Perceived and behavioral distress tolerance: links with avoidance and anxiety.

Background: Theories propose that low distress tolerance (DT) leads to anxious avoidance. Operational definitions and measurement of DT are inconsistent across studies. This study examined associations between perceived and behavioral DT with experiential and anxiety-specific behavioral avoidance in the context of anxiety.

Design and methods: 174 undergraduate students (68% women, 18-27 years) participated in an online study that included questionnaires assessing perceived DT, anxiety symptoms, experiential avoidance, anxiety-specific behavioral avoidance, and a behavioral DT task.

Results: Perceived DT was associated with experiential avoidance and anxiety-specific behavioral avoidance. Associations between DT and avoidance were not moderated by anxiety. On the behavioral DT task, participants with high anxiety reported higher distress pre-, mid-, and post-task compared to participants with low anxiety. Participants with distress increases from pre-to-mid-task were more likely to quit the task; this was not moderated by anxiety. When all measures of DT and avoidance were examined together, only perceived DT and experiential avoidance explained variance in anxiety.

Conclusions: Perceived and behavioral DT measures likely capture different components of DT. Behavioral DT tasks may be less effective in inducing distress in participants with high anxiety compared to low anxiety. Perceived DT and experiential avoidance were most associated with anxiety.