Within the United States (U.S.), one-third of those who use cannabis (the most commonly used illicit drug in the U.S.), exhibit cannabis use problems significant enough to warrant a diagnosis of cannabis use disorder (CUD; Compton, Grant, Colliver, Glantz, & Stinson, 2004). Data suggests that quitting cannabis is highly difficult (Copersino et al., 2006), yet, there is little empirical knowledge about the nature of factors that relate to quit processes (e.g., self-efficacy). One potentially promising variable of relevance to CUD is distress intolerance (Leyro, Zvolensky, & Bernstein, 2010). Distress intolerance is referred to as (a) the perceived capacity to withstand negative emotional and/or aversive states, and (b) the behavioral act of withstanding distressing internal states elicited by some type of stressor. Although theoretically nested within a broader network of risk and protective processes, distress intolerance is posited to be related to, though conceptually distinct from, other variables (e.g., anxiety sensitivity; emotion regulation; Leyro et al., 2010). Individuals with higher levels of distress intolerance may be prone to maladaptively respond to distress (e.g., life stressors), and attempt to avoid negative emotions and/or aversive states (e.g., use cannabis to alter the perception or impact of negative mood, or to enhance positive mood). In contrast, persons with lower levels of distress intolerance may be more able to adaptively respond to distress (e.g., seek out alternative, more adaptive coping strategies instead of using cannabis). There is limited knowledge of the explanatory role of the inability to tolerate negative affect and other aversive internal sensations (e.g., withdrawal) in terms of CUD and the nature of the quit experience (e.g., beliefs about barriers to quitting). The aim of the present study was to examine the main and interactive effects of perceived and behavioral indices of distress intolerance in terms of cannabis quit-related variables, including (a) failed quit attempts, and duration of average time to relapse for past quit attempts; (b) greater severity of withdrawal symptoms experienced while quitting in the past, lower self-efficacy for abstaining, and greater perceived barriers for quitting cannabis; and (c) greater CUD problems. The sample recruited was characterized by racially and ethnically diverse (65.2% minority) adult cannabis users, many of whom had not completed college (46.5%). The sample had high rates of co-occuring psychiatric and medical illness (e.g., 36.1% had a current anxiety disorder, 26.4% had a current mood disorder, and half endorsed a medical condition), and over 25% fell below the 2013 Federal Poverty Level. There was no empirical support for an interactive or main effect of perceived or behavioral distress intolerance for any of the dependent variables. Although previous studies did not employ most of the cannabis dependent measures utilized in the current report, the lack of significant effects in the regression models was surprising given previous work on the topic (focused largely on coping motives for cannabis use). At the bi-variate level, there was some modest evidence of a 'signal' for perceived distress intolerance for certain cannabis dependent variables; these effects ranged from small to moderate. These data suggest, at least among the present largely minority sample, neither perceived or behavioral distress intolerance are robustly related to the cannabis dependent measures. One conservative interpretation of these findings is that distress intolerance may not perform the same across all CUD samples. Post hoc analyses focused on perceived distress intolerance subfactors relations to the dependent variables; indirect explanatory role of negative affect in perceived distress intolerance-cannabis relations; and bi-variate relations between perceived and behavioral distress intolerance with other transdiagnostic distress processes. Results suggested (a) no incremental explanatory effect for specific perceived distress intolerance subfactors; (b) a significant indirect effect of negative affect in the relation between perceived distress intolerance and certain cannabis dependent variables; and (c) consistent evidence of convergent validity for perceived distress intolerance with other transdiagnostic affective vulnerability factors. I contextualize the findings in relation to past work, and the methodology employed in the current study. I discuss how future theory-driven work that seeks to uncover the time course and patterning between distress intolerance, negative mood, and cannabis use behavior are needed. I also suggest that this work will likely have the greatest impact when the social contexts of CUD populations (e.g., social determinants of health) are more directly integrated into the theoretical models.

Posttraumatic stress disorder (PTSD) is a common psychiatric disorder and is associated with impairment in multiple domains. Research on the development of PTSD symptoms is often limited by the use of cross-sectional designs and retrospective reports of pre-trauma factors. The trauma film paradigm allows for the measurement of pre-trauma factors to determine which variables serve as prospective predictors of posttraumatic stress symptom development. Two factors which may predict posttraumatic stress symptom development are distress intolerance and attentional control. Research suggests distress intolerance is related to posttraumatic stress symptoms, but this relationship has only been shown cross-sectionally. Research has further shown attention control prospectively predicts posttraumatic stress symptoms. Cross-sectional research also suggests attentional control moderates the relationship between distress intolerance and posttraumatic stress symptoms. The current study used the trauma film paradigm to investigate whether attentional control moderates the relationship between distress intolerance and posttraumatic stress symptoms. The current study findings were mixed, but suggest that attentional control does not moderate the association between distress intolerance and posttraumatic stress symptoms. These results suggest distress intolerance and attentional control may not be important variables in the development of posttraumatic stress symptoms.

Obsessive-compulsive disorder (OCD) contributes to significant distress and chronic individual and societal impairment (e.g., DuPont et al., 1995; Ruscio et al., 2010). Despite the effectiveness of existing exposure-based therapies, some clients do not achieve symptom reduction or remission (Öst et al., 2015). Thus, identification of the mechanisms of change in treatment and more focused interventions are warranted to improve intervention effectiveness (e.g., Zvolensky et al., 2006). Distress intolerance may be an important but understudied mechanism of change in treatment for OCD. The current study replicated and extended previous findings that were limited by a small sample size (Macatee & Cougle, 2015), lack of focus on OCD specifically (McHugh et al., 2014; Bornovalova et al., 2012; Williams et al., 2013), and the use of non-clinical participants (Cougle et al., 2011; Macatee & Cougle, 2015) by using a residential and intensive outpatient sample of patients diagnosed with OCD. The current study found that reductions in DI accounted for significant improvement in OCD severity beyond changes in biological sex, anxiety change, depression change. Further, reductions in DI significantly contributed to OCD treatment response. Limitations and future directions were discussed.

Despite major advances in the development of evidence-based practices (EBPs) for child anxiety, there remains a critical need to improve upon current treatments. Identifying common, transdiagnostic processes underlying child anxiety disorders offers a promising avenue to refine conceptualizations of the etiology and maintenance of child anxiety disorders, to enhance the efficacy of interventions, and to facilitate the dissemination of EBPs. Distress intolerance (DI), defined as the perceived inability to tolerate negative somatic and emotional states or experiential discomfort (Simons & Gaher, 2005), is a transdiagnostic factor contributing to multiple forms of mental illness. Emerging research suggests that DI may be associated with elevated anxiety in community samples of youth; however, associations between DI and child anxiety have yet to be evaluated in a clinical population. The present multimodal investigation (N = 56) examined patterns and correlates of DI in a treatment-seeking sample of anxious youth (ANX, n = 28) relative to community controls (COM, n = 28). The aims of the study were to examine differences in DI between ANX and COM youth on self-report and behavioral measures of DI, and to determine the extent to which DI mediates links between child anxiety and associated behavioral avoidance. Youth ages 10-17 completed self-report measures assessing child anxiety symptoms, behavioral avoidance, and DI. Next, participants completed a behavioral task intended to provoke mild levels of distress that assessed behavioral persistence in the face of that distress. Consistent with hypotheses, ANX participants demonstrated higher levels of self-reported DI than COM participants, and greater anxiety-disorder severity was associated with higher levels of self-reported DI. Contrary to hypotheses, there were no between-group differences in behaviorally assessed DI. Mediation analyses revealed that a composite summary score of three self-report DI measures significantly mediated the link between anxiety status and behavioral avoidance. These findings provide compelling preliminary support that self-perceived DI may underlie the behavioral avoidance that is a cardinal feature across anxiety disorders. Results can inform the optimization of EBPs for child anxiety such that clinicians might directly target DI within treatment to better alleviate symptoms and yield more enduring treatment gains in anxiety-disordered youth.