Elsevier

Behavior Therapy

Volume 43, Issue 3, September 2012, Pages 641-651
Behavior Therapy

Refining the Measurement of Distress Intolerance

https://doi.org/10.1016/j.beth.2011.12.001Get rights and content

Abstract

Distress intolerance is an important transdiagnostic variable that has long been implicated in the development and maintenance of psychological disorders. Self-report measurement strategies for distress intolerance (DI) have emerged from several different models of psychopathology and these measures have been applied inconsistently in the literature in the absence of a clear gold standard. The absence of a consistent assessment strategy has limited the ability to compare across studies and samples, thus hampering the advancement of this research agenda. This study evaluated the latent factor structure of existing measures of DI to examine the degree to which they are capturing the same construct. Results of confirmatory factor analysis in three samples totaling 400 participants provided support for a single-factor latent structure. Individual items of these four scales were then correlated with this factor to identify those that best capture the core construct. Results provided consistent support for 10 items that demonstrated the strongest concordance with this factor. The use of these 10 items as a unifying measure in the study of DI and future directions for the evaluation of its utility are discussed.

Highlights

► Distress intolerance is an important transdiagnostic vulnerability factor. ► Measurement of distress intolerance is hampered by inconsistency across studies. ► Measures of distress intolerance appear to load onto 1 latent factor. ► Use of 10 items drawn from existing measures may provide an alternative to use of multiple measures.

Section snippets

Study 1

In the first study, an unselected sample was recruited using community advertisements. A sample of 300 community adults with a mean age of 36.8 years (SD = 14.4) completed a battery of DI measures using a Web-based data collection program (SurveyMonkey). The latent factor structure was first evaluated using exploratory factor analysis (EFA), and then a more restrictive confirmatory factor analysis (CFA). We conducted these procedures sequentially because of a lack of clear guidance from the

Results

The distribution of scores for each subscale was roughly normal, with Shapiro-Wilk scores close to 1 (all scores >.94) and did not evidence skewness or kurtosis, or univariate outliers. Descriptive statistics for both samples are presented in Table 1. Standard deviations of continuous demographic and DI measures were equivalent in both samples supporting the use of t tests to evaluate group differences. No significant differences between samples with respect to age or any of the DI subscales

Study 1 Discussion

In a large unselected sample, a one-factor model of DI was extracted from four candidate self-report measures that have been widely applied in the measurement of DI; this was replicated in a second unselected sample. This model exhibited strong fit to the data in both the original and replication samples. These results are consistent with an evaluation of the shared variance among these DI self-report measures that supported moderate to high correlations among these measures in both clinical

Study 2

The same one-factor model was tested in a clinical sample, consisting of patients diagnosed with a unipolar mood or anxiety disorder who were seeking treatment at a specialty affective disorders clinic. The aim of this analysis was to examine the reliability of the findings from Study 1 with respect to both the latent factor structure and individual items demonstrating the strongest concordance with a composite score calculated based on this factor structure.

Results

The distribution of scores for each subscale was evaluated for normality and one scale evidenced minor deviation from normality (Shapiro-Wilk test >.80) but evidenced no skewness or kurtosis. No outliers were identified. Given that maximum likelihood estimation is robust to minor deviations from normality (Chou & Bentler, 1995), analyses proceeded as planned. Descriptive statistics are presented in Table 1.

Fit indices for the CFA supported good model fit, χ2(49) = 64.12, SRMR = .05, RMSEA = .06, TLI = 

Study 2 Discussion

In this study, we replicated the findings from Study 1 in a clinical sample. A one-factor latent structure demonstrated good model fit in the CFA and individual item analysis yielded a similar list of items to those from the two samples in Study 1. The replication of these findings in a clinical sample suggests that this latent factor structure is robust across a wide range of values including those characterizing clinical samples in which intolerance of distress is elevated.

General Discussion

Using the four most widely applied measures of DI—each based on different theoretical models—we found a one-factor solution with all factor loadings in an acceptable range (i.e., >.40) and good overall model fit in both unselected and clinical samples. This single-factor solution was replicated across three large samples, including a total of 400 participants, suggesting that the degree of concordance of these measures is high. This finding is consistent with previous investigations suggesting

References (55)

  • S. Reiss et al.

    Anxiety sensitivity, anxiety frequency and the predictions of fearfulness

    Behaviour Research and Therapy

    (1986)
  • N.B. Schmidt et al.

    Discomfort intolerance: Evaluation of a potential risk factor for anxiety psychopathology

    Behavior Therapy

    (2007)
  • N.B. Schmidt et al.

    Discomfort intolerance: Development of a construct and measure relevant to panic disorder

    Journal of Anxiety Disorders

    (2006)
  • N.B. Schmidt et al.

    Attentional focus and fearful responding in patients with panic disorder during a 35% CO2 challenge

    Behavior Therapy

    (1999)
  • A.D. Sirota et al.

    Intolerance for Smoking Abstinence Questionnaire: Psychometric properties and relationship to tobacco dependence and abstinence

    Addictive Behaviors

    (2010)
  • A.A. Vujanovic et al.

    Cognitive-affective characteristics of smokers with and without posttraumatic stress disorder and panic psychopathology

    Addictive Behaviors

    (2010)
  • K.S. White et al.

    Avoidance behavior in panic disorder: The moderating influence of perceived control

    Behaviour Research and Therapy

    (2006)
  • S.P. Whiteside et al.

    The five factor model and impulsivity: Using a structural model of personality to understand impulsivity

    Personality and Individual Differences

    (2001)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (1994)
  • M.D. Anestis et al.

    The multifaceted role of distress tolerance in dysregulated eating behaviors

    International Journal of Eating Disorders

    (2007)
  • S. Barone et al.

    The association between anxiety sensitivity and atopy in adult asthmatics

    Journal of Behavioral Medicine

    (2008)
  • A. Bernstein et al.

    Multi-method evaluation of distress tolerance measures and construct(s): Concurrent relations to mood and anxiety psychopathology and quality of life

    Journal of Experimental Psychopathology

    (2011)
  • R.A. Brown et al.

    Distress tolerance and duration of past smoking cessation attempts

    Journal of Abnormal Psychology

    (2002)
  • R.A. Brown et al.

    A prospective examination of distress tolerance and early smoking lapse in adult self-quitters

    Nicotine and Tobacco Research

    (2009)
  • R.A. Brown et al.

    Distress tolerance treatment for early-lapse smokers: Rationale, program description, and preliminary findings

    Behavior Modification

    (2008)
  • T.A. Brown

    Confirmatory factor analysis for applied research

    (2006)
  • C.P. Chou et al.

    Estimates and tests in structural equation modeling

  • Cited by (139)

    View all citing articles on Scopus

    The authors are aware of no conflicts of interest relevant to the current manuscript. Nonetheless, Dr. McHugh would like to report consultant support in the past year from WebEBP and receipt of royalties from Oxford University Press and Dr. Otto would like to report past (3 years) consultant and research support from Organon (Merck), and royalties received for use of the SIGH-A from Lilly.

    View full text