Multi-Method Evaluation of Distress Tolerance Measures and Construct(s): Concurrent Relations to Mood and Anxiety Psychopathology and Quality of Life

Abstract

Despite the growing theoretical and clinical interest in distress tolerance (DT) and its role(s) in psychopathology vulnerability, we lack knowledge regarding the: (1) nature and degree of associations between putatively related measures of DT, and (2) universal/differential nature of associations between these DT measures and psychopathological syndromes. Accordingly, the purpose of the current multimethod study was thus to investigate the relations between and among various self-report and behavioral DT measures, as well as to examine the measures' differential relations to multiple forms of mood and anxiety psychopathology and quality of life. Participants were 149 adults (61.3% women; M age = 23.4, SD = 8.8) who completed self-report [Distress Tolerance Scale (DTS;Simons & Gaher, 2005), Discomfort Intolerance Scale (DIS; Schmidt, Richey, & Fitzpatrick, 2006)] and behavioral (mirror-tracing, breath-holding, and CO 2 -enriched air tolerance tasks) measures of DT, as well as a structured clinical interview and quality of life measure. As hypothesized, the self-report DT measures were significantly related to one another and the behavioral DT measures were significantly related to one another, though the self-report and behavioral DT measures were orthogonal. Furthermore, DTS scores evidenced significant transdiagnostic relations to psychopathology and quality of life; lower levels of perceived tolerance of emotional distress were related to mood and anxiety disorder diagnostic status, greater levels of co/multi-morbidity, and poorer quality of life. In contrast, the behavioral DT measures were not related to any of the clinical outcomes studied. Implications of the present study for conceptualizing the nature of individual differences in DT construct(s), and the role(s) of these individual differences for psychopathology vulnerability, are discussed.

State, But Not Trait, Measures of Persistence Are Related to Negative Affect

“…We see this distinction as comparable to Spielberger's conceptualization of state versus trait anxiety or state versus trait anger (Spielberger and Sydeman, 1994). Although Bernstein et al (2011) andMcHugh et al (2011) reported a similar association between self-report and behavioral measures of distress tolerance, they did not specifi cally conceptualize these as state versus trait differences. Although we equate state persistence with behavioral measures and trait measures with self-report measures, it is clear that self-report measures could be developed to measure state persistence.…”

Examination of the Relationship Between PTSD and Distress Tolerance in a Sample of Male Veterans With Comorbid Substance Use Disorders

“…Further, work in a civilian community sample determined that perceived (i.e., self-report) DT for emotional stimuli, compared with actual, behaviorally observed DT or DT for physical stimuli, appears to be particularly relevant to PTSD symptom severity, after covarying for neuroticism, trauma load, and participant sex (Marshall-Berenz et al, 2010). It is important to note that self-report measures of DT and behavioral measures are generally uncorrelated (Bernstein, Marshall, & Zvolensky, 2011; Marshall-Berenz et al, 2010; McHugh et al, 2011), as they potentially assess different aspects of DT. Furthermore, they have been found to be differentially related to clinical outcomes, with self-report measures of DT often being related to PTSD and anxiety (Bernstein et al, 2011; Marshall-Berenz et al, 2010).…”

Examining Associations Between Cognitive-Affective Vulnerability and HIV Symptom Severity, Perceived Barriers to Treatment Adherence, and Viral Load Among HIV-Positive Adults

“…In support of this, two investigations by Brandt and colleagues [37,38] suggest that both AS and ER evidence greater specificity to poor outcomes among HIV+ individuals, as compared with DT. Alternatively, the method of measurement of DT may have contributed to this null finding [28]. Given the observed differential relations between objective and subjective measures of DT among individuals with HIV [36], it is possible that including a multimethod assessment of DT in the present investigation would have provided more nuanced findings in terms of the importance of DT in the measured outcomes.…”

“…Exploring malleable (i.e., changeable via intervention) cognitive-affective vulnerability factors that have demonstrated both strong theoretical and empirical relations to a range of health risk behaviors (i.e., distress tolerance [10]; anxiety sensitivity, [11]; emotion regulation, [12]), may provide a novel and relevant avenue by which to develop more effective, specialized interventions for individuals with HIV. More specifically, interventions targeting behavioral, cognitive, and physical sequelae associated with HIV, including HIV symptom severity, perceived barriers to ART adherence, and disease presence, progression, and symptomatology, have the potential to result in numerous improvements in overall quality of life (e.g., [13]). …”

“…AS is characterized by the fear of anxiety and its related health, social, and mental consequences [21], while poor distress tolerance (DT) is characterized by the inability to withstand uncomfortable somatic or emotional perturbation [22]. Both AS [23][24][25][26][27] (e.g., pain, panic disorder, posttraumatic stress disorder, alcohol, and drug use) and DT [22,26,28,29] (e.g., posttraumatic stress, borderline personality disorder, cigarette smoking) have demonstrated empirical relations with negative affect, broadly, as well as a range of psychiatric disorders and substance use disorders.…”