Distress tolerance and symptoms of depression: A review and integration of literatures

Abstract

Distress tolerance has emerged as a transdiagnostic risk factor for psychopathology but has received little theoretical attention in the depression literature. Evidence strongly suggests that individuals who have trouble tolerating distress display greater symptoms of depression, however. The lack of overlap between literatures is an important oversight, as the depression literature provides unique perspectives that have yet to be addressed in the distress tolerance literature. The current review thus (1) integrates findings from different literatures on distress tolerance and symptoms of depression, (2) discusses how this synthesis can inform clinical science and burgeoning distress tolerance treatments, (3) outlines important gaps in the distress tolerance and depression literatures, and (4) describes how they may be addressed by incorporating recent theoretical advances.

Negative affect interference and fear of happiness are independently associated with depressive symptoms

“…These individuals may be less likely to respond to existing therapies that focus on challenging negative cognitions (e.g., cognitive‐behavioral therapy) or increasing engagement in positive behaviors (Dunn et al, 2019). Moreover, existing treatments may not address the underlying processes of individuals who have difficulties with experiencing pleasure or positive affect; there may be a positivity paradox for these individuals such that the prospect of experiencing positivity may result in more distress (Lass & Winer, 2020). Further understanding of whether and how negative affect intrudes upon positive or pleasurable situations may also foster alternative treatment for such individuals.…”

Regaining control of your emotions? Investigating the mechanisms underlying effects of cognitive control training for remitted depressed patients.

“…For instance, recent findings indicate that distress tolerance, the ability to persist in goal-related activities despite distress, may be involved in the mechanism underlying effects of cognitive control training (Lass et al, 2021). As to date, this transdiagnostic risk factor for psychopathology has received relatively little attention in the context of cognitive risk for depression (Lass & Winer, 2020). However, in a sample of 72 students showing elevated depressive symptoms which were randomized to a waitlist condition or modifications of the adaptive PASAT, change in distress tolerance has recently been linked to both change in rumination and depressive symptomatology over time (Lass et al, 2021).…”

Commentary on distress tolerance and symptoms of depression: A review and integration of the literature.

“…It is a privilege to have the opportunity to comment on Lass and Winer's excellent contribution to this journal, “Distress tolerance and symptoms of depression: A review and integration of the literature” (2020). This qualitative review addresses an appealing question that has received surprisingly little attention: to what extent are distress intolerance and depressive symptoms related?…”

“…This qualitative review addresses an appealing question that has received surprisingly little attention: to what extent are distress intolerance and depressive symptoms related? Distress tolerance (DT) is defined “as one's ability to withstand and tolerate negative and/or uncomfortable emotional states” (Lass & Winer, 2020, p. 2) or negative cognitions; distress intolerance (DI) is the counterpart to DT.…”