Amit Bernstein

Distress Tolerance and Psychopathological Symptoms and Disorders: A Review of the Empirical Literature among Adults.

We review theory and empirical study of distress tolerance, an emerging risk factor candidate for various forms of psychopathology. Despite the long-standing interest in and promise of work on distress tolerance for understanding adult psychopathology, there has not been a comprehensive review of the extant empirical literature focused on the construct. As a result, a comprehensive synthesis of theoretical and empirical scholarship on distress tolerance, including integration of extant research on the relations between distress tolerance and psychopathology, is lacking. Inspection of the scientific literature indicates that there are a number of promising ways to conceptualize and measure distress tolerance, as well as documented relations between distress tolerance factors and psychopathological symptoms and disorders. Although promising, there also is notable conceptual and operational heterogeneity across the distress tolerance literature. Moreover, a number of basic questions remain unanswered regarding the associations between distress tolerance and other risk and protective factors and processes, as well as its putative role(s) in vulnerability for and resilience to psychopathology. Thus, the current article provides a comprehensive review of past and contemporary theory and research and proposes key areas for future empirical study of this construct.

Cigarette Smoking and Panic Psychopathology

The present paper summarizes empirical evidence suggesting that smoking and panic problems often co-occur; that smoking is a risk factor for, and may serve to maintain, panic attacks and panic disorder; and that premorbid panic-specific vulnerability variables and full-blown panic problems are related to coping-oriented smoking motives and perhaps to the maintenance of smoking behavior. An integrative model is offered to stimulate further work on this topic, followed by future directions for research.

Relations Between Anxiety Sensitivity, Distress Tolerance, and Fear Reactivity to Bodily Sensations to Coping and Conformity Marijuana Use Motives Among Young Adult Marijuana Users

The present investigation examines anxiety sensitivity, distress tolerance, and fear reactivity to bodily sensations in relation to Coping and Conformity marijuana use motives among a sample of young adult marijuana users (n = 135; 46.7% women; Mage = 20.45, SD = 5.0). After controlling for current marijuana use frequency (past 30 days), daily cigarette smoking rate, average volume of alcohol used over the past year, negative affectivity, and other marijuana use motives, anxiety sensitivity was significantly and uniquely associated with Coping and Conformity motives for marijuana use. Distress tolerance evidenced significant and unique incremental relations to Coping motives, whereas fear reactivity to bodily sensations was unrelated to any marijuana use motive. These results provide novel information related to the role of emotional sensitivity and tolerance factors as they pertain to specific types of motives for marijuana use among young adults.

Multimethod study of distress tolerance and PTSD symptom severity in a trauma-exposed community sample.

Despite initial evidence linking distress tolerance to posttraumatic stress disorder (PTSD) symptom severity, there is a need for the investigation of interrelations among multiple measures of distress tolerance and PTSD symptom severity. Therefore, the present study investigated concurrent relations among multiple measures of distress tolerance, as well as the relations between these measures and PTSD symptom severity, within a trauma-exposed community sample. The sample consisted of 81 trauma-exposed adults (63.1% women). Results indicated that Distress Tolerance Scale (Simons & Gaher, 2005) scores, but no other measures of distress tolerance were significantly related to PTSD symptom severity above and beyond the variance accounted for by number of traumas, trait-level neuroticism, and participant sex. Implications and future directions are discussed.

Integrating anxiety sensitivity, distress tolerance, and discomfort intolerance: a hierarchical model of affect sensitivity and tolerance.

The purpose of the present investigation was to concurrently examine the latent dimensional and hierarchical structure of anxiety sensitivity (AS) and two key theoretically relevant and related affect (in)tolerance and sensitivity constructs: distress tolerance and discomfort intolerance. These constructs were measured using the Anxiety Sensitivity Index (Reiss, Peterson, Gursky, & McNally, 1986), the Distress Tolerance Scale (Simons & Gaher, 2005), and the Discomfort Intolerance Scale (Schmidt, Richey, & Fitzpatrick, 2006). A total of 229 individuals (124 females; M(age)=21.0 years, SD=7.5) without current Axis I psychopathology participated by completing a battery of self-report questionnaires. A two-stage exploratory factor analysis was conducted to examine the lower- and higher-order latent structural relations among the variables. The factor solution was subsequently evaluated in relation to negative affectivity, anxious arousal, and anhedonic depression. AS and distress tolerance appeared to be related to one another as distinct lower-order facets of a common higher-order affect tolerance and sensitivity factor, whereas discomfort intolerance did not appear to demonstrate similar relations with either AS or distress tolerance at the lower-order or higher-order levels. A unique pattern of association with theoretically-relevant criterion variables was observed between the affect tolerance and sensitivity higher-order factor, the AS and distress tolerance lower-order factors, and the discomfort intolerance factor. Findings are discussed in the context of theoretical and clinical implications and future directions for the study of affect tolerance and sensitivity in relation to emotional vulnerability.

Distress Tolerance Theory, Measurement, and Relations to Psychopathology

In this article we present the theoretical and empirical bases of distress tolerance research. Although distress tolerance offers a promising lens through which to better understand various psychological symptoms and disorders, further theoretical development and empirical inquiry is needed to promote our understanding of the construct. Overall, a number of questions regarding its theoretical conceptualization and measurement, associations with related constructs and psychopathology, and role(s) in therapeutic change and intervention remain unanswered. Directions for future research are discussed to stimulate further empirical study on this theoretically and clinically promising topic.

Impact of Posttraumatic Stress Disorder on Early Smoking Lapse and Relapse During a Self-Guided Quit Attempt Among Community-Recruited Daily Smokers

The present investigation examined whether daily smokers with posttraumatic stress disorder (PTSD), as compared to daily smokers with either anxiety psychopathology or no current Axis I psychopathology, have decreased success in the early phases of a self-guided smoking quit attempt. Participants were 140 daily smokers (81 women; M (age) = 29.5; SD = 11.9; range = 18-65 years); approximately one-third of the sample met criteria for current PTSD (n = 47), one-third met criteria for other current anxiety disorders (without PTSD; n = 33), and one-third did not meet criteria for any current Axis I disorder (n = 60). Consistent with prediction, membership in the PTSD group, compared to membership in the other anxiety disorders group and the group with no current Axis I psychopathology, was associated with increased risk of lapse during the first week following quit day. Additionally, daily smokers with PTSD and other anxiety disorders were at significantly increased risk of relapse during the first week post-cessation compared to persons without Axis I psychopathology. However, the PTSD group and the other anxiety disorders group did not differ from one another in terms of relapse. Results suggest that PTSD is associated with increased risk of smoking lapse and relapse compared to smokers with no current Axis I psychiatric problems, and increased risk of early smoking lapse but not relapse, as compared to those with other anxiety disorders. Findings provide novel evidence that PTSD, and perhaps anxiety disorders more generally, may be important factors in reducing the odds of successful unaided quit attempts in the early phases of cessation.

Anxiety Sensitivity and Smoking Motives and Outcome Expectancies Among Adult Daily Smokers: Replication and Extension

The present investigation examined the incremental validity of anxiety sensitivity in the context of distress intolerance in terms of predicting smoking motives and outcome expectancies. Participants were a community sample of 144 daily smokers (85 women, M (age) = 29.72 years, SD = 11.96). Results indicated that above and beyond discomfort intolerance, Axis I diagnoses, gender, volume of alcohol consumption, and average number of cigarettes smoked per day, anxiety sensitivity significantly incrementally predicted habitual, addictive, and negative affect reduction motives to smoke, as well as negative reinforcement outcome expectancies. No such incremental effects were similarly evident for distress intolerance. Findings are discussed in relation to the role of anxiety sensitivity in smoking motives and outcome expectancies.

Interoceptive Exposure-Based Cessation Intervention for Smokers High in Anxiety Sensitivity: A Case Series

The current report presents the underlying rationale and components of an interoceptive exposure-based smoking cessation treatment for anxiety-sensitive smokers. The intervention was pilot-tested on three (female) daily smokers with moderate to high levels of nicotine dependence and high levels of anxiety sensitivity. Results indicated meaningful therapeutic gains in smoking outcome and theoretically expected changes in anxiety sensitivity, distress tolerance, and negative as well as positive affective states. Overall, the present case series highlights a potentially promising way to integrate interoceptive exposure-based treatment with standard smoking cessation treatment for smokers high in anxiety sensitivity. From a treatment development perspective, these case-series data suggest that future study of this intervention in a large-scale (controlled) clinical trial is indicated.

Temporal Dynamics of Attentional Bias

Biases of emotional attention are believed to be central to human (mal)adaptation and multiple forms of psychopathology. Yet fundamental questions remain regarding the nature and empirical study of attentional bias (AB). We thus aimed to (a) test a novel conceptualization and related operationalization of AB expression in time and (b) illuminate the nature of AB and specifically its temporal expression. We examined AB expression in time by means of a novel trial-level bias score (TL-BS) analysis of dot probe task data in two experiments—among spider phobics and healthy controls, and among smoking-deprived daily smokers. Findings revealed evidence of the dynamic expression of AB in time; furthermore, TL-BS parameters demonstrated unique associations with psychopathology and addiction beyond traditional bias score. The present research may help to bring the conceptualization and quantification of AB closer to the nature of the phenomenon and thereby advance basic and clinical knowledge.