ORIGINAL ARTICLE

Distress Tolerance and its Role in Psychopathology

Michael J. Zvolensky • Julianna Hogan

Published online: 7 March 2013

� Springer Science+Business Media New York 2013

Abstract This introductory paper briefly introduces the

present special series, the purpose of which was to pro-

vide a forum for the systematic presentation of theory,

empirical evidence, and directions for future work as it

pertains to distress tolerance and psychopathology. Arti-

cles in the series were selected to highlight a broad range

of research on topics dealing with distress tolerance and

its relation to various aspects of psychopathology. The

articles in this series collectively suggest the importance

of developing more integrated models that explicitly

integrate both basic and applied research in order to

translate basic research on distress tolerance to the

applied realm and cast such work in a more comprehen-

sive nomological net.

Keywords Distress tolerance � Psychopathology �Vulnerability � Mechanism � Assessment

Distress tolerance has historically and presently been a

focus of interest for clinical scientists and practitioners

(Zvolensky et al. 2011). Indeed, the distress tolerance

construct has been theorized to contribute to (a) the

development and maintenance of a wide range of psycho-

pathology phenotypes (Otto et al. 2005) and (b) serve as a

key mechanism underlying therapeutic change for psy-

chological health (Linehan 1993). Thus, distress tolerance

has been involved in models of risk and resilency for

psychopathology.

Although there has been long-standing interest in elu-

cidating the role of distress tolerance in psychopathology

(e.g., Frenkel-Brunswik 1948), there has, in fact, been

relatively little empirical work focused on the subject

matter. Although limited, scientific attention has focused

on distress tolerance in regard to its potential role as a

clinical target for intervention/prevention programs (Line-

han 1993). This scientific attention has been presumably

influenced by the lack of theoretically grounded concep-

tualizations and corresponding instrumentation develop-

ment for the construct (Zvolensky et al. 2010). Over the

past decade, there has been a marked improvement in

distress tolerance theory and development of self-report

and behavioral tools that can tap the construct from various

viewpoints (Leyro et al. 2010). This work, in turn, has

served as a major catalyst for behaviorally-oriented, and

more recently, neurobehavioral study of the role of distress

tolerance in psychopathology ranging from laboratory-

based experimental (e.g., Bernstein et al. 2008) to field-

based clinical research (e.g., Bornovalova et al. 2012).

Presently, scholars have conceptualized a wide variety of

distress tolerance constructs that differ primarily in their

focus of distress (e.g., somatic vs. emotional) and mea-

surement approach (e.g., self-report vs. behavioral; Zvo-

lensky et al. 2010). Further, current research suggests that

self-report and behavioral indices of distress tolerance are

often only modestly related, suggesting that thery are

related, but distinct aspects of the latent construct (Bern-

stein et al. 2011).

M. J. Zvolensky

Department of Behavioral Sciences, University of Texas MD

Anderson Cancer Center, Houston, TX, USA

M. J. Zvolensky (&)

Department of Psychology, University of Houston, 126 Fred J.

Heyne Building, Suite 104, Houston, TX 77204, USA

e-mail: mjzvolen@central.uh.edu

J. Hogan

Department of Psychology, University of Vermont, 2 Colchester

Ave, Burlington, VT 05405, USA

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Cogn Ther Res (2013) 37:419–420

DOI 10.1007/s10608-013-9533-4

Notably, although nested conceptually within a broader

network of risk and protective processes, distress tolerance

is theorized to be related to, though conceptually distinct

from, other variables (e.g., avoidant coping, anxiety sen-

sitivity, emotion regulation, experiential avoidance; Leyro

et al. 2010). Many theories posit that individuals with

lower levels of distress tolerance may be prone to mal-

adaptively respond to distress and distress-eliciting con-

texts (Linehan 1993; Lynch and Mizon 2011; Trafton and

Gifford 2011). As a result, individuals with lower distress

tolerance may attempt to avoid negative emotions or

related aversive states in a rigid or context insensitive

manner. In contrast, persons with higher levels of distress

tolerance may be more able to adaptively respond to dis-

tress or distress-eliciting contexts. Theoretically, distress

tolerance may affect, and be affected by, a variety of other

processes involved in self-regulation, including attention,

cognitive appraisals of distressing emotional and physical

states, and emotional, as well as behavioral, responses to

distress (Leyro et al. 2010). Individual differences in the

experience of emotions (e.g., strength frequency), as one

example, can influence the nature of distress tolerance

(Marshall et al. 2008). Despite initial evidence suggesting

distress tolerance may be an individual difference variable

that could potentially influence vulnerability to psychopa-

thology (Leyro et al. 2010), questions remain regarding the

latent structure of distress tolerance as well as its potential

as a mechanism of change in interventions.

The overarching aim of the present special series is to

provide a forum for the systematic presentation of emerg-

ing theory, empirical evidence, and directions for future

work pertaining to distress tolerance and psychopathology

by some of the leading research groups carrying out such

work. To accomplish this aim, articles were invited to

highlight a range of distress tolerance conceptualizations

and showcase findings across psychopathology phenotypes.

Although the articles differ in their approach and content,

the special issue collectively suggests that focusing on

distress tolerance processes and the contexts in which they

operate is a highly valuable and promising pursuit in efforts

to uncover some of the enigmas of psychopathology.

Additionally, the present series includes papers that cover

basic and clinical research, and in so doing, attempts to

highlight the importance of translating research findings

and ideas from basic to applied and from applied to basic

work in this area of study. Overall, by covering a range of

issues interconnected by their focus on distress tolerance in

relation to psychopathology, it is hoped that such ‘‘broad

coverage’’ will: (1) alert readers to the significance of this

work at a variety of different levels of analysis; (2) illus-

trate current research questions being explored via inno-

vative approaches; and (3) identify promising areas for

future research and clinical advances.

Conflict of interest None.

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