Examining the utility of functional process models of distress tolerance in predicting psychopathology
AuthorVillatte, Jennifer L.
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Background: Distress tolerance is targeted as both a predictor and mechanism of psychopathology development and maintenance, treatment engagement and response, and relapse of psychological symptoms and problem behaviors. Empirical inconsistencies limit the utility of this construct, however, and distress tolerance has not been well investigated in nonclinical samples or in prospective study designs, making it difficult to determine its course of influence on psychopathology and to distinguish it from other psychological processes.Aims and Methods: The current study examined the operating characteristics of multi-method distress tolerance measures in the context of theoretically important psychological processes (i.e., experiential acceptance and mindfulness) in a nonclinical sample (N = 240) of 18-20 year old college students, a population at risk for emerging psychopathology. The unique and shared contributions of these variables were examined in multiple regression analyses at index assessment and in regression-based path analyses of models predicting changes in psychological functioning over one year. Results: No significant correlations were observed among the Distress Tolerance Scale, the PASAT, and the Breath Holding Task. Concurrent and future psychopathology in five domains was better predicted by models that included acceptance and mindfulness processes. All main effects of distress tolerance predicting psychopathology were moderated and/or mediated by acceptance and mindfulness. In every case, greater distress tolerance predicted both healthy and harmful psychological outcomes depending on its relationship to one or more acceptance and mindfulness process. Conclusions: As proposed, the conditional and indirect effects of acceptance and mindfulness often clarified seemingly incoherent main effects on psychopathology and often transformed distress tolerance into a significant predictor when main effects were absent. These results indicate that inconsistencies in the distress tolerance literature may be resolved by taking a functional contextual approach to conceptualizing and assessing the construct. However, it is not known whether distress tolerance measures improve the clinical utility of acceptance and mindfulness measures, which were independently strong predictors of psychological functioning in the present study. Further investigation of functional process models may increase the clinical utility and empirical progress of the distress tolerance construct.