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.

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