Distress tolerance

Distress tolerance is an emerging construct in psychology that has been conceptualized in several different ways. Broadly, however, it refers to an individuals' "perceived capacity to withstand negative emotional and/or other aversive states (e.g. physical discomfort), and the behavioral act of withstanding distressing internal states elicited by some type of stressor." Some definitions of distress tolerance have also specified that the endurance of these negative events occur in contexts in which methods to escape the distressor exist.

Within the literature, differences in conceptualizations of distress tolerance have corresponded with two different methods of assessing this construct. As self-report inventories fundamentally assess an individuals' perception and reflection of constructs related to the self, self-report measures of distress tolerance (i.e. questionnaires) specifically focus on the perceived ability to endure distressful states, broadly defined. Within these self-report measures, some questionnaires focus specifically on emotional distress tolerance, (e.g. the distress tolerance scale), others on distress tolerance of negative physical states (e.g. discomfort intolerance scale), and yet others focus specifically on tolerance of frustration as an overarching process of distress tolerance (e.g. frustration-discomfort scale).

In contrast, studies that incorporate behavioral or biobehavioral assessments of distress tolerance provide information about real behavior rather than individuals' perceptions. Examples of stress-inducing tasks include those that require the individual to persist in tracing a computerized mirror under timed conditions (i.e. computerized mirror tracing persistence task) or complete a series of time-sensitive math problems for which incorrect answers produce an aversive noise (i.e. computerized paced auditory serial addition task). Some behavioral tasks are conceptualized to assess physical distress tolerance, and require individuals to hold their breath for as long as possible (breath holding task).

As this is a nascent field of research, the relationships between perceptual and behavioral assessments of distress tolerance have not been clearly elucidated. Disentangling distinct components of emotional/psychological distress tolerance and physical distress tolerance within behavioral tasks also remains a challenge in the literature.

Several models about the structural hierarchy of distress tolerance have been proposed. Some work suggests that physical and psychological tolerance are distinct constructs. Specifically, sensitivity to feelings of anxiety and tolerance of negative emotional states may be related to each other as aspects of a larger construct representing sensitivity and tolerance of affect broadly; discomfort surrounding physical stressors, however, was found to be an entirely separate construct not associated with sensitivity to emotional states. Notably, this preliminary work was conducted with self-report measures and findings are cross-sectional in nature. The authors advise that additional longitudinal work is necessary to corroborate these relationships and elucidate directions of causality.

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