The Role of Distress Tolerance in the Use of Specific Emotion Regulation Strategies

Jeffries, Emily R.; McLeish, Alison C.; Kraemer, Kristen M.; Avallone, Kimberly M.; Fleming, John B.

doi:10.1177/0145445515619596

Cited by 105Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesChild and Adolescent Psychosocial and Emotional DevelopmentMindfulness and Compassion Interventions

The Role of Distress Tolerance in the Use of Specific Emotion Regulation Strategies

Jeffries, Emily R., McLeish, Alison C., Kraemer, Kristen M., Avallone, Kimberly M., Fleming, John B.·2016·Behavior Modification

DOI 10.1177/0145445515619596

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Abstract

The present study evaluated the role of distress tolerance (DT), defined as the ability to tolerate negative emotional states, in the use of four specific emotion regulation strategies (suppression, avoidance, rumination, and reappraisal). Undergraduate psychology students (N = 431, 71.7% female; Mage = 19.80 years, SD= 3.71) completed self-report measures online for course credit. It was hypothesized that, after controlling for the effects of anxiety sensitivity and negative affectivity, DT would be negatively associated with suppression, avoidance, and rumination, and positively associated with reappraisal. Consistent with prediction, low DT significantly predicted greater use of suppression, avoidance, and rumination. However, contrary to prediction, DT did not significantly predict reappraisal. These results suggest that individuals who are unable to withstand negative emotions are more likely to use maladaptive regulation strategies.

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Individuals with low distress tolerance may demonstrate more maladaptive emotion regulation strategies than individuals with high distress tolerance.
“Further, individuals with low DT may demonstrate more “maladaptive” ER strategies (e.g., rumination, avoidance, emotion suppression) than individuals with high DT (Jeffries et al., 2016; Naragon-Gainey et al., 2017).”
From The relationship between distress tolerance and behavioral activation on anxiety and depression symptomatology in autistic youth: Leveraging self and caregiver perspectives (2024) · cites this paper as Jeffries et al., 2016
Low distress tolerance significantly predicts the use of maladaptive emotion regulation strategies, including suppression of emotions, avoidance, rumination and substance abuse.
“studies have shown that low distress tolerance significantly predicts the use of maladaptive emotion regulation strategies, including the suppression of emotions, avoidance, rumination and substance abuse”
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 [16]

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“It motivates individuals to face and resolve the current situation rather than tie their hands (Onyedibe et al., 2014 ; Jeffries et al., 2016).”
Cognitive control: modeling the impact on mental health
Alker, L. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1452714 · Cited by 6 · see citing works
“…counterproductive coping mechanisms (e.g., behavioral avoidance or suppression), which are involved in the development of psychological disorders (Jeffries et al., 2016; Larrazabal et al., 2022; Leyro et al., 2010), such as borderline personality disorder, self-injurious behavior, gambling and…”
Tolérance à la détresse et expérience de la douleur chronique
Trépanier, A., Turcotte, S., & Foldes‐Busque, G. (2021) · L Encéphale · doi:10.1016/j.encep.2021.06.022 · Cited by 6 · see citing works
The mediating role of distress intolerance in the bidirectional relationships between loneliness and short-form video addiction
Zhao, Y., Wang, Z., Feng, N., Griffiths, M. D., & Cui, L. (2025) · Applied Research in Quality of Life · doi:10.1007/s11482-025-10512-3 · Cited by 6 · see citing works
“Only one cross-sectional study involving undergraduate students has found that individuals with low distress tolerance are more likely to engage in maladaptive emotion regulation strategies, such as avoidance and suppression (Jeffries et al., 2016).”
E-Cigarette Use: The Effects of Psychological Vulnerabilities, Perceptions, and Intentions to Use E-Cigarettes
Tran, D. D., & Morrell, H. E. R. (2023) · Psychological Reports · doi:10.1177/00332941231161277 · Cited by 5 · see citing works
Anxiety sensitivity and panic symptoms: the moderating influence of distress tolerance
Geyer, R. B., Magee, J. C., & Clerkin, E. M. (2022) · Anxiety Stress & Coping · doi:10.1080/10615806.2022.2146102 · Cited by 6 · see citing works
Demanslı Hastalarla İlgilenen Aile Üyelerinin Bakım Veren Yükünün İncelenmesi
Tuğba, A. T. A. K., & Özekes, M. (2019) · Ege Eğitim Dergisi · doi:10.12984/egeefd.561901 · Cited by 5 · see citing works
The Role of Emotional Distress Tolerance on Fear Responding in a Heights-Fearful Sample: Perceived Versus Actual Behavior
Billingsley, A. L., & Steinman, S. A. (2021) · Behavior Therapy · doi:10.1016/j.beth.2020.12.002 · Cited by 5 · see citing works
Reduction of Distress Intolerance With Salutotherapeutic Interventions: Results From a Randomized Controlled Clinical Trial
Otto, J., & Linden, M. (2018) · Chronic Stress · doi:10.1177/2470547018800484 · Cited by 5 · see citing works
“Research has shown that low distress tolerance or higher distress intolerance significantly predicts the greater use of suppression, avoidance, and rumination when a person is confronted with stressors.(10) Persons with a high level of distress intolerance also perceive and evaluate stressors more threatening than per…”
Background
Associations of Adverse and Positive Childhood Experiences with Transdiagnostic Risk Factors for Mental Health Problems in Black American Adults
Dieujuste, N., Ejadi, G., Narayan, A. J., & Doom, J. R. (2025) · Adversity and Resilience Science · doi:10.1007/s42844-025-00171-6 · Cited by 4 · see citing works
“Consistent with prior research in other samples (Conway et al., 2021; Jeffries et al., 2016; Keough et al., 2010; Paltell et al., 2019; Paulus et al., 2016; Vujanovic et al., 2008), this suggests there may be considerable overlap between emotion dysregulation, anxiety sensitivity, and distress…”
A transdiagnostic approach to investigate of the relationships between anxiety sensitivity and health anxiety: the mediated roles of distress tolerance and emotion regulation
Mohsenabadi, H., Pirmoradi, M., Tajrishi, K. Z., & Gharraee, B. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1478442 · Cited by 4 · see citing works
Distress Tolerance as a Risk Factor for Specific Internet-Use Disorders
Hew, Y. C., & Chew, P. K. H. (2025) · Journal of Technology in Behavioral Science · doi:10.1007/s41347-025-00489-z · Cited by 4 · see citing works
The mediating role of distress tolerance in the relationship between childhood maltreatment and anxiety in a sample of Lebanese adults
Mattar, E., Sawma, T., Hallit, R. R., Malaeb, D. N., Sakr, F., Dabbous, M., Hallit, S. R., Fekih‐Romdhane, F., & Obeïd, S. (2025) · Scientific Reports · doi:10.1038/s41598-025-98417-x · Cited by 6 · see citing works
Cognitive Control and Flexibility to Happiness: Distress Tolerance and Difficulties in Emotion Regulation as Serial Mediators
Satıcı, S. A., Ozturk, M., Okur, S., & Deniz, M. E. (2024) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-024-00540-7 · Cited by 4 · see citing works
“Low distress tolerance often causes difficulty regulating emotions (Bardeen et al., 2014; Gratz & Roemer, 2004; Jeffries et al., 2016 ).”
Linear and curvilinear association of pain tolerance and social anxiety symptoms among youth with different subgroups of childhood trauma
Yu, Y., Cui, X., Du, J., Wilson, A. D., Xu, S., & Wang, Y. Y. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.03.087 · Cited by 4 · see citing works
Die deutsche Übersetzung der Distress-Intoleranz-Skala
Otto, J., & Linden, M. (2019) · Verhaltenstherapie · doi:10.1159/000494763 · Cited by 4 · see citing works
“Personen mit einer hohen Distress-Toleranz benutzen eher adaptive Regulationsmechanismen, was zu korrigierenden Erfahrungen in der Auseinandersetzung mit Stressoren führt und eine Symptommanifestation und -chronifizierung verhindert [Jeffries et al., 2016].”
Background
The association between repetitive negative thinking and distress across mental disorders: Preliminary findings from an outpatient treatment-seeking sample
Miethe, S., Muehlhan, M., & Trautmann, S. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114478 · Cited by 4 · see citing works
The association of emotion regulation with distress tolerance depends on a neural correlate of cognitive control
Milam, A. L., & Judah, M. R. (2023) · Biological Psychology · doi:10.1016/j.biopsycho.2023.108571 · Cited by 4 · see citing works
Motives for opioid use explain the relation between borderline personality disorder pathology and opioid use problems
Scamaldo, K. M., Tull, M. T., & Gratz, K. L. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113609 · Cited by 4 · see citing works
Using a transdiagnostic approach to examine the associations among internalizing symptoms, emotion regulation, and distress tolerance
Tanguy, W. J., Kaur, K., & Asnaani, A. (2024) · Journal of Experimental Psychopathology · doi:10.1177/20438087241249682 · Cited by 3 · see citing works
Emotion Regulation Difficulties, Distress Tolerance and Psychopathological Symptoms
del Valle, M. V., Zamora, E. V., Urquijo, S., Olsen, C. D., López‐Morales, H., & Andrés, M. L. (2022) · Roczniki Psychologiczne · doi:10.18290/rpsych2022.0013 · Cited by 3 · see citing works
“Regarding DT, the inability to tolerate negative emotions would lead to the use of maladaptive strategies, such as, for example, avoidance or substance use (Jeffries et al., 2016; Zvolensky et al., 2010).”
Are Parent Substance Use Severity and Psychopathology Associated with Parenting Behaviors Among Parents with Substance Use Disorders?
Franz, D. J., Cioffi, C. C., DeGarmo, D., Trevino, S. D., Halvorson, S., Brahn-Perrot, A., & Leve, L. D. (2025) · Parenting · doi:10.1080/15295192.2025.2515379 · Cited by 2 · see citing works
“…to impairments in emotion regulation and social cognition that negatively impact parenting behaviors (De France & Evans, 2021; Gard et al., 2020; Jeffries et al., 2015; Leyro et al., 2010; Singh & Shankar, 2013), including their hostility and warmth toward their child(ren) (Masarik & Conger,…”
Network structure of rumination and resilience in adolescents with traumatic experiences: A comparison of PTSD and non-PTSD groups
Yang, L., Liang, Y., Huang, Q. R., Wu, Y., Guan, Z., Ju, K., Bian, X., & Xi, J. (2025) · International Journal of Social Psychiatry · doi:10.1177/00207640251361657 · Cited by 2 · see citing works
“The positive brooding-positive cognition link may reflect cognitive dissonance, wherein adolescents display superficial optimism while remaining trapped in maladaptive cognitive loops (Burwell & Shirk, 2007; Jeffries et al., 2016).”
The mediating role of distress tolerance on the relationship between childhood trauma and suicide risk in patients with major depressive disorder
Yao, K., Zhong, J., Huang, X., Kuang, J., & Xu, M. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.09.003 · Cited by 2 · see citing works
Distress Intolerance Is Associated With Emotion Regulation Effort and Difficulty, But Not Success in Daily Life
Gross, A. M., Eckland, N. S., & Thompson, R. J. (2025) · Behavior Therapy · doi:10.1016/j.beth.2025.11.005 · Cited by 2 · see citing works
Impacts of Distress Intolerance and Anxiety Sensitivity on the Maintenance and Treatment of Youth Misophonia
Cepeda, S. L., Milgram, L., Bigler, M. E., Tonarely, N. A., Lewin, A. B., & Ehrenreich, J. T. (2026) · Journal of Clinical Psychology · doi:10.1002/jclp.70095 · Cited by 2 · see citing works
The Impact of Emotion Coaching on Changes in Caregiver Burden and Distress Tolerance During Family‐Based Treatment
KRAMER, R. A., Stevens, K. S., Mikhail, M. E., Grange, D. L., Shaffer, A. E., & Peterson, C. M. (2026) · International Journal of Eating Disorders · doi:10.1002/eat.70035 · Cited by 2 · see citing works
Development and preliminary validation of a scale to assess physicians’ emotional distress intolerance in end-of-life care communication
Brondolo, E. N., Keating, L., Crete, A., Kaur, A., Randrianarivony, R., Statman, D., Schwartz, J. E., Basello, G., & Roth, A. R. (2022) · Palliative & Supportive Care · doi:10.1017/s1478951522000219 · Cited by 2 · see citing works
Association between psychological pain and suicidal ideation among men with substance use disorder: a moderated mediation model
Zeng, X., Nie, J., & Wei, B. (2022) · Journal of Ethnicity in Substance Abuse · doi:10.1080/15332640.2022.2141411 · Cited by 2 · see citing works
“Contrastingly, individuals with low IU use other adaptive emotion regulation strategies, which in turn reduces the likelihood of suicidal ideation (Jeffries et al., 2016).”
The Relationship between Distress Tolerance and Anxiety in Adolescents: The Mediating Role of Emotion Regulation Strategies
徐, 舵. (2023) · Advances in Psychology · doi:10.12677/ap.2023.133155 · Cited by 2 · see citing works
Distress Tolerance in Patients with Metastatic and Non-metastatic Breast Cancer: A Single-center Experience
Erdal, G. Ş., Balcioglu, S. S. K., & Namlı, M. N. (2023) · Acibadem Universitesi Saglik Bilimleri Dergisi · doi:10.31067/acusaglik.1266533 · Cited by 2 · see citing works
“In addition, low distress tolerance has been associated with both poorer quality of life and reduced life satisfaction (12,13).”
Background
I know why the caged bird sings: Distress tolerant individuals show greater resting state connectivity between ventromedial prefrontal cortex and right amygdala as a function of higher vagal tone
McIntosh, R. C., Hoshi, R. A., Nomi, J. S., Goodman, Z., Kornfeld, S., & Vidot, D. C. (2023) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2023.112274 · Cited by 2 · see citing works
Development and validation of the Closure and Resolution Scale (CRS)
Boucher, C. M., Scoboria, A., Soucie, K. M., & Pascual‐Leone, A. (2024) · Memory · doi:10.1080/09658211.2024.2427666 · Cited by 2 · see citing works
“…ratings are also assumed to be consciously accepted appraisals of subjective reality rather than unconscious defenses, and thus, were not expected to correlate with responses to emotions such as suppression, avoidance, or rumination (Responses to Emotions Questionnaire; Jeffries et al., 2016).”
Influential
Sexual Self-Objectification and Sex-Related Drinking Motives Among College Women: Do Emotion Regulation and Distress Tolerance Matter?
Ndungu, R. W., Hammett, J. F., Peddle, A. K., Jaffe, A. E., Duckworth, J. C., & Stappenbeck, C. A. (2025) · Archives of Sexual Behavior · doi:10.1007/s10508-025-03138-x · Cited by 2 · see citing works
“Distress tolerance, referring to one’s ability to manage actual or perceived stressors (Conway et al., 2021), is closely tied to emotion regulation abilities (Jeffries et al., 2016).”
A Psychometric Investigation of the Distress Tolerance Scale Short Form (DTS-SF): Reliability, Validity, and Factor Structure in a Trauma-Exposed Sample
Byllesby, B. M., Charak, R., Cano-González, I., & Christ, N. M. (2025) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-025-10226-8 · Cited by 2 · see citing works
“In addition to associations with distress disorder symptom severity, distress tolerance has been found to be negatively associated with neuroticism (Kaiser et al., 2012 ), negative affect intensity (Vujanovic et al., 2013), and negative affect (Jeffries et al., 2016).”
Loss of Control Eating Predicted by the Interaction Between Emotion Regulation Difficulties, Distress Tolerance, and the Expectancy that Eating Reduces Negative Affect
Burr, E. K. (2021) · Journal of International Crisis and Risk Communication Research · Cited by 2 · see citing works
The relationship between distress tolerance and behavioral activation on anxiety and depression symptomatology in autistic youth: Leveraging self and caregiver perspectives
Schwartzman, J. M., Antezana, L., & Conner, C. M. (2024) · Autism Research · doi:10.1002/aur.3208 · Cited by 1 · see citing works
“Further, individuals with low DT may demonstrate more “ maladaptive ” ER strategies (e.g., rumination, avoidance, emotion suppression) than individuals with high DT (Jeffries et al., 2016; Naragon-Gainey et al., 2017).”
“I thought that crying was weakness”: a thematic analysis of emotional experience in an online self-harm forum
Rymer, L. J., Dodd, A., & Bell, B. T. (2024) · Journal of Mental Health · doi:10.1080/09638237.2024.2390389 · Cited by 1 · see citing works
“…dysregulation more generally, where distress (in)tolerance, (non)acceptance of emotions, and a (perceived) lack of ability to access effective emotion regulation strategies are linked to, or key facets of, difficulties with emotion regulation (e.g. Gratz & Roemer, 2004; Jeffries et al., 2016).”
The relationship between irritability and suicidal ideation: the chain mediating effects of rumination and distress tolerance
Yao, K., Huang, X., Kuang, J., & Xu, M. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07598-2 · Cited by 1 · see citing works
“Previous studies have found a significant association between more serious rumination and lower distress tolerance [39, 40, 48, 49].”
Distress Intolerance, Social Anxiety, and Depressive Symptoms in Adolescents: Evidence from Random-Intercept Cross-Lagged Panel and Cross-Lagged Panel Network Analyses
Tian, X., Chen, J., Wang, B., Wan, X., & Wang, S. (2026) · Journal of Youth and Adolescence · doi:10.1007/s10964-026-02391-0 · Cited by 1 · see citing works
“…distress as unbearable may possess diminished confidence in their capacity to endure aversive emotional states, making them more likely to rely on maladaptive regulation strategies such as avoidance, withdrawal, rumination, or suppression (Jeffries et al., 2016; Naragon-Gainey et al., 2017).”
The Relationship between Distress Tolerance, Parenting, and Substance Use Among Adolescent Mothers
Im, J. (2021) · doi:10.7916/d8-4haz-vk57 · Cited by 1 · see citing works
Evaluating the Model of Direct and Indirect Effects of Origin Family Function and Perception of Parents' Marriage on Depression and Marital Quality in Women: The Mediating Role of Emotional Maturity
Makvandzadeh, P. B., Koraei, A., Alavi, S. Z., & Esmaeil, H. S. S. (2022) · Journal of Research in Behavioural Sciences · doi:10.52547/rbs.19.4.671 · Cited by 1 · see citing works
The Effect of Unpreparedness for Immigration Court on Psychopathology in Recently Immigrated Adolescents
Bailey, C. A. (2016)
A Randomized Controlled Trial of a Hatha Yoga Intervention for Smokers
Jeffries, E. R. (2018) · doi:10.31390/gradschool_dissertations.4692
Self-citation
Emotion regulation in young people with complex mental health and substance use issues
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Tavoosi, A., Rezapour-Mirsaleh, Y., Ahmadi, Z., & Choobforoushzadeh, A. (2025) · Women & Health · doi:10.1080/03630242.2025.2503295
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Distress Tolerance Predicts Day-To-Day Emotion Regulation Behaviors
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Authors: Jeffries, E. R., McLeish, A. C., Kraemer, K. M., Avallone, K. M., & Fleming, J. B.
Affiliations: University of Cincinnati (US)
Corresponding author: McLeish, Alison C.
ORCID: Jeffries, Emily R.
McLeish, Alison C.
Kraemer, Kristen M.
Fleming, John B.
Venue: Behavior Modification
Publisher: SAGE Publications
Published: 2015-12-08
Volume: 40
Issue: 3
Pages: 439-451
ISSN: 0145-4455 (ISSN-L)
1552-4167
DOI: 10.1177/0145445515619596
OpenAlex: W2216480565
Cited by: 105
References: 31
Citations by year: 2026: 10 · 2025: 17 · 2024: 15 · 2023: 15 · 2022: 12 · 2021: 10 · 2020: 7 · 2019: 6 · 2018: 7 · 2017: 3 · 2016: 3
FWCI: 6.53
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Behavior Modification (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5ul1rr026314-03)
National Center for Research Resources (UL1-RR026314)
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
Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Keywords: distress tolerance, emotion regulation strategies, emotional suppression, avoidance, rumination, cognitive reappraisal, anxiety sensitivity, negative affectivity, maladaptive emotion regulation, negative emotions
MeSH terms: Emotional Adjustment, Adaptation, Psychological, Adolescent, Anxiety, Anxiety Disorders, Avoidance Learning, Emotions, Female, Humans, Male, Psychiatric Status Rating Scales, Surveys and Questionnaires, Stress, Psychological, Young Adult, Self Report

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The Role of Distress Tolerance in the Use of Specific Emotion Regulation Strategies

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