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Patel TA, Zech JM, Cougle JR. Do appearance related safety behaviors contribute to distress intolerance? A Multi-method examination. Behav Res Ther 2024; 182:104617. [PMID: 39178529 DOI: 10.1016/j.brat.2024.104617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/19/2024] [Accepted: 08/17/2024] [Indexed: 08/26/2024]
Abstract
Individuals elevated in distress intolerance (DI) may engage in dysfunctional behavioral strategies to cope with their distress. One behavioral strategy that may be related to DI is appearance related safety behavior (ARSB; i.e., maladaptive behavior that seeks to mitigate the feared consequences of the negative evaluation of appearance). We examined the relationship between DI and ARSBs in two separate samples of women. In Study 1 (N = 91), we found in an unselected sample that ARSBs were robustly associated with DI cross-sectionally while accounting for symptoms of depression and body dysmorphia. Further, greater ARSBs predicted increases in DI longitudinally. In Study 2, among a clinical sample of women with elevated appearance concerns (N = 94), we examined the experimental effect of reducing ARSBs compared to a self-monitoring control. Relative to control, instructions to reduce ARSBs led to lower DI, but this effect was only found for individuals low in baseline DI. Overall, we found preliminary evidence that ARSBs may be a salient factor in contributing to and maintaining DI; and SB fading may be a helpful strategy for reducing DI. We discuss these findings in the context of existing literature and provide directions for future research.
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2
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Lee M. Introjected regulation and academic burnout: A moderated mediation model of social comparison and distress overtolerance. Stress Health 2024; 40:e3381. [PMID: 38380890 DOI: 10.1002/smi.3381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 12/01/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024]
Abstract
The primary purpose of this study is to examine the mediation effect of Contrastive Upward Comparison (CUC) on the relationship between introjected regulation and exhaustion (i.e., introjected regulation-CUC-exhaustion). It is also aimed to examine the moderation effect of distress overtolerance on this mediated relationship. In order to resolve the uncertainty about the causality of cross-sectional studies, this study worked on the relationship among the variables by setting an alternative model (i.e., CUC-introjected regulation - exhaustion). The participants were 167 (females, 70.7%) undergraduate and graduate students in South Korea. The results of this study indicated that introjected regulation showed indirect and significant effect on exhaustion via CUC. However, in the alternative model, the indirect effect of introjected regulation in the relationship between CUC and exhaustion was not significant. Furthermore, high distress overtolerance buffered the relationship between introjected regulation and CUC, while it strengthened the association of CUC and exhaustion. Lastly, the results of moderated mediation suggested that students with higher distress overtolerance, experienced more CUC, and emotional exhaustion. The implications and limitations were also discussed.
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Aguirre P, Michelini Y, Bravo AJ, Pautassi RM, Pilatti A. Association between personality traits and symptoms of depression and anxiety via emotional regulation and distress tolerance. PLoS One 2024; 19:e0306146. [PMID: 39024203 PMCID: PMC11257275 DOI: 10.1371/journal.pone.0306146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 06/05/2024] [Indexed: 07/20/2024] Open
Abstract
The Big Five personality traits have shown associations with symptoms of depression and anxiety among college students, but it is unclear which factors mediate these relationships. Past research suggests that psychological distress is closely related to difficulties in affect regulation (e.g., low distress tolerance). Therefore, the present study examined the associations between personality traits and depression and anxiety via emotion regulation and distress tolerance. Participants were 694 (81.4% females; Mean age = 23.12 [SD 2.75]) Argentinian college students who completed an online survey examining mental health and personality variables. A sizeable percentage of students endorsed moderate to severe symptoms of depression (45.1%) or anxiety (25.9%). Utilizing path analyses, we found that appraisal, a dimension of distress tolerance, atemporally mediated the association between emotional stability and symptoms of depression/anxiety (i.e., higher levels of emotional stability → higher appraisal distress tolerance → fewer symptoms of depression/anxiety). Further, expressive suppression (a dimension of emotion regulation) significantly mediated the associations between personality traits (i.e., agreeableness and extraversion) and symptoms of depression (higher levels of agreeableness/extraversion → lower use of expressive suppression → fewer symptoms of depression). Taken together, the results suggest that higher levels of emotional stability, extraversion and agreeableness could protect students from the development of symptoms of depression/anxiety via lower maladaptive emotion regulation strategies and higher distress tolerance (particularly appraisal). These findings highlight the relevance of intervention strategies specifically tailored to improve distress tolerance and emotion regulation for those students undergoing mental health problems.
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Affiliation(s)
- Paula Aguirre
- Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Córdoba, Argentina
- Instituto de Investigaciones Psicológicas, IIPsi-CONICET-UNC, Córdoba, Córdoba, Argentina
| | - Yanina Michelini
- Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Córdoba, Argentina
- Instituto de Investigaciones Psicológicas, IIPsi-CONICET-UNC, Córdoba, Córdoba, Argentina
| | - Adrian J. Bravo
- Department of Psychological Sciences, William & Mary, Williamsburg, Virginia, United States of America
| | - Ricardo Marcos Pautassi
- Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Córdoba, Argentina
- Instituto de Investigación Médica M. y M. Ferreyra, INIMEC-CONICET-UNC, Córdoba, Córdoba, Argentina
| | - Angelina Pilatti
- Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Córdoba, Argentina
- Instituto de Investigaciones Psicológicas, IIPsi-CONICET-UNC, Córdoba, Córdoba, Argentina
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Malas O, Gómez-Domenech A. Effect of Dialectical Behavior Therapy on Negative Affect, and Symptoms of Depression and Anxiety in Individuals with Borderline Personality Disorder during COVID-19 Pandemic. J Clin Med 2024; 13:2603. [PMID: 38731131 PMCID: PMC11084774 DOI: 10.3390/jcm13092603] [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: 03/24/2024] [Revised: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Background: This study investigated the effectiveness of dialectical behavior therapy (DBT) in patients with borderline personality disorder (BPD) during the COVID-19 pandemic, assessing negative affect, depression, and anxiety levels as indicators of health. Methods: A total of 287 participants were recruited, including BPD patients at different stages of treatment and the general population without a diagnosis of BPD. Questionnaires were used to assess the fear of COVID-19 and the referenced health indicators. Results: No differences were observed between groups in levels of fear of COVID-19, but there were differences in the health indicators studied. BPD patients in long-term treatment showed levels of negative affect similar to those of the general population, while those in early treatment stages exhibited significantly higher levels. However, no significant improvements were observed in levels of depression and anxiety in the long-term treatment group compared to those who underwent the initial treatment phase. Conclusions: These findings underscore the importance of effectively intervening in BPD, especially in stress-inducing situations such as the pandemic, and suggest the need to explore complementary approaches to addressing depression and anxiety in this clinical context.
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Affiliation(s)
- Olga Malas
- Department of Psychology, Sociology and Social Work, University of Lleida, 25001 Lleida, Spain
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Caiado B, Santos D, Pereira B, Góis AC, Canavarro MC, Moreira H. The Factorial Structure, Psychometric Properties and Sensitivity to Change of the Distress Tolerance Scale for Children with Emotional Disorders. CHILDREN (BASEL, SWITZERLAND) 2024; 11:115. [PMID: 38255428 PMCID: PMC10814728 DOI: 10.3390/children11010115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND The Distress Tolerance Scale (DTS) was adapted for American and Chinese youth, but never for European youth. Moreover, the factor structures found in these previous studies were not consistent. METHODS The DTS was adapted for Portuguese children and then validated among 153 children aged 6-13 years with emotional disorders. A confirmatory factor analysis (CFA) was conducted; the DTS reliability and validity were analyzed, and sex and age differences were explored. A sub-sample of children who received a transdiagnostic CBT (Unified Protocol for Children) was used to analyze the DTS's sensitivity to therapeutic change. RESULTS The five tested models (based on previous studies) exhibited adequate fit in the CFA. However, the model previously reported for use in American children with emotional disorders was selected as the most appropriate. The DTS demonstrated adequate psychometric properties, and its validity was established through significant negative associations with measures of anxiety, depression and negative affect, as well as positive associations with positive affect. Age and sex differences were discussed. The DTS scores significantly increased from pre- to post-treatment, demonstrating sensitivity to therapeutic change. CONCLUSIONS The DTS is a suitable and useful measure for assessing children's distress tolerance and to assess the efficacy of CBT.
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Affiliation(s)
| | | | | | | | | | - Helena Moreira
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention (CINEICC), Faculty of Psychology and Education Sciences, University of Coimbra, 3000-548 Coimbra, Portugal; (B.C.); (D.S.); (B.P.); (A.C.G.); (M.C.C.)
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6
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Labella MH, Klein ND, Yeboah G, Bailey C, Doane AN, Kaminer D, Bravo AJ. Childhood bullying victimization, emotion regulation, rumination, distress tolerance, and depressive symptoms: A cross-national examination among young adults in seven countries. Aggress Behav 2024; 50:e22111. [PMID: 37682733 DOI: 10.1002/ab.22111] [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] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/10/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023]
Abstract
Existing research suggests a robust association between childhood bullying victimization and depressive symptoms in adulthood, but less is known about potential mediators of this link. Furthermore, there is limited cross-national research evaluating similarities and differences in bullying victimization and its associations with mental health. The current study addressed gaps in the literature by evaluating cognitive and affective responses to stress (i.e., emotion regulation, rumination, and distress tolerance) as potential mediators of the link between recalled bullying victimization and current depressive symptoms among 5909 (70.6% female) college students from seven countries. Results revealed specific indirect associations of bullying victimization through distress tolerance and three out of four facets of rumination, as well as a persistent direct association of childhood bullying on adulthood depression. Emotion regulation strategies were not significantly associated with bullying victimization and did not mediate its association with depressive symptoms. Constrained multigroup models indicated that results were invariant across country and gender. Findings provide evidence of statistical mediation in a cross-sectional sample and await replication in prospective studies. Rumination and distress tolerance may be promising targets for resilience-promoting interventions among children experiencing peer victimization. Ongoing research is needed to clarify cross-national patterns in childhood bullying, identify additional mediators accounting for the remaining direct association, and evaluate emotion regulation as a potential moderator of associations between bullying victimization and adult mental health.
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Affiliation(s)
- Madelyn H Labella
- Department of Psychological Sciences, William & Mary, Williamsburg, Virginia, USA
| | - Neelamberi D Klein
- Department of Psychological Sciences, William & Mary, Williamsburg, Virginia, USA
| | - Georgina Yeboah
- Department of Psychological Sciences, William & Mary, Williamsburg, Virginia, USA
| | - Claire Bailey
- Department of Psychological Sciences, William & Mary, Williamsburg, Virginia, USA
| | - Ashley N Doane
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Debra Kaminer
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Adrian J Bravo
- Department of Psychological Sciences, William & Mary, Williamsburg, Virginia, USA
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Patel A, Daros AR, Irwin SH, Lau P, Hope IM, Perkovic SJM, Laposa JM, Husain MI, Levitan RD, Kloiber S, Quilty LC. Associations between rumination, depression, and distress tolerance during CBT treatment for depression in a tertiary care setting. J Affect Disord 2023; 339:74-81. [PMID: 37392943 DOI: 10.1016/j.jad.2023.06.063] [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: 12/15/2022] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Rumination is strongly associated with depressive symptom severity and course. However, changes in rumination during outpatient cognitive behavioral therapy (CBT), and their links to baseline features such as distress tolerance and clinical outcomes, have received limited attention. METHODS 278 outpatients with depression received group or individual CBT. Measures of rumination, distress tolerance, and depression symptom severity were assessed at baseline and periodically during treatment. Mixed effect and regression-based models evaluated changes over time, and associations between rumination, distress tolerance and depression severity. RESULTS Depression and rumination decreased throughout acute treatment. Rumination reduction was concurrently associated with depressive symptom reduction. Lower levels of rumination at each time point prospectively predicted lower depressive symptoms at the next time point. Distress tolerance measured at baseline was positively associated with depression symptom severity; the indirect effect on post-treatment depression symptoms via rumination measured mid-treatment was nonsignificant when rumination at baseline was accounted for. Changes in and associations between depression and rumination were replicated in sensitivity analyses; although changes in depression and rumination were smaller in magnitude in patients receiving treatment during COVID-19. LIMITATIONS Additional assessment points would permit a more nuanced assessment of the role rumination may play in mediating the associations between distress tolerance and depression severity. Additional investigation of treatments in community settings may also further our understanding of variability in rumination during depression treatment. CONCLUSIONS The current study provides unique real-world support for variability in rumination as a key indicator of change over the course of CBT for depression.
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Affiliation(s)
- Alina Patel
- Campbell Family Mental Health Research Institute, CAMH, Canada; University of Toronto, Canada
| | | | | | - Parky Lau
- Toronto Metropolitan University, Canada
| | - Ingrid M Hope
- Campbell Family Mental Health Research Institute, CAMH, Canada
| | | | - Judith M Laposa
- Campbell Family Mental Health Research Institute, CAMH, Canada; University of Toronto, Canada
| | - M Ishrat Husain
- Campbell Family Mental Health Research Institute, CAMH, Canada; University of Toronto, Canada
| | - Robert D Levitan
- Campbell Family Mental Health Research Institute, CAMH, Canada; University of Toronto, Canada
| | - Stefan Kloiber
- Campbell Family Mental Health Research Institute, CAMH, Canada; University of Toronto, Canada
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, CAMH, Canada; University of Toronto, Canada.
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Del Giacco AC, Jones SA, Hernandez KO, Barnes SJ, Nagel BJ. Heightened adolescent emotional reactivity in the brain is associated with lower future distress tolerance and higher depressive symptoms. Psychiatry Res Neuroimaging 2023; 333:111659. [PMID: 37263126 PMCID: PMC10330591 DOI: 10.1016/j.pscychresns.2023.111659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/26/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023]
Abstract
Distress tolerance, the ability to persist while experiencing negative psychological states, is essential for regulating emotions and is a transdiagnostic risk/resiliency trait for multiple psychopathologies. Studying distress tolerance during adolescence, a period when emotion regulation is still developing, may help identify early risk and/or protective factors. This study included 40 participants (mean scan age = 17.5 years) and using an emotional Go-NoGo functional magnetic resonance imaging task and voxel-wise regression analysis, examined the association between brain response during emotional face processing and future distress tolerance (two ± 0.5 years), controlling for sex assigned at birth, age, and time between visits. Post-hoc analyses tested the mediating role of distress tolerance on the emotional reactivity and depressive symptom relationship. Whole-brain analysis showed greater inferior occipital gyrus activation was associated with less distress tolerance at follow-up. The mediating role of distress tolerance demonstrated a trend-level indirect effect. Findings suggest that individuals who allocate greater visual resources to emotionally salient information tend to exhibit greater challenges in tolerating distress. Distress tolerance may help to link emotional reactivity neurobiology to future depressive symptoms. Building distress tolerance through emotion regulation strategies may be an appropriate strategy for decreasing depressive symptoms.
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Affiliation(s)
- Amanda C Del Giacco
- Departments of Psychiatry, Oregon Health & Science University, Portland, OR, United States of America
| | - Scott A Jones
- Departments of Psychiatry, Oregon Health & Science University, Portland, OR, United States of America
| | - Kristina O Hernandez
- Departments of Psychiatry, Oregon Health & Science University, Portland, OR, United States of America
| | - Samantha J Barnes
- Departments of Psychiatry, Oregon Health & Science University, Portland, OR, United States of America
| | - Bonnie J Nagel
- Departments of Psychiatry, Oregon Health & Science University, Portland, OR, United States of America; Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, United States of America.
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9
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Zhong J, Huang XJ, Wang XM, Xu MZ. The mediating effect of distress tolerance on the relationship between stressful life events and suicide risk in patients with major depressive disorder. BMC Psychiatry 2023; 23:118. [PMID: 36814223 PMCID: PMC9945729 DOI: 10.1186/s12888-023-04600-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Despite widespread acknowledgment of the impact of stressful life events on suicide risk, the understanding of the psychological mechanisms underlying the relationship between stressful life events and suicide risk in major depressive disorder (MDD) remain unclear. This study aim to examine whether the distress tolerance mediates the relationship between the stressful life events and suicide risk in patients with MDD. METHODS A cross-sectional study was carried out among 125 Chinese patients with MDD, mean age was 27.05 (SD=0.68) and 68.8% were females. The 17-item Hamilton Depression Rating scale (HAMD-17), the validated Chinese version of the Mini International Neuropsychiatric Interview (MINI) suicide module, Life Events Scale (LES) and Distress Tolerance Scale (DTS) were utilized to evaluate depressive symptoms, stressful life events, levels of distress tolerance, and suicide risk, respectively. Mediation analyses was used to test the mediation effect of distress tolerance on the relationship between stressful life events and suicide risk. RESULTS The ratio of suicide risk in patients with MDD was 75.2%. Pearson correlation analysis showed that stressful life events were positively correlated with suicide risk(r=0.182, p<0.05). Stressful life events(r=-0.323, p<0.01) and suicide risk(r=-0.354, p<0.01) were negatively correlated with distress tolerance. Mediation analyses showed that the direct path from stressful life events to suicide risk was not significant (B= 0.012, 95% confidence interval (CI) [-0.017, 0.042]). Stressful life events affected suicide risk indirectly through distress tolerance (B= 0.018, 95% CI [0.007, 0.031]), and the mediating effect accounted for 60.0% of the total effect. CONCLUSION Distress tolerance completely played a mediating role between stressful life events and suicide risk. Further suicide prevention and intervention strategies should focus on increasing levels of distress tolerance in patients with MDD.
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Affiliation(s)
- Jing Zhong
- grid.284723.80000 0000 8877 7471School of Public Health, Southern Medical University, Guangzhou, Guangdong People’s Republic of China ,grid.284723.80000 0000 8877 7471Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510120 Guangdong People’s Republic of China
| | - Xiao-Jie Huang
- grid.284723.80000 0000 8877 7471Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510120 Guangdong People’s Republic of China
| | - Xue-Mei Wang
- grid.411866.c0000 0000 8848 7685Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China
| | - Ming-Zhi Xu
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, People's Republic of China. .,Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510120, Guangdong, People's Republic of China.
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Kozak S, Dezachyo O, Stanford W, Bar-Haim Y, Censor N, Dayan E. Elevated integration within the reward network underlies vulnerability to distress. Cereb Cortex 2022; 33:5797-5807. [PMID: 36453462 DOI: 10.1093/cercor/bhac460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022] Open
Abstract
Abstract
Distress tolerance (DT), the capability to persist under negative circumstances, underlies a range of psychopathologies. It has been proposed that DT may originate from the activity and connectivity in diverse neural networks integrated by the reward system. To test this hypothesis, we examined the link between DT and integration and segregation in the reward network as derived from resting-state functional connectivity data. DT was measured in 147 participants from a large community sample using the Behavioral Indicator of Resiliency to Distress task. Prior to DT evaluation, participants underwent a resting-state functional magnetic resonance imaging scan. For each participant, we constructed a whole-brain functional connectivity network and calculated the degree of reward network integration and segregation based on the extent to which reward network nodes showed functional connections within and outside their network. We found that distress-intolerant participants demonstrated heightened reward network integration relative to the distress-tolerant participants. In addition, these differences in integration were higher relative to the rest of the brain and, more specifically, the somatomotor network, which has been implicated in impulsive behavior. These findings support the notion that increased integration in large-scale brain networks may constitute a risk for distress intolerance and its psychopathological correlates.
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Affiliation(s)
- Stas Kozak
- School of Psychological Sciences, Tel Aviv University , Tel Aviv 6997801 , Israel
| | - Or Dezachyo
- School of Psychological Sciences, Tel Aviv University , Tel Aviv 6997801 , Israel
- Sagol School of Neuroscience, Tel Aviv University , Tel Aviv 6997801 , Israel
| | - William Stanford
- Biological & Biomedical Sciences Program, University of North Carolina at Chapel Hill , Chapel Hill, NC 27599 , United States
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University , Tel Aviv 6997801 , Israel
- Sagol School of Neuroscience, Tel Aviv University , Tel Aviv 6997801 , Israel
| | - Nitzan Censor
- School of Psychological Sciences, Tel Aviv University , Tel Aviv 6997801 , Israel
- Sagol School of Neuroscience, Tel Aviv University , Tel Aviv 6997801 , Israel
| | - Eran Dayan
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill , Chapel Hill, NC 27599 , United States
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11
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Brown RJ, Burton AL, Abbott MJ. The relationship between distress tolerance and symptoms of depression: Validation of the Distress Tolerance Scale (DTS) and short-form (DTS-SF). J Clin Psychol 2022; 78:2609-2630. [PMID: 35510827 PMCID: PMC9790670 DOI: 10.1002/jclp.23370] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/13/2022] [Accepted: 04/20/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Distress tolerance (DT) has been found to be implicated in the development and maintenance of depressive symptomatology and various other significant psychological conditions. As such, it is critical to have measures of DT that are effective and easy to administer. This study aimed to examine the factor structure, psychometric properties, and clinical utility of the Distress Tolerance Scale (DTS) and the short-form version, the Distress Tolerance Scale Short-form (DTS-SF), in a large population of individuals with varying levels of self-reported depressive symptoms. METHOD A total of 959 participants completed an online battery of questionnaires which included an assessment of depressive symptoms as well as the DTS and related measures. Results: Confirmatory factor analyses validated the four-factor structure of the DTS and the one-factor structure of the DTS-SF. Good construct validity and good internal consistency were observed across both the DTS and DTS-SF. CONCLUSION Overall, this paper provides new evidence for the validity, reliability and discriminative ability of the DTS and the brief version of the questionnaire, the DTS-SF.
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Affiliation(s)
- Ruby J. Brown
- Clinical Psychology Unit, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
| | - Amy L. Burton
- Clinical Psychology Unit, School of PsychologyThe University of SydneySydneyNew South WalesAustralia,Discipline of Clinical Psychology, Graduate School of HealthUniversity of Technology SydneySydneyAustralia
| | - Maree J. Abbott
- Clinical Psychology Unit, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
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12
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LaRowe LR, Bohlen LC, Gaudiano BA, Abrantes AM, Butryn ML, Dunsiger SI, Griffin E, Loucks EB, Uebelacker LA, Williams DM. Testing the Feasibility and Acceptability of an Acceptance and Commitment Therapy Intervention to Increase Physical Activity among Individuals with Depression: A Protocol Paper. Ment Health Phys Act 2022; 23:100475. [PMID: 37649877 PMCID: PMC10465112 DOI: 10.1016/j.mhpa.2022.100475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Engaging in regular physical activity (PA) is particularly important among individuals with depression, who are at heightened risk for a host of negative health outcomes. However, people with depression are 50% less likely to meet national guidelines for PA and face unique barriers to PA adherence, including lower distress tolerance and motivation for exercise. Acceptance and Commitment Therapy (ACT) may offer promise for increasing PA among adults with depressive symptoms due to its effects on distress tolerance and motivation. Therefore, we developed ACTivity, an ACT-based intervention designed to promote PA among low-active adults with elevated depressive symptoms. Prior to testing the efficacy of ACTivity in an RCT, an important first step is to conduct a preliminary trial to establish feasibility of study procedures for the ACTivity and comparison intervention programs, as well as to establish the credibility/acceptability of the intervention. The purpose of this paper is to describe the ACTivity intervention and the design of this feasibility trial. Method/Design We will conduct a feasibility RCT with two parallel groups and a 1:1 allocation ratio comparing ACTivity to a comparison intervention (relaxation training + PA promotion) among 60 low-active adults with elevated depressive symptoms. All study procedures will be conducted remotely. Discussion Results of this feasibility study will inform a subsequent RCT designed to test the efficacy of ACTivity. If shown to be efficacious, ACTivity will provide a treatment that can be widely disseminated to increase PA among adults with depressive symptoms and thereby decrease their risk for chronic disease.
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Affiliation(s)
- Lisa R. LaRowe
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Lauren Connell Bohlen
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Brandon A. Gaudiano
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
- Butler Hospital, Providence, RI, 02906, USA
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
- Butler Hospital, Providence, RI, 02906, USA
| | - Meghan L. Butryn
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, 19104, USA
| | - Shira I. Dunsiger
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Elizabeth Griffin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Eric B. Loucks
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Lisa A. Uebelacker
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
- Butler Hospital, Providence, RI, 02906, USA
| | - David M. Williams
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02903, USA
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Liu CH, Koire A, Erdei C, Mittal L. Unexpected changes in birth experiences during the COVID-19 pandemic: Implications for maternal mental health. Arch Gynecol Obstet 2022; 306:687-697. [PMID: 34724569 PMCID: PMC8558094 DOI: 10.1007/s00404-021-06310-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 10/22/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This study examined the rates of unexpected birth experiences due to the COVID-19 pandemic and its association with women's postpartum mental health symptoms (depression, generalized anxiety, and PTSD). METHODS Our cross-sectional analysis included postpartum women (N = 506) who reported on birth plan changes attributed to the COVID-19 pandemic through the PEACE (Perinatal Experiences and COVID-19 Effects) Study, an online survey that took place between May 2020 and May 2021. Covariates included sociodemographic variables, number of days since the pandemic, pre-pregnancy mental health history, and protective factors such as social support, distress tolerance, and resilience. RESULTS Prevalent COVID-19 pandemic changes in the birth experience included not having support people (e.g., partners and friends) permitted to participate in the baby's delivery (33.5%), reduced access to preferred medications before or after delivery (9.7%), unavailable health care providers for the baby's birth as planned (9.6%), and other changes (13.8%). The reduced access to medications was associated with those reporting higher levels of depressive (β = .10, p < .01) and PTSD symptoms (β = .07, p < .05). Separation from their baby for a long period after delivery (β = .10, p < .05) and other changes (β = .10, p < .01) were associated with higher levels of PTSD symptoms. CONCLUSION Unexpected changes to the birth experience due to the COVID-19 pandemic may have small but persistent effects on depressive and PTSD symptoms. Given increased vigilance and its association with subsequent PTSD, acknowledging any fear of viral contagion within the hospital setting but informing women the plans for ensuring safety may be preventive for later mental health symptomatology.
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Affiliation(s)
- Cindy H Liu
- Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Amanda Koire
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Carmina Erdei
- Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Leena Mittal
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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14
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Rahman A, Sánchez M, Bursac Z, Whiting CY, de Dios MA, Cano M, Meek R, Taskin T, Shawon MSR, Vazquez V, Koly KN, Ullrich HS, Cano MÁ. Ethnic discrimination and psychological stress among Hispanic emerging adults: Examining the moderating effects of distress tolerance and optimism. INTERNATIONAL JOURNAL OF INTERCULTURAL RELATIONS : IJIR 2022; 86:217-226. [PMID: 36212111 PMCID: PMC9540438 DOI: 10.1016/j.ijintrel.2021.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Hispanic emerging adults are often exposed to ethnic discrimination, yet little is known about coping resources that may mitigate the effects of ethnic discrimination on psychological stress in this rapidly growing population. As such, this study aims to examine (1) the associations of ethnic discrimination, distress tolerance, and optimism with psychological stress and (2) the moderating effects of distress tolerance and optimism on the association between ethnic discrimination and psychological stress. Data were drawn from a cross-sectional study of 200 Hispanic adults ages 18-25, recruited from two urban counties in Arizona and Florida. Hierarchical multiple regression and moderation analyses were utilized to examine these associations and moderated effects. Findings indicated that higher optimism was associated with lower psychological stress. Conversely, higher ethnic discrimination was associated with higher psychological stress. Moderation analyses indicated that both distress tolerance and optimism moderated the association between ethnic discrimination and psychological stress. These study findings add to the limited literature on ethnic discrimination among Hispanic emerging adults and suggest that distress tolerance may be a key intrapersonal factor that can protect Hispanic emerging adults against the psychological stress often resulting from ethnic discrimination.
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Affiliation(s)
- Abir Rahman
- College of Public Health & Social Work, Florida International University, USA
- Cabell-Huntington Health Department, USA
| | - Mariana Sánchez
- College of Public Health & Social Work, Florida International University, USA
| | - Zoran Bursac
- College of Public Health & Social Work, Florida International University, USA
| | | | | | - Manuel Cano
- Department of Social Work, University of Texas at San Antonio, USA
| | - Robert Meek
- College of Public Health & Social Work, Florida International University, USA
| | - Tanjila Taskin
- College of Public Health & Social Work, Florida International University, USA
| | | | - Vicky Vazquez
- College of Public Health & Social Work, Florida International University, USA
| | - Kamrun Nahar Koly
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Helen Sanchez Ullrich
- Department of Psychological, Health, & Learning Sciences, University of Houston, USA
| | - Miguel Ángel Cano
- College of Public Health & Social Work, Florida International University, USA
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15
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Hruschak VJ, Yuan Y, Ringwald W, Beaugard C, Repine M, Pacella-LaBarbara M, Rosen D, Cochran G. Pain Appraisals in Patients with Physical Injury: Assessing the Role of Distress Tolerance in the Relationship between Depression and Pain Catastrophizing. HEALTH & SOCIAL WORK 2021; 46:187-198. [PMID: 34312666 PMCID: PMC8785948 DOI: 10.1093/hsw/hlab021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2020] [Indexed: 05/04/2023]
Abstract
Pain is a complex construct contributing to significant impairment, particularly among physically injured patients seeking treatment in trauma and orthopedic surgery settings in which social workers are an integral component of care. The biopsychosocial theory, fear-avoidance, and cognitive mediation models of pain suggest that psychological factors (for example, depression) affect one's ability to tolerate distress, leading to negative pain appraisals, such as catastrophizing. This study examined whether distress tolerance serves as a mechanism by which depression is associated with pain catastrophizing. We administered a health survey to outpatient trauma and orthopedic surgery clinic patients who were using opioid medications; 84 patients were included in the final analysis; 39.3 percent screened positive for depression. A multilevel mediation model using structural equation modeling revealed a significant direct effect from depression to pain catastrophizing (ß = .31, z = 3.96, p < .001) and a significant indirect effect by distress tolerance (Δß = .27, z = 3.84, p < .001). These results, which suggest that distress tolerance partially mediated the path from depression to pain catastrophizing, can inform social workers and other members of the multidisciplinary team about both the critical role of psychosocial factors after injury and interventions to improve postinjury recovery.
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Affiliation(s)
- Valerie J Hruschak
- research fellow in anesthesia, Brigham and Women’s Hospital, Harvard Medical, Anesthesiology, Perioperative, and Pain Medicine, 75 Francis Street, Boston, MA 02115
| | - Yan Yuan
- postdoctoral associate, School of Social Work, University of Pittsburgh
| | - Whitney Ringwald
- PhD student, Clinical Psychology Department, University of Pittsburgh
| | | | - Melissa Repine
- clinical research coordinator, Department of Emergency Medicine, University of Pittsburgh
| | | | - Daniel Rosen
- professor, School of Social Work, University of Pittsburgh
| | - Gerald Cochran
- associate professor, Internal Medicine, Epidemiology, University of Utah, Salt Lake City
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16
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Preonas PD, Lau-Barraco C. Affective factors explaining the association between depressive functioning and alcohol outcomes among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:513-519. [PMID: 31702975 DOI: 10.1080/07448481.2019.1683565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/08/2019] [Accepted: 10/06/2019] [Indexed: 06/10/2023]
Abstract
Rates of co-occurring depression and alcohol use are higher among college students than in the general population. Further research is needed to illuminate how the mechanisms with which individuals process negative emotions may clarify the link between depressive symptoms and drinking. Objective: To assess how three potential mediators representing affective functioning (ie, need for affect, distress tolerance, emotion regulation) explain the relationship between depressive symptoms and alcohol use (ie, quantity and problems). Participants: The sample consisted of 227 college student heavy drinkers. Methods: Participants completed computerized self-report surveys in Fall 2016. Results: Path analyses revealed need for affect mediated the association between depressive symptoms and alcohol quantity, while emotion regulation mediated the relationship between depressive symptoms and alcohol-related problems. Conclusions: Findings highlight the importance of various affective functioning mechanisms to the depressive symptom-drinking link. Future research could target these mechanisms in college interventions for co-occurring mood symptoms and alcohol use.
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Affiliation(s)
- Peter D Preonas
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia, USA
| | - Cathy Lau-Barraco
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia, USA
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17
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Rette DN, Arnold MS, McDonald EM, Hoptman MJ, Collins KA, Iosifescu DV. Influences on childhood depressive symptoms: The effects of trauma and distress tolerance across age and sex groups. J Affect Disord 2021; 283:373-376. [PMID: 33578351 DOI: 10.1016/j.jad.2021.01.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/09/2021] [Accepted: 01/30/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Depression affects many children and adolescents, leading to poor academic performance, impaired psychosocial functioning, and an increased frequency of suicidal behavior. Depression has also been notably associated with trauma and distress tolerance. Our study sought to understand the relationships of these variables across age and sex categories in youth and adolescents. METHODS The current study examined data from a total of 324 participants between the ages of 7 and 17 years-old who were a part of a larger study. Data related to age, sex, depression, trauma, and distress tolerance were examined. RESULTS A multiple regression revealed a significant interaction between age and sex on depression severity. Further, trauma and age by sex categories significantly predicted depression score, as well as distress tolerance predicting depression score. Lastly, a regression analysis, including trauma, distress tolerance, and age by sex categories were significant predictors of depression. LIMITATIONS The results are limited by the cross-sectional design. CONCLUSION Clinicians should consider age by sex effects when treating childhood depression. Future research should further the understanding of depression across age and sex groups, as well as among children with extensive trauma experiences. Future research should also seek to further understand the implications of distress tolerance therapy on childhood depression.
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Affiliation(s)
- Danielle N Rette
- Division of Clinical Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962.
| | - Molly S Arnold
- Division of Clinical Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962
| | - Erin M McDonald
- Division of Clinical Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962
| | - Matthew J Hoptman
- Division of Clinical Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962; Department of Psychiatry, New York University School of Medicine, New York, NY 10016
| | - Katherine A Collins
- Division of Clinical Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Dan V Iosifescu
- Division of Clinical Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962; Department of Psychiatry, New York University School of Medicine, New York, NY 10016
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18
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Cho J, Bello MS, Christie NC, Monterosso JR, Leventhal AM. Adolescent emotional disorder symptoms and transdiagnostic vulnerabilities as predictors of young adult substance use during the COVID-19 pandemic: mediation by substance-related coping behaviors. Cogn Behav Ther 2021; 50:276-294. [PMID: 33706676 DOI: 10.1080/16506073.2021.1882552] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The COVID-19 pandemic presents unique stressors (e.g. social isolation) that may increase substance use risk among young adults with a history of emotional disturbance. This study examined whether emotional disorder symptoms and transdiagnostic vulnerabilities during adolescence predicted young adult substance use during COVID-19, and whether using substances to cope with the pandemic's social conditions mediated these associations. Adolescents (N = 2,120) completed baseline surveys assessing transdiagnostic emotional vulnerabilities (anhedonia, distress intolerance, anxiety sensitivity, negative urgency) and symptoms (major depression[MD], generalized anxiety[GAD], panic disorder[PD], social phobia[SP], obsessive-compulsive disorder[OCD]) in adolescence (September-December 2016; M[SD] age = 17.45[0.38]). At follow-up (May-August 2020; M[SD] age = 21.16[0.39]), past 30-day substance use and using substances to cope with social isolation during the pandemic were reported. Adjusted models showed that baseline distress intolerance, anxiety sensitivity, negative urgency, and MD symptoms each significantly predicted higher number of past-month single-substance using days and number of substances used at follow-up (βs = 0.04-0.06). In each case, associations were mediated by tendency to use substances to cope with the pandemic (βindirect range: 0.028-0.061). To mitigate disproportionate escalation of substance use in young adults with a history of certain types of emotional disturbance, interventions promoting healthy coping strategies to deal with the pandemic's social conditions warrant consideration.
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Affiliation(s)
- Junhan Cho
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mariel S Bello
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Nina C Christie
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - John R Monterosso
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Adam M Leventhal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Psychology, University of Southern California, Los Angeles, CA, USA
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19
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Brief psychological intervention for distress tolerance in an adult secondary care community mental health service: an evaluation. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Distress intolerance has been suggested to be a maintaining factor in several mental health conditions. Distress tolerance skills training has been found to be beneficial in emotionally unstable personality disorder (EUPD) and post-traumatic stress disorder (PTSD). Short-term targeted interventions are increasingly being implemented in response to demand. This study investigates the efficacy of a distress tolerance brief psychological intervention (DT BPI) delivered by non-psychologists within an adult secondary care mental health service. Questionnaire data (pre and post) are reported from 43 participants who completed the intervention. Results suggest that the intervention was associated with significant improvements in distress tolerance, mood, anxiety and wellbeing. This indicates that a DT BPI can be effective when delivered by non-psychologists to real-world adult secondary care clients. The findings offer promising evidence that DT BPI could be a beneficial, cost-effective intervention and warrants further large-scale investigation.
Key learning aims
(1)
To enhance practitioners’ awareness of distress intolerance as a potential maintaining factor and therefore treatment target.
(2)
To outline a transdiagnostic distress tolerance brief psychological intervention.
(3)
To illustrate the potential of this distress tolerance brief psychological intervention to produce positive reliable change with real-world clients when delivered by non-psychologists.
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20
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Katz DE, Laposa JM, Rector NA. Excessive reassurance seeking in depression versus obsessive-compulsive disorder: Cross-sectional and cognitive behavioural therapy treatment comparisons. J Anxiety Disord 2020; 75:102280. [PMID: 32805518 DOI: 10.1016/j.janxdis.2020.102280] [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] [Received: 12/20/2019] [Revised: 07/06/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
UNLABELLED Excessive reassurance seeking (ERS) has been hypothesized as an important maintenance factor in depression and obsessive compulsive disorder (OCD). The present study examined the types of ERS in depression and OCD, the effects of CBT on ERS, predictors of ERS reduction, and the relation between ERS reduction and symptom change. METHOD Treatment-seeking participants diagnosed with a depressive disorder (N = 361) or OCD (N = 156) completed the Reassurance Seeking Scale (RSS) and symptom measures before and following CBT treatment. Measures of intolerance of uncertainty and distress tolerance were completed pre-treatment as potential predictors of ERS change. RESULTS Individuals with depression demonstrated higher pre-treatment ERS related to social attachment compared to those with OCD. ERS significantly decreased over treatment in both groups and change in ERS predicted symptom change among both OCD and depression groups. Higher pre-treatment intolerance of uncertainty significantly predicted less ERS change regardless of diagnosis. Distress tolerance was not associated with ERS changes. CONCLUSION ERS is significantly related to symptom severity cross-sectionally as well as over treatment in depression and OCD, though types of ERS may differ. Higher intolerance of uncertainty may impede the reduction of ERS in CBT.
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Affiliation(s)
- Danielle E Katz
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, Ontario, Canada
| | - Judith M Laposa
- University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada; Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Neil A Rector
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada.
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21
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Prior K, Ross J, Mills K, Teesson M. Social Phobia Among Depressed Individuals Entering Residential Rehabilitation Programmes: Prevalence and Correlates. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-019-00131-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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22
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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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23
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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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24
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Farris SG, Aston ER, Leyro TM, Brown LA, Zvolensky MJ. Distress Intolerance and Smoking Topography in the Context of a Biological Challenge. Nicotine Tob Res 2020; 21:568-575. [PMID: 30137455 DOI: 10.1093/ntr/nty167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/17/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Distress intolerance (DI), one's perceived or behavioral incapacity to withstand distress, is implicated in psychopathology and smoking. This study evaluated the effect of DI on smoking reinforcement in the context of a carbon dioxide (CO2) biological challenge. METHODS Adult daily smokers (n = 90; 48.9% female) were randomized to receive a single inhalation/breath of 35% CO2-enriched air (n = 45) or compressed room air (n = 45). Perceived DI was assessed before the challenge. Smoking reinforcement was examined via average post-challenge puff volume across puffs and at the puff-to-puff level. RESULTS Higher DI was associated with an increased average puff volume (b = -4.7, p = .031). CO2 produced decreased average puff volume compared with room air (b = -7.7, p = .018). There was a DI* condition interaction (ƒ2 = 0.02), such that CO2 decreased average puff volume compared with room air in smokers with higher DI (b = -13.9, t = -3.06, p = .003), but not lower DI. At the puff-to-puff level, there was a significant interaction between DI, condition, and cubic time (b = 0.0003, p =. 037). Specifically, room air produced large initial puff volumes that decreased from puff to puff over the cigarette for high- and low-DI smokers. CO2 produced persistent flat volumes from puff to puff over the cigarette for higher DI smokers, whereas CO2 produced puff volumes like that of room air in lower DI smokers. DISCUSSION Findings suggest DI heightens smoking reinforcement generally, and in the context of intense cardiorespiratory distress, is associated with stable and persistent smoking. DI is a promising therapeutic target that, if addressed through psychological intervention, may improve cessation outcomes by decreasing smoking reinforcement. IMPLICATIONS This study contributes to our understanding of the relationship between DI and smoking reinforcement, via examining these processes in response to acute cardiorespiratory distress. Specifically, we found that smokers who are less tolerant of distress, as opposed to those who are more tolerant, evince a decrease in average puff volume, and consistently low puff-to-puff volume, in response to a biological stressor. These findings suggest that smokers high in DI alter smoking behavior following acute cardiorespiratory distress, perhaps to reduce overstimulation, yet also persist in smoking in a manner that suggests an inability to achieve satiation.
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Affiliation(s)
- Samantha G Farris
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI.,Centers for Behavioral and Prevention Medicine, The Miriam Hospital, Providence, RI
| | - Elizabeth R Aston
- Center for Alcohol and Addiction Studies, School of Public Health at Brown University, Providence, RI
| | - Teresa M Leyro
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ
| | - Lily A Brown
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX.,Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
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25
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Cano MÁ, Castro FG, De La Rosa M, Amaro H, Vega WA, Sánchez M, Rojas P, Ramírez-Ortiz D, Taskin T, Prado G, Schwartz SJ, Córdova D, Salas-Wright CP, de Dios MA. Depressive Symptoms and Resilience among Hispanic Emerging Adults: Examining the Moderating Effects of Mindfulness, Distress Tolerance, Emotion Regulation, Family Cohesion, and Social Support. Behav Med 2020; 46:245-257. [PMID: 31935162 PMCID: PMC7358125 DOI: 10.1080/08964289.2020.1712646] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Emerging adulthood has been described as a difficult stage in life and may be particularly stressful for Hispanic emerging adults who are disproportionately exposed to adversity and chronic sociocultural stressors. To better prevent and treat depressive disorders among Hispanic emerging adults, more research is needed to identify and understand modifiable determinants that can help this population enhance their capacity to offset and recover from adversity and sociocultural stressors. As such, this study aimed to (1) examine the association between resilience and depressive symptoms among Hispanic emerging adults, and (2) examine the extent to which intrapersonal resources (e.g., mindfulness, distress tolerance, emotion regulation strategies) and interpersonal resources (e.g., family cohesion, social support) moderate the association between resilience and depressive symptoms. To examine these aims, 200 Hispanic emerging adults (ages 18-25) from Arizona (n = 99) and Florida (n = 101) completed a cross-sectional survey, and data were analyzed using hierarchical multiple regression and moderation analyses. Findings from the hierarchical multiple regression indicate that higher resilience was associated with lower depressive symptoms. Findings from the moderation analyses indicate that family cohesion, social support, and emotion regulation strategies (e.g., cognitive reappraisal and expressive suppression) functioned as moderators; however, mindfulness and distress tolerance were not significant moderators. Findings from this study add to the limited literature on resilience among Hispanics that have used validated measures of resilience. Furthermore, we advance our understanding of who may benefit most from higher resilience based on levels of intrapersonal and interpersonal resources.
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Affiliation(s)
- Miguel Ángel Cano
- Florida International University, College of Public Health and Social Work
| | | | - Mario De La Rosa
- Florida International University, College of Public Health and Social Work
| | - Hortensia Amaro
- Florida International University, College of Public Health and Social Work
| | - William A. Vega
- Florida International University, College of Public Health and Social Work
| | - Mariana Sánchez
- Florida International University, College of Public Health and Social Work
| | - Patria Rojas
- Florida International University, College of Public Health and Social Work
| | | | - Tanjila Taskin
- Florida International University, College of Public Health and Social Work
| | - Guillermo Prado
- University of Miami, Division of Prevention Science and Community Health
| | - Seth J. Schwartz
- University of Miami, Division of Prevention Science and Community Health
| | | | | | - Marcel A. de Dios
- University of Houston, Department of Psychological, Health, and Learning Sciences
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26
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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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27
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Hernandez DC, Daundasekara SS, Arlinghaus KR, Sharma AP, Reitzel LR, Kendzor DE, Businelle MS. Fruit and vegetable consumption and emotional distress tolerance as potential links between food insecurity and poor physical and mental health among homeless adults. Prev Med Rep 2019; 14:100824. [PMID: 30997322 PMCID: PMC6453825 DOI: 10.1016/j.pmedr.2019.100824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 12/21/2018] [Accepted: 02/06/2019] [Indexed: 01/04/2023] Open
Abstract
Food insecurity is associated with mental health outcomes among adults experiencing homelessness. Different theoretical explanations have emerged to account for the negative health outcomes among vulnerable populations. The neomaterial theoretical perspective suggests that nutritional deficiencies from experiencing food insecurity are related to negative health outcomes. Whereas, the psychosocial theoretical perspective indicates that perceived disadvantages or inability to cope emotionally (i.e. lower distress tolerance) from food insecurity leads to adverse health outcomes. Building on these theoretical perspectives, the purpose of the study was to determine whether fruit and vegetable consumption (as a measure of diet quality) or emotional distress tolerance act as potential links between food insecurity and poor physical and mental health among adults experiencing homelessness. Adults were recruited from six area shelters in Oklahoma City (N = 566) during July–August 2016. Data was collected via a self-administered questionnaire on a tablet computer. Self-rated poor health, depression, and post-traumatic stress disorder (PTSD) were regressed on food insecurity using logistic regressions. Indirect effects were assessed using bootstrapping methods outlined by Preacher and Hayes. In covariate-adjusted models, lower levels of distress tolerance, but not fruit and vegetable consumption, partially mediated the association between food insecurity and poor health (β = 0.28, [0.14, 0.44]), depression (β = 0.56, [0.33, 0.88]), and PTSD (β = 0.39, [0.22, 0.60]). Results suggest that experiencing food insecurity may lower the ability to withstand emotional distress and consequently contributes to negative health outcomes. Among homeless adults, a positive link exists between food insecurity and poor health. Distress tolerance partially mediates the relation between food insecurity and health. Fruit and vegetable intake is not a mediator among homeless adults.
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Affiliation(s)
- Daphne C. Hernandez
- The University of Houston, Department of Health, & Health Performance, 3875 Holman Street, Garrison Gymnasium, Room 104, Houston, TX 77204-6015, USA
- The University of Houston, HEALTH Research Institute, 4849 Calhoun Road, Houston, TX 77204, USA
- Corresponding author at: Department of Health, & Health Performance, 3875 Holman Street, Garrison Gymnasium, Room 104, Houston, TX 77204-6015, USA.
| | - Sajeevika S. Daundasekara
- The University of Houston, Department of Health, & Health Performance, 3875 Holman Street, Garrison Gymnasium, Room 104, Houston, TX 77204-6015, USA
| | - Katherine R. Arlinghaus
- The University of Houston, Department of Health, & Health Performance, 3875 Holman Street, Garrison Gymnasium, Room 104, Houston, TX 77204-6015, USA
| | - Anika Pal Sharma
- The University of Houston, Honors College, 4333 University Drive, Houston, TX 77204-2001, USA
| | - Lorraine R. Reitzel
- The University of Houston, HEALTH Research Institute, 4849 Calhoun Road, Houston, TX 77204, USA
- The University of Houston, Department of Psychological, Health, & Learning Sciences, Social Determinants/Health Disparities Lab, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
| | - Darla E. Kendzor
- The University of Oklahoma Health Sciences Center, Department of Family and Preventive Medicine, USA
- The University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA
| | - Michael S. Businelle
- The University of Oklahoma Health Sciences Center, Department of Family and Preventive Medicine, USA
- The University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA
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Macatee RJ, Albanese BJ, Clancy K, Allan NP, Bernat EM, Cougle JR, Schmidt NB. Distress intolerance modulation of neurophysiological markers of cognitive control during a complex go/no-go task. JOURNAL OF ABNORMAL PSYCHOLOGY 2019; 127:12-29. [PMID: 29369665 DOI: 10.1037/abn0000323] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Distress intolerance (DI), a trait-like individual difference reflective of the inability to endure aversive affective states, is relevant to multiple forms of psychopathology, but its relations to theoretically relevant neurobiological systems have received little attention. Altered cognitive control-related neurobiology has been theorized to underlie individual differences in DI, but little empirical work has been conducted. To test this hypothesis, baseline data from a large community sample with elevated high levels of emotional psychopathology and comorbidity was utilized (N = 256). Participants completed a complex go/no-go task while EEG was recorded, and P2, N2, and P3 amplitudes were measured. Based upon prior findings on the relations between these components and response inhibition, a core cognitive control function, we hypothesized that DI would predict reduced no-go N2 and P3 amplitude while controlling for current anxious/depressive symptom severity (i.e., negative affect). Peak amplitudes from the raw data and principal components analysis were used to quantify amplitude of ERP components. Partially consistent with predictions, high DI was independently associated with reduced no-go N2 peak amplitude in the raw ERP data, and was significantly related to a frontal positivity factor in the N2 time window across no-go and go trials. Contrary to predictions, no relations between DI and the P3 were found. Overall, results support the theorized relevance of cognitive control-linked neurobiology to individual differences in tolerance of distress over and above distress severity itself, and suggest specific relations between DI and alterations in early controlled attention/conflict-monitoring but not response inhibition or response inhibition-related sequelae. (PsycINFO Database Record
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Affiliation(s)
| | | | - Kevin Clancy
- Department of Psychology, Florida State University
| | | | - Edward M Bernat
- Department of Psychology, University of Maryland, College Park
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Brown RC, Overstreet C, Sheerin C, Berenz E, Hawn S, Pickett T, McDonald S, Danielson CK, Amstadter AB. The Nomological Network of a Behavioral Distress Tolerance Task in Veterans. J Trauma Stress 2018; 31:876-885. [PMID: 30537021 PMCID: PMC6352717 DOI: 10.1002/jts.22349] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is a relative lack of research on distress tolerance (DT) in veteran samples. The aims of the study were to (a) evaluate convergent and discriminant validity of a behavioral measure of DT compared to theoretically similar (i.e., self-report DT, negative urgency) and dissimilar (i.e., risk-taking) constructs and (b) evaluate the concurrent validity of DT in relation to posttraumatic stress disorder (PTSD) and depressive symptoms in a veteran sample. A sample of U.S. veterans who served after the September 11, 2001 terror attacks (N = 306, 89.9% male; M age 30.2 years, SD = 4.5, range: 21-40 years) completed self-report and behavioral measures of DT, risk-taking, impulsivity, and depressive symptoms, and completed a clinical interview for PTSD. Results of a multitrait-multimethod matrix found significant yet minimal shared variance, r2 = .01-.03, ps = .002-.055, between the self-report and behavioral measures of DT. We used a series of multiple regressions to examine the relative contribution of the behavioral and self-report DT measures in the prediction of PTSD and depressive symptoms. Self-reported, but not behavioral, DT accounted for unique variance in PTSD, r2 = .12, p < .001, and depressive symptoms, r2 = .23, p < .001. Participants with PTSD or higher scores on measures of depression were more likely to report greater increases in frustration and irritability after completing the behavioral task. Results indicate that DT is not a unidimensional construct and must be considered in the context of specific emotions (e.g., tolerance of irritability vs. fear) and contexts (e.g., behavioral, affective).
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Affiliation(s)
- Ruth C Brown
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Cassie Overstreet
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Christina Sheerin
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Erin Berenz
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Sage Hawn
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Treven Pickett
- Hunter Holmes McGuire Veterans Administration Medical Center, Richmond, Virginia, USA
| | - Scott McDonald
- Hunter Holmes McGuire Veterans Administration Medical Center, Richmond, Virginia, USA
| | - Carla Kmett Danielson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ananda B Amstadter
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
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Slabbert A, Hasking P, Boyes M. Riding the emotional roller coaster: The role of distress tolerance in non-suicidal self-injury. Psychiatry Res 2018; 269:309-315. [PMID: 30172188 DOI: 10.1016/j.psychres.2018.08.061] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022]
Abstract
Non-Suicidal Self-Injury (NSSI) is the deliberate damage to one's bodily tissue without suicidal intent. The Emotional Cascade Model proposes NSSI functions as a distraction from 'cascades' of intense affect and rumination. Low distress tolerance is one factor thought to potentially amplify these cascades but has yet to be empirically tested. Using the Emotional Cascade Model as a framework, we investigated the moderating roles of rumination and distress tolerance in the relationship between affect intensity and NSSI. A sample of 400 university students between the ages of 17 and 62 years (M = 21.02, SD = 5.32) completed well-validated measures of NSSI, affect intensity, rumination, and distress tolerance. As expected, rumination was associated with history of NSSI but only among individuals who reported high levels of distress tolerance. Further, affect intensity was positively associated with NSSI frequency, but only at low levels of rumination and distress tolerance. These results provide promising insight into potential prevention and intervention initiatives that may target rumination and distress tolerance to reduce the likelihood and frequency of self-injury.
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Affiliation(s)
- A Slabbert
- School of Psychology, Curtin University, Perth, Australia
| | - P Hasking
- School of Psychology, Curtin University, Perth, Australia.
| | - M Boyes
- School of Psychology, Curtin University, Perth, Australia
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Felton JW, Collado A, Havewala M, Shadur JM, MacPherson L, Lejuez CW. Distress Tolerance Interacts With Negative Life Events to Predict Depressive Symptoms Across Adolescence. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2018; 48:633-642. [PMID: 29364742 DOI: 10.1080/15374416.2017.1405354] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Adolescence is a vulnerable period for the development of depressive disorders. Recent research has demonstrated the importance of distress tolerance in the onset and maintenance of depression during adulthood; however, little is known about its role in predicting depressive symptoms among adolescents. The current study examines the effect of distress tolerance and co-occurring negative life events on the developmental trajectory of depressive symptoms from middle to late adolescence. Our sample included 117 adolescent boys and girls (44.4% female, 54.6% White). Participants were, on average, 16 years old at baseline (SD = 0.90) and completed self-report inventories of negative life events and depressive symptoms; distress tolerance was assessed using a behavioral measure. Utilizing a latent growth curve approach, we found a significant interaction between distress tolerance and negative life events in predicting increases in depressive symptoms over time. Follow-up analyses suggest that negative life events were associated with greater increases in depressive symptoms over time for adolescents with lower levels of distress tolerance only. The study highlights the moderating role of distress intolerance in the relation between negative life events and depressive symptoms, and underscores the importance of targeting distress tolerance for treating depression among youth.
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Affiliation(s)
| | | | | | | | - Laura MacPherson
- c University of Maryland Marlene and Stuart Greenebaum , Comprehensive Cancer Center
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32
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O'moore KA, Newby JM, Andrews G, Hunter DJ, Bennell K, Smith J, Williams AD. Internet Cognitive-Behavioral Therapy for Depression in Older Adults With Knee Osteoarthritis: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2017; 70:61-70. [DOI: 10.1002/acr.23257] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 04/11/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Kathleen A. O'moore
- St. Vincent's Hospital; and University of New South Wales, and The Black Dog Institute; Prince of Wales Hospital; Sydney Australia
| | - Jill M. Newby
- St. Vincent's Hospital; and University of New South Wales; Sydney Australia
| | - Gavin Andrews
- St. Vincent's Hospital; and University of New South Wales; Sydney Australia
| | - David J. Hunter
- University of Sydney; Sydney Medical School; and Royal North Shore Hospital
| | - Kim Bennell
- University of Melbourne; School of Health Sciences; Melbourne Australia
| | - Jessica Smith
- St. Vincent's Hospital; and University of New South Wales; Sydney Australia
| | - Alishia D. Williams
- St. Vincent's Hospital; and University of New South Wales; Sydney Australia
- Utrecht University; Utrecht The Netherlands
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33
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Garner LE, Van Kirk N, Tifft ED, Krompinger JW, Mathes BM, Fraire M, Falkenstein MJ, Brennan BP, Crosby JM, Elias JA. Validation of the distress tolerance scale-short form in obsessive compulsive disorder. J Clin Psychol 2017; 74:916-925. [PMID: 29139125 DOI: 10.1002/jclp.22554] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 05/08/2017] [Accepted: 08/01/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study aimed to develop and validate the Distress Tolerance Scale-Short Form (DTS-SF), a modification of the original Distress Tolerance Scale, in a severe/complex sample of individuals with obsessive compulsive disorder (OCD). Currently, there are multiple self-report measurements of distress tolerance (DT), highlighting the need for a more refined measure. METHOD Participants included 222 individuals with a primary diagnosis of OCD (57% male, average age = 31) seeking intensive/residential treatment. Participants completed surveys at admission, discharge, and each week. RESULTS An exploratory factor analysis revealed a one-factor solution representing overall DT ability. The DTS-SF was found to be sensitive to treatment effects. Appropriate associations between the DTS-SF and other measures were also found, with lower DT associated with greater OCD and depression severity and lower reported quality of life. CONCLUSION The DTS-SF was found to be a valid and reliable measure with high clinical utility for quickly and accurately measuring DT.
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Affiliation(s)
| | - Nathaniel Van Kirk
- McLean Hospital, 115 Mill St., Belmont, MA, USA, 02478.,Harvard Medical School, Boston, MA, USA
| | - Eric D Tifft
- McLean Hospital, 115 Mill St., Belmont, MA, USA, 02478
| | - Jason W Krompinger
- McLean Hospital, 115 Mill St., Belmont, MA, USA, 02478.,Harvard Medical School, Boston, MA, USA
| | - Brittany M Mathes
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Maria Fraire
- McLean Hospital, 115 Mill St., Belmont, MA, USA, 02478.,Harvard Medical School, Boston, MA, USA
| | - Martha J Falkenstein
- McLean Hospital, 115 Mill St., Belmont, MA, USA, 02478.,Harvard Medical School, Boston, MA, USA
| | - Brian P Brennan
- McLean Hospital, 115 Mill St., Belmont, MA, USA, 02478.,Harvard Medical School, Boston, MA, USA
| | - Jesse M Crosby
- McLean Hospital, 115 Mill St., Belmont, MA, USA, 02478.,Harvard Medical School, Boston, MA, USA
| | - Jason A Elias
- McLean Hospital, 115 Mill St., Belmont, MA, USA, 02478.,Harvard Medical School, Boston, MA, USA
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Ameral V, Bishop LS, Palm Reed KM. Beyond symptom severity: The differential impact of distress tolerance and reward responsiveness on quality of life in depressed and non-depressed individuals. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2017. [DOI: 10.1016/j.jcbs.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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35
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Katz D, Rector NA, Laposa JM. The interaction of distress tolerance and intolerance of uncertainty in the prediction of symptom reduction across CBT for social anxiety disorder. Cogn Behav Ther 2017. [DOI: 10.1080/16506073.2017.1334087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Danielle Katz
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Neil A. Rector
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Judith M. Laposa
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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36
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Banducci AN, Connolly KM, Vujanovic AA, Alvarez J, Bonn-Miller MO. The impact of changes in distress tolerance on PTSD symptom severity post-treatment among veterans in residential trauma treatment. J Anxiety Disord 2017; 47:99-105. [PMID: 28109673 DOI: 10.1016/j.janxdis.2017.01.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/17/2016] [Accepted: 01/05/2017] [Indexed: 12/01/2022]
Abstract
Given that rates of PTSD, particularly among military populations, are increasing, it is critical to gain a better understanding of factors associated with treatment response. Low distress tolerance (DT), conceptualized as the perceived or actual inability to tolerate negative emotional states, may impacts veterans' responses to PTSD treatment. Low DT has been associated with more severe PTSD symptoms in clinical and non-clinical samples; however, its impact on PTSD symptomatology across treatment has yet to be assessed. We examined the impact of changes in DT, from intake to discharge, on post-treatment PTSD symptom severity within two samples of veterans recruited from Veterans Affairs residential PTSD treatment facilities in the northwestern and southern United States (Total N=86; 87% male; 46% White, 39% Black, 9% Latino, 6% Other). Veterans completed the Distress Tolerance Scale and PTSD Checklist (PCL) at intake and discharge from residential PTSD treatment. Regression analyses revealed that, within each veteran sample, those with the greatest improvements in DT had the lowest PCL total and subscale scores at discharge after controlling for respective intake PCL scores. This suggests increases in DT across treatment help explain the degree of benefits experienced by veterans following PTSD treatment.
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Affiliation(s)
- Anne N Banducci
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (NC-PTSD 324), Menlo Park, CA 94025, United States; Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States; G.V. (Sonny) Montgomery Veterans Affairs Medical Center, 1500 E Woodrow Wilson Ave, Jackson, MS 39216, United States; University of Mississippi Medical Center. 2500 N State St. Jackson, MS 39216, United States.
| | - Kevin M Connolly
- G.V. (Sonny) Montgomery Veterans Affairs Medical Center, 1500 E Woodrow Wilson Ave, Jackson, MS 39216, United States; University of Mississippi Medical Center. 2500 N State St. Jackson, MS 39216, United States
| | - Anka A Vujanovic
- University of Houston, Department of Psychology, 3695 Cullen Bouleva rd, Houston, TX 772014, United States
| | - Jennifer Alvarez
- VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, United States
| | - Marcel O Bonn-Miller
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (NC-PTSD 324), Menlo Park, CA 94025, United States; Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road(152-MPD), Menlo Park, CA 94025, United States; Center of Excellence in Substance Abuse Treatment and Education, Philadelphia VA Medical Center, 3900 Woodland Ave., Philadelphia, PA 19104, United States; Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3440 Market St, Suite 370, Philadelphia, PA 19104, United States
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The Role of Distress Tolerance in Multiple Facets of Hostility and Willingness to Forgive. COGNITIVE THERAPY AND RESEARCH 2016. [DOI: 10.1007/s10608-016-9808-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Van Eck K, Warren P, Flory K. A Variable-Centered and Person-Centered Evaluation of Emotion Regulation and Distress Tolerance: Links to Emotional and Behavioral Concerns. J Youth Adolesc 2016; 46:136-150. [DOI: 10.1007/s10964-016-0542-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/11/2016] [Indexed: 11/24/2022]
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Michel NM, Rowa K, Young L, McCabe RE. Emotional distress tolerance across anxiety disorders. J Anxiety Disord 2016; 40:94-103. [PMID: 27161839 DOI: 10.1016/j.janxdis.2016.04.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 04/06/2016] [Accepted: 04/21/2016] [Indexed: 11/28/2022]
Abstract
Emotional distress tolerance (EDT) has increasingly been recognized as a transdiagnostic vulnerability factor. However, research assessing EDT in anxiety disorder populations is lacking. The current study addressed this gap in the literature by examining EDT in a sample of outpatients with panic, social anxiety, generalized anxiety, or obsessive compulsive disorders (n=674), and by assessing its relationship to symptom severity and impairment. Results showed that poor EDT was common across diagnostic groups. However, correlation and regression analyses suggested that although EDT was associated with symptom severity and impairment, it did not account for unique variance in scores beyond the effect of negative affect, stress, intolerance of uncertainty (IU) and anxiety sensitivity (AS). IU and AS had a stronger relationship with overall symptom severity and impairment in the regression models. Together, findings suggest that although EDT may be transdiagnostic, IU and AS are more relevant to our understanding of anxiety disorders.
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Affiliation(s)
- Natalie M Michel
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada.
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare, West 5th Campus, 100 West 5th Street, Hamilton, ON L8 N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.
| | - Lisa Young
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare, West 5th Campus, 100 West 5th Street, Hamilton, ON L8 N 3K7, Canada.
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare, West 5th Campus, 100 West 5th Street, Hamilton, ON L8 N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.
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Brooks Holliday S, Pedersen ER, Leventhal AM. Depression, posttraumatic stress, and alcohol misuse in young adult veterans: The transdiagnostic role of distress tolerance. Drug Alcohol Depend 2016; 161:348-55. [PMID: 26948757 PMCID: PMC4792662 DOI: 10.1016/j.drugalcdep.2016.02.030] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/15/2016] [Accepted: 02/14/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Alcohol misuse is common among young adult veterans, and is commonly associated with depression and posttraumatic stress disorder (PTSD). In fact, rates of comorbid depression, PTSD, and problem drinking are high in this population. Although distress tolerance, the capacity to experience and withstand negative psychological states, has been examined as a potential transdiagnostic factor that accounts for the development of mental health disorders, problem drinking, and the comorbidity between these presenting concerns, its role has not been evaluated in a veteran population. METHODS Young adult veterans were recruited for an online survey related to alcohol use. Participants (n=783) completed self-report measures of alcohol use, depression and PTSD symptoms, and distress tolerance. Mediation models were conducted to examine whether distress tolerance mediated the relationship between (1) probable PTSD, (2) probable depression, and (3) comorbid probable PTSD and depression with alcohol misuse. Moderated mediation models were conducted to examine gender as a moderator. RESULTS Significant bivariate associations were observed among mental health symptoms, distress tolerance, and alcohol misuse. Distress tolerance significantly mediated the relationship between probable depression and PTSD (both alone and in combination) and alcohol misuse. Evidence of moderated mediation was present for probable PTSD and probable comorbid PTSD and depression, such that the indirect effect was stronger among males. CONCLUSIONS These results suggest that distress tolerance may be a transdiagnostic factor explaining the comorbidity of depression and PTSD with alcohol misuse in young adult veterans. These findings may inform screening and intervention efforts with this high-risk population.
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Affiliation(s)
| | - Eric R Pedersen
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States
| | - Adam M Leventhal
- University of Southern California, Los Angeles, CA 90089, United States
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41
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Reid HH, Ledgerwood DM. Depressive symptoms affect changes in nicotine withdrawal and smoking urges throughout smoking cessation treatment: Preliminary results. ADDICTION RESEARCH & THEORY 2015; 24:48-53. [PMID: 27547173 PMCID: PMC4988686 DOI: 10.3109/16066359.2015.1060967] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Individuals who report more depressive symptoms consistently demonstrate higher rates of nicotine dependence and less successful smoking cessation than do individuals who report fewer depressive symptoms. Nicotine withdrawal and smoking urges are two potential factors that may account for the differences observed between these two groups. This study assessed whether elevated depression symptoms among nicotine dependent smokers are associated with changes in withdrawal and urges to smoke when undergoing smoking cessation treatment. METHOD Data on 81 nicotine dependent smokers were collected as part of a smoking cessation randomized trial that compared standard and contingency management treatment across one baseline week and four treatment weeks. Linear mixed model analyses were conducted with high and low depression scores predicting changes in withdrawal and urge ratings from a baseline week and four treatment weeks. RESULTS Participants with elevated depression symptoms reported more intense nicotine withdrawal and smoking urges throughout treatment. Further, participants with greater depressive symptoms exhibited an increase in smoking urges at the start of treatment, compared with a gradual decline in urges among participants with fewer depressive symptoms. CONCLUSIONS Smokers with elevated depressive symptoms experience significantly elevated discomfort during smoking cessation efforts in the form of increased withdrawal and craving. This discomfort has the potential to make quitting smoking more difficult. Clinical Trial Identifier: NCT00865254.
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Affiliation(s)
- Holly H. Reid
- Department of Psychology, Wayne State University, Detroit, MI, USA
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - David M. Ledgerwood
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
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42
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Leventhal AM, Zvolensky MJ. Anxiety, depression, and cigarette smoking: a transdiagnostic vulnerability framework to understanding emotion-smoking comorbidity. Psychol Bull 2015; 141:176-212. [PMID: 25365764 PMCID: PMC4293352 DOI: 10.1037/bul0000003] [Citation(s) in RCA: 349] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Research into the comorbidity between emotional psychopathology and cigarette smoking has often focused upon anxiety and depression's manifest symptoms and syndromes, with limited theoretical and clinical advancement. This article presents a novel framework to understanding emotion-smoking comorbidity. We propose that transdiagnostic emotional vulnerabilities-core biobehavioral traits reflecting maladaptive responses to emotional states that underpin multiple types of emotional psychopathology-link various anxiety and depressive psychopathologies to smoking. This framework is applied in a review and synthesis of the empirical literature on 3 transdiagnostic emotional vulnerabilities implicated in smoking: (a) anhedonia (Anh; diminished pleasure/interest in response to rewards), (b) anxiety sensitivity (AS; fear of anxiety-related sensations), and (c) distress tolerance (DT; ability to withstand distressing states). We conclude that Anh, AS, and DT collectively (a) underpin multiple emotional psychopathologies, (b) amplify smoking's anticipated and actual affect-enhancing properties and other mechanisms underlying smoking, (c) promote progression across the smoking trajectory (i.e., initiation, escalation/progression, maintenance, cessation/relapse), and (d) are promising targets for smoking intervention. After existing gaps are identified, an integrative model of transdiagnostic processes linking emotional psychopathology to smoking is proposed. The model's key premise is that Anh amplifies smoking's anticipated and actual pleasure-enhancing effects, AS amplifies smoking's anxiolytic effects, and poor DT amplifies smoking's distress terminating effects. Collectively, these processes augment the reinforcing properties of smoking for individuals with emotional psychopathology to heighten risk of smoking initiation, progression, maintenance, cessation avoidance, and relapse. We conclude by drawing clinical and scientific implications from this framework that may generalize to other comorbidities.
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Affiliation(s)
- Adam M Leventhal
- Department of Psychology, Keck School of Medicine, University of Southern California
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Norr AM, Allan NP, Macatee RJ, Keough ME, Schmidt NB. The effects of an anxiety sensitivity intervention on anxiety, depression, and worry: mediation through affect tolerances. Behav Res Ther 2014; 59:12-9. [PMID: 24949907 PMCID: PMC4151115 DOI: 10.1016/j.brat.2014.05.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/24/2014] [Accepted: 05/28/2014] [Indexed: 11/29/2022]
Abstract
Recently there has been increased interest in emotional and physical tolerance risk factors for mood and anxiety disorders. Three tolerance risk factors that have been shown to be related are anxiety sensitivity (AS), distress tolerance (DT), and discomfort intolerance (DI). Although previous research has demonstrated these constructs are malleable, no research has investigated the effects of an AS intervention on DT or DI. Further, no studies have investigated whether changes in DT or DI play a role in mood and anxiety symptom amelioration due to an AS intervention. Participants (N = 104), who were selected for elevated levels of AS, completed a single-session computer-assisted AS intervention or a control intervention and follow-up assessments at 1-week and 1-month post intervention. Results revealed that the intervention reduced AS and increased DT, but did not affect DI at the 1-week follow-up. Mediation analyses revealed that changes in AS and DT both mediated changes in symptoms (depression, anxiety, worry) due to the intervention at 1-month follow-up, however, when AS and DT were considered in the same model only the effect via AS remained significant. These results have important implications for the nature of the relationships between AS, DT, and DI as well as the specific mechanistic pathways through which an AS intervention ameliorates symptoms.
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Affiliation(s)
- Aaron M Norr
- Florida State University, Department of Psychology, 1107 W. Call St., Tallahassee, FL 32306-4301, USA.
| | - Nicholas P Allan
- Florida State University, Department of Psychology, 1107 W. Call St., Tallahassee, FL 32306-4301, USA.
| | - Richard J Macatee
- Florida State University, Department of Psychology, 1107 W. Call St., Tallahassee, FL 32306-4301, USA.
| | - Meghan E Keough
- University of Washington, Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, 325 Ninth Ave, PS-5035, Box 359911, Seattle, WA 98104, USA.
| | - Norman B Schmidt
- Florida State University, Department of Psychology, 1107 W. Call St., Tallahassee, FL 32306-4301, USA.
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Direct and Interactive Effects of Distress Tolerance and Anxiety Sensitivity on Generalized Anxiety and Depression. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9623-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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McHugh RK, Kertz SJ, Weiss RB, Baskin-Sommers AR, Hearon BA, Björgvinsson T. Changes in distress intolerance and treatment outcome in a partial hospital setting. Behav Ther 2014; 45:232-40. [PMID: 24491198 PMCID: PMC4191891 DOI: 10.1016/j.beth.2013.11.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 10/28/2013] [Accepted: 11/04/2013] [Indexed: 11/23/2022]
Abstract
Despite the well-established role of distress intolerance (DI) in a wide range of psychological disorders, few studies have examined whether DI improves during treatment and whether these changes are associated with symptom outcomes. Patients (N=626) enrolled in a brief cognitive-behavioral partial hospital program completed pre- and posttreatment measures of DI. Results indicated that DI decreased significantly during treatment, with more than 30% of the sample exhibiting a reduction of more than 2 standard deviations from the sample mean. Women reported higher DI than men at baseline; however, there were no gender differences in changes in DI over time. Participants also completed a pre- and posttreatment measure of depression and a subset completed a measure of anxiety (n=167). DI was associated with more severe depression and anxiety at pre- and posttreatment, with participants who reported a decrease in DI also reporting lower depression and anxiety symptoms at post-treatment. These results further highlight the transdiagnostic relevance of DI and suggest that DI may be a relevant factor in treatment outcome for depression and anxiety.
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