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A Longitudinal Study of Emotional Distress Intolerance and Psychopathology Following Exposure to a Potentially Traumatic Event in a Community Sample

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Abstract

This study focused on better understanding the association between anxiety sensitivity (AS), distress tolerance (DT), and psychopathology, including posttraumatic stress, depression, panic and suicidality, in the aftermath of a potentially traumatizing event. A community-based sample of 151 adults exposed to the Mount Carmel Forest Fire Disaster were assessed within 30-days of exposure (T1) and then at 3- (T2) and 6-month (T3) follow-up intervals. At T1, AS, DT, and psychopathology symptoms loaded on a single common latent factor reflecting Emotional Avoidance and Distress; whereas by T2 AS-DT and psychopathology symptoms diverged into distinct latent variables—Emotional Distress Intolerance and Distress Post-Trauma, respectively. Levels of Emotional Distress and Avoidance at T1 predicted levels of Emotional Distress Intolerance as well as Distress Post-Trauma at T2. Finally, levels of Emotional Intolerance at T2 predicted levels of Distress Post-Trauma at T3 above and beyond the strong stability effects of Distress Post-Trauma over time. Findings are discussed with respect to their theoretical and clinical implications for understanding and promoting resilience to, and recovery following, exposure to potentially traumatic events.

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Notes

  1. First, suicidality represents arguably the most severe outcome of depression and posttraumatic stress. Second, it has been understudied in this area of research despite calls for such research (Stein et al. 2010). Third, due to our focus on emotional tolerance specifically, suicidality is a particularly important facet of depressive symptoms (i.e., more so than sleep problems, dysphoria, anhedonia, etc.). Indeed, it has been conceptualized as an extreme and tragic expression of experiential intolerance and avoidance (Anestis et al. 2013; Zvolensky et al. 2015).

  2. We ran two models to evaluate measurement invariance. In the first model, measurement error was free to vary between repeated measurements of the same construct. In the second model, measurement error was constrained to equality across repeated measurement. We compared goodness-of-fit between these models using the Chi square difference test as the two models are nested. The model with measurement invariance constraints is a specific case of the non-constrained model. We found the difference between the models to be non-significant. This indicates that allowing variance parameters to vary does not significantly improve model fit compared to having them constrained therefore establishing measurement invariance.

  3. Identical to the reported measurement model, we observe the identical uni-dimensional factor solution when we run a separate measurement model at T1.

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Acknowledgments

Dr. Bernstein recognizes the funding support from the Israeli Science Foundation (ISF), Israeli Council for Higher Education Yigal Alon Fellowship, the European Union FP-7 Marie Curie Fellowship International Reintegration Grant, Psychology Beyond Borders Mission Award, and the Rothschild-Caesarea Foundation. We thank Dr. Barbara M. Byrne for her kind assistance with the SEM analyses in AMOS.

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Authors and Affiliations

  1. Department of Psychology, University of Haifa, Mount Carmel, 31905, Haifa, Israel

    Raneen Hashoul-Andary, Yaara Assayag-Nitzan, Kim Yuval, Idan M. Aderka & Amit Bernstein

  2. VA Boston Healthcare System and Boston University, Boston, MA, USA

    Brett Litz

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  1. Raneen Hashoul-Andary
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  2. Yaara Assayag-Nitzan
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  3. Kim Yuval
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  4. Idan M. Aderka
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  5. Brett Litz
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  6. Amit Bernstein
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Correspondence to Amit Bernstein.

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Raneen Hashoul-Andary, Yaara Assayag-Nitzan, Kim Yuval, Brett Litz, Idan Aderka, and Amit Bernstein have no conflict of interest to report.

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Hashoul-Andary, R., Assayag-Nitzan, Y., Yuval, K. et al. A Longitudinal Study of Emotional Distress Intolerance and Psychopathology Following Exposure to a Potentially Traumatic Event in a Community Sample. Cogn Ther Res 40, 1–13 (2016). https://doi.org/10.1007/s10608-015-9730-4

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