Impact of a brief distress intolerance intervention on acute stress modulation of response inhibition neurophysiology in cannabis use disorder

BACKGROUND

The prevalence of cannabis use in the US has increased within the past two decades. Moreover, cannabis use disorder (CUD) is associated with significant disability, but the underlying neural mechanisms of CUD are unclear. Distress intolerance (DI), a psychological risk factor for CUD, may confer risk in part via impaired inhibitory control (IC) capacity during acute stress. DI and cannabis use problems have been associated with altered N2 amplitude, an IC-related event-related potential, in prior cross-sectional studies, but whether altered N2 is a state marker of CUD severity, a pathoplastic factor responsive to intervention and predictive of CUD symptom change over time, or an enduring trait-like vulnerability is unclear. In this secondary analysis, we tested the impact of a DI-targeted intervention on acute stress-related modulation of the N2 and whether pre-intervention N2 predicted CUD symptom change through follow-up.

METHOD

Sixty participants were randomly assigned to a DI-targeted or control intervention. Participants completed an IC task before and after a stress induction at pre- and post-intervention lab visits while EEG activity was recorded.

RESULTS

The DI intervention did not alter the N2 compared to a control intervention. Pre-intervention post-stress IC-related N2 was associated with worse CUD severity but did not predict changeover time.

CONCLUSION

Findings are consistent with blunted N2 after acute stress acting as a stable marker of CUD severity rather than a pathoplastic factor predictive of CUD trajectory. Future research should investigate whether stress-related blunting of N2 is a consequence of severe CUD or a pre-existing vulnerability.

Evaluating competing models of distress tolerance via structural equation modeling

Distress Tolerance (DT) is a transdiagnostic risk and maintenance factor implicated in a wide range of internalizing spectrum (INT) disorders. DT is commonly conceptualized as a higher-order construct, yet its lower-order dimensions are still debated. While the tolerance of negative emotions, frustration, and physical discomfort are widely considered to be central features of DT, the inclusions of intolerance of uncertainty (IU) and anxiety sensitivity (AS) are disputed. This study is the first to compare the two leading hierarchical models of DT directly. We also propose and test a DT model which includes IU and AS as lower-order dimensions. This "combined" model drew from the prior hierarchical theories and subsequent research demonstrating IU and AS to be highly correlated. To evaluate the competing models of DT, structured equation modeling was used to construct latent models representing each leading model and our novel "combined" model. A clinical sample was analyzed (N = 278), with participants having completed self-report scales measuring DT's theorized lower-order dimensions. Of the proposed models, the "combined" model demonstrated the best fit indices in the context of INT. A regression model with our "combined" model indicated that even after its shared variance with the Distress Intolerance Index (DII) was removed, it still had a moderate association with INT (β = 0.805, p < .01). This suggests that the only extant measure of the higher-order DT construct, the DII, fails to capture considerable variance in its latent structure. Future directions are discussed.

Exploring the Link Between Transdiagnostic Cognitive Risk Factors, Anxiogenic Parenting Behaviors, and Child Anxiety

Theoretical models suggest parent anxiety leads to increased anxiogenic parenting, an important etiological factor for child anxiety disorders. Evidence suggests that parents engage in anxiogenic parenting to reduce distress in response to their child's anxiety; however, further study of this mechanism is needed. Cognitive risk factors, including distress intolerance, anxiety sensitivity, emotion-related impulsivity, and repetitive negative thinking are promising to examine as they impact emotion regulation. This study examined whether an indirect association between parent anxiety and anxiogenic parenting via these risk factors exists, and if child anxiety moderated this effect. Findings demonstrated evidence for an indirect association via distress intolerance in mothers at high levels of child anxiety, but not low levels. An unmoderated indirect effect via emotion-related impulsivity was found. Anxiety sensitivity and repetitive negative thinking did not demonstrate significant indirect effects. These findings suggest distress intolerance and emotional-related impulsivity may be targets for parent-focused child anxiety treatments.

Parent Distress Intolerance, Repetitive Negative Thinking, and Mental Health Service Use

While extensive evidence links service use for mental health problems to demographic variables and positive attitudes, studies have not explored the role of transdiagnostic risk factors, like distress intolerance (DI) and repetitive negative thinking (RNT). This study examined the relationship between parental DI and RNT on mental health treatment seeking for parents themselves and their children. Results suggest higher DI and RNT predict service use among parents (p < 0.05) but were not significantly associated with help seeking for their children, indicating that factors more proximal to the child may have greater influence when parents make treatment decisions for their children. Results also indicte that DI moderates the relationship between parent psychopathology and parent service use, such that parent psychopathology is significantly associated with service use for those with lower DI, but not at moderate or high levels of DI. Implications for marketing mental health information to parents and engaging them in treatment are discussed.

Keeping hope alive: Racial-ethnic disparities in distress tolerance are mitigated by religious/spiritual hope among Black Americans

Racial and ethnic minorities, including Blacks/African-Americans and Hispanics/Latinos,indicate lower tolerance to psychological distress (DT) and secular hope yet endorse more religious and spiritual hope than their non-Hispanic White (NHW) counterparts. Whether racial-ethnic minorities derive greater benefit from non-secular hope on the tolerance of psychological distress remains unclear. Self-reported endorsement of religious/spiritual (R/S) hope, secular hope, DT, and a number of other psychosocial, R/S and sociodemographic variables were analyzed from a nationwide survey of persons aged over 18 years (N = 2875) identifying as Black (14.2%), Hispanic (15.4%), or NHW (67.3%) using multiple regression. Overall, higher levels of both R/S and secular hope predicted greater DT. In turn, greater DT was associated with lower psychosomatic distress. Compared to NHW, the ethnic-minority groups reported lower overall levels of DT. An interaction for race-ethnicity further revealed that compared to distress intolerant NHW, Blacks/African-Americans at lower levels of DT report higher R/S and secular hope. Hispanics/Latinos were also higher on R/S and secular hope, but endorsed lower hope at higher levels of DT than the reference group. Although hope is considered a more passive form of coping, it is more frequently endorsed in marginalized ethnic-minority groups. However, compared to NHW, differences do exist in the extent to which R/S hope mitigates DT in Blacks/African-Americans compared to Hispanics/Latinos.

Cingulum and abnormal psychological stress response in schizophrenia

Stress is implicated in many aspects of schizophrenia, including heightened distress intolerance. We examined how affect and microstructure of major brain tracts involved in regulating affect may contribute to distress intolerance in schizophrenia. Patients with schizophrenia spectrum disorders (n = 78) and community controls (n = 95) completed diffusion weighted imaging and performed psychological stress tasks. Subjective affect was collected pre and post stressors. Individuals who did not persist during one or both stress tasks were considered distress intolerant (DI), and otherwise distress tolerant (DT). Fractional anisotropy (FA) of the dorsal cingulum showed a significant diagnosis x DT/DI phenotype interaction (p = 0.003). Post-hoc tests showed dorsal cingulum FA was significantly lower in DI patients compared with DI controls (p < 0.001), but not different between DT groups (p = 0.27). Regarding affect responses to stress, irritability showed the largest stress-related change (p < 0.001), but irritability changes were significantly reduced in DI patients compared to DI controls (p = 0.006). The relationship between irritability change and performance errors also differed among patients (ρ = -0.29, p = 0.011) and controls (ρ = 0.21, p = 0.042). Further modeling highlighted the explanatory power of dorsal cingulum for predicting DI even after performance and irritability were taken into account. Distress intolerance during psychological stress exposure is related to microstructural properties of the dorsal cingulum, a key structure for cognitive control and emotion regulation. In schizophrenia, the affective response to psychological stressors is abnormal, and distress intolerant patients had significantly reduced dorsal cingulum FA compared to distress intolerant controls. The findings provide new insight regarding distress intolerance in schizophrenia.

Impact of a computerized intervention for high distress intolerance on cannabis use outcomes: A randomized controlled trial

OBJECTIVE

Prevalence of regular cannabis use and cannabis use disorder (CUD) have increased in the past two decades, but treatment-seeking is low and extant brief interventions do not target causal risk factors implicated in etiological models of addiction. Elevated distress intolerance (DI) is one risk factor that has been empirically linked with greater CUD severity and maintenance in regular users, but, to our knowledge, research has never targeted it in a brief intervention among cannabis users with CUD or at high risk. The current RCT evaluated the impact of a DI intervention (i.e., Distress Tolerance Intervention [DTI]) compared to a healthy habits control intervention (i.e., Healthy Video Control [HVC]) on DI and cannabis use outcomes.

METHOD

We randomized cannabis users with high DI (N = 60) to the DTI or HVC condition and they received two computerized intervention sessions. We assessed relief cannabis craving at pre- and post-treatment; and we assessed DI, cannabis use coping motives, use-related problems, and use frequency at pre- and post-treatment as well as one- and four-month follow-ups. We assessed CUD symptoms via interviews at pre-treatment and four-month follow-up.

RESULTS

Significant, durable reductions in DI and all cannabis use outcomes occurred in both conditions. Compared to the HVC condition, the DTI led to greater reductions in use frequency during the treatment period. Reductions in self-reported DI were correlated with reductions in coping motives and CUD symptoms.

CONCLUSION

The DTI's impact on all outcomes was largely comparable to the control condition, though it may have utility as an adjunctive intervention.

Distress intolerance mediates attentional control on posttraumatic stress symptoms: Evidence from two clinical samples

Theoretical models emphasize the importance of both affective and cognitive risk factors in the development of posttraumatic stress symptoms (PTSS). Two such factors predicting PTSS have been studied extensively: distress intolerance (DI) - an affective factor indicative of the ability to tolerate negative affective states - and attentional control (AC), a cognitive factor reflecting the ability to flexibly shift and maintain attention to goal-relevant tasks. Previous work primarily highlights the independent contributions of DI and AC and their interaction to predict PTSS. Some models, however, suggest a mediational pathway such that AC indirectly affects PTSS via diminished DI. The current paper addressed this gap by first attempting to replicate prior findings, while also exploring this mediation model. Results were examined in two clinical samples - a trauma-exposed sample of adults (study 1; N = 73) and trauma-exposed treatment-seeking adults (study 2; N = 204). Results partially supported our hypotheses; both studies failed to replicate prior moderation findings, but our mediational hypothesis was supported in both samples. Low AC appears to decrease an individual's tolerance for distressing situations, which in turn increases the severity of PTSS. Results suggest that PTSD treatments may benefit by incorporating components of AC, DI, or a combination of the two to mitigate PTSS. Taken together, this study provides a novel examination of how cognitive and affective risk factors, namely AC and DI, work in tandem to increase PTSS.

Pain catastrophizing and distress intolerance: prediction of pain and emotional stress reactivity

Exposure to stress is associated with poor outcomes in people with chronic pain. Dispositional variables, such as pain catastrophizing and distress intolerance, may impact reactivity to stressors. Importantly, these variables can be modified with treatment. The aim of this study was to investigate whether pain catastrophizing and distress intolerance were associated with tolerance of a pain stressor or a psychosocial stressor, and heightened negative affect following these stressors. A sample of 50 adults with chronic pain completed self-report measures and pain and psychosocial stress inductions. Results indicated that pain catastrophizing was associated with heightened anxiety during pain induction. Distress intolerance was associated with negative affect following a psychosocial stressor, and with poorer tolerance of the psychosocial stressor. Pain catastrophizing and distress intolerance are related factors, however, they exhibit distinct associations with amplification of pain and psychosocial stress reactivity. These variables may be important treatment targets in people with chronic pain.

Distress Intolerance in Relation to Reliance on Cigarettes for Weight, Shape, and Appetite Control

BACKGROUND

Distress intolerance, one's inability to withstand distressing emotional or physical states, is a transdiagnostic vulnerability implicated in affect-based health behaviors, including cigarette smoking and poor weight control. The current study evaluated associations between distress intolerance and the reliance on cigarettes for management of weight, appetite, or body dissatisfaction, which may pose a burden for cessation and increase risk of weight-related health problems.

METHOD

Daily smokers (n = 577) completed an online survey assessing distress tolerance and reliance on cigarettes for weight and shape control with the four subscales of the Smoking and Weight Eating Episodes Test (SWEET). Four hierarchical regression models were constructed to test the association between distress intolerance and SWEET scores, accounting for the effect of relevant covarying factors.

RESULTS

After adjusting for model covariates, distress intolerance was significantly incrementally associated with greater tendency to rely on cigarettes to suppress appetite (adjR² = .040), prevent overeating (adjR² = .034), cope with body dissatisfaction (adjR² = .046), and cope with nicotine withdrawal-related appetite increases (adjR² = .030).

CONCLUSION

Distress intolerance may play an etiological role in maladaptive use of cigarettes to control appetite, weight, and body dissatisfaction among daily smokers, particularly those with weight- or shape-related concerns. Interventions aimed at increasing perceived ability to withstand distress could potentially reduce reliance on cigarettes for the aforementioned purposes.

Distress intolerance and withdrawal severity among daily smokers: The role of smoking abstinence expectancies

BACKGROUND

Distress intolerance (DI), the perceived inability to withstand distress, is implicated in cigarette smoking maintenance. Greater DI may contribute to anticipation of negative outcomes from smoking abstinence, which in turn could contribute to withdrawal symptom severity. The current study aimed to evaluate (1) the association between DI and acute abstinence expectancies and (2) the potential mediating role of abstinence expectancies in the relationship between DI and withdrawal symptom severity.

METHOD

Participants (n = 444) were daily smokers who reported at least one prior quit attempt, participating in a larger online study on distress and smoking. DI, subjective nicotine withdrawal, and smoking abstinence expectancies were assessed using the Distress Tolerance Scale (DTS), Minnesota Nicotine Withdrawal Scale (MNWS), and Smoking Abstinence Expectancies Questionnaire (SAEQ).

RESULTS

DTS was significantly negatively associated with SAEQ, specifically Negative Mood (r = -0.37, p < .001), Somatic Symptoms (r = -0.47, p < .001), and Harmful Consequences (r = -0.59, p < .001) subscales, but was not associated with Positive Expectancies subscale (r = 0.05, p = .31). Results indicated a significant effect of DTS on withdrawal symptom severity via SAEQ. Follow-up analyses indicated that the indirect effects were driven specifically by SAEQ Negative Mood and Harmful Consequences subscales.

DISCUSSION

DI is related to more negative abstinence expectancies, particularly affective aspects of abstinence, which may contribute to the severity of nicotine withdrawal symptoms. This study provides initial evidence of a specific cognitive process that may explain why DI contributes to heightened subjective experience of nicotine withdrawal symptoms.

Recent Advances in Research on Hoarding

PURPOSE OF REVIEW

The purpose of the following paper is to review recent literature trends and findings in hoarding disorder (HD). Our goal is to highlight recent research on etiology, associated features, and empirically based treatments.

RECENT FINDINGS

Recent literature has added support for cognitive differences as a risk factor for HD; however, there is evidence that individuals with HD may overestimate their level of cognitive impairment. Several associated features have been highlighted in recent studies, including emotion regulation, intolerance of uncertainty and distress intolerance, and attachment. Finally, several psychotherapeutic treatments for hoarding have been recently validated, including group-based therapy and treatments using the cognitive-behavioral model. Although recent research demonstrates that hoarding can be effectively treated with available psychotherapeutic modalities, the effectiveness of current treatments is not as robust as that for other psychiatric disorders and more work is needed in treatment precision.

The Sequential Indirect Effect of Negative Urgency on Drinking Consequences Through Distress Intolerance and Drinking Motives: Initial Examination in College Students Reporting Past Month Alcohol Use

Identification of cognitive and affective vulnerabilities among college drinkers may aid in developing focused interventions that promote a reduction in the prevalence of alcohol use. Negative urgency (NU) and distress intolerance (DI) evidence concurrent, unique, and synergistic relations with drinking motives and negative consequences of alcohol use. Utilizing a sequential multiple mediation framework to investigate a comprehensive model of these variables, we examined NU as a behavioral risk factor that potentiates the development of DI, thereby contributing to drinking motives that increase the risk of problematic use in young adults. A diverse sample of undergraduate students (N = 616; M _age= 19.1, SD=1.4, range=18-25; 50.6% female; 60.6% Caucasian; recruited between September 2015 and Spring 2017) reporting past month alcohol use completed an online questionnaire battery. The results suggested that NU may contribute to negative alcohol use outcomes via its relation to DI and the motivation to drink in order to cope with negative emotional states and conform to social pressure. These findings suggest that NU may be a primary intervention target in young adults.

Applying attachment theory to indecisiveness in hoarding disorder

Research shows that individuals who experience distress when discarding their possessions are more indecisive than individuals who do not experience such difficulty. These individuals report more intense emotional responses and greater intolerance to distress when faced with a discarding task. The aim of this study was to determine whether an insecure attachment style contributes to indecisiveness among individuals with discarding difficulties and whether this association is mediated by emotional reactivity and distress intolerance. This study used a within-group cross-sectional design. One hundred fifty-six participants with clinically significant discarding problems (82.7% female; Mean age = 21.96, SD = 7.38) from a population of university students and community members completed self-report questionnaires that assessed severity of hoarding behaviours, insecure attachment styles, emotional reactivity, distress intolerance, and indecisiveness. Analyses revealed that an anxious attachment style was associated with greater indecisiveness, and this relationship was mediated by emotional reactivity, but not distress intolerance. Furthermore, avoidant attachment was not related to indecisiveness. Clinical interventions should consider the role of attachment styles in hoarding disorder and address emotional reactivity difficulties in treatment through the use of discarding exposures, as emotion plays an important role in these decision-making processes.

Development and validation of a contextual behavioral distress intolerance task in cigarette smokers

INTRODUCTION

Distress intolerance, an individual's perceived or actual inability to withstand negative emotional or physical distress, contributes to the maintenance of smoking. However, there is limited understanding of the contextual factors that impact distress intolerance in general or among smokers specifically. This study aimed to adapt and test a computerized behavioral persistence task that requires re-typing a passage while adhering to specific instructions (Contextual-Frustration Intolerance Typing Task [C-FiTT]). C-FiTT was designed to model contextual factors that influence distress intolerance, negative affect, and smoking urges.

METHOD

Daily smokers (n = 550) were recruited through the use of Qualtrics Panels. Using a 2 × 2 + 1 experimental design, participants were randomly assigned to one of four C-FiTT conditions that crossed task difficulty (low or high difficulty) with passage content (neutral or tobacco withdrawal text), or a neutral control group.

RESULTS

C-FiTT produced an average persistence time of 94.1 ± 114.3 s and 64.7% of participants self-terminated the task. C-FiTT also produced small to medium sized-increases in negative affect and smoking urges. Between-condition comparisons indicated that the high-difficulty C-FiTT produced shorter behavioral persistence, greater self-termination likelihood, and larger increases in negative affect and smoking urges. The combination of high-difficulty and withdrawal content resulted in the shortest persistence time, 100% self-termination rate, and largest increases in negative affect and smoking urges, compared to other conditions CONCLUSIONS: Findings provide initial evidence for the validity of C-FiTT in smokers within the context of tobacco withdrawal at low and high levels of task difficulty. Avenues for refinement and use of C-FiTT are discussed.

Sex-Specific Link Between Emotional Vulnerability and Poor Weight Control in Cigarette Smokers

BACKGROUND

Cigarette smoking and poor weight control independently and synergistically increase risk for morbidity and mortality. However, few studies have examined the etiological role of emotion-regulatory dysfunction in the link between smoking and poor weight control, as well as the possible moderating role of sex.

METHOD

Participants (n = 577; M_age = 44.42; SD = 13.80; 52.7% female) were daily smokers who completed a single survey online through Qualtrics. Emotional vulnerability was indexed by a latent construct comprised of the subscales from the Distress Tolerance Scale (DTS) and the Anxiety Sensitivity Index-3 (ASI-3). A regression model was constructed to examine the relation between emotional vulnerability and poor weight control, measured via body mass index (BMI).

RESULTS

Emotional vulnerability was significantly and positively associated with BMI (b = .08, p = .020). The effect was moderated by sex, such that emotional vulnerability was significantly related to BMI in female smokers (b = .15, p = .002), but not in male smokers (b = .01, p = .806).

CONCLUSIONS

Emotional vulnerability appears to be a novel female-specific psychological mechanism related to poor weight control in smokers. Possible limitations are discussed.

Distress Intolerance Mediates the Relationship between Child Maltreatment and Nonsuicidal Self-Injury among Chinese Adolescents: A Three-Wave Longitudinal Study

Nonsuicidal self-injury (NSSI) is a serious public health concern among adolescents. Identifying risk factors of NSSI is important to effectively prevent or reduce such behavior. Child maltreatment is one of the most widely recognized risk factors for NSSI. How child maltreatment and NSSI is related, however, is still unclear. The present study tested the temporal relationship between physical and emotional abuse and NSSI, with distress intolerance as the potential mediator. Potential gender differences on these associations were also tested. We assessed all study variables among 2259 Chinese adolescents (53.8% females; M_age = 15.11 years, SD = 1.57) for three times at 6-month intervals. The results showed that distress intolerance only mediated the relationship between emotional abuse and NSSI, but not between physical abuse and NSSI. In addition, this mediation effect of distress intolerance was significant only for females. The findings of this study can help researchers and practitioners understand pathways by which child maltreatment impacts adolescent NSSI. Implications for preventions and interventions of NSSI were discussed.

Investigating the latent structure of distress intolerance

Distress intolerance (DI) is defined as a perceived or actual inability to withstand distressing emotional or somatic states, which motivates the use of avoidance strategies. Despite widespread interest in DI, key questions about its underlying structure remain unanswered. The current study evaluated the latent structure of DI in two large samples using four-indicators and three taxometric procedures (MAMBAC, MAXEIG, and L-Mode). Data interpretation relied primarily on the Comparison Curve Fit Indices (CCFI). Overall, results from the three non-redundant procedures suggested that DI was more accurately characterized by a dimensional rather than a categorical conceptualization. Implications for assessment and conceptual models of DI are discussed.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

The role of distress intolerance in the relationship between childhood sexual abuse and problematic alcohol use among Latin American MSM

BACKGROUND

Despite the high prevalence of childhood sexual abuse (CSA) among men who have sex with men (MSM) and its well-documented association with substance use in adulthood, little research has examined the psychological mechanisms underlying this association. The current study utilized a large, multinational sample of MSM in Latin America to examine the role of distress intolerance (i.e., decreased capacity to withstand negative psychological states) in the relationship between childhood sexual abuse history and problematic alcohol use.

METHODS

As part of an online survey conducted among members of the largest social/sexual networking website for MSM in Latin America, participants (n=19,451) completed measures of childhood sexual abuse history, distress intolerance, and problematic alcohol use (CAGE score>=2).

RESULTS

Participants who reported a history of childhood sexual abuse indicated higher levels of distress intolerance, which was in turn associated with greater odds of engaging in problematic alcohol use. A mediation analysis further showed that distress intolerance partially accounted for the significant association between childhood sexual abuse history and problematic alcohol use.

CONCLUSION

These findings provide initial evidence for the role of distress intolerance as a process through which early trauma shapes MSM health later in life. These findings also underscore the potential utility of addressing distress intolerance in alcohol use prevention and intervention efforts that target MSM with a history of childhood sexual abuse.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Age and Gender Differences in the Associations of Self-Compassion and Emotional Well-being in A Large Adolescent Sample

Adolescence is a challenging developmental period marked with declines in emotional well-being; however, self-compassion has been suggested as a protective factor. This cross-sectional survey study (N = 765, grades 7th to 12th; 53 % female; 4 % Hispanic ethnicity; 64 % White and 21 % Black) examined whether adolescents' self-compassion differed by age and gender, and secondly, whether its associations with emotional well-being (perceived stress, life satisfaction, distress intolerance, depressive symptoms, and anxiety) also differed by age and gender. The findings indicated that older females had the lowest self-compassion levels compared to younger females or all-age males. Self-compassion was associated with all emotional well-being measures, and gender and/or age moderated the associations with anxiety and depressive symptoms. Among older adolescents, self-compassion had a greater protective effect on anxiety for boys than for girls. Additionally, older adolescents with low and average self-compassion had greater levels of depressive symptoms than those with high self-compassion. These results may inform for whom and at what age self-compassion interventions may be implemented to protect adolescents from further declines in emotional well-being.

The role of distress intolerance for panic and nicotine withdrawal symptoms during a biological challenge

BACKGROUND

Distress intolerance is linked to the maintenance of panic disorder and cigarette smoking, and may underlie both problems.

METHOD

Smokers (n = 54; 40.7% panic disorder) were recruited for an experimental study; half were randomly assigned to 12-hour nicotine deprivation and half smoked as usual. The current investigation consisted of secondary, exploratory analyses from this larger experimental study. Four distress intolerance indices were examined as predictors of anxious responding to an emotional elicitation task (10% carbon dioxide (CO2)-enriched air challenge); anxious responding was in turn examined as a predictor of post-challenge panic and nicotine withdrawal symptoms.

RESULTS

The Distress Tolerance Scale (DTS) was significantly negatively associated with anxious responding to the challenge (β = -0.41, p = 0.017). The DTS was negatively associated with post-challenge increases nicotine withdrawal symptoms indirectly through the effect of anxious responding to the challenge (b = -0.485, CI95% (-1.095, -0.033)). This same indirect effect was found for post-challenge severity of panic symptoms (b = -0.515, CI95% (-0.888, -0.208)). The DTS was directly predictive of post-challenge increases nicotine withdrawal symptoms, in the opposite direction (β = 0.37, p = 0.009), but not panic symptom severity.

CONCLUSIONS

Anxious responding in response to stressful experiences may explain the impact of perceived distress intolerance on panic and nicotine withdrawal symptom expression.

The role of anxiety sensitivity in daily physical activity and eating behavior

Anxiety sensitivity (AS), or the fear of somatic arousal, has been linked to both maladaptive eating behavior as well as exercise avoidance in both self-report and laboratory-based experiments. The current pilot study sought to extend these finding to the naturalistic setting. A sample of 32 adults completed affect and dietary monitoring and wore actigraphs across a three-day monitoring period. Results indicated that high AS was associated with greater calorie consumption overall in women and less consumption in men, and high AS predicted an increase in calories consumed following participants' greatest increase in negative affect in both sexes. For physical activity, results indicated an AS by BMI interaction such that obese individuals with high AS engaged in less moderate-intensity physical activity, whereas the opposite was true for normal weight individuals. These results indicate that AS may represent a double-edged risk factor for obesity contributing to both exercise avoidance and calorie consumption.

An Examination of the Association of Distress Intolerance and Emotion Regulation with Avoidance

Distress intolerance is an important motivator of maladaptive avoidance-based coping strategies. The selection of such avoidance behaviors is also influenced by one's access to alternative emotion regulatory strategies. However, little research has examined the relative contributions of these vulnerability factors to avoidance. This study examined whether distress intolerance and access to emotion regulation strategies were uniquely (additively or interactively) associated with self-reported avoidance. Two samples-an unselected sample (n = 300) and a clinical sample (n = 100)-comprised of patients seeking treatment for unipolar mood and/or anxiety disorders were administered measures of distress intolerance, emotion regulation, and avoidance. Results of linear regression analyses indicated that distress intolerance and access to emotion regulation strategies were uniquely and additively associated with avoidance. Implications for the prevention and treatment of psychological disorders are discussed.

Distress Tolerance Scale: A Confirmatory Factor Analysis Among Daily Cigarette Smokers

The present investigation evaluated the factor structure of the Distress Tolerance Scale (DTS; Simons and Gaher 2005) among a sample of 173 (54.9% males) daily cigarette smokers (M=16.64 cigarettes per day, SD=7.83). Comparison of a single higher-order model and a hierarchical multidimensional model was conducted using confirmatory factor analyses (CFA). In addition, evaluation of the internal consistency and convergent and discriminant validity of the better-fitting model was completed. CFA of the DTS indicated a single second-order factor of distress tolerance, and four lower-order factors including Tolerance, Appraisal, Absorption, and Regulation; each factor demonstrated acceptable levels of internal consistency. In addition, the DTS displayed good convergent and discriminant validity with theoretically relevant smoking and affect variables. Results are discussed in terms of explicating the latent structure of distress tolerance, as measured by the DTS, within the context of smoking research.