Distress Tolerance: Theory, Measurement, and Relations to Psychopathology
Open accessAbstract
In this article we present the theoretical and empirical bases of distress tolerance research. Although distress tolerance offers a promising lens through which to better understand various psychological symptoms and disorders, further theoretical development and empirical inquiry is needed to promote our understanding of the construct. Overall, a number of questions regarding its theoretical conceptualization and measurement, associations with related constructs and psychopathology, and role(s) in therapeutic change and intervention remain unanswered. Directions for future research are discussed to stimulate further empirical study on this theoretically and clinically promising topic.
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DT is important in the etiopathology of mental diseases and could be a factor to improve in psychotherapy.
“DT is important in the etiopathology of mental diseases, and it could be one of the factors that should be improved in psychotherapy and that it determines the response to treatment 17 .”
From Could distress tolerance levels be associated with the severity of chronic spontaneous urticaria? (2022) · cites this paper as [17]
The Summary describes distress tolerance as important to the development and maintenance of psychopathology and a promising target for psychotherapy. The Future Directions section says its role in therapeutic change needs further study, so the source does not establish that distress tolerance determines response to treatment. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIndividuals low in distress tolerance or high in experiential avoidance would likely report greater challenges with being mindful in the presence of negative emotions.
“If someone is especially averse to experiencing negative thoughts and feelings (i.e., someone low in distress tolerance or high in experiential avoidance [74,75]), that person would likely report greater challenges with being mindful in the presence of negative emotions.”
Attachment insecurity is correlated with lower levels of distress tolerance.
“and lower levels of distress tolerance [75]”
From Being in the moment so you can keep moving forward: Mindfulness and rumination mediate the relationship between attachment orientations and negative conflict styles (2020) · cites this paper as [75]
The Theoretical Framework discusses lower distress tolerance and related processes, but does not mention attachment insecurity. A search of our copy for attachment and insecure attachment found no passage reporting the claimed correlation; page numbers were not available. (LLM, conf=0.74)
Experimental — accuracy not yet measured
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“, distress tolerance; see (40)) has been the focus of considerable research in the context of psychopathology (see (40,41)), but also has received attention in behavioral medicine (e.”
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“In contrast, self-report measures assess the perceived ability to withstand distress, without a goal-directed or reward component (Leyro et al., 2010; McHugh, et al., 2011; Zvolensky et al., 2010).”
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“…has involved a broad conceptual and operational definition of subjective ‘‘distress’’, without delineating the specific negatively-valenced affective states or emotions that may be distressing and to which a person may be more or less tolerant (Simons and Gaher 2005; Zvolensky et al. 2010).”
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“Ultimately, we concur with others who have stated that distress tolerance is an important transdiagnostic risk factor for psychopathology (Leyro et al., 2010; Zvolensky et al., 2010).”
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“On the other hand, this result can be viewed in light of the effects of emotion regulation strategies on distress tolerance (e.g., Zvolensky et al. 2010), taking into account the mediating role of changes in DER on dose–effect relationship between treatment attendance and EA trend during…”
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“distress tolerance, distress intolerance, self-efficacy, theory, distress intensity, experiential avoidance Received 12/17/21; Revision accepted 7/15/22 focused on individual differences (Leyro et al., 2010; Zvolensky et al., 2010).”
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“…tolerance is used in literature in order to refer to both a “perceived capacity to withstand negative emotional and/or other aversive states” (Zvolensky et al., 2010) and the “behavioral act of withstanding distressing internal states elicited by some type of stressor” (Zvolensky et al.,…”
BackgroundInfluentialSadeh, N., & Bredemeier, K. (2019) · Journal of Personality Disorders · doi:10.1521/pedi_2019_33_456 · Cited by 35 · see citing works
Trujillo, M. A., Khoddam, R., Greenberg, J. B., Dyal, S. R., Ameringer, K. J., Zvolensky, M. J., & Leventhal, A. M. (2015) · Behavioral Medicine · doi:10.1080/08964289.2015.1110559 · Cited by 35 · see citing works
Self-citationBenfer, N., Bardeen, J. R., Fergus, T. A., & Rogers, T. A. (2018) · Journal of Personality Assessment · doi:10.1080/00223891.2018.1492927 · Cited by 33 · see citing works
Confirming the Factor Structure and Validity of the Distress Tolerance Scale (DTS) in Youth
Tonarely, N. A., & Ehrenreich-May, J. (2020) · Child Psychiatry & Human Development · doi:10.1007/s10578-019-00935-z · 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
Katz, D., Rector, N. A., & Laposa, J. M. (2017) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2017.1334087 · Cited by 31 · see citing works
“Theoretically and through structural equation modelling, IU and DT have been posited to be related but distinct constructs, with one measuring the ability to tolerate uncertainty and the other measuring the ability to tolerate negative emotional experiences (Bardeen et al., 2013; Zvolensky et al., 2010).”
BackgroundGoodwin, R. D., Wall, M. M., Choo, T. H., Galea, S., Horowitz, J. D., Nomura, Y., Zvolensky, M. J., & Hasin, D. S. (2014) · Annals of Epidemiology · doi:10.1016/j.annepidem.2014.01.014 · Cited by 32 · see citing works
Self-citationFronk, G. E., Sant'Ana, S. J. K., Kaye, J. T., & Curtin, J. J. (2020) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-102419-125016 · Cited by 32 · see citing works
Marijuana use and panic psychopathology among a representative sample of adults.
Zvolensky, M. J., Cougle, J. R., Johnson, K. A., Bonn‐Miller, M. O., & Bernstein, A. (2010) · Experimental and Clinical Psychopharmacology · doi:10.1037/a0019022 · Cited by 32 · see citing works
Self-citationHayes, A. M., Yasinski, C. W., Grasso, D. J., Ready, C. B., Alpert, E., McCauley, T. G., Webb, C. P. M., & Deblinger, E. (2016) · Behavior Therapy · doi:10.1016/j.beth.2016.06.004 · Cited by 31 · 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
Bilewicz, M., Babińska, M., & Gromova, A. (2024) · European Journal of Psychotraumatology · doi:10.1080/20008066.2024.2394296 · Cited by 30 · see citing works
Baskin-sommers, A. R., & Newman, J. P. (2013) · Cited by 29 · see citing works
Distress Tolerance as a Predictor of Risky and Aggressive Driving
Beck, K. H., Ali, B., & Daughters, S. B. (2013) · Traffic Injury Prevention · doi:10.1080/15389588.2013.829569 · Cited by 29 · see citing works
“It has been established that individuals with lower levels of distress tolerance are more likely to respond maladaptively to certain situations that elicit stress (Leyro et al. 2010) and frustration (Zvolensky et al. 2010).”
BackgroundMcIntosh, R., Ironson, G., & Krause, N. (2021) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2021.110403 · Cited by 28 · see citing works
“For example, indices of DT based upon the duration participants are willing to keep their hands submerged during the cold-pressor task are shown to vary as a function of individual differences in emotion regulation and coping style [56,98].”
BackgroundApplying attachment theory to indecisiveness in hoarding disorder
Crone, C., Kwok, C., Chau, V., & Norberg, M. M. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.01.055 · Cited by 28 · see citing works
You, J., & Leung, F. (2012) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-011-9256-3 · Cited by 26 · see citing works
Farris, 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
“…intolerance may uniquely mark risk for panic psychopathology and smoking-relevant processes, when experienced in the context anxious responding/distress due to a stressor (e.g. CO2 challenge), which is consistent with prior related work (Marshall et al., 2008) and theory (Zvolensky et al., 2010).”
ResultSelf-citationDistress tolerance and its role in psychopathology
Zvolensky, M. J., & Hogan, J. (2013) · Cognitive Therapy and Research · doi:10.1007/s10608-013-9533-4 · Cited by 25 · see citing works
Self-citationHulburt, K. J., Colaianne, B. A., & Roeser, R. W. (2020) · Emerald Group Publishing Limited eBooks · doi:10.1108/s1479-368720200000034001 · Cited by 25 · see citing works
MacDonald, E. M., Pawluk, E. J., Koerner, N., & Goodwill, A. M. (2014) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2014.964303 · Cited by 29 · see citing works
“These findings are consistent with transdiagnostic conceptualizations of distress tolerance, but also suggest that certain experiences may be more distressing for people with specific types of psychopathology (Zvolensky et al., 2010).”
Examining the Specific Facets of Distress Tolerance That Are Relevant to Health Anxiety
Fergus, T. A., Bardeen, J. R., & Orcutt, H. K. (2015) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.29.1.32 · Cited by 25 · see citing works
“Intolerance of ambiguity has been defined as difficulties tolerating complicated, novel, or vague situations and/or stimuli (Zvolensky et al., 2010).”
InfluentialMeidlinger, P. C., & Hope, D. A. (2017) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.11.002 · Cited by 33 · see citing works
Factor Structure and Incremental Utility of the Distress Tolerance Scale: A Bifactor Analysis
Rogers, T. A., Bardeen, J. R., Fergus, T. A., & Benfer, N. (2018) · Assessment · doi:10.1177/1073191118789496 · Cited by 26 · see citing works
Trip, S., Marian, M. I., Hălmăjan, A., Drugas, M. I., Bora, C. H., & Roşeanu, G. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01184 · Cited by 24 · see citing works
“” Many studies described LFT as a multidimensional construct (Dryden, 1999; Harrington, 2005; Zvolensky et al., 2010; Bardeen et al., 2013; Bebane et al., 2015).”
BackgroundSmoking Behavior and Alcohol Consumption in Individuals With Panic Attacks
Mathew, A., Norton, P. J., Zvolensky, M. J., Buckner, J., & Smits, J. A. J. (2011) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.25.1.61 · Cited by 19 · see citing works
Self-citation
- Authors
- Zvolensky, M. J., Vujanovic, A. A., Bernstein, A., & Leyro, T.
- Affiliations
- University of Vermont (US)
- Boston University (US)
- University of Haifa (IL)
- Corresponding author
- Zvolensky, Michael J.
- Venue
- Current Directions in Psychological Science
- Publisher
- SAGE Publications
- Published
- 2010-12
- Volume
- 19
- Issue
- 6
- Pages
- 406-410
- ISSN
- 0963-7214 (ISSN-L)
- 1467-8721
- PMC
- PMC7978414
- OpenAlex
- W2144595430
- Cited by
- 357
- References
- 16
- Citations by year
- 2026: 33 · 2025: 32 · 2024: 28 · 2023: 34 · 2022: 20 · 2021: 23 · 2020: 29 · 2019: 27 · 2018: 26 · 2017: 12 · 2016: 15 · 2015: 19 · 2014: 13 · 2013: 18 · 2012: 9
- FWCI
- 14.44
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Current Directions in Psychological Science (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Veterans Affairs
- National Institutes of Health (5r01da027533-04)
- National Institute of Mental Health (R01MH076629)
- National Institute on Drug Abuse (R01-DA027533, F31DA024919)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Resilience and Mental Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- distress tolerance, psychological distress, psychopathology, therapeutic change, psychological intervention, theoretical conceptualization
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