Distress tolerance and pre-smoking treatment attrition: Examination of moderating relationships
Open accessAbstract
This study focused on the understudied group of smokers who commit to a smoking research study and then subsequently drop out before completing even one session of treatment (pre-inclusion attrition). This is an important group typically not examined in their own right, leaving little knowledge about the characteristics that differentiate them from those who complete treatment. As an initial investigation, the current study examined affective risk factors for attrition in a sample of 53 adults (79% African-American; median income=$30,000-$39,999) enrolled in a smoking cessation study. Twenty-one (40%) participants never attended a session of treatment. Results indicated that lower psychological distress tolerance was related to pre-inclusion attrition, but only among women. Additionally, lower physical distress tolerance corresponded to pre-inclusion attrition, but only among men. These effects remained after including other important affective factors such as anxiety sensitivity and current depressive symptoms. No other predictors examined corresponded with pre-inclusion attrition in the present sample. Results indicate the need for more research attention to this at-risk group of smokers who do not continue on to cessation intervention.
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Pain tolerance on the cold pressor has been linked to negative mood and to abstinence in addiction.
“tolerance of physical pain in the cold pressor task has been associated with negative mood and addiction abstinence”
From The Effect of a Brief Mindfulness Training on Distress Tolerance and Stress Reactivity. (2019) · cites this paper as MacPherson, Stipelman, Duplinsky, Brown, & Lejuez, 2008
The Methods (2.2 Measures; page unavailable) identify the cold pressor task as a measure of pain tolerance. The Results (4.3; page unavailable) link longer persistence on that task to entering smoking treatment among men, but not women. The paper does not establish a link between cold-pressor tolerance and negative mood or addiction abstinence; treatment entry is not abstinence. (LLM, conf=0.86)
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Flagged first, then by citations
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“This is somewhat in contrast to studies documenting that women have lower distress tolerance than men (MacPherson et al. 2008; Simons and Gaher 2005; but see Bornovalova et al. 2008 for contradictory results).”
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“2003), may explain the association of low distress tolerance with greater risks for cessation treatment drop-out (MacPherson et al. 2008) and relapse (Abrantes et al.”
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“Given past findings of a significant positive association between behavioral measures of psychological and physiological distress tolerance (see [49-51]), as well as research linking high DT to the acquired capability for suicide (see [15,16]), there is reason to believe that our model has merit.”
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“McHugh and Otto (2012) used factor analytic procedures on different affect tolerance measures to derive the items comprising the DII, only some of which came from the DTS, suggesting that the DTS may also include items peripheral to the core DI construct.”
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“, frustration tasks with physical tasks) are often nonsignificant (Brown et al., 2002; Glassman et al., 2016; MacPherson et al., 2008; Szuhany & Otto, 2015).”
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Self-citationDistress tolerance and physiological reactivity to stress predict women's problematic alcohol use
Holzhauer, C. G., Wemm, S., & Wulfert, E. (2017) · Experimental and Clinical Psychopharmacology · doi:10.1037/pha0000116 · Cited by 33 · see citing works
Distress intolerance during smoking cessation treatment
Farris, S. G., Leyro, T. M., Allan, N. P., Øverup, C. S., Schmidt, N. B., & Zvolensky, M. J. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.08.002 · Cited by 33 · see citing works
Distress tolerance and symptoms of depression: A review and integration of literatures
Lass, A. N. S., & Winer, E. S. (2020) · Clinical Psychology: Science and Practice · doi:10.1111/cpsp.12336 · Cited by 62 · see citing works
Luberto, C. M., & McLeish, A. C. (2018) · Addictive Behaviors · doi:10.1016/j.addbeh.2017.09.013 · Cited by 29 · see citing works
MacPherson, L., Calvin, O. L., Richards, J., Guller, L., Mayes, L. C., Crowley, M. J., Daughters, S. B., & Lejuez, C. W. (2012) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2011.01703.x · Cited by 27 · see citing works
Self-citationBuckner, J. D., Jeffries, E. R., Terlecki, M. A., & Ecker, A. H. (2016) · Behavior Modification · doi:10.1177/0145445515610315 · Cited by 26 · see citing works
“Given data finding low DT to be related to greater pre-treatment attrition (MacPherson et al., 2008), future work could benefit from testing whether pre-treatment drop-outs differ on DT from students who do comply with treatment recommendations.”
InfluentialFarris, S. G., Zvolensky, M. J., Otto, M. W., & Leyro, T. M. (2015) · Journal of Psychopharmacology · doi:10.1177/0269881115575536 · Cited by 25 · see citing works
“, 1996), and high distress intolerant smokers, in particular, are more likely to drop out of cessation programs (MacPherson et al., 2008), and are more likely to lapse during a self-guided quit attempt (Abrantes et al.”
BackgroundMethodInfluentialLass, A. N. S., Winer, E. S., Collins, A. C., & Rokke, P. D. (2020) · Cognitive Therapy and Research · doi:10.1007/s10608-020-10131-2 · Cited by 26 · see citing works
Inhibitory Control and Drug Abuse Prevention
Bardo, M., Fishbein, D., & Milich, R. (2011) · Springer eBooks · doi:10.1007/978-1-4419-1268-8 · Cited by 12 · see citing works
Langdon, K. J., Farris, S. G., Hogan, J., Grover, K. W., & Zvolensky, M. J. (2016) · Addictive Behaviors · doi:10.1016/j.addbeh.2016.02.017 · Cited by 21 · see citing works
“…of factors being related to dropout of initiating cessation despite expressing a previous desire to quit, including less education, less readiness to quit, distress tolerance, and related variables (Ahluwalia et al., 2002; Copeland et al., 2006; Curtin et al., 2000; MacPherson et al., 2008).”
BackgroundFemale smokers show lower pain tolerance in a physical distress task
Pulvers, K. M., Hood, A., Limas, E. F., & Thomas, M. D. (2012) · Addictive Behaviors · doi:10.1016/j.addbeh.2012.05.002 · Cited by 20 · see citing works
Pedrelli, P., MacPherson, L., Khan, A. J., Shapero, B. G., Fisher, L. B., Nyer, M., Cassano, P., Parnarouskis, L., Farabaugh, A. H., D, M. F. M., et al. (2018) · Alcohol and Alcoholism · doi:10.1093/alcalc/agy045 · Cited by 20 · see citing works
Self-citationDoorley, J. D., Kashdan, T. B., Alexander, L. A., Blalock, D. V., & McKnight, P. E. (2019) · Motivation and Emotion · doi:10.1007/s11031-019-09751-3 · Cited by 17 · see citing works
Travaglini, L. E., Li, L., Brown, C. H., & Bennett, M. E. (2017) · Addictive Behaviors · doi:10.1016/j.addbeh.2017.07.005 · Cited by 15 · see citing works
Reductions in Distress Intolerance via Intervention: A Review
Heiland, A. M., & Veilleux, J. C. (2023) · Cognitive Therapy and Research · doi:10.1007/s10608-023-10425-1 · Cited by 14 · see citing works
“The cold pressor task (Macpherson et al., 2008) was also given in three studies (Carpenter et al., 2019; Limas, 2014; Smith et al., 2019).”
Development and validation of a contextual behavioral distress intolerance task in cigarette smokers
Farris, S. G., DiBello, A. M., & Zvolensky, M. J. (2018) · Addictive Behaviors · doi:10.1016/j.addbeh.2018.07.020 · Cited by 14 · see citing works
Catchpole, R. E. H., McLeod, S. L., Brownlie, E. B., Allison, C. J., & Grewal, A. (2016) · Journal of Child & Adolescent Substance Abuse · doi:10.1080/1067828x.2016.1184600 · Cited by 12 · see citing works
“with attrition at the outset of treatment (MacPherson et al., 2008).”
BackgroundRace as a Moderator of the Relationship Between Distress Tolerance and Cigarette Smoking
Dahne, J., Stratton, K. J., Brown, R. C., Amstadter, A., Lejuez, C., & MacPherson, L. (2013) · Substance Use & Misuse · doi:10.3109/10826084.2013.863346 · Cited by 11 · see citing works
“, 1996) and smoking cessation outcomes (e.g., Abrantes et al., 2008; Brown et al., 2009; MacPherson et al., 2008).”
BackgroundSelf-citationFactors Predicting Smoking in a Laboratory-Based Smoking-Choice Task
Bold, K., Yoon, H., Chapman, G. B., & McCarthy, D. (2013) · Experimental and clinical psychopharmacology · doi:10.1037/a0031559 · Cited by 13 · see citing works
Distress Tolerance is Indirectly Related to Nicotine Use through the Smoking Motives
Niezabitowska, A., Rokosz, M., & Poprawa, R. (2022) · Substance Use & Misuse · doi:10.1080/10826084.2022.2034875 · Cited by 10 · see citing works
“Despite this, low distress tolerance increases the susceptibility to start smoking and maintain the habit (Leventhal & Zvolensky, 2015), is linked with a higher risk of relapse (MacPherson et al., 2008) and lapse when attempting to quit (Kahler et al.”
BackgroundThe role of negative affect management in postpartum relapse to smoking
Psaros, C., Pajolek, H., & Park, E. R. (2011) · Archives of Women s Mental Health · doi:10.1007/s00737-011-0250-2 · Cited by 10 · see citing works
Garey, L., Kauffman, B. Y., Neighbors, C., Schmidt, N. B., & Zvolensky, M. J. (2016) · Addictive Behaviors · doi:10.1016/j.addbeh.2016.07.018 · Cited by 9 · see citing works
“Smokers who drop out prior to initiating treatment also report greater anxiety sensitivity, lower distress tolerance (MacPherson et al., 2008), and less motivation to quit than smokers who initiate treatment (Ahluwalia et al.”
BackgroundMethodInfluentialThe effect of passive heat stress on distress andself-control in male smokers and non-smokers
Veilleux, J. C., Zielinski, M. J., Moyen, N. E., Tucker, M. A., Dougherty, E. K., & Ganio, M. S. (2018) · The Journal of General Psychology · doi:10.1080/00221309.2018.1494127 · Cited by 9 · see citing works
“We were particularly interested in men because of noted relationships between smoking low distress tolerance in men (MacPherson et al., 2008, Perkins et al., 2012; Tull et al., 2013) and because men and women have different thermoregulatory responses to heat (Kaciuba-Uscilko & Grucza, 2001).”
BackgroundState, but not trait, measures of persistence are related to negative affect.
Steinberg, M., & Williams, J. M. (2013) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2013.74.584 · Cited by 10 · see citing works
“A computerized version of this procedure is also available (e.g., Daughters et al., 2005; MacPherson et al., 2008).”
MethodDistress Tolerance and Craving for Cigarettes Among Heavy Drinking Smokers
Lim, A. C., Roche, D. J. O., & Ray, L. A. (2018) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2018.79.918 · Cited by 8 · see citing works
Nichols, J. A., Grob, P. R., de Lusignan, S., Kite, W., & Williams, P. (2014) · BMC Pulmonary Medicine · doi:10.1186/1471-2466-14-77 · Cited by 8 · see citing works
“The normal experience in NHS smoking cessation clinics is a drop-out rate of 40-50% [30-32].”
BackgroundTreatment non-response: Associations with smoking expectancies among treatment-seeking smokers
Garey, L., Taha, S. A., Kauffman, B. Y., Manning, K. F., Neighbors, C., Schmidt, N. B., & Zvolensky, M. J. (2017) · Addictive Behaviors · doi:10.1016/j.addbeh.2017.05.013 · Cited by 8 · see citing works
Mathew, A., & Zhou, M. (2019) · Addictive Behaviours · doi:10.1016/j.addbeh.2019.106124 · Cited by 9 · see citing works
Distress Intolerance in Relation to Reliance on Cigarettes for Weight, Shape, and Appetite Control
Burr, E. K., O’Keeffe, B., Kibbey, M. M., Coniglio, K., Leyro, T., & Farris, S. G. (2020) · International Journal of Behavioral Medicine · doi:10.1007/s12529-020-09858-9 · Cited by 7 · see citing works
Kauffman, B. Y., Garey, L., Bakhshaie, J., Rodríguez, R., Cárdenas, S. J., Coy, P., & Zvolensk, M. J. (2017) · Addictive Behaviours · doi:10.1016/j.addbeh.2017.01.024 · Cited by 7 · see citing works
Multi-Method Assessment of Distress Tolerance and Smoking-Related Factors among Adult Daily Smokers
Mathew, A., Heckman, B., Froeliger, B., Saladin, M., Brown, R. A., Hitsman, B., & Carpenter, M. (2018) · Experimental and clinical psychopharmacology · doi:10.1037/pha0000238 · Cited by 8 · see citing works
“…$5 in compensation for those participants whose total latency time (summed over each of the four tasks) exceeded a “target score,” based on the sum of average latency times for each task (12 min) published in previous studies (MacPherson et al., 2008; McHugh et al., 2011; McHugh & Otto, 2011).”
Self-citationGarey, L., Rogers, A. H., Manning, K. F., Smit, T., Derrick, J. L., Viana, A. G., Schmidt, N. B., & Zvolensky, M. J. (2019) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2019.10.006 · Cited by 8 · see citing works
Magidson, J. F., Ali, B., Listhaus, A., & Daughters, S. B. (2013) · doi:10.1002/9781118384404.ch9 · Cited by 7 · see citing works
A Functional Analytic Framework for Understanding Adolescent Risk-Taking Behavior
MacPherson, L., Richards, J., Collado, A., & Lejuez, C. (2011) · Springer eBooks · doi:10.1007/978-1-4419-1268-8_10 · Cited by 6 · see citing works
“2005), early substance use treatment dropout (Daughters et al. 2005; MacPherson et al. 2008), and dysregulated eating behaviors (Anestis et al.”
BackgroundSelf-citationCash, A. R., & Breaux, R. (2025) · Journal of American College Health · doi:10.1080/07448481.2025.2458088 · Cited by 5 · see citing works
“52 Additionally, it has been postulated that females, whom prior research has found tend to have higher subjective emotional reactivity and negative affect after experiencing acute psychosocial stress in lab studies when compared to males, 53,54 engage in health risk behaviors (e.g., drinking) to…”
Rung, J. M., Johnson, P. S., & Madden, G. J. (2018) · Experimental and Clinical Psychopharmacology · doi:10.1037/pha0000198 · Cited by 5 · see citing works
“Alternatively, behavioral measures of psychological distress tolerance such as the PASAT-C tend to significantly correlate with behavioral outcomes (e.g., dropout from treatment; MacPherson et al., 2008) but not self-reported behaviors (e.”
Predictors of attrition in a smoking cessation trial conducted in the lung cancer screening setting
Kim, E., Williams, R. M., Eyestone, E., Cordon, M., Smith, L., Davis, K., Luta, G., Anderson, E., McKee, B. J., Batlle, J. C., et al. (2021) · Contemporary Clinical Trials · doi:10.1016/j.cct.2021.106429 · Cited by 6 · see citing works
Moschak, T. M., Sloand, T. J., & Carelli, R. (2022) · Journal of Neuroscience · doi:10.1523/jneurosci.1718-22.2022 · Cited by 2 · see citing works
“Studies have shown that DT may be a more important driver of relapse for women than for men (MacPherson et al., 2008; Ali et al., 2015), and in preclinical literature, females self-administer higher doses of cocaine (Becker and Koob, 2016; Sanchis-Segura and Becker, 2016) and exhibit heightened…”
Bello, M. S., Pang, R. D., Colby, S. M., Cassidy, R. N., Zvolensky, M. J., & Langdon, K. J. (2023) · Experimental and Clinical Psychopharmacology · doi:10.1037/pha0000639 · Cited by 4 · see citing works
Validity of the distress tolerance inventory in predicting response to the Cold-Pressor Test
Siegel, E., Cassidy, G. P., & Telch, M. J. (2024) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2024.2333963 · Cited by 3 · see citing works
“Carpenter et al., 2019) and has demonstrated associations with non-suicidal self-injury (Hiraoka, 2014), substance use treatment attrition (MacPherson et al., 2008), and self-efficacy and perceived control (Litt, 1988; see Methods).”
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The role of distress tolerance in aggressive behavior
McIntyre, A. W. (2013) · Aquila Digital Community (University of Southern Mississippi) · Cited by 1 · see citing works
Evaluation of Behavioral Distress Tolerance Task Stability Across Settings
Overstreet, C. M. (2015) · VCU Scholars Compass (Virginia Commonwealth University) · doi:10.25772/qtgt-mf81
Distress Intolerance: Measurement and Aetiology of a Five-Factor Bifactor Model
Bebane, S. (2017) · Figshare
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The role of distress tolerance and expectancies in women's alcohol consumption
Holzhauer, C. G. (2014) · Scholars Archive - University at Albany (University at Albany, State University of New York) · doi:10.54014/4h88-c4km
- Authors
- MacPherson, L., Stipelman, B. A., Duplinsky, M., Brown, R. A., & Lejuez, C. W.
- Affiliations
- University of Maryland, College Park (US)
- Brown University (US)
- Corresponding author
- MacPherson, Laura
- Venue
- Addictive Behaviors
- Publisher
- Elsevier BV
- Published
- 2008-11
- Volume
- 33
- Issue
- 11
- Pages
- 1385-1393
- ISSN
- 0306-4603 (ISSN-L)
- PMC
- PMC2561069
- OpenAlex
- W2077146491
- Cited by
- 73
- References
- 48
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 6 · 2019: 4 · 2018: 10 · 2017: 7 · 2016: 6 · 2015: 6 · 2014: 2 · 2013: 10 · 2012: 5
- FWCI
- 1.81
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Addictive Behaviors (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (K23DA023143, R01DA015375, R01DA018730)
- National Cancer Institute (P30CA134274)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Keywords
- distress tolerance, treatment discontinuation, smoking cessation, anxiety sensitivity, depressive symptoms, gender differences, African American smokers
- MeSH terms
- Adult, Aged, Anxiety Disorders, Breath Tests, Depressive Disorder, Epidemiologic Methods, Female, Humans, Male, Middle Aged, Patient Dropouts, Regression Analysis, Sex Factors, Stress, Psychological, Health Behavior, Randomized Controlled Trials as Topic, Smoking Cessation, Young Adult
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