This study seeks to extend the literature by examining distress tolerance (DT) levels for a substance dependent group of individuals. Next, it considers the potential relationship of DT levels with substance dependence features and finally, it compares those factors with a healthy control group. This study included 93 individuals (49 substance dependent and 44 healthy controls). Participants were evaluated using the Structured Clinical Interview for DSM-IV Axis I Diagnosis (SCID-I) and given the Distress Tolerance Scale (DTS), Beck Depression Inventory (BDI), and State & Trait Anxiety Inventory (STAI). Consistent with our expectations, the substance dependent group showed higher scores on the BDI and STAI, and lower scores on the DTS. There was no difference between the single drug dependent group and multiple substance-dependent groups, and their DT levels were not correlated with the duration of substance use, nor with the age of first substance use. Instead, DT was strongly correlated with trait anxiety, state anxiety, and depressive symptoms. The DT levels of this group of substance dependent individuals were very low in comparison to controls and to other groups reported in the literature. Our results suggest that distress tolerance may represent a therapeutic target factor in substance dependency treatment. Limitations and future research directions are also discussed.
Distress tolerance (DT) is a well established psychological construct that is defined as an individual’s perceived capacity to withstand negative emotional states [1] and [2]. Although this construct shares some qualities with frustration or discomfort tolerance, it is a unique concept related to tolerance for negative psychological distress [1] and [3].
The early literature on distress tolerance dates back to the 1980’s. As described in Linehan’s work, DT was originally considered most relevant to borderline personality disorder [4]. Marsha Linehan has highlighted the importance of DT as a factor in the treatment of challenging psychological problems in her dialectical behavioral therapy (DBT) [5]. According to DBT, a promising therapy modality for borderline personality disorder (BPD), an individual’s low distress tolerance is one of the main contributors to disruptive behaviors. At the same time, one of the main purposes of DBT treatment is to boost the distress tolerance level of a patient [6]. In the last decade, primarily as related to an individual’s capacity to withstand emotional distress, DT has been a focus of research in the area of substance use [2], [7] and [8] and other psychological disorders such as major depressive disorder, eating disorders and anxiety disorders [9], [10], [11], [12] and [13].
Previous research has primarily been conducted in normal populations in addition to a few disordered populations. This research suggests that distress tolerance has a relationship with depression and anxiety symptoms, and also shows an independent association with the symptom measurements of various anxiety disorders [13], [14] and [15]. In addition to anxiety disorders, Ellis et al. [12] found that decreased distress tolerance, along with increased anger and blunted physiological arousal, distinguished depressed and non-depressed individuals. DT has been found, either directly or indirectly, to be related to suicidal behavior, smoking relapse, risky sexual behavior and eating disorders [11], [16], [17] and [18]. In addition, some have suggested that DT may be specifically related to the motives for alcohol use [19] and cannabis abuse [20]. Although there are some theoretical studies in this area, to the best of our knowledge, there has been no study with a control group conducted on a substance dependent group of individuals.
Therefore the purpose of this study is twofold: first, to compare distress tolerance levels and factors as well as anxiety and depressive symptom levels between a substance dependent group and non-substance abusing healthy controls and second, to investigate whether there is a relationship between substance use features and distress tolerance levels.
