Academic journal article Journal of Cognitive Psychotherapy

Examining the Specific Facets of Distress Tolerance That Are Relevant to Health Anxiety

Academic journal article Journal of Cognitive Psychotherapy

Examining the Specific Facets of Distress Tolerance That Are Relevant to Health Anxiety

Article excerpt

Researchers have called for examinations of associations between distinct facets of distress tolerance and specific forms of psychopathology. We examined associations between five facets of distress tolerance (intolerance of uncertainty, ambiguity, frustration, negative emotion, and physical discomfort) and health anxiety using a large community sample of adults. Structural equation modeling was used to examine associations. Intolerance of uncertainty, negative emotion, and physical discomfort were the only facets of distress tolerance that shared unique associations with health anxiety after accounting for the overlap among the facets of distress tolerance. Intolerance of physical discomfort shared an especially strong unique association with health anxiety. These results highlight facets of distress tolerance that are particularly relevant to health anxiety. Conceptual and therapeutic implications are discussed.

Keywords: distress tolerance; health anxiety; intolerance of uncertainty; intolerance of negative emotion; intolerance of physical discomfort

Distress tolerance is a construct that purportedly underlies multiple forms of psychopathology and has been defined as "the perceived capacity to withstand negative emotional and/or other aversive states" (Zvolensky, Vujanovic, Bernstein, & Leyro, 2010, p. 406). To better understand the potential transdiagnostic importance of distress tolerance, Zvolensky et al. (2010) called for examinations of (a) the associations between distress tolerance and forms of psychopathology and (b) whether specific facets of distress tolerance share stronger associations with certain forms of psychopathology than do other facets of distress tolerance. According to Zvolensky et al., studies examining these two issues could ultimately lead to the use of specialized psychological interventions that target the facet(s) of distress intolerance of particular importance to a given form of psychopathology.

Heeding Zvolensky et al.'s (2010) call for targeted examinations of relations between distress tolerance and psychopathology, we examined the strength of associations between facets of distress tolerance and health anxiety in this study. Health anxiety consists of four interrelated factors, including affective (anxiety about health), cognitive (dysfunctional beliefs about health), perceptual (hypervigilance to physical sensations), and behavioral (avoidance behavior, typically reassurance seeking) factors, within cognitive-behavioral models (Longley, Watson, & Noyes, 2005). Mild health anxiety is considered a ubiquitous phenomenon (Salkovskis & Warwick, 2001). However, severe health anxiety is a symptom of multiple Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) psychological disorders, including somatic symptom disorder and illness anxiety disorder (American Psychiatric Association, 2013a, 2013b). Severe health anxiety is related to several negative outcomes, such as lowered household income, interpersonal difficulties, emotional distress, and the overuse of medical services (Noyes, Carney, Hillis, Jones, & Langbehn, 2005). Thus, identifying possible risk factors for health anxiety is important to improve outcomes for individuals suffering from health anxiety (Asmundson, Abramowitz, Richter, & Whedon, 2010).

The reduced capacity to withstand body sensations has been long thought of as a core predisposing factor for health anxiety, with Barsky, Wyshak, and Klerman (1990) labeling this phenomenon as somatosensory amplification. Somatosensory amplification refers to the tendency to experience body/physical sensations as particularly bothersome. Somatosensory amplification significantly correlates with health anxiety, and the correlation is not accounted for by related variables (e.g., anxiety sensitivity; Fergus & Valentiner, 2010). In addition, somatosensory amplification interacts with daily stressors to prospectively predict greater body sensations and medical use (Barsky, Ahern, Bailey, & Delamater, 1996). …

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