Refining the Measurement of Distress Intolerance☆
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)
- et al.
Integrating anxiety sensitivity, distress tolerance, and discomfort intolerance: A hierarchical model of affect sensitivity and tolerance
Behavior Therapy
(2009) - et al.
Discomfort intolerance: Evaluation of incremental validity for panic-relevant symptoms using 10% carbon dioxide-enriched air provocation
Journal of Anxiety Disorders
(2009) - et al.
Distress tolerance and early smoking lapse
Clinical Psychology Review
(2005) - et al.
Problematic alcohol and cannabis use among young adults: The roles of depression and discomfort and distress tolerance
Addictive Behavior
(2007) - et al.
Distress tolerance in the eating disorders
Eating Behaviors
(2007) It's too difficult! Frustration intolerance beliefs and frustration
Personality and Individual Differences
(2005)- et al.
Anxiety symptomatology: The association with distress tolerance and anxiety sensitivity
Behavior Therapy
(2010) - et al.
A novel method for assessing distress intolerance: Adaptation of a measure of willingness to pay
Journal of Behavior Therapy and Experimental Psychiatry
(2011) - et al.
Does distress tolerance moderate the impact of major life events on psychosocial variables and behaviors important in the management of HIV?
Behavior Therapy
(2007) - et al.
Emotional exposure in the treatment of substance use disorders: Conceptual model, evidence, and future directions
Clinical Psychology Review
(2005)
Anxiety sensitivity, anxiety frequency and the predictions of fearfulness
Behaviour Research and Therapy
Discomfort intolerance: Evaluation of a potential risk factor for anxiety psychopathology
Behavior Therapy
Discomfort intolerance: Development of a construct and measure relevant to panic disorder
Journal of Anxiety Disorders
Attentional focus and fearful responding in patients with panic disorder during a 35% CO2 challenge
Behavior Therapy
Intolerance for Smoking Abstinence Questionnaire: Psychometric properties and relationship to tobacco dependence and abstinence
Addictive Behaviors
Cognitive-affective characteristics of smokers with and without posttraumatic stress disorder and panic psychopathology
Addictive Behaviors
Avoidance behavior in panic disorder: The moderating influence of perceived control
Behaviour Research and Therapy
The five factor model and impulsivity: Using a structural model of personality to understand impulsivity
Personality and Individual Differences
Diagnostic and statistical manual of mental disorders
The multifaceted role of distress tolerance in dysregulated eating behaviors
International Journal of Eating Disorders
The association between anxiety sensitivity and atopy in adult asthmatics
Journal of Behavioral Medicine
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
Distress tolerance and duration of past smoking cessation attempts
Journal of Abnormal Psychology
A prospective examination of distress tolerance and early smoking lapse in adult self-quitters
Nicotine and Tobacco Research
Distress tolerance treatment for early-lapse smokers: Rationale, program description, and preliminary findings
Behavior Modification
Confirmatory factor analysis for applied research
Estimates and tests in structural equation modeling
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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.