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Tracy M, Penney E, Norton AR. Group schema therapy for personality disorders: Systematic review, research agenda and treatment implications. Psychother Res 2024:1-20. [PMID: 38862126 DOI: 10.1080/10503307.2024.2361451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 05/22/2024] [Indexed: 06/13/2024] Open
Abstract
OBJECTIVE There are significant temporal and financial barriers for individuals with personality disorders (PD) receiving evidence-based psychological treatments. Emerging research indicates Group Schema Therapy (GST) may be an accessible, efficient, and cost-effective PD intervention, however, there has been no synthesis of the available evidence to date. This review therefore aimed to investigate the efficacy of GST for PDs by systematically synthesizing available literature. METHOD Five electronic databases were screened with resulting studies subjected to a specific eligibility criteria, which yielded fourteen relevant studies. Characteristics were extracted and methodological quality rigorously assessed. RESULTS Strong support was evidenced for GST's ability to reduce Cluster B and C symptomology, particularly for Borderline and Avoidant PD. GST appeared to improve global symptom severity, quality of life and functional capacity, as well as treatment targets such as schemas and modes. CONCLUSION Although not without limitations and a moderate risk of bias, the current body of evidence supports GST as a potential solution to current service deficits in economical and evidence-based care for individuals with PD. Implications for treatment and future research are discussed.
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Affiliation(s)
- Mikaela Tracy
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, Australia
| | - Erika Penney
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Alice R Norton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, Australia
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Wolitzky-Taylor K. Integrated behavioral treatments for comorbid anxiety and substance use disorders: A model for understanding integrated treatment approaches and meta-analysis to evaluate their efficacy. Drug Alcohol Depend 2023; 253:110990. [PMID: 37866006 DOI: 10.1016/j.drugalcdep.2023.110990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Substance use disorders (SUD) and anxiety disorders are highly comorbid, and this comorbidity is associated with poor clinical outcomes. Emerging research in the last decade has shifted from addressing these problems separately to the development and evaluation of behavioral treatments that integrate care for anxiety disorders (or elevated symptoms of anxiety) and SUD. METHODS An extensive literature search revealed a sufficient number of studies (K=11) to conduct a meta-analysis comparing the efficacy of integrated SUD/anxiety disorder behavioral treatment to SUD treatment alone on substance use and anxiety symptom outcomes. Randomized clinical trials including those with SUD and either anxiety disorders or elevations in constructs implicated in the maintenance of anxiety disorder/SUD comorbidity were included. This study meta-analyzes the effects of these studies. RESULTS Integrated treatments outperformed SUD treatments alone on both substance use and anxiety outcomes, with small to moderate effects favoring integrated treatments. There was no significant heterogeneity across studies in the primary analyses, such that moderator analyses to identify variables that yielded differential patterns of effect sizes were not conducted. DISCUSSION Integrated treatments for SUD/anxiety disorders demonstrate an incremental but significant and clinically meaningful improvement over SUD treatment alone for SUD/anxiety disorder comorbidity. Implications for future research and clinical practice paradigm shifting are discussed.
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The relationship between psychiatric symptoms and affective forecasting bias. J Behav Ther Exp Psychiatry 2023; 79:101825. [PMID: 36813417 DOI: 10.1016/j.jbtep.2022.101825] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 11/20/2022] [Accepted: 11/29/2022] [Indexed: 12/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Affective forecasting (AF) is the prediction of future emotional states. Negatively biased affective forecasts (i.e., overestimating negative affect) have been associated with trait anxiety, social anxiety, and depression symptoms, but few studies have tested these relationships while covarying commonly co-occurring symptoms. METHODS In this study, participants (N = 114) completed a computer game in dyads. Participants were randomized into one of two conditions: a condition in which they were led to believe they were at-fault for losing their dyad money (n = 24 dyads) or a condition in which they were told no one was at fault (n = 34 dyads). Prior to the computer game, participants forecasted their affect for each potential game outcome. RESULTS More severe social anxiety, trait-level anxiety, and depressive symptoms were all associated with more negative AF bias in the at-fault relative to the no-fault condition, and this effect persisted when controlling for other symptoms. Cognitive and social anxiety sensitivity was also associated with more negative AF bias. LIMITATIONS The generalizability of our findings is innately limited by our non-clinical, undergraduate sample. Future work should replicate and extend our research in more diverse populations and clinical samples. CONCLUSIONS Overall, our results support that AF biases are observed across a range of psychopathology symptoms and associated with transdiagnostic cognitive risk factors. Future work should continue investigating the etiological role of AF bias in psychopathology.
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de Lafontaine MF, Turcotte S, Denis I, Foldes-Busque G. Investigating the relationship between the five-factor model of distress tolerance, anxiety and anxiety sensitivity. ANXIETY, STRESS, AND COPING 2023; 36:353-365. [PMID: 35587513 DOI: 10.1080/10615806.2022.2077929] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND Distress tolerance (DT) has been conceptualized as a vulnerability factor for several psychopathologies. A five factor model of DT has been suggested, but its associations with anxiety and anxiety sensitivity have yet to be explored. OBJECTIVES This study aimed to further validate the five-factor model of DT, identify the associations between its factors and elevated anxiety, and assess if anxiety sensitivity mediates the association between DT and anxiety. DESIGN AND METHODS This observational study included 330 students and university workers (women = 82.7%; mean age = 27.7 years, SD = 9.4). They completed online questionnaires assessing DT, anxiety sensitivity and anxiety levels. RESULTS The five-factor model was a good fit to the data (RMSEA = .04). Two factors, and the sex of the participants, contributed to the variance in anxiety (r2 = .418, p < .001). Tolerance of negative emotion was directly (β = -1.98, 95% CI = [-2.53, -1.42]) and indirectly (β = -1.10, 95% CI = [-1.55, -.78]) associated with lower anxiety through anxiety sensitivity. Tolerance of uncertainty was also directly (β = -.08, 95% CI = [-.10, -.06]) and indirectly (β = -.04, 95% CI = [-.05, -.02]) associated with lower anxiety through anxiety sensitivity. CONCLUSIONS Tolerance of negative emotion and uncertainty were associated with anxiety independently of the other factors of DT. These associations seem partially explained by the effect of anxiety sensitivity.
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Affiliation(s)
- Marie-France de Lafontaine
- School of Psychology, Université Laval, Québec, Canada
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Canada
- Research Centre of the Quebec Heart and Lung Institute, Québec, Canada
| | - Stéphane Turcotte
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, Québec, Canada
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Canada
- Centre de recherche sur les jeunes et les familles (CRUJeF), Québec, Canada
| | - Guillaume Foldes-Busque
- School of Psychology, Université Laval, Québec, Canada
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Canada
- Research Centre of the Quebec Heart and Lung Institute, Québec, Canada
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Wesner E, Pavuluri A, Norwood E, Schmidt B, Bernat E. Evaluating competing models of distress tolerance via structural equation modeling. J Psychiatr Res 2023; 162:95-102. [PMID: 37121119 DOI: 10.1016/j.jpsychires.2023.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 03/13/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023]
Abstract
Distress Tolerance (DT) is a transdiagnostic risk and maintenance factor implicated in a wide range of internalizing spectrum (INT) disorders. DT is commonly conceptualized as a higher-order construct, yet its lower-order dimensions are still debated. While the tolerance of negative emotions, frustration, and physical discomfort are widely considered to be central features of DT, the inclusions of intolerance of uncertainty (IU) and anxiety sensitivity (AS) are disputed. This study is the first to compare the two leading hierarchical models of DT directly. We also propose and test a DT model which includes IU and AS as lower-order dimensions. This "combined" model drew from the prior hierarchical theories and subsequent research demonstrating IU and AS to be highly correlated. To evaluate the competing models of DT, structured equation modeling was used to construct latent models representing each leading model and our novel "combined" model. A clinical sample was analyzed (N = 278), with participants having completed self-report scales measuring DT's theorized lower-order dimensions. Of the proposed models, the "combined" model demonstrated the best fit indices in the context of INT. A regression model with our "combined" model indicated that even after its shared variance with the Distress Intolerance Index (DII) was removed, it still had a moderate association with INT (β = 0.805, p < .01). This suggests that the only extant measure of the higher-order DT construct, the DII, fails to capture considerable variance in its latent structure. Future directions are discussed.
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Wolitzky-Taylor K, Smit T, Vujanovic AA, Zvolensky MJ. Transdiagnostic Processes Linking Posttraumatic Stress Disorder Symptoms to Alcohol Use Severity. J Dual Diagn 2023; 19:97-110. [PMID: 37389859 DOI: 10.1080/15504263.2023.2225373] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Objective: The high comorbidity between posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is well-established and complex. However, there is a need to explore transdiagnostic constructs that may underlie this association to better understand what accounts for this comorbidity and to inform treatment development. Method: Thus, the present study utilized a large, cross-sectional dataset (N = 513; Mage = 38.25 years, SD = 10.07; 49.9% female), based on national recruitment, to (1) examine whether the associations between PTSD symptom severity (PCL-5) and alcohol use severity (AUDIT) were statistically mediated by (a) anxiety sensitivity (SSASI); and (b) difficulties with emotion regulation (DERS-16); and (2) examine whether coping motives for drinking moderate this indirect effect. Sex assigned at birth was included as a covariate. Results: When examining the hypothesized mediators (SSASI and DERS-16) in separate models, there was a statistically significant indirect effect of PCL-5 on AUDIT through both SSASI and DERS. However, when both SSASI and DERS were entered into a model simultaneously, only SSASI served as a statistically significant mediator. Coping motives for drinking did not moderate the observed indirect effect. Conclusions: The current findings highlight anxiety sensitivity and emotion regulation as transdiagnostic processes that may explain, at least partially, the relationship between PTSD symptom severity and alcohol use; however, stronger evidence was evident for anxiety sensitivity. These findings may help inform the development of refined, streamlined interventions for PTSD and alcohol use that directly target these processes.
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Affiliation(s)
- Kate Wolitzky-Taylor
- Integrated Substance Abuse Programs, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California - Los Angeles, Los Angeles, California, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Anka A Vujanovic
- Department of Psychology, University of Houston, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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7
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Broos HC, Stamatis CA, Goodman Z, Llabre MM, Zvolensky M, Timpano KR. Situational uncertainty interacts with anxiety sensitivity and distress intolerance to predict anticipated worry and preparation for a hurricane. ANXIETY, STRESS, AND COPING 2023; 36:241-258. [PMID: 35238689 PMCID: PMC9936893 DOI: 10.1080/10615806.2022.2045013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is evidence for the impact of emotional intolerance on reactivity to stressors, but it is unknown whether the level of situational uncertainty may moderate this relationship. We examined whether situational uncertainty moderated the relationship between emotional intolerance and anticipated anxious responding to hurricane forecasts, considering three aspects of emotional tolerance: anxiety sensitivity, distress intolerance, and hurricane-specific distress intolerance. METHODS Participants (N = 358) were Florida residents who experienced Hurricane Irma. Participants were presented with two hypothetical storm forecasts that varied in level of uncertainty: 5-day forecast (high uncertainty) and 3-day forecast (low uncertainty). Participants rated their anticipated worry and preparation for each forecast. RESULTS Significant interactions between forecast uncertainty and both anxiety sensitivity and hurricane-specific distress intolerance emerged on anticipated worry, such that there was a stronger relationship in the high uncertainty condition. Forecast uncertainty also moderated the relationship between anxiety sensitivity and anticipated preparation in the same direction. There were no significant interactions between forecast uncertainty and distress intolerance on either anticipated worry or preparation. CONCLUSIONS Specific aspects of emotional intolerance appear to have a stronger influence on anticipated worry and preparatory behavior in high uncertainty situations. These findings suggest that distinct emotional tolerance factors may influence these responses.
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Affiliation(s)
- Hannah C. Broos
- Department of Psychology, University of Miami, Coral Gables, FL
| | - Caitlin A. Stamatis
- Department of Psychology, University of Miami, Coral Gables, FL
- NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr, 10th Floor, Chicago, IL, 60611
| | - Zachary Goodman
- Department of Psychology, University of Miami, Coral Gables, FL
| | - Maria M. Llabre
- Department of Psychology, University of Miami, Coral Gables, FL
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A preliminary investigation into testing a transdiagnostic cognitive model of fear of childbirth (FOC): a multiple indicators multiple causes (MIMIC) model. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-04010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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9
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Zvolensky MJ, Kauffman BY, Smit T, Matoska CT, Mayorga NA, Gallagher M, Garey L. Anxiety sensitivity and its association with perceived barriers for quitting, smoking inflexibility, and severity of quit problems among Black smokers. J Ethn Subst Abuse 2022:1-18. [PMID: 36190317 PMCID: PMC10067536 DOI: 10.1080/15332640.2022.2129538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
Black individuals who smoke in the United States experience health disparities related to tobacco use (e.g., greater nicotine dependence, less success in quitting smoking) and interoceptive distress (e.g., somatic symptoms, anxiety). Individual difference factors that amplify interoceptive distress and contribute to poorer smoking behaviors and outcomes warrant further attention and investigation. Thus, the present study sought to explore the association between anxiety sensitivity and clinically-relevant smoking variables of perceived barriers for quitting, smoking inflexibility, and problems experienced during past quit attempts. Participants in the current study included 98 Black adult smokers (71.4% male; Mage = 44.08 years, SD = 11.44 years). Results indicated greater levels of anxiety sensitivity were associated with greater levels of perceived barriers for quitting smoking (b = 0.10, SE = 0.08, p = 0.01), smoking inflexibility (b = 0.02, SE <.001, p <.001), and problems experienced during past smoking quit attempts (b = 0.17, SE = 0.07, p = 0.02). Clinical implications and future directions are further discussed as it relates to anxiety sensitivity and efforts to reduce or quit smoking for this health disparities population.
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Affiliation(s)
- Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
| | | | - Tanya Smit
- Department of Psychology, University of Houston, Houston, Texas, USA
| | | | - Nubia A. Mayorga
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Matthew Gallagher
- Department of Psychology, University of Houston, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
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10
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Yang MJ, Sawhney V, McHugh RK, Leyro TM. Examination of the indirect effect of childhood emotional trauma on internalizing symptoms through distress intolerance. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1347-1353. [PMID: 32877634 DOI: 10.1080/07448481.2020.1810053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/01/2020] [Accepted: 07/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Extant studies document a prospective link between early childhood trauma and internalizing symptoms, such as anxiety and depression. Less is known regarding specific cognitive-affective mechanisms. The current study sought to examine distress intolerance (DI) as a mechanism that may explain the relation between early childhood emotional abuse and internalizing symptoms. PARTICIPANTS AND METHODS Participants (N = 230; 54.3% women; mean age = 19.72, SD = 2.28) completed multiple self-report indices of early childhood emotional abuse, DI, and internalizing symptom indices. Using structural equation modeling, a series of mediation models was run to examine the indirect effect of childhood emotional abuse on latent and specific internalizing symptom indices through a latent index of subjective DI. RESULTS Childhood emotional abuse was significantly associated with internalizing symptoms through DI (effect size range = .083-.227, medium to large). CONCLUSIONS The results provide preliminary evidence for DI as a mechanism of interest in the relation between early childhood emotional abuse and internalizing symptoms.
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Affiliation(s)
- Min-Jeong Yang
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Vyom Sawhney
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - R Kathryn McHugh
- Division of Alcohol and Drug Abuse, Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, Massachusetts, USA
| | - Teresa M Leyro
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
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Vujanovic AA, Webber HE, McGrew SJ, Green CE, Lane SD, Schmitz JM. Distress tolerance: prospective associations with cognitive-behavioral therapy outcomes in adults with posttraumatic stress and substance use disorders. Cogn Behav Ther 2022; 51:326-342. [PMID: 34994673 PMCID: PMC8986561 DOI: 10.1080/16506073.2021.2007995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/13/2021] [Indexed: 11/03/2022]
Abstract
74Distress tolerance (DT; perceived or actual ability to tolerate aversive physical or emotional states) is related to both posttraumatic stress disorder (PTSD) symptoms and substance use disorders (SUD). This investigation evaluates self-report and behavioral measures of DT as potential predictors of PTSD and SUD cognitive-behavioral therapy outcomes. Participants included 41 treatment-seeking adults (53.7% women; 73.2% African American; Mage = 44.90, SD = 9.68) who met at least four symptoms of DSM-5 PTSD and DSM-IV substance dependence, assessed via structured interviews. At baseline (pre-treatment), participants completed the Distress Tolerance Scale (DTS), Mirror-Tracing Persistence Task (MTPT), Breath Holding task, and Paced Auditory Serial Addition Task. The Clinician-Administered PTSD Scale for DSM-5 severity scores and percent days of primary substance use, measured via Timeline Follow-back, were used as indicators of PTSD symptoms and substance use, respectively. Covariates included treatment condition, baseline PTSD symptom severity, and baseline substance use. Lower perceived DT at baseline (DTS total score) was associated with higher PTSD symptom severity at end-of-treatment. Lower behavioral DT at baseline (MTPT duration) was associated with higher substance use at the conclusion of treatment (i.e. proportion of number of use days to total number of days between two final treatment sessions).
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Affiliation(s)
| | | | | | | | - Scott D. Lane
- University of Texas Health Science Center at Houston
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Businelle MS, Garey L, Gallagher MW, Hébert ET, Vujanovic A, Alexander A, Kezbers K, Matoska C, Robison J, Montgomery A, Zvolensky MJ. An Integrated mHealth App for Smoking Cessation in Black Smokers With Anxiety: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e38905. [PMID: 35635746 PMCID: PMC9153912 DOI: 10.2196/38905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Black smokers have greater difficulty in quitting and higher rates of smoking-related diseases and disabilities than the general population. The smoking disparities experienced by this group are, in part, a consequence of multiple chronic life stressors (eg, racial discrimination) that engender increased exposure to interoceptive stress symptoms (eg, anxiety), which can ultimately lead to smoking as a means of immediate emotion regulation. OBJECTIVE This study aimed to culturally adapt and initially test a novel mobile intervention (ie, Mobile Anxiety Sensitivity Program for Smoking [MASP]) that targets anxiety sensitivity (AS; a proxy for difficulty and responsivity to interoceptive stress) among Black smokers. The MASP intervention is culturally informed to address interoceptive stress management difficulties among Black smokers and is thus hypothesized to facilitate smoking cessation. METHODS In phase 1, a total of 25 Black smokers with elevated AS will be administered MASP for 6 weeks. Following the completion of phase 1, we will further refine the MASP based on qualitative and quantitative data from participants to produce the final MASP iteration. In phase 2, a total of 200 Black smokers with elevated AS will be enrolled and randomly assigned to receive nicotine replacement therapy and either the smartphone-based National Cancer Institute QuitGuide app for standard mobile smoking cessation treatment or the MASP intervention. All participants in phases 1 and 2 will be enrolled remotely and will complete a web-based study screener; smartphone-based baseline assessment; daily smartphone-based ecological momentary assessments for 6 weeks; phone-based end-of-treatment qualitative interviews; and smartphone-based follow-up assessments at postbaseline weeks 1, 2 (quit date), 3, 4, 5, 6, 28, and 54 (weeks 28 and 54 follow-ups will be completed by phase 2 participants only). The MASP intervention is intended to offset barriers to treatment and encourage treatment engagement via smartphones. RESULTS This project was funded in September 2020. Phase 1 data collection began in January 2022. Phase 2 data collection is scheduled to begin in July 2022. CONCLUSIONS If successful, data from this study will support culturally informed treatment approaches for Black smokers and, pending findings of efficacy, provide an evidence-based mobile intervention for smoking cessation that is ready for dissemination and implementation. TRIAL REGISTRATION ClinicalTrials.gov NCT04838236; https://clinicaltrials.gov/ct2/show/NCT04838236. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/38905.
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Affiliation(s)
- Michael S Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- HEALTH Institute, University of Houston, Houston, TX, United States
| | - Lorra Garey
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Matthew W Gallagher
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, United States
| | - Emily T Hébert
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Austin, TX, United States
| | - Anka Vujanovic
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Adam Alexander
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Krista Kezbers
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Cameron Matoska
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Jillian Robison
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Audrey Montgomery
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Michael J Zvolensky
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
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Mattingley S, Youssef GJ, Manning V, Graeme L, Hall K. Distress tolerance across substance use, eating, and borderline personality disorders: A meta-analysis. J Affect Disord 2022; 300:492-504. [PMID: 34986376 DOI: 10.1016/j.jad.2021.12.126] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/08/2021] [Accepted: 12/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Distress tolerance (DT) has received increased attention in recent years due to its purported role in dysregulated behaviours and their clinical manifestations, such as problematic substance use (PSU), disordered eating behaviours (e.g., binge-eating and purging; DEB), and borderline personality disorder (BPD) symptomatology. Despite the proposed transdiagnostic utility of DT across PSU, DEB, and BPD, there has yet to be a systematic and comprehensive examination characterising and comparing its association with this class of impulsive-type psychopathology. METHODS A systematic search was conducted across five electronic databases using search terms designed to capture extant literature on the association between DT and PSU, DEB, and BPD symptomatology. A series of meta-analyses were undertaken on correlation coefficients from 81 studies to examine the association between DT and each psychopathology domain, as well as impulsive-type psychopathology overall. Moderator analyses were conducted to examine whether these relationships were moderated by DT measurement type, sample type, age, and gender. RESULTS DT shared significant, negative, medium correlations with PSU (r = -.18,), DEB (r = -.20), and BPD symptomatology (r = -.27). The magnitude of these associations was not significantly different across the three psychopathology domains, supporting transdiagnostic conceptualisation. DT measurement type, age, and sample type moderated several of these indicated relationships. LIMITATIONS The majority of studies were conducted in adult samples from Western countries, limiting understanding of these relationships across development and different cultures. CONCLUSIONS The present findings support the putative transdiagnostic role of DT across PSU, DEB, and BPD, which may ultimately inform novel, cross-cutting interventions.
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Affiliation(s)
| | - George J Youssef
- Deakin University, Geelong, Australia, School of Psychology; Centre for Drug Use, Addictive, and Anti-social Behaviour Research (CEDAAR), Deakin University, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Victoria Manning
- Monash Addiction Research Centre (MARC), Eastern Health Clinical School, Monash University, Australia; Turning Point, Eastern Health, Australia
| | - Liam Graeme
- Deakin University, Geelong, Australia, School of Psychology
| | - Kate Hall
- Deakin University, Geelong, Australia, School of Psychology; Centre for Drug Use, Addictive, and Anti-social Behaviour Research (CEDAAR), Deakin University, Australia.
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Vujanovic AA, McGrew SJ, Walton JL, Raines AM. Posttraumatic stress and substance use among military veterans: Associations with distress intolerance and anxiety sensitivity. Addict Behav 2022; 126:107177. [PMID: 34801295 DOI: 10.1016/j.addbeh.2021.107177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 12/17/2022]
Abstract
The co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is highly prevalent among military veterans and represents a difficult-to-treat comorbidity. Distress intolerance (DI; i.e., the perceived inability to tolerate negative emotional states) and anxiety sensitivity (AS, i.e., the fear of anxiety-related sensations) are two promising targetable mechanisms with potential to predict and improve treatment outcomes for veterans with PTSD/SUD. We hypothesized that PTSD symptom severity would be related to (a) alcohol use severity and (b) drug use severity through DI and AS, evaluated concurrently. Participants included 120 military veterans (98.3% male; Mage = 41.41, SD = 10.77) presenting for psychological services at a Veterans Affairs PTSD/SUD clinic. Results indicated that PTSD symptom severity was related to alcohol use severity through AS, but not DI; and PTSD symptom severity was related to drug use severity through DI, but not AS. Clinical and research implications are discussed.
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Affiliation(s)
| | - Shelby J McGrew
- University of Houston, USA; Southeast Louisiana Veterans Health Care System, USA
| | - Jessica L Walton
- Southeast Louisiana Veterans Health Care System, USA; South Central Mental Illness Research, Education and Clinical Center (MIRECC), USA; Department of Psychiatry and Behavioral Sciences, Tulane University, USA
| | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System, USA; South Central Mental Illness Research, Education and Clinical Center (MIRECC), USA; School of Medicine, Louisiana State University, USA.
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15
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Mayorga NA, Brooks JR, Walker RL, Garey L, Cardoso JB, Garza M, Ochoa-Perez M, Lemaire C, Viana A, Zvolensky MJ. Evaluating the Role of Anxiety Sensitivity on Behavioral Health Outcomes among Latinx Persons. COGNITIVE THERAPY AND RESEARCH 2022; 46:31-42. [PMID: 37800123 PMCID: PMC10552789 DOI: 10.1007/s10608-021-10239-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 11/24/2022]
Abstract
Background Mexican Americans represent the largest subpopulation among Latinx persons and experience numerous health inequalities for psychological symptoms and behavioral health problems. First generation Mexican Americans are particularly vulnerable to such disparities and past work suggests that the experience of acculturative stress may play a vital role in terms of mental and physical health problems among this population. The current study sought to bridge past work on acculturative stress among first-generation Mexican Americans by exploring the role of anxiety sensitivity (AS; fear of the negative consequences of internal sensations) as a potential mediational factor in terms of psychological and behavioral health problems among this group. Methods The current study consisted of 369 first generation Mexican American persons (86.2% female, 40.1 years of age (SD = 11.1) years in the U.S. attending a Federally Qualified Healthcare Center located in an urban southwestern community. We explored whether AS served as a mediator between acculturative stress and some of the most common and disabling clinical problems among this group, including social anxiety, anxious arousal, general depression, insomnia and pain intensity and disability. Result Consistent with prediction, there was a statistically significant indirect effect of acculturative stress via AS across all criterion variables apart from pain intensity (depression [ab = - 0.17, SE = 0.05, 95% CI [0.08, 0.26]], insomnia [ab = 0.07, SE = 0.02, 95% CI [0.03, 0.10]], social anxiety [ab 0.05, SE = 0.02, 95% CI [0.02, 0.08]], anxious arousal [ab = 0.08, SE = 0.03, 95% CI [0.03, 0.12]], pain disability [ab = 0.05, SE = 0.02, 95% CI [0.02, 0.09]]). Comparative models were run to evaluate the specificity of hypothesized statistically significant models. For all models except anxious arousal and general depression, the alternative model was rejected, adding support to the hypothesized pathway. Conclusion Overall, this work provides initial support for the role of AS in terms of the relation between acculturative stress and numerous psychological and behavioral health problems among Mexican American adults in a clinical setting.
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Affiliation(s)
- Nubia A. Mayorga
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Jasmin R. Brooks
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Rheeda L. Walker
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | | | | | | | - Andres Viana
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Michael J. Zvolensky
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX 77204, USA
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16
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When is your distress harder to tolerate? A qualitative analysis of situations in which distress tolerance is impaired and strengthened. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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17
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Weiss NH, Kiefer R, Goncharenko S, Raudales AM, Forkus SR, Schick MR, Contractor AA. Emotion regulation and substance use: A meta-analysis. Drug Alcohol Depend 2022; 230:109131. [PMID: 34864568 PMCID: PMC8714680 DOI: 10.1016/j.drugalcdep.2021.109131] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/26/2021] [Accepted: 09/30/2021] [Indexed: 01/03/2023]
Abstract
There has been exponential growth in research on emotion regulation and substance use in the past decade. The current meta-analysis evaluated variability in the magnitude of the relation between aspects of emotion regulation and substance use. A search of PsycINFO, Embase, PubMed, CINAHL Plus, and PILOTS in December 2020 resulted in 6642 initial studies, of which 95 met inclusion criteria (association between emotion regulation and substance use was reported, participants were > 18 years old, article was in English). A total of 445 effects were obtained (N = 156,025 participants; weighted Mage = 29.31; 59.5% female; 66.1% White; 76.6% non-clinical). Emotion regulation and substance use were significantly related (r = 0.19; p < 0.001; 95%CI [0.17, 0.20]). Emotion regulation abilities were generally more strongly related to substance use than emotion regulation strategies; this pattern was stronger for behavioral vs. cognitive abilities and extended to both negative and positive emotions. Relations were stronger for older and clinical samples; mixed effects were found for sex and no conclusive effects were found for race. Despite limitations of the existing literature (e.g., cross-sectional, self-reports), results indicated that the magnitude of the relation between emotion regulation and substance use varied considerably as a function of emotion regulation and substance use constructs and sample characteristics.
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18
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Targeting maladaptive reactivity to negative affect in emerging adults with cannabis use disorder: A preliminary test and proof of concept. Behav Res Ther 2022; 150:104032. [DOI: 10.1016/j.brat.2022.104032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/27/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022]
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Trépanier A, Turcotte S, Foldes-Busque G. [Distress tolerance and experience of chronic pain]. Encephale 2021; 48:653-660. [PMID: 34801233 DOI: 10.1016/j.encep.2021.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/07/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Chronic pain is a highly prevalent condition that is associated with distressing somatic and emotional experiences. Consequently, an individual's distress tolerance, the perceived capacity to tolerate negative psychological and physical states, may influence their pain experience. This effect could be explained in part by a reduction in the catastrophic interpretation of pain which is associated with increased pain intensity and interference in everyday activities. AIMS The first aim of this study was to explore the association between the components of the 5-factor model of distress tolerance and (1) pain intensity and (2) pain interference in everyday activities. The secondary aim was to assess the potential mediating effect of pain catastrophizing in the eventual association between components of distress tolerance and (1) pain intensity or (2) pain interference in everyday activities. METHOD This is a cross-sectional study of adult (18 years or older) university students and staff with chronic pain (3 months). They were invited to complete the online questionnaire through an email invitation. Pain intensity and interference in everyday functioning were assessed with the corresponding subscales of the Brief Pain Inventory. The following instruments were used to assess the components of the 5-factor model of distress tolerance: Ambiguity Tolerance Scale (tolerance to ambiguity), Intolerance to Uncertainty Scale (reversed score: tolerance to uncertainty), Discomfort Intolerance Scale (reversed score: discomfort tolerance), Distress Tolerance Scale (tolerance to negative emotions), Frustration Discomfort Scale (tolerance to frustration). Participants also completed the Pain Catastrophizing Scale. RESULTS Eighty participants were recruited (57 % women, mean age=33.09; standard deviation=12,87). Tolerance to negative emotions was the only component of distress tolerance that was associated with pain (ß=-0.04; 95% CI): -0.07--0.01; t (78)=-3.06, p<0.01) or pain interference in everyday functioning (ß=-0.07; 95% CI: -0.10--0.03; t (78)=-3.97, p<0.01), independently of the others. Combined with age, these factors explained 16.2 % of the variance in pain intensity and 19.4 % of the variance in pain interference. Pain catastrophizing partially mediated the association between tolerance to negative emotions and pain interference in everyday functioning, but it was not involved in the association between tolerance to negative emotions and pain intensity. CONCLUSION Tolerance to negative emotions appears to be the most relevant aspect of distress tolerance in the context of chronic pain and is a potential clinical target that is independent and complementary from pain catastrophizing.
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Affiliation(s)
- A Trépanier
- École de psychologie, faculté des sciences sociales, 2325, rue des Bibliothèques, local L-042, Québec, G1V 0A6, Canada; Centre de recherche du Centre intégré de santé et de service sociaux Chaudière-Appalaches, Lévis, QC, Canada
| | - S Turcotte
- Centre de recherche du Centre intégré de santé et de service sociaux Chaudière-Appalaches, Lévis, QC, Canada
| | - G Foldes-Busque
- École de psychologie, faculté des sciences sociales, 2325, rue des Bibliothèques, local L-042, Québec, G1V 0A6, Canada; Centre de recherche du Centre intégré de santé et de service sociaux Chaudière-Appalaches, Lévis, QC, Canada; Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada.
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20
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Defining and Measuring Tolerance of Uncontrollability. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10259-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Psychometric Properties of the Italian Version of the Distress Tolerance Scale (DTS). JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021. [DOI: 10.1007/s10862-021-09876-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Akbari M, Hosseini ZS, Seydavi M, Zegel M, Zvolensky MJ, Vujanovic AA. Distress tolerance and posttraumatic stress disorder: a systematic review and meta-analysis. Cogn Behav Ther 2021; 51:42-71. [PMID: 34279189 DOI: 10.1080/16506073.2021.1942541] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The association between distress tolerance (DT) and posttraumatic stress disorder (PTSD) is well established. This study aimed to provide an account of the magnitude of this effect across available studies. From the 2,212 records yielded by the initial search, 56 studies comprised 12,672 participants (Mage = 29.96, SD = 12.05; 44.94% women) were included in the investigation upon a priori criteria. Results demonstrated consistent negative associations between DT and PTSD symptoms, such that lower DT was associated with higher PTSD symptom severity and vice versa; the effect size (ES) was relatively small in magnitude (r = -0.335, 95% CI [-0.379, -0.289]). Moreover, ESs for the DT-PTSD association were significantly greater for studies which examined self-reported DT compared to those that examined behavioral DT. The number of traumatic event types experienced (trauma load) was the most consistent moderator of the DT and PTSD association. The clinical implications of the role of DT in PTSD are discussed.
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Affiliation(s)
- Mehdi Akbari
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | | | - Mohammad Seydavi
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Maya Zegel
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Anka A Vujanovic
- Department of Psychology, University of Houston, Houston, Texas, USA
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23
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The Role of Emotional Distress Tolerance on Fear Responding in a Heights-Fearful Sample: Perceived Versus Actual Behavior. Behav Ther 2021; 52:945-955. [PMID: 34134833 DOI: 10.1016/j.beth.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/23/2022]
Abstract
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.
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24
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Mayorga NA, Garey L, Viana A, Cardoso JB, Schmidt NB, Zvolensky MJ. Psychological Distress and Physical Health Symptoms in the Latinx Population During the COVID-19 Pandemic: Exploring the Role of Anxiety Sensitivity. COGNITIVE THERAPY AND RESEARCH 2021; 46:20-30. [PMID: 34177003 PMCID: PMC8214047 DOI: 10.1007/s10608-021-10243-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2021] [Indexed: 12/24/2022]
Abstract
Objective The outbreak of the novel 2019 SARS2-Coronavirus disease (COVID-19) has led to substantial physical and mental health consequences. Rates of mortality and hospitalization are highest among those of racial and ethnic minority persons, including Latinx persons. Further, Latinx persons have been experiencing elevated mental health problems in response to the pandemic compared to non-Latinx Whites. The current study examined whether individual differences in anxiety sensitivity (AS) related to more severe emotional distress associated with social distancing, financial strain, fear of COVID-19, and physical health symptoms stemming from the COVID-19 pandemic among Latinx adults. Methods Participants included 188 Latinx persons (31.4% female, Mage = 34.1 years, SD = 8.16) recruited via an online survey panel program. Results Results indicated that AS significantly contributed to increased severity of the emotional stress response associated with social distancing (ΔR2 = 0.15, p < 0.001), financial strain (ΔR2 = 0.15, p < 0.001), physical health symptoms (ΔR2 = 0.03, p = 0.006), and fear of COVID-19 (ΔR2 = 0.15, p < 0.001). These effects were evident over and above the variance accounted for by gender, years living in the United States, education, and work and home life COVID-19-related stress. Conclusions These cross-sectional findings suggest AS may be an important individual difference factor for better understanding mental health among Latinx persons in the context of the COVID-19 pandemic.
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Affiliation(s)
- Nubia A. Mayorga
- Department of Psychology, University of Houston, Houston, TX USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX USA
| | - Andres Viana
- Department of Psychology, University of Houston, Houston, TX USA
- Texas Institute of Measurement, Evaluation, and Statistics, Houston, USA
| | - Jodi Berger Cardoso
- HEALTH Institute, University of Houston, Houston, TX USA
- Graduate College of Social Work, University of Houston, Houston, TX USA
| | | | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX USA
- HEALTH Institute, University of Houston, Houston, TX USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX USA
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX 77204 USA
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25
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Anxiety Sensitivity and Distress Tolerance Predict Changes in Internalizing Symptoms in Individuals Exposed to Interpersonal Trauma. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10234-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Kremyar AJ, Lee TTC. MMPI-3 Predictors of Anxiety Sensitivity and Distress Intolerance. Assessment 2021; 29:1103-1116. [PMID: 33759600 DOI: 10.1177/10731911211001948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Documenting empirical correlates of the Minnesota Multiphasic Personality Inventory-3 (MMPI-3) scale scores is important for expanding the clinical utility of the instrument. To this end, the goals of the current study were to examine associations between scores on MMPI-3 scales and measures of anxiety sensitivity and distress intolerance, two constructs reflecting intolerance of negative emotional states that are implicated in many psychological conditions, and to identify the scales that most strongly predict each construct. Using a sample of 287 undergraduate students (71% women; Mage = 18.90, SD = 1.12; 85% White), zero-order correlational, regression, and dominance analyses were performed to address these goals. Results indicate that when MMPI-3 scale scores are considered conjointly by scale family, they predict meaningful variance in anxiety sensitivity and distress intolerance measure scores, with conceptually implicated scales offering the strongest prediction across scale families. Implications for both research and practice, limitations, and future research directions are discussed.
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27
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Klein KP, Bartholomay EM, Stevens KT, Harris EK, Björgvinsson T, Kertz SJ. Re-examination of the Latent Structure of the Distress Intolerance Index. Int J Cogn Ther 2021. [DOI: 10.1007/s41811-021-00103-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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Shaw AM, Halliday ER, Tonarely NA, Ehrenreich-May J. Relationship of affect intolerance with anxiety, depressive, and obsessive-compulsive symptoms in youth. J Affect Disord 2021; 280:34-44. [PMID: 33202336 DOI: 10.1016/j.jad.2020.10.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/11/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Structural research on the construct of affect intolerance (an overarching latent construct indicated by distress tolerance and anxiety sensitivity) has only been conducted in adults. Given that a self-report measure of distress tolerance was recently validated for youth and affect intolerance may be a core mechanism of transdiagnostic interventions for internalizing disorders, we examined how affect intolerance relates to internalizing symptoms in youth. We predicted that a latent affect intolerance factor (indicated by distress tolerance and anxiety sensitivity) would be associated with self and parent-reports of youth anxiety, depressive, and obsessive-compulsive symptoms, controlling for age and gender. METHODS At a pre-treatment evaluation, youth with a primary depressive, anxiety, or obsessive-compulsive spectrum disorder (N=277) aged 8-17, and their parent, completed questionnaires. RESULTS Greater levels of the affect intolerance factor predicted greater youth- and parent-reported youth anxiety, depression, and obsessive-compulsive symptoms, controlling for age. LIMITATIONS Future research should replicate findings in a sample with a greater proportion of depressed youth and utilize experimental or longitudinal methods. CONCLUSIONS Importantly, distress tolerance and anxiety sensitivity are core transdiagnostic processes that can be targeted in cognitive-behavioral interventions. Future research should examine how transdiagnostic interventions for youth with internalizing disorders can target these cross-cutting emotional vulnerabilities.
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Affiliation(s)
- Ashley M Shaw
- Florida International University, 11200 SW 8th St., AHC 1, Miami, Florida 33199.
| | | | - Niza A Tonarely
- University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL 33146, USA.
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29
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Anxiety and Opioid Use Disorder: Potential Targets for Treatment and Prevention. CURRENT ADDICTION REPORTS 2021. [DOI: 10.1007/s40429-020-00350-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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30
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Kraemer KM, Luberto CM, Hall DL, Ngo LH, Yeh GY. A systematic review and meta-analysis of mindfulness- and acceptance-based interventions for affect intolerance/sensitivity. Behav Res Ther 2020; 135:103746. [PMID: 33011486 PMCID: PMC7943058 DOI: 10.1016/j.brat.2020.103746] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 12/18/2022]
Abstract
Affect intolerance/sensitivity, defined as one's sensitivity to, or inability to tolerate, affective states, is a transdiagnostic process implicated in the development and maintenance of numerous forms of psychopathology. Mindfulness and acceptance interventions are posited to improve affect intolerance/sensitivity; however, there has been no quantitative synthesis of this research to date. Seven electronic databases were searched up until November 2018. Hedges' g values, 95% confidence intervals, p-values, and Q-values were calculated for a series of random-effects models. Twenty-five studies (pooled N = 1778) met eligibility criteria and were included in the qualitative synthesis (n = 22 included in the meta-analysis). There was a small, significant effect of mindfulness and acceptance interventions on improving affect intolerance/sensitivity from pre-to post-intervention (Hedges' g = -0.37, 95% CI = -0.52 to -0.23, p < .001), with effects maintained up to 6-months (Hedges' g = -0.35, 95% CI = -0.61 to -0.09, p < .01). There was a significantly larger effect for studies with inactive compared to active controls. No significant effect size differences were found for intervention length (<8 vs. ≥ 8 sessions), intervention type (mindfulness vs. acceptance) or sample type (clinical vs. non-clinical). Mindfulness and acceptance interventions modestly improve affect intolerance/sensitivity.
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Affiliation(s)
- Kristen M Kraemer
- Division of General Medicine, Harvard Medical School/Beth Israel Deaconess Medical Center, 330 Brookline Avenue, CO-1309, 2nd Floor, Boston, MA, 02215, USA.
| | - Christina M Luberto
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA, 02108, USA.
| | - Daniel L Hall
- Division of General Medicine, Harvard Medical School/Beth Israel Deaconess Medical Center, 330 Brookline Avenue, CO-1309, 2nd Floor, Boston, MA, 02215, USA; Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA, 02108, USA.
| | - Long H Ngo
- Division of General Medicine, Harvard Medical School/Beth Israel Deaconess Medical Center, 330 Brookline Avenue, CO-1309, 2nd Floor, Boston, MA, 02215, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
| | - Gloria Y Yeh
- Division of General Medicine, Harvard Medical School/Beth Israel Deaconess Medical Center, 330 Brookline Avenue, CO-1309, 2nd Floor, Boston, MA, 02215, USA.
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Cardiovascular risk as a moderator of associations among anxiety sensitivity, distress tolerance, PTSD and depression symptoms among trauma-exposed firefighters. J Psychosom Res 2020; 139:110269. [PMID: 33039951 DOI: 10.1016/j.jpsychores.2020.110269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Firefighters experience frequent and severe trauma exposure, which places them at elevated risk for posttraumatic stress disorder (PTSD) and major depression. Cardiovascular issues may exacerbate the effects of mental health risk factors, such as anxiety sensitivity (AS) and distress tolerance (DT), on PTSD and depression. The current study investigated cardiovascular risk as a moderator of associations between risk factors (AS and DT) and psychiatric symptoms (PTSD and depression) among firefighters. METHODS Participants were 836 trauma-exposed active duty firefighters (93.90% men; with mean age 38 years, [SD = 9]). Participants endorsing at least one of three cardiovascular risk items-experiencing current high blood pressure, history of heart problems, and experiencing chest pains in the past 2 years-were considered high in cardiovascular risk. RESULTS A structural equation model indicated that higher AS was associated with greater PTSD (β = 0.38, p < .01) and depression symptoms (β = 0.32, p < .01); lower DT was associated with greater PTSD (β = -0.18, p < .01) and depression symptoms (β = -0.31, p < .01). Multigroup analyses showed that cardiovascular risk moderated the association between 1) AS and PTSD symptoms, but not 2) AS and depression symptoms, 3) DT and PTSD symptoms, or 4) DT and depression symptoms. For those high in cardiovascular risk, higher AS was associated more strongly with greater PTSD symptoms (high cardiovascular risk group: β = 0.46, p < .01]; low cardiovascular risk group: β = 0.33, p < .01). CONCLUSIONS High cardiovascular risk may contribute to PTSD symptoms among trauma-exposed firefighters with high AS. These results highlight the importance of considering physical and mental health vulnerabilities in first responder populations.
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Brindle K, Moulding R, Bakker K, Nedeljkovic M. Is the relationship between sensory‐processing sensitivity and negative affect mediated by emotional regulation? AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12084] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kimberley Brindle
- Faculty of Life and Social Science, Swinburne University of Technology, Melbourne, Victoria, Australia,
| | - Richard Moulding
- Faculty of Life and Social Science, Swinburne University of Technology, Melbourne, Victoria, Australia,
- Centre for Mental Health and Wellbeing Research, Deakin University, Melbourne, Victoria, Australia,
| | - Kaitlyn Bakker
- Faculty of Life and Social Science, Swinburne University of Technology, Melbourne, Victoria, Australia,
| | - Maja Nedeljkovic
- Faculty of Life and Social Science, Swinburne University of Technology, Melbourne, Victoria, Australia,
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Sauer KS, Jungmann SM, Witthöft M. Emotional and Behavioral Consequences of the COVID-19 Pandemic: The Role of Health Anxiety, Intolerance of Uncertainty, and Distress (In)Tolerance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7241. [PMID: 33022993 PMCID: PMC7578938 DOI: 10.3390/ijerph17197241] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023]
Abstract
The COVID-19 pandemic represents a worldwide threat to mental health. To optimize the allocation of health care resources, research on specific vulnerability factors, such as health anxiety, intolerance of uncertainty, and distress (in)tolerance, and particularly their effect on the time course of SARS-CoV-2 related anxiety appears crucial for supporting high risk groups suffering from elevated mental distress during the pandemic. N = 887 participants (78.4% female; Mage = 38.15, SD = 17.04) completed an online survey in Germany (April to mid-May 2020), comprising measures of SARS-CoV-2 related anxiety, health anxiety, safety and preventive behavior, intolerance of uncertainty, and distress intolerance. Higher levels of health anxiety pre and during COVID-19 were associated with an initially intensified increase (b = 1.10, p < 0.001), but later on a more rapid dampening (b = -0.18, p < 0.001) of SARS-CoV-2 related anxiety. SARS-CoV-2 related preventive behavior was intensified by both pre (b = 0.06, p = 0.01) and during (b = 0.15, p < 0.001) COVID-19 health anxiety, while reassurance behavior only was associated with health anxiety during COVID-19 (b = 0.14, p < 0.001). Distress intolerance and intolerance of uncertainty did not moderate the relationship between health anxiety and SARS-CoV-2 related anxiety and behavior. The results suggest detrimental effects of health anxiety on the emotional and behavioral response to virus outbreaks.
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Affiliation(s)
- Karoline S. Sauer
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Wallstraße 3, 55122 Mainz, Germany; (S.M.J.); (M.W.)
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Tonarely NA, Ehrenreich-May J. Confirming the Factor Structure and Validity of the Distress Tolerance Scale (DTS) in Youth. Child Psychiatry Hum Dev 2020; 51:514-526. [PMID: 31637572 DOI: 10.1007/s10578-019-00935-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Niza A Tonarely
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., Flipse Building, Room 345, Coral Gables, FL, 33146, USA. .,University of Miami, Coral Gables, FL, USA.
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35
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The prediction of distress tolerance based on the feeling of loneliness and self-handicapping in students. PERSONALITY AND INDIVIDUAL DIFFERENCES 2020. [DOI: 10.1016/j.paid.2020.109994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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36
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Raudales AM, Preston TJ, Albanese BJ, Schmidt NB. Emotion dysregulation as a maintenance factor for posttraumatic stress symptoms: The role of anxiety sensitivity. J Clin Psychol 2020; 76:2183-2197. [DOI: 10.1002/jclp.22966] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Alexa M. Raudales
- Department of Psychology University of Rhode Island Kingston Rhode Island
| | - Thomas J. Preston
- Department of Psychology Florida State University Tallahassee Florida
| | | | - Norman B. Schmidt
- Department of Psychology Florida State University Tallahassee Florida
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37
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Lass ANS, Winer ES. Distress tolerance and symptoms of depression: A review and integration of literatures. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2020. [DOI: 10.1111/cpsp.12336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alisson N. S. Lass
- Department of Psychology Mississippi State University Starkville Mississippi
| | - E. Samuel Winer
- Department of Psychology Mississippi State University Starkville Mississippi
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38
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Simons JS, Simons RM, Grimm KJ, Keith JA, Stoltenberg SF. Affective dynamics among veterans: Associations with distress tolerance and posttraumatic stress symptoms. Emotion 2020; 21:757-771. [PMID: 32191092 DOI: 10.1037/emo0000745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We tested a dynamic structural equation model (DSEM; Asparouhov, Hamaker, & Muthén, 2018) of positive and negative affect in 254 veterans with approximately 1.5 years of experience sampling data. The analysis provided estimates of several aspects of veteran's emotional experience including "trait" positive and negative affect (i.e., mean levels), inertia (i.e., tendency for emotions to self-perpetuate), innovation variance (conceptualized as lability, reactivity, or exposure to stressors), and cross-lagged associations between positive and negative affect. Veterans with higher trait negative affect had more negative affect inertia and innovation variance. This suggests a pattern whereby the veteran has more negative reactions, and negative emotions, in turn, tend to maintain themselves, contributing to higher trait negative affect. In contrast, veterans with higher trait positive affect exhibited more positive affect innovation variance (e.g., positive reactivity). Although veterans showed some consistency in dynamics across emotions (e.g., positive and negative reactivity were positively correlated), trait positive and negative affect were not significantly associated. Veterans with higher posttraumatic stress symptoms (PTSS) at baseline exhibited higher reactivity to negative events, less positive affect, and more negative affect during the follow-up. Veterans with higher distress tolerance reported not only lower PTSS but also a more adaptive pattern of affective experience characterized by lower inertia and reactivity in negative affect and more positive lagged associations between negative affect and subsequent positive affect. The results demonstrated that distress tolerance and PTSS in veterans were associated with dynamics of positive and negative emotion over time, suggesting specific differences in affect regulation processes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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39
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Watt MC, Gallagher CE, Couture ME, Wells R, MacLean K. Anxiety Sensitivity Mediates Relations Between Attachment and Aggression Differently by Gender. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:364-383. [PMID: 29294626 DOI: 10.1177/0886260516683173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The present study examined relations among attachment, aggression, and anxiety sensitivity (AS) in a sample of male and female undergraduates. Given that some individuals may use aggression to modulate negative emotional states, it was predicted that AS dimensions would mediate relations between attachment anxiety (vs. attachment avoidance) and certain forms of aggression, particularly impulsive aggression. Moreover, it was hypothesized that the relations among attachment, aggression, and AS would be moderated by gender. Participants (N = 1,042) completed measures of attachment (Experiences in Close Relationships-Revised [ECR-R]), aggression (Aggression Questionnaire [AQ]; Impulsive/Premeditated Aggression Scales [IPAS]), and AS (AS Index-3 [ASI-3]). Results indicated that AS mediated relations between attachment dimensions (both anxiety and avoidance) and most forms of aggression, with each of the AS dimensions playing a unique role differentially by gender. Cognitive concerns emerged as a significant mediator, particularly for men; physical and social concerns played more of a mediating role for women. Interestingly, none of the AS dimensions played a significant mediating role between attachment (either anxiety or avoidance) and physical aggression for men. Results are discussed in terms of their clinical implications and directions for future research.
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Affiliation(s)
- Margo C Watt
- St. Francis Xavier University, Antigonish, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | - Robyn Wells
- St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Kim MacLean
- St. Francis Xavier University, Antigonish, Nova Scotia, Canada
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40
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Tull MT, Edmonds KA, Forbes CN, Richmond JR, Rose JP, Anestis MD, Gratz KL. Examining Relationships between Gender, Opioid Dependence, and Distress Tolerance among Patients in Substance Use Disorder Treatment. Subst Use Misuse 2020; 55:1327-1334. [PMID: 32193972 PMCID: PMC8177557 DOI: 10.1080/10826084.2020.1741632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Opioid abuse/dependence is associated with multiple negative outcomes relative to other forms of substance abuse/dependence, including relapse. Research identifying modifiable characteristics associated with opioid dependence and associated negative outcomes may inform the development of targeted interventions for this high-risk population. One factor warranting investigation is low distress tolerance (DT). Purpose/Objectives: In a sample of patients in substance use disorder (SUD) treatment, the present study examined DT levels among patients with current opioid dependence versus no history of opioid dependence, as well as the moderating role of gender. We predicted that patients with opioid dependence would exhibit lower DT than those without a history of opioid dependence, and that women with opioid dependence would exhibit lower levels of DT than men with opioid dependence. Methods: A sample of 203 patients in residential SUD treatment were administered a series of diagnostic interviews and a behavioral measure of DT. Results: DT did not differ significantly as a function of opioid dependence. However, there was a significant opioid dependence by gender interaction, such that men with current opioid dependence exhibited significantly lower levels of DT than women with opioid dependence and men without a history of opioid dependence. Conclusions/Importance: Findings highlight a modifiable characteristic associated with opioid dependence among men that may be targeted in interventions.
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Affiliation(s)
- Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Keith A Edmonds
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | | | | | - Jason P Rose
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Michael D Anestis
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, OH, USA
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41
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Kosiba JD, Mitzel LD, Zale EL, Zvolensky MJ, Ditre JW. A Preliminary Study of Associations between Discomfort Intolerance, Pain Severity/Interference, and Frequency of Cannabis Use among Individuals with Chronic Pain. ADDICTION RESEARCH & THEORY 2020; 28:76-81. [PMID: 33041738 PMCID: PMC7540627 DOI: 10.1080/16066359.2019.1590557] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Cannabis use is more common among individuals with chronic pain, and is often used to relieve physical discomfort. However, little is known about factors that are associated with cannabis use among individuals with chronic pain, and there is reason to suspect that perceptions of discomfort intolerance (DI) play an important role in pain-cannabis relations. The goal of this study was to conduct an initial examination of perceived DI, pain severity, and pain-related interference in relation to frequency of cannabis use among individuals with chronic pain. Specifically, we hypothesized that pain severity/interference and factors of DI (avoidance and intolerance), would each be positively associated with cannabis use frequency. Participants (N = 109; 44% male; M age = 27) endorsed chronic pain and at least one instance of lifetime cannabis use. Most participants characterized their chronic pain as high intensity and low disability, and the two most commonly reported frequencies of cannabis use were "less than monthly" (n = 38), and "daily/almost daily" (n = 32). Results indicated that discomfort avoidance (but not discomfort intolerance), pain severity, and pain-related interference were each independently and positively associated with frequency of cannabis use. These preliminary findings suggest that continued examination of perceived discomfort avoidance in relation to co-occurring pain and cannabis use is warranted. Future research should replicate these results among treatment-seeking pain patients who are prescribed medical cannabis.
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Affiliation(s)
| | - Luke D. Mitzel
- Department of Psychology, Syracuse University, Syracuse, NY
| | - Emily L. Zale
- Department of Psychology, Binghamton University, Binghamton, NY
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
- Health Institute, University of Houston, Houston TX
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42
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The Construct Validity of Distress Intolerance: Is it Distinct from Demoralization and Negative Emotionality? JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2019. [DOI: 10.1007/s10862-019-09764-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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43
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Jaso BA, Hudiburgh SE, Heller AS, Timpano KR. The Relationship Between Affect Intolerance, Maladaptive Emotion Regulation, and Psychological Symptoms. Int J Cogn Ther 2019. [DOI: 10.1007/s41811-019-00061-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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44
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Cox RC, Olatunji BO. Differential associations between chronotype, anxiety, and negative affect: A structural equation modeling approach. J Affect Disord 2019; 257:321-330. [PMID: 31302521 PMCID: PMC6711779 DOI: 10.1016/j.jad.2019.07.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/23/2019] [Accepted: 07/04/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Increasing evidence implicates circadian rhythms, including chronotype, in anxiety symptoms and disorders. However, it remains unclear whether this relation is accounted for by sleep disturbance. Likewise, given overlap between anxiety and negative affect, a unique link between chronotype and anxiety remains to be established. The present study addressed these questions using a multimethod approach to determine whether there is a unique relation between chronotype and anxiety symptoms, controlling for sleep disturbance. METHODS Indicators of chronotype, sleep disturbance, anxiety, and negative affect were collected in a sample of adults (N = 151) using a combination of subjective and behavioral measures both within and outside the laboratory over a 9-day period. Structural equation modeling was used to examine associations between latent constructs. RESULTS Results revealed significant associations between sleep disturbance and both anxiety and negative affect. A significant association was found between chronotype and anxiety, over and above the effect of sleep disturbance. In contrast, the relation between chronotype and negative affect was nonsignificant after controlling for sleep disturbance. LIMITATIONS Unselected sample, lack of experimental manipulation, cross-sectional design. CONCLUSIONS These findings suggest a unique role of chronotype in anxiety and point to circadian disruption as a potential biological mechanism in anxiety-related disorders.
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Affiliation(s)
- Rebecca C. Cox
- Correspondence concerning this article should be addressed to Rebecca Cox, Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN 37240,
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45
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Keller AE, Langer DA, Pincus DB, Elkins RM, Kerns CE, Comer JS. A Psychometric Evaluation of the Distress Intolerance Index for Youth. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2019; 41:447-455. [PMID: 31452578 PMCID: PMC6709990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Distress Intolerance (DI), defined as the perceived inability to tolerate negative mood states and experiential discomfort, has been posited as a vulnerability factor for several anxiety and emotional disorders. There is a relative paucity of research on DI in youth samples, in large part due to the absence of a psychometrically sound measure of DI in youth. The current study evaluated the psychometric properties of the Distress Intolerance Index for Youth (DII-Y) and the Distress Intolerance Index for Youth-Parent Report (DII-Y-P), which are downward extension adaptations of the adult-oriented Distress Intolerance Index (McHugh & Otto, 2012). Participants were 176 youth (ages 9-17) and their parents who were seeking treatment for child anxiety problems. The DII-Y and DII-Y-P demonstrated good-to-excellent internal consistency. Convergent validity of the DII-Y and the DII-Y-P was supported by large, significant associations with measures of intolerance of uncertainty, as well as with anxiety sensitivity in the case of the DII-Y. Discriminant validity of the DII-Y and the DII-Y-P was supported by the absence of significant direct relationships with a measure of defiant behavior. Results support the use of DII-Y and DII-Y-P as reliable and valid instruments for the assessment of youth DI, providing a practical and efficient tool to study DI as a potential factor in the etiology and maintenance of youth anxiety and emotional disorders.
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Affiliation(s)
- Alex E. Keller
- Department of Psychological and Brain Sciences, Boston University
| | - David A. Langer
- Department of Psychological and Brain Sciences, Boston University
| | - Donna B. Pincus
- Department of Psychological and Brain Sciences, Boston University
| | - R. Meredith Elkins
- Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School
| | | | - Jonathan S. Comer
- Mental Health Interventions and Technology (MINT) Program, Florida International University
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46
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Conway CC, Penrod MT, Pugsley GM, Larrazabal MA, Snyder CE. Cross-Domain Assessment of Distress Intolerance: Associations With Borderline Personality Disorder Features. J Pers Disord 2019; 33:560-575. [PMID: 30307823 DOI: 10.1521/pedi_2018_32_359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
| | | | | | | | - Casey E Snyder
- Department of Psychology, College of William & Mary, Williamsburg, Virginia
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47
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Crabtree MA, Meyer EC, Kimbrel NA, DeBeer BB, Kruse MI, Gulliver SB, Telch M, Morissette SB. Factor Structure and Initial Validation of a Brief Measure of Perceived Emotional and Physical Distress Tolerance in Post-9/11 US Veterans. MILITARY PSYCHOLOGY 2019; 31:10.1080/08995605.2019.1637210. [PMID: 31660019 PMCID: PMC6816279 DOI: 10.1080/08995605.2019.1637210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 06/24/2019] [Indexed: 12/24/2022]
Abstract
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 (Mage= 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.
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Affiliation(s)
| | - Eric C Meyer
- VA VISN 17 Center of Excellence for Research on Returning War Veterans at Central Texas Veterans Health Care System
- Texas A&M University Health Science Center, College of Medicine
- Warriors Research Institute, Baylor Scott & White Health
| | - Nathan A Kimbrel
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center
- Duke University School of Medicine
| | - Bryann B DeBeer
- VA VISN 17 Center of Excellence for Research on Returning War Veterans at Central Texas Veterans Health Care System
- Warriors Research Institute, Baylor Scott & White Health
| | - Marc I Kruse
- Austin Fire Department & Austin-Travis County Emergency Medical Services
| | - Suzy B Gulliver
- Texas A&M University Health Science Center, College of Medicine
- Warriors Research Institute, Baylor Scott & White Health
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48
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Veilleux JC. The relationship between distress tolerance and cigarette smoking: A systematic review and synthesis. Clin Psychol Rev 2019; 71:78-89. [DOI: 10.1016/j.cpr.2019.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 06/19/2018] [Accepted: 01/21/2019] [Indexed: 12/23/2022]
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49
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McLeish AC, Kraemer KM, O’Bryan EM. Discomfort Intolerance in Relation to Asthma Outcomes. COGNITIVE THERAPY AND RESEARCH 2019; 43:24-31. [PMID: 31511753 PMCID: PMC6738939 DOI: 10.1007/s10608-018-9965-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Anxiety symptoms and disorders are common among those with asthma and contribute to poorer health outcomes. Building on work examining anxiety-related cognitive-affective risk factors in asthma, the current study sought to explore associations between discomfort intolerance (i.e., the inability to withstand or tolerate unpleasant bodily sensations) in relation to lung function, asthma control, and quality of life. Participants were 61 adults with asthma (61.9% female; 54.8% African American; M age = 34.72, SD = 13.58) who were administered a self-report assessment battery and a lung function assessment. We found that, above and beyond the effects of anxiety sensitivity-physical concerns, greater discomfort intolerance was significantly associated with poorer lung function (9.5% variance), asthma control (9.9% variance), and overall asthma-related quality of life (11.7% variance) as well as the specific quality of life domains of activity limitations (12.6% variance) and asthma symptoms (6.8% variance). Thus, individuals with asthma who are unable to tolerate physical discomfort may be at risk for poor asthma outcomes and interventions to reduce discomfort intolerance could potentially be useful in this population.
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Affiliation(s)
- Alison C. McLeish
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Kristen M. Kraemer
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
- Division of General Medicine and Primary Care Section for Research, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Emily M. O’Bryan
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
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50
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Keller AE, Langer DA, Pincus DB, Meredith Elkins R, Kerns CE, Comer JS. A Psychometric Evaluation of the Distress Intolerance Index for Youth. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2018. [DOI: 10.1007/s10862-018-9711-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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