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Reductions in Distress Intolerance via Intervention: A Review

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Abstract

Purpose

People who seek psychotherapy often have problems tolerating distress. The purpose of the current systematic review was to understand whether treatments successfully reduce distress intolerance. We intentionally focused both on treatments developed specifically to target distress intolerance and we also evaluated whether any type of treatment resulted in reduced distress intolerance.

Methods

We reviewed 106 papers covering (a) interventions specific to improving distress intolerance, and (b) pre-post reductions in distress intolerance over the course of any intervention, with a transdiagnostic and trans-intervention lens. Intervention was broadly construed to include laboratory single-session experimental treatments. Included studies required a measure of distress intolerance, and both self-report and behavioral measures were examined.

Results

Across all papers reviewed, there were a variety of samples (people with psychopathology, non-clinical samples, etc.) and treatments (mindfulness-and-acceptance based treatment, cognitive-behavioral treatments, one-time workshops, etc.) relevant for distress intolerance. Findings generally support the notion that self-reported distress intolerance declines as a function of treatment across modalities, while studies that included behavioral measures were less consistent. Specifically, mindfulness and acceptance-based approaches appear to be at the core of most successful treatments for distress intolerance.

Conclusion

Distress intolerance may be a useful transdiagnostic treatment target, with reductions in distress intolerance indicating decreased avoidance and greater psychological flexibility.

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Notes

  1. The term “negative emotions” is used throughout this paper to refer to emotions that are negative or unpleasant in valence, including (but not limited to) sadness, fear/anxiety, disgust, shame, guilt, anger and generally feeling “bad” or “upset.”

  2. Note that while we searched for both “distress tolerance” and “distress intolerance,” we will primarily frame our findings by talking about reductions in distress intolerance. However, we will use “distress tolerance” in the context of skills (particularly in DBT) which are designed to improve tolerance, and in the context of behavioral tasks which index the tolerance side of the dimension.

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  1. University of Arkansas, 216 Memorial Hall, Fayetteville, AR, 72701, USA

    Ally M. Heiland & Jennifer C. Veilleux

  2. The Ohio State University, Columbus, USA

    Ally M. Heiland

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Heiland, A.M., Veilleux, J.C. Reductions in Distress Intolerance via Intervention: A Review. Cogn Ther Res (2023). https://doi.org/10.1007/s10608-023-10425-1

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