Anxiety symptomatology: the association with distress tolerance and anxiety sensitivity
Open accessAbstract
Research focused on psychological risk factors for anxiety psychopathology has led to better conceptualization of these conditions as well as pointed toward preventative interventions. Anxiety sensitivity (AS) has been well-established as an anxiety risk factor, while distress tolerance (DT) is a related construct that has received little empirical exploration within the anxiety psychopathology literature. The current investigation sought to extend the existing literature by examining both DT and the relationship between DT and AS across a number of anxiety symptom dimensions, including panic, generalized anxiety, social anxiety, and obsessive-compulsive anxiety. Participants (N=418) completed a number of measures that assessed DT, AS, anxiety symptomatology, and negative affect. Findings indicated that DT was uniquely associated with panic, obsessive compulsive, general worry, and social anxiety symptoms, but that DT and AS were not synergistically associated with each of these symptom dimensions. These findings indicate that an inability to tolerate emotional distress is associated with an increased vulnerability to experience certain anxiety symptoms.
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Distress tolerance is associated with lower anxiety symptoms and higher quality of life in prior studies.
“Distress tolerance is associated with lower anxiety symptomatology and higher QOL in prior studies [32, 33]”
From Correlates of Quality of Life in Anxiety Disorders: Review of Recent Research (2021) · cites this paper as [33]
The Results and Discussion report that greater distress tolerance was associated with lower anxiety symptomatology. The paper does not report an association between distress tolerance and quality of life (searched: quality of life, QOL, wellbeing, functioning), so that part of the citing sentence is unsupported by this source. The indexed passages provide section labels but no page numbers. (LLM, conf=0.89)
Experimental — accuracy not yet measuredIn regression analyses, ASI remained a significant predictor of total OCI-R score even after other factors had been accounted for.
“In regression analyses, ASI remained a significant predictor of total OCI-R score even after other factors had been accounted for.”
From Emotion and internal experience in Obsessive Compulsive Disorder: Reviewing the role of alexithymia, anxiety sensitivity and distress tolerance (2014) · cites this paper as Keough, Riccardi, Timpano, Mitchell, and Schmidt (2010)
The Methods (Statistical Analyses; page unavailable) describe regressions that included ASI and used OCI-R as an outcome. The Discussion (page unavailable) says anxiety sensitivity and distress tolerance were uniquely associated with various anxiety symptoms, but the available Results specifically report that DTS—not ASI—remained significantly associated with OCI-R after adjustment. Our copy does not establish the claimed adjusted significance for ASI on total OCI-R score. (LLM, conf=0.76)
Experimental — accuracy not yet measuredKeough et al. (2010) reported a significant correlation between ASI total score and OCI-R total score (r=0.51) in a large student sample.
“Keough, Riccardi, Timpano, Mitchell, and Schmidt (2010) reported a significant correlation between ASI total score OCI-R total score (r=0.51) in a large student sample.”
From Emotion and internal experience in Obsessive Compulsive Disorder: Reviewing the role of alexithymia, anxiety sensitivity and distress tolerance (2014) · cites this paper as Keough, Riccardi, Timpano, Mitchell, and Schmidt (2010)
Methods > Participants describes 418 individuals recruited through a university, supporting the large student-sample description. Results says Table 1 presents zero-order correlations, but the passages available in our copy do not give the ASI–OCIR coefficient or establish that it was significant; searches for r = .51 did not find it. Page numbers were not available. (LLM, conf=0.78)
Experimental — accuracy not yet measuredIndividuals with SAD have lower distress tolerance, which is associated with a heightened reactivity to stress, anxiety and distress.
“Individuals with SAD have lower DT which is associated with a heightened reactivity to stress, anxiety and distress (Keough et al., 2010).”
From Can dialectical behavior therapy skills group treat social anxiety disorder? A brief integrative review (2024) · cites this paper as Keough et al., 2010
The Discussion reports that lower distress tolerance was associated with more social anxiety symptoms, and the paper describes people low in distress tolerance as more likely to be reactive to stress and distress. However, the Methods identify the participants as university students assessed with a social-anxiety symptom scale, not individuals diagnosed with social anxiety disorder (SAD). The heightened reactivity is presented as a belief, not a measured finding. (LLM, conf=0.88)
Experimental — accuracy not yet measuredEngagement in maladaptive emotional regulation strategies can predispose and perpetuate psychopathological symptoms, particularly those related to anxiety and depression.
“the engagement in such maladaptive emotional regulation strategies can predispose and perpetuate psychopathological symptoms, particularly those related to anxiety and depression [8,9,25]”
From The Factorial Structure, Psychometric Properties and Sensitivity to Change of the Distress Tolerance Scale for Children with Emotional Disorders. (2024) · cites this paper as [9]
The text indexed under Abstract proposes that avoidance and similar coping strategies can maintain anxiety problems, and the Discussion links low distress tolerance with anxiety symptoms. These passages support the anxiety portion, but frame the mechanism as a possibility rather than establishing that such strategies cause symptoms. They do not establish the claimed effect on depression. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Low distress tolerance might lead to perceiving anxiety symptoms as uncontrollable and intensify the reliance on avoidance and safety behaviors.
“For example, Keough et al. (2010) theorized low DT might lead to perceiving anxiety symptoms as uncontrollable and intensify the reliance on avoidance and safety behaviors.”
From Can dialectical behavior therapy skills group treat social anxiety disorder? A brief integrative review (2024) · cites this paper as Keough et al., 2010
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References 54 · Cited by 284
- Authors
- Keough, M. E., Riccardi, C. J., Timpano, K. R., Mitchell, M. A., & Schmidt, N. B.
- Affiliations
- Florida State University (US)
- Massachusetts General Hospital (US)
- Corresponding author
- Schmidt, Norman B.
- Venue
- Behavior Therapy
- Publisher
- Elsevier BV
- Published
- 2010-12
- Volume
- 41
- Issue
- 4
- Pages
- 567-574
- ISSN
- 0005-7894 (ISSN-L)
- PMC
- PMC4490862
- OpenAlex
- W2029576616
- Cited by
- 284
- References
- 54
- Citations by year
- 2026: 13 · 2025: 17 · 2024: 18 · 2023: 19 · 2022: 23 · 2021: 28 · 2020: 25 · 2019: 20 · 2018: 19 · 2017: 23 · 2016: 17 · 2015: 19 · 2014: 8 · 2013: 14 · 2012: 11
- FWCI
- 14.65
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behavior Therapy (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (F31MH086174)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- distress tolerance, anxiety sensitivity, panic, generalized anxiety disorder, social anxiety, negative affect, risk factors for anxiety, psychological vulnerability
- MeSH terms
- Adaptation, Psychological, Adolescent, Adult, Anxiety, Female, Humans, Male, Obsessive-Compulsive Disorder, Psychiatric Status Rating Scales, Risk Factors, Stress, Psychological, Panic Disorder, Self Report
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