Distress Tolerance as a Familial Vulnerability for Distress-Misery Disorders

The association between posttraumatic stress disorder symptom severity and distress tolerance in traumatic stress treatment

Distress tolerance, or the perceived ability to tolerate negative emotional states, is often associated with posttraumatic stress disorder (PTSD) such that higher distress tolerance is generally associated with less severe PTSD symptom levels. As distress tolerance is often considered a risk and maintenance factor in distress disorders, examining the association between changes in distress tolerance and changes in PTSD symptoms may have clinical relevance. The present study examined the associations between PTSD symptom severity and distress tolerance across three assessment points over 12 weeks among 212 patients receiving outpatient psychotherapy services. Using random-intercept cross-lagged panel modeling (RI-CLPM), concurrent and prospective associations between PTSD and distress tolerance were examined. PTSD symptoms at Time 1 and Time 2 significantly predicted distress tolerance at Time 2, β = -.296, and Time 3, β = -.395, respectively. Distress tolerance did not predict subsequent PTSD symptom severity. Exploratory analyses examined distress tolerance and four PTSD symptom clusters over time. Patterns of results differed across clusters, though it was consistent that only PTSD symptom clusters predicted subsequent distress tolerance and not vice versa. The results support the interrelationship of changes in psychopathology and emotional distress tolerance and indicate that distress tolerance may be an important factor in symptom remission during PTSD treatment.

Pathological fear, anxiety and negative affect exhibit distinct neurostructural signatures: evidence from psychiatric neuroimaging meta-analysis

Internalizing disorders encompass anxiety, fear and depressive disorders, which exhibit overlap at both conceptual and symptom levels. Given that a neurobiological evaluation is lacking, we conducted a Seed-based D-Mapping comparative meta-analysis including coordinates as well as original statistical maps to determine common and disorder-specific gray matter volume alterations in generalized anxiety disorder (GAD), fear-related anxiety disorders (FAD, i.e., social anxiety disorder, specific phobias, panic disorder) and major depressive disorder (MDD). Results showed that GAD exhibited disorder-specific altered volumes relative to FAD including decreased volumes in left insula and lateral/medial prefrontal cortex as well as increased right putamen volume. Both GAD and MDD showed decreased prefrontal volumes compared to controls and FAD. While FAD showed less robust alterations in lingual gyrus compared to controls, this group presented intact frontal integrity. No shared structural abnormalities were found. Our study is the first to provide meta-analytic evidence for distinct neuroanatomical abnormalities underlying the pathophysiology of anxiety-, fear-related and depressive disorders. These findings may have implications for determining promising target regions for disorder-specific neuromodulation interventions (e.g. transcranial magnetic stimulation or neurofeedback).

Association of emotion reactivity and distress intolerance with suicide attempts in U.S. Army soldiers

INTRODUCTION

Emotion reactivity (ER) and distress intolerance (DI) may be associated with increased suicide attempt (SA) risk among U.S. Army soldiers.

METHOD

In this case-control study, 74 soldiers recently hospitalized for SA (cases) were compared with 133 control soldiers from the same Army installations selected based on either propensity score matching (n = 103) or reported 12-month suicide ideation (SI) (n = 30). Controls were weighted to represent the total Army population at the study sites and the subpopulation of 12-month ideators. Participants completed questionnaires assessing ER, DI, and other psychosocial variables. Logistic regression analyses examined whether ER and DI differentiated SA cases from the general population and from 12-month ideators before and after controlling for additional important risk factors (sociodemographic characteristics, stressors, mental disorders).

RESULTS

In univariate analyses, ER differentiated SA cases from both the general population (OR = 2.5[95%CI = 1.7-3.6]) and soldiers with 12-month SI (OR = 2.5[95%CI = 1.3-4.6]). DI also differentiated cases from the general population (OR = 2.9[95%CI = 2.0-4.1]) and 12-month ideators (OR = 1.9[95%CI = 1.1-3.5]). These associations persisted after controlling for sociodemographic variables, stressors, and mental disorders.

CONCLUSION

Findings provide evidence that higher ER and DI are associated with increased risk of SA among soldiers, even after adjusting for known risk factors. Prospective research with larger samples is needed.

The Association between Distress Tolerance and Alcohol Outcomes via Internal Drinking Motives

Previous work suggests that college students who perceive themselves as less able to tolerate negative affect are more motivated to use alcohol to alleviate psychological distress. Recent findings also indicate that distress tolerance influences alcohol outcomes via a positive reinforcement pathway. However, results concerning the association between distress tolerance and alcohol outcomes remain inconsistent. Aim: The present study examined the association between distinctive features of distress tolerance and alcohol outcomes via internal drinking motives (i.e., coping and enhancement) in Argentinean college students. Method: From April to November 2019, a sample of 387 college students with last-month alcohol use (Mean age = 21.09 ± 4.98) completed an online survey assessing alcohol outcomes (past-month frequency of binge drinking and negative alcohol-related consequences), internal drinking motives, and four components of distress tolerance (i.e., tolerance, appraisal, absorption, and regulation). Results: The associations between specific facets of distress tolerance and drinking outcomes were atemporally mediated by coping and enhancement motives. Coping motives significantly mediated the effect of absorption and appraisal on alcohol-related problems (i.e., lower absorption and lower appraisal were associated with more problems via higher coping motives). Enhancement motives significantly mediated the effect of absorption (lower absorption was associated with greater enhancement motives) on binge drinking frequency and alcohol-related problems. Conclusions: Distress tolerance was associated with alcohol outcomes via coping and enhancement motives in this sample of Argentinean undergraduates. The ability to withstand negative affect could be a focal point of interventions to prevent the development of maladaptive patterns of drinking.