Linear mixed model analyses were conducted with high and low depression scores predicting changes in withdrawal and urge ratings from a baseline week and four treatment weeks.

RESULTS

Participants with elevated depression symptoms reported more intense nicotine withdrawal and smoking urges throughout treatment. Further, participants with greater depressive symptoms exhibited an increase in smoking urges at the start of treatment, compared with a gradual decline in urges among participants with fewer depressive symptoms.

CONCLUSIONS

Smokers with elevated depressive symptoms experience significantly elevated discomfort during smoking cessation efforts in the form of increased withdrawal and craving. This discomfort has the potential to make quitting smoking more difficult. Clinical Trial Identifier: NCT00865254.

Distress intolerance in substance dependent patients

This study seeks to extend the literature by examining distress tolerance (DT) levels for a substance dependent group of individuals. Next, it considers the potential relationship of DT levels with substance dependence features and finally, it compares those factors with a healthy control group. This study included 93 individuals (49 substance dependent and 44 healthy controls). Participants were evaluated using the Structured Clinical Interview for DSM-IV Axis I Diagnosis (SCID-I) and given the Distress Tolerance Scale (DTS), Beck Depression Inventory (BDI), and State & Trait Anxiety Inventory (STAI). Consistent with our expectations, the substance dependent group showed higher scores on the BDI and STAI, and lower scores on the DTS. There was no difference between the single drug dependent group and multiple substance-dependent groups, and their DT levels were not correlated with the duration of substance use, nor with the age of first substance use. Instead, DT was strongly correlated with trait anxiety, state anxiety, and depressive symptoms. The DT levels of this group of substance dependent individuals were very low in comparison to controls and to other groups reported in the literature. Our results suggest that distress tolerance may represent a therapeutic target factor in substance dependency treatment. Limitations and future research directions are also discussed.

Mindfulness and rumination as predictors of persistence with a distress tolerance task

Distress tolerance (DT) is a proposed transdiagnostic factor in psychopathology, yet sources of individual differences in DT are largely unknown. The present study examined mindfulness and rumination facets as predictors of persistence on a standardized DT task (mirror tracing). Acting with awareness (a facet of mindfulness) and reflection (a potentially adaptive form of rumination) predicted increased DT. Increased task-induced skin conductance reactivity predicted decreased DT. These results held after controlling for task skill and subjective and heart rate reactivity. Together, these results suggest that teaching skills to promote mindful awareness and reflection hold promise as interventions to enhance DT.