Elsevier

Behavior Therapy

Volume 46, Issue 4, July 2015, Pages 449-462
Behavior Therapy

Distress Tolerance and Pathological Worry: Tests of Incremental and Prospective Relationships

https://doi.org/10.1016/j.beth.2015.03.003Get rights and content

Highlights

  • GAD patients report lower distress tolerance (DT) than controls independent of comorbidity.

  • Lower DT was associated with unique variance in daily worry.

  • DT did not moderate the impact of stressors on worry over time.

Abstract

Pathological worry and generalized anxiety disorder (GAD) have been linked with low distress tolerance (DT), although questions remain including whether this association exists independent of depression and comorbidity, the directionality of the relationship between worry and DT, and DT’s nonredundancy with other worry-relevant variables (i.e., emotional reactivity, stressful life events). Further, it is unclear whether DT is merely a correlate of excessive worry or acts as a risk factor for its development. Two independent studies were completed to evaluate these questions. In Study 1, DT was examined in patients with GAD and healthy controls. In Study 2, a nonclinical sample completed baseline measures of DT, negative affect, and worry, as well as daily assessments of these constructs and stressors for 1 month. In Study 1, lower DT was associated with GAD diagnosis and greater worry symptoms independent of extent of comorbidity and depressive symptoms. In Study 2, lower baseline DT predicted unique variance in daily worry and increases in worry over time, whereas baseline worry did not predict daily DT or decreases in DT 1 month later. Findings suggest that low DT plays a role in excessive worry independent of relevant covariates (i.e., comorbidity, emotional reactivity, stressful life events) and that this relationship is unidirectional. Further, preliminary evidence indicates that low DT may be an overall risk factor for the development of worry, particularly during periods of romantic stress, although further research and replication is required.

Section snippets

Participants

The sample in this study consisted of 34 adult outpatients receiving psychological services at the Florida State University (FSU) Anxiety and Behavioral Health Clinic (ABHC) and 37 adults sampled from the community. The GAD group consisted of individuals with a diagnosis of GAD determined by a structured diagnostic interview, whereas the control group was made up of individuals who had no diagnoses. Exclusionary criteria at the clinic are minimal: the individuals are only referred elsewhere if

Participants

Participants were recruited through introductory psychology courses at a large southeastern university and completed this study as partial fulfillment of course requirements. All participants provided written informed consent. Of the 102 subjects initially recruited, 87 completed the Time 1 and Time 2 assessments.

The sample was 75.9% female and ranged in age from 18 to 35 years (M = 19.46, SD = 2.62). The sample consisted of the following ethnic groups: Caucasian (66.7%), African-American (9.2%),

Discussion

The results of the present studies were largely consistent with hypotheses. In Study 1, observed results supported hypotheses 1 and 2 such that lower DT was related to a GAD diagnosis and pathological worry symptoms, consistent with prior findings in nonclinical and clinical samples (Allan et al., 2014, Keough et al., 2010). These data represent an extension of prior work by demonstrating the association independent of the extent of comorbidity and depressive symptoms, suggesting that low DT is

Conflict of Interest Statement

The authors declare that there are no conflicts of interest.

References (58)

  • D.S. Mennin et al.

    Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder

    Behaviour Research and Therapy

    (2005)
  • T.J. Meyer et al.

    Development and validation of the Penn State Worry Questionnaire

    Behaviour Research and Therapy

    (1990)
  • M.G. Newman et al.

    A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a contrast avoidance model of worry

    Clinical Psychology Review

    (2011)
  • A.M. Norr et al.

    Evaluating the unique contribution of intolerance of uncertainty relative to other cognitive vulnerability factors in anxiety psychopathology

    Journal of Affective Disorders

    (2013)
  • C. Ottaviani et al.

    Flexibility as the key for somatic health: From mind wandering to perseverative cognition

    Biological Psychology

    (2013)
  • K. Özdel et al.

    Distress intolerance in substance dependent patients

    Comprehensive Psychiatry

    (2014)
  • D.M. Sloan

    Emotion regulation in action: emotional reactivity in experiential avoidance

    Behaviour Research and Therapy

    (2004)
  • N.P. Allan et al.

    Direct and interactive effects of distress tolerance and anxiety sensitivity on generalized anxiety and depression

    Cognitive Therapy and Research

    (2014)
  • D.M. Almeida et al.

    The Daily Inventory of Stressful Events: An Interview-Based Approach for Measuring Daily Stressors

    Assessment

    (2002)
  • T.B. Baker et al.

    Addiction motivation reformulated: An affective processing model of negative reinforcement

    Psychological Review

    (2004)
  • M. Berking et al.

    Deficits in emotion-regulation skills predict alcohol use during and after cognitive-behavioral therapy for alcohol dependence

    Journal of Consulting and Clinical Psychology

    (2011)
  • D. Berle et al.

    Preliminary Validation of an Ultra-brief Version of the Penn State Worry Questionnaire

    Clinical Psychology and Psychotherapy

    (2011)
  • T.D. Borkovec et al.

    Avoidance theory of worry and generalized anxiety disorder

  • A.S. Bryk et al.

    Hierarchical linear models: Applications and data analysis methods

    (1992)
  • N. Cohen et al.

    Linking executive control and emotional response: A training procedure to reduce rumination

    Clinical Psychological Science

    (2015)
  • J.R. Cougle et al.

    Validation of Self-Report Measures of Emotional and Physical Distress Tolerance

    Journal of Psychopathology and Behavioral Assessment

    (2013)
  • J.R. Cummings et al.

    Time doesn’t change everything: The longitudinal course of distress tolerance and its relationship with externalizing and internalizing symptoms during early adolescence

    Journal of Abnormal Child Psychology

    (2013)
  • A.J. Ellis et al.

    Enhanced anger reactivity and reduced distress tolerance in major depressive disorder

    Cognitive Therapy & Research

    (2013)
  • M.B. First et al.

    Structured Clinical Interview for DSM-IV (SCID-I): User’s guide and interview, research version

    (1995)
  • Cited by (33)

    • Distress Tolerance as a Familial Vulnerability for Distress-Misery Disorders

      2020, Behavior Therapy
      Citation Excerpt :

      Another, not mutually exclusive possibility is that low perceived DT is a pathoplastic factor in that it causally influences the expression of distress-misery disorders over time (Klein et al., 2009). In support of a pathoplastic interpretation, prior research has found that low perceived DT predicted greater maintenance/increases in worry symptoms 1 month later (Macatee et al., 2015), and increases in perceived DT as a consequence of treatment predicted subsequent decreases in posttraumatic stress symptoms (Boffa et al., 2018). It is also possible that perceived DT functions as a preexisting vulnerability for some distress-misery disorders (or some individuals), but functions as a scar or pathoplastic factor in others.

    • Riding the emotional roller coaster: The role of distress tolerance in non-suicidal self-injury

      2018, Psychiatry Research
      Citation Excerpt :

      As explicitly noted by Hasking et al. (2017a) further research regarding the relationship between affect intensity and NSSI is required. Transdiagnostic in nature, distress tolerance has drawn the attention of many clinicians and researchers as it contributes to the development and maintenance of several psychological disorders (Laposa et al., 2015; Macatee et al., 2015; Williams et al., 2013). Of particular relevance, low distress tolerance is known to be a key mechanism underlying dysregulated behaviours such as substance use (Brown et al., 2005), disordered eating (Anestis et al., 2007) and NSSI (Brown et al., 2002).

    View all citing articles on Scopus
    View full text