Distress tolerance and psychopathological symptoms and disorders: A review of the empirical literature among adults.

The ability to tolerate distress and negative emotional states has long been associated with the development and maintenance of psychopathology and with difficulties discontinuing or withdrawing from psychiatric medications and drugs of abuse.

“The ability to tolerate distress negative emotional states has long been associated with the development and maintenance of psychopathology [49–51] as well as difficulties discontinuing or withdrawing from psychiatric medications as well as drugs of abuse [49].”

Improving distress tolerance is a central aim of CBT and ACT.

“Notably, increased emotional distress tolerance is a key goal of several behavioral therapies, including cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999; Leyro, Zvolensky, & Bernstein, 2010).”

Distress tolerance is negatively correlated with anxiety and depression across diagnostic boundaries.

“DT is negatively correlated with anxiety and depression across diagnostic boundaries (Leyro et al., 2010; Yoon et al., 2018).”

Through practicing mindfulness and other MIED exercises, individuals may become less likely to appraise uncomfortable emotions as unacceptable and better equipped to tolerate distressing experiences, thereby reducing emotional distress in the long run.

“This suggests that through practicing mindfulness and engaging in other exercises within the MIED program, individuals may become less likely to appraise uncomfortable emotions as unacceptable and better equipped to tolerate distressing experiences (e.g., Lotan et al., 2013), thereby reducing emotional distress in the long run (Leyro et al., 2010; Li et al., 2023b).”

Low distress tolerance has been proposed as a transdiagnostic factor that plays a key role in the maintenance of many psychopathological disorders, including obsessive-compulsive and related disorders.

“Low DT has been proposed as a transdiagnostic factor that plays a key role in the maintenance of many psychopathological disorders, including obsessive-compulsive and related disorders (Barton et al., 2021;Leyro et al., 2010;Yap et al., 2018).”

Distress tolerance is importantly involved in depression and anxiety.

“Distress tolerance, defined as the ability to withstand aversive emotions, plays a significant role in depression and anxiety [3].”

Distress tolerance is central to the theoretical basis of numerous therapeutic approaches.

“Thus, it is not surprising that distress tolerance is central to the theoretical basis of numerous therapeutic approaches [49].”

Various forms of distress may matter more for different psychological problems.

“different types of distress may be more relevant for distinct psychological issues”

This brings into question both the validity of self-report methodology and the taxonomy of aversive internal experiences.

“This brings into question both the validity of self-report methodology and the taxonomy of aversive internal experiences (see also Leyro, et al., 2010).”

Deficits in one's ability to tolerate negative affect (low DT) contribute to engagement in maladaptive behaviours that function to alleviate psychological discomfort associated with aversive emotional states, thereby strengthening a negative feedback loop through which such behaviours are maintained.

“It has been theorised that deficits in one's ability to tolerate negative affect (i.e., low DT) contributes to engagement in maladaptive behaviours that function to alleviate psychological discomfort associated with aversive emotional states, thereby strenghtening a negative feedback loop through which such behaviours are maintained (Leyro et al., 2010;Zvolensky and Hogan, 2013).”

Search terms were replicated from Leyro et al. (2010) to assure adequate breadth of DT terminology.

“We replicated the DT search terms used in the widely cited narrative review of DT and psychopathology by Leyro et al. (2010) to assure adequate breadth of DT terminology.”

Distress tolerance is viewed as an important transdiagnostic factor underlying psychopathology, including emotional disorders in childhood.

“Recently, with the emergence of transdiagnostic approaches, distress tolerance is viewed as an important transdiagnostic factor underlying psychopathology; namely, emotional disorders (e.g., [8,69]), including in childhood [25,50].”