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Distress tolerance in romantic relationships: A daily diary exploration with methodological considerations

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Despite growing research interest in distress tolerance (DT), studies have routinely neglected the role that DT plays in close, interpersonal relationships and how DT fluctuates from 1 day to the next. In addition, an understanding of DT hinges on the presence of distress, yet existing studies have failed to include distress in conceptual and analytical models. To address these gaps, we conducted a 1-week, daily diary study with 65 heterosexual couples (n = 130) exploring the effects of DT on basic psychological needs satisfaction in romantic relationships—accounting for distress as a covariate and moderator. Findings indicated that DT was more variable over time than previously suggested. DT was also associated with greater relationship need satisfaction, but less so after accounting for distress. Our study provides initial data on the role of DT in the daily lives of romantic couples and the methodological consequences of accounting for distress along with DT in analytical models.
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Running head: DISTRESS TOLERANCE IN ROMANTIC RELATIONSHIPS 1
Distress Tolerance in Romantic Relationships: A Daily Diary Exploration with Methodological
Considerations
James D. Doorley*
Todd B. Kashdan*
Lisa A. Alexander
Dan V. Blalock**
Patrick E. McKnight
George Mason University
Correspondence to:
Todd B. Kashdan
Department of Psychology
MS 3F5
George Mason University
Fairfax, VA 22030
Email: tkashdan@gmu.edu
*Joint first authors
** Dan Blalock is now affiliated with the Health Services Research & Development, Durham
Veterans Affairs Medical Center and Department of Psychiatry and Behavioral Sciences, Duke
University Medical Center, and is supported by Grant No. TPH 21-000 from the Department of
Veterans Affairs Office of Academic Affiliations and the Center of Innovation for Health
Services Research in Primary Care (CIN 13-410) at the Durham VA Medical Center.
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Abstract
Despite growing research interest in distress tolerance (DT), studies have routinely neglected the
role that DT plays in close, interpersonal relationships and how DT fluctuates from one day to
the next. In addition, an understanding of DT hinges on the presence of distress, yet existing
studies have failed to include distress in conceptual and analytical models. To address these gaps,
we conducted a one-week, daily diary study with 65 heterosexual couples (n = 130) exploring the
effects of DT on basic psychological needs satisfaction in romantic relationships accounting
for distress as a covariate and moderator. Findings indicated that DT was more variable over
time than previously suggested. DT was also associated with greater relationship need
satisfaction, but less so after accounting for distress. Our study provides initial data on the role of
DT in the daily lives of romantic couples and the methodological consequences of accounting for
distress along with DT in analytical models.
Keywords: distress tolerance; basic psychological needs; romantic relationships; well-being;
daily diary
DISTRESS TOLERANCE IN ROMANTIC RELATIONSHIPS
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Distress tolerance – defined as the capacity to experience and withstand undesirable
psychological states (Simons & Gaher, 2005) – has received increasing attention as a predictor of
health and psychological functioning. A majority of research has focused specifically on low
levels of DT as a risk and maintenance factor for maladaptive behaviors and personality traits
(e.g., Leyro, Zvolensky, & Bernstein, 2010). This research suggests that individuals with low
levels of DT are more prone to engaging in harmful, self-defeating behaviors aimed at alleviating
distress, including dysregulated eating (Anestis, Selby, Fink, & Joiner, 2007), problematic use of
alcohol and cannabis (e.g., Buckner, Keough, & Schmidt, 2007; Howell, Leyro, Hogan, Buckner,
& Zvolensky, 2010), and non-suicidal self-injury (e.g., Anestis, Pennings, Lavendar, Tull, &
Gratz, 2013; Nock & Mendes, 2008). Individuals with low DT are more likely to report
symptoms of panic, worry, and social anxiety (Keough, Riccardi, Timpano, Mitchell, & Schmidt,
2010). They are more prone to PTSD symptomatology following traumatic events (Vujanovic,
Bonn-Miller, Potter, Marshall, & Zvolensky, 2011). Low DT may also be common among
individuals with borderline personality disorder (Gratz, Rosenthal, Tull, Lejuez, & Gunderson,
2006) and antisocial personality disorder (Sargeant, Daughters, Curtin, Schuster, & Lejuez,
2011). The benefits of high DT, on the other hand, are often overlooked. Some research suggests
that high DT is associated with enhanced coping abilities (Krause, Ironson, & Pargament, 2016),
greater adherence to exercise programs (Baird et al., 2016), and more sustained abstinence from
smoking (Brandon et al., 2003), but further research with advanced measurement approaches is
needed to understand how high DT impacts people’s daily lives.
Gaps in distress tolerance measurement
There is a lack of consensus in how to measure DT. Several self-report questionnaires of
DT exist that measure different DT-related constructs. Among the most widely used are the
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Distress Tolerance Scale (DTS: Simons & Gaher, 2005), which measures perceived ability to
tolerate general distress, the Frustration Discomfort Scale (FDS; Harrington, 2005), which
measures perceived ability to tolerate the particular state of frustration, and the Tolerance of
Negative Affective States Scale (TNAS; Bernstein & Brantz, 2013), which measures perceived
tolerance of a range of discrete negative emotions.. Despite the disparate aims of these measures,
factor analyses suggest that all three scales load onto a single DT factor across samples of
undergraduate students and adults in treatment for substance use (Kiselica, Rojas, Bornovalova,
& Dube, 2015). Behavioral measures of DT are also widely used, which attempt to capture the
manifestation of DT in real-time, in the laboratory – often by measuring the duration of exposure
individuals can withstand to psychologically taxing computer tasks that gradually increase in
difficulty (e.g., adding numbers together rapidly, solving complex or unsolvable anagrams, or
tracing figures using a cursor that moves in the opposite direction of the mouse) (e.g.,
Eisenberger & Leonard, 1980; Lejuez, Kahler, & Brown, 2003; Strong et al., 2003).
While data suggest that trait self-report and behavioral DT measures do not correlate
(e.g., Anestis et al., 2012; Kiselica et al., 2015; McHugh et al., 2011), studies using these
methods have advanced knowledge of the role of DT as an individual difference variable (e.g.,
using self-report measures; Buckner et al., 2007) and as a phenomenon related to task persistence
(e.g., using behavioral tasks; Feldman, Dunn, Stemke, Bell, & Greeson, 2014). However, such
methods have not revealed how DT operates in naturalistic settings. The lack of attention given
to daily and momentary DT may be partially attributable to assumptions about the temporal
stability of DT. One four-year longitudinal study of adolescents suggested that DT (as assessed
by the Behavioral Indicator of Resiliency to Distress; Lejuez, Daughters, Danielson, & Ruggiero,
2006) is relatively invariant, with no significant mean- or individual-level changes across annual
DISTRESS TOLERANCE IN ROMANTIC RELATIONSHIPS
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assessments (Cummings et al., 2013). Another study of undergraduates found that trait self-
report DT remained stable from baseline to 6-month follow-up (Simons & Gaher, 2005). An
RCT examining the efficacy of a distress tolerance intervention showed that behaviorally
assessed DT improved within the treatment group, but remained stable in the treatment-as-usual
group over a six-week span (Bornovalova, Gratz, Daughters, Hunt, & Lejuez, 2012). One study
using a breath-holding task as a behavioral index of DT demonstrated high test-retest reliability
from baseline to one-year follow-up (r = .67; p > .001; Sütterlin et al., 2013). However, the
construct validity of breath holding tasks in the assessment of DT has been called into question;
such tasks may not induce adequate levels of distress in healthy populations (Sütterlin et al.,
2013). Lastly, Kiselica, Weber, and Bornovalova (2014) evaluated the stability of DT over 6-
months at three time points using three trait self-report questionnaires: the DTS, FDS, and
TNAS. Results showed no meaningful change in DT over six months. Thus, the authors
concluded that DT is indeed a stable, trait-like construct.
The convergent findings above are convincing, and it seems evident that DT varies
minimally when measured over long spans of time (e.g., several months, four years) over a range
of follow-up periods (e.g., six weeks, one year). However, these studies provide no insights into
the possibility of meaningful fluctuations in DT from one situation to the next. Intensive repeated
measures designs (e.g., experience sampling methods) are required to draw firm conclusions
about the stability of DT at the daily level. To our knowledge, only two studies have measured
DT in daily life. One examined the effects of daily DT on pathological worry (Macatee, Capron,
Guthrie, Schmidt, & Cougle, 2015) and the other explored associations between daily DT and
problematic anger (Hawkins, Macatee, Guthrie, & Cougle, 2013). While both studies represent
important steps toward understanding the daily form and function of DT, participants only
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completed measures of DT twice per week - leaving questions about the effects of daily DT on
daily outcomes.
Distress tolerance and romantic relationships
Another unexplored area in the DT literature is romantic relationships. Romantic
relationships offer opportunities for intimacy, security, love, and shared positive experiences,
and are also a common source of threat and loss, triggering uncomfortable psychological states
such as anxiety, guilt, anger, and sadness. From the perspective of self-determination theory
(SDT; Ryan & Deci, 2000), optimal individual and social functioning is achieved when basic
psychological needs are satisfied. That is, the need for autonomy (i.e., self-initiation, volition,
and willing endorsement of one’s behavior; Deci & Ryan, 1975), competence (i.e., the
propensity to experience challenge and mastery in one’s activity; White, 1959), and relatedness
(i.e., the extent to which strong and stable interpersonal bonds are formed; Ryan & Deci, 2000).
In romantic relationships, this means that couples are at their best when they understand and
respect each other’s preferences and perspectives (autonomy), provide opportunities for
accomplishing one’s goals and using psychological strengths (competence), and ensure that each
feels cared for, valued, and understood (relatedness) (La Guardia & Patrick, 2008). Meta-analytic
data suggest that when partners satisfy each other’s basic psychological needs, they exhibit
greater self-esteem, vitality, and positive affect as well as less negative affect (Patrick, Knee,
Canevello, & Lonsbary, 2007).
Data suggest that distress from external sources (e.g., caused by work or financial
difficulties) can “spill over” into the relationship domain (Dionisi & Barling, 2015; Lavee,
McCubbin, & Olsen, 1987; Vinokur, Price, & Caplan, 1996), causing individuals to perceive
more problems in their relationship and blame their partners more frequently for transgressions
DISTRESS TOLERANCE IN ROMANTIC RELATIONSHIPS
7
(Neff & Karney, 2004). It would make sense that high DT mitigates this spill over by helping
individuals tolerate and cope with external stressors more adaptively and providing partners with
the emotional availability required to satisfy one another’s psychological needs while they
themselves successfully reap the psychological benefits of the relationship. We chose to explore
satisfaction and well-being in relationships through an SDT lens by examining the impact of DT
on 1) the extent to which one’s basic psychological needs are satisfied by one’s partner and 2)
the extent to which one satisfies their partner’s basic psychological needs.
There is an absence of research examining DT and psychological needs satisfaction in
romantic relationships. Research suggests that emotion regulation strategies (i.e., emotional
suppression versus cognitive reappraisal) have a number of interpersonal consequences.
Experimental data suggest that individuals who frequently suppress their negative emotions are
more avoidant within close relationships (Gross & John, 2003), as they may be less willing to
endure emotionally charged interactions. Excessive suppression may adversely affect one’s
partner as well. One study of unacquainted pairs found that after viewing an upsetting film clip,
those who interacted with a confederate who suppressed their negative emotions in response to
the clip experienced significantly greater markers of physiological stress (e.g., increased blood
pressure) compared to those interacting with confederates who used cognitive reappraisal (Butler
et al., 2003). Further, a study of undergraduates found that effective emotion regulation, as rated
on an emotional intelligence test, was associated with self-reports and peer nominations of
greater interpersonal sensitivity and pro-social tendencies and more positive peer nominations
(Lopes, Salovey, Côté, Beers, & Petty, 2005). Maladaptive emotion regulation may hinder open
communication in relationships as well. People who suppress rather than reappraise their
negative emotions may be less inclined to express both positive and negative emotions with
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others (e.g., Rime, Philippot, Boca, & Misquita, 1992), thereby limiting the possibility for deep
interpersonal connections. Conversely, those who reappraise negative emotions are more likely
to share both negative and positive emotions with others (Gross & John, 2003).
It is possible that higher levels of DT act similarly to adaptive emotion regulation
strategies such as reappraisal by fostering greater interpersonal openness and emotional
expression within relationships and promoting more positive responses from interaction
partners. Except for Butler and colleagues (2003), despite measuring the intensity of distress
experienced, none of the aforementioned studies included levels of distress or negative affect in
their analytic models. Butler and colleagues measured levels of negative affect in response to the
upsetting film clip across reappraisers, suppressors, and controls, but did not measure weather
the association between an actor’s emotion regulation strategy and their physiological stress, or
that of their partner, depended on the actor’s level of negative affect. When considering the
effects of DT on romantic relationships, or any outcome, we argue that the amount of distress
one experiences in daily life may be equally, or more important than the degree to which one is
tolerant.
The impact of distress on distress tolerance
The very nature of DT is obscured without a meaningful amount of distress to be
tolerated. Studies suggest that DT is highly correlated with distress and negative affective states
(e.g., Kiselica et al., 2015; Simons, Gaher, Oliver, Bush, & Palmer, 2005). However, numerous
DT studies have neglected to include both distress and DT in analytic models, particularly at the
daily level, in an effort to disentangle their relative contributions to meaningful outcomes.
Several studies, however, have tested interactions between trait DT and daily negative events to
predict a number of outcomes, including changes in trait anger over time (Hawkins et al., 2013),
DISTRESS TOLERANCE IN ROMANTIC RELATIONSHIPS
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daily obsessive-compulsive behaviors (Macatee, Capron, Schmidt, & Cougle, 2013), daily
negative affect and psychopathology (Macatee, Albanese, Allan, Schmidt, & Cougle, 2016) and
daily pathological worry (Macatee et al., 2015). Of note, all of these studies except for Macatee
and colleagues (2015) found significant interactions between DT and daily negative events in
predicting pathological outcomes. However, two of these studies did not measure DT at the daily
level (Macatee, 2013; 2016), one study did not assess daily outcomes (Hawkins et al., 2013), and
none of these studies included a measure of subjective distress in response to the daily negative
events in their moderation models. The presence of negative events is not synonymous with the
presence of distress, and people vary in the intensity of distress following life events. Bonnano
and colleagues found that the most common reaction to stressful and/or traumatic events is
resilience (Bonanno, 2004; 2005; Bonanno, Westphal, & Mancini, 2011). It may be that a
number of factors, including fluctuations in distress, cause one’s ability to effectively tolerate
distress to vary substantially across days, which in turn impact relationship functioning and well-
being.
A large body of research demonstrates the adverse consequences of distress on romantic
relationships (e.g., Dionisi & Barling, 2015; Lavee et al., 1987; Neff & Karney, 2004; Vinokur,
Price, & Caplan, 1996). Consistent with this research, it may be that higher levels of daily
distress place a strain on romantic relationships that cannot be mitigated by DT. Another
possibility is that daily distress moderates the effects of DT on relationship quality. Imagine
Person A faces tremendous daily distress and tolerates this distress effectively, while Person B
faces minimal distress each day and also tolerates this distress effectively. While Person A and
Person B would score identically on a measure of daily DT, the amount of distress they are
tasked with tolerating is different. Thus, their distress tolerance levels may not impact their
DISTRESS TOLERANCE IN ROMANTIC RELATIONSHIPS
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respective romantic relationships in the same way. The association between DT and relationship
quality may be stronger for Person A (with high daily distress) than Person B (with low daily
distress), since the consequences of failing to tolerate higher versus lower levels of distress
should be more impactful on romantic relationships.
The present study
We explored conceptual and methodological gaps in the DT literature by examining: 1)
daily, within-person variance in DT, 2) the association between daily DT and daily satisfaction
of autonomy, competence, and relatedness in romantic relationships, and 3) how daily distress
impacts this association as a covariate and as a moderator.
Hypothesis 1: While existing studies allude to DT as a stable construct over time, we
hypothesized that an exploration of DT at the daily level will yield a meaningful amount of
within-person variance across seven consecutive days.
Hypothesis 2: We hypothesized that higher levels of daily DT will be associated with
higher levels of satisfaction of all three psychological needs in romantic relationships for
individuals and their partners.
Hypothesis 3: We hypothesized that daily distress will moderate the association between
daily DT and daily psychological needs satisfaction in relationships such that when daily distress
is higher, DT will have a greater positive impact on daily psychological needs satisfaction for
individual and their partners.
Methods
Participants
Our sample consisted of 65 heterosexual couples (130 participants; 50% women) from
the community, together for at least six months. The racial/ethnic composition was as follows:
DISTRESS TOLERANCE IN ROMANTIC RELATIONSHIPS
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57% Caucasian, 18% Multiple/Other, 10% African American, 9% Hispanic, and 6% Asian.
Participants’ average age was 29.88 years old (SD = 13.29) and the average length of romantic
relationships was 6 years (SD = 9.5 years). Regarding relationship status, 50% were dating, 27%
were married, 16% were engaged, and 7% endorsed “other.” Nearly all participants reported that
they were “seriously involved” with their romantic partners (98%). We recruited participants
from the Northern Virginia area using advertisements in the Washington Post, Craigslist.org, and
other online forums. Couples received $80 for participation. See Table 1 for additional
descriptive statistics.
Procedure
As part of a larger study of interpersonal dynamics within romantic couples, participants
completed baseline trait measures on a secure website and came into the laboratory for two, 1.5-
hour sessions. During the final laboratory session, participants received training on how to
complete an online daily diary on their personal computers for seven consecutive nights. Each
night, participants answered questions about their day, including how much distress they
encountered, how well they tolerated distress, and the degree to which they felt their
psychological needs were satisfied in their relationship. Participants received email reminders to
complete the measures each night between 8 and 10 p.m. Diaries had to be completed after 6pm
and could not be completed after 10am the next following day; outliers were removed from
further analyses. Participants completed all daily diaries on their own and responses were kept
confidential from their romantic partners. Three couples had one partner who failed to complete
the daily diaries. Thus, our final sample included 65 couples (130 individual participants) who
completed an average of 6.31 daily diaries across seven days.
Daily Diary Measures
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Basic Psychological Needs Satisfaction in Romantic Relationships. We measured the
extent to which participants believed their romantic partners satisfied their basic psychological
needs each day. Our scale was adapted from a basic needs satisfaction scale used by La Guardia,
Ryan, Couchman, and Deci (2000), which measures the extent to which individuals feel support
for their autonomy, competence, and relatedness from key figures in their lives, including
parents, romantic partners, and friends. Participants responded to a total of 9 items on a 7-point
Likert scale (1 = “Not at all true” through 7 = “Very true”) measuring the extent to which
romantic partners satisfied their needs. We used three items to measure each psychological need:
autonomy (e.g., “I felt free to be who I am”), competence (e.g., “I had a say in what happens and
could voice my opinion”), and relatedness (e.g., “I felt a lot of closeness and intimacy”) each
day. These item scores were averaged to create composite subscales for autonomy, competence,
and relatedness. See Table 2 for internal consistency of all scales.
Distress Tolerance. We measured daily distress tolerance using four items from the
psychometrically validated Distress Tolerance Scale (DTS; Simons & Gaher, 2005) using a 5-
point Likert scale (1 = “Strongly agree” through 5 = “Strongly disagree”). We made sure to
select items from each of the four domains of DT in the DTS: tolerating (“I couldn’t handle
feeling distressed or upset”), appraising (“My feelings of distress or being upset scared me”),
absorbing (“My feelings of distress were so intense that they completely took over”), and
regulating (“I’d do anything to stop feeling distressed or upset”), and these item scores were
averaged to create a total DT score. We chose these specific DTS items based on high factor
loadings on the relevant factors in the initial scale validation study (e.g., .76, .80, .74, and .86
respectively; Simons & Gaher, 2005).
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Distress. We measured daily distress using the Negative Affect (NA) items from the
Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988). Participants
rated the extent to which they felt sad/depressed, anxious, worried, lonely, miserable, guilty,
angry, frustrated, ashamed, and disgusted each day with a 5-point Likert scale (1 = “Very slightly
or not at all” through 5 = “Extremely”). We averaged these item scores to create a total distress
score. Prior research suggests that the NA items from this scale are highly correlated with widely
used measures of general psychological distress (e.g., the Hopkins Symptom Checklist) and thus,
may be used interchangeably to measure the same construct (Watson et al., 1988). Further, the
nature of distress captured by the NA scale of the PANAS aligns with the nature of distress that
is embedded in our operationalization of distress tolerance with the DTS (“negative
psychological states”).
Data Analysis
We calculated means, standard deviations, and correlations for all measures using R
version 3.2.3 (R Core Team, 2017) (see Table 2). Participants’ daily distress scores on the NA
scale of the PANAS (M = 1.57; SD = .69) were similar to similarly aged non-clinical populations
sampled in daily diary research (e.g., Röcke, Li, & Smith, 2009). To account for the non-
independence of participants’ data, we calculated actor-partner interdependence models (APIM)
using HLM 7.01 (Campbell & Kashy, 2002; Raudenbush, Bryk, Cheong, Congdon, & Du Toit,
2011). APIM allowed us to investigate the within-person effect of how an individual’s daily DT
influences their own daily psychological needs satisfaction in their relationship (i.e., actor effect)
and the between-person effect of how an individual’s daily DT influences their partner’s daily
psychological need’s satisfaction in their relationship (i.e., partner effect). We controlled for the
effect of one partner’s DT when examining the effects of another partner’s DT, which is a
DISTRESS TOLERANCE IN ROMANTIC RELATIONSHIPS
14
standard procedure in APIM. This is considered a conservative approach because the effect of a
given predictor (e.g., DT) can only reach statistical significance if it accounts for unique variance
in the outcome above and beyond the other predictor in the model (e.g., the partner’s DT). Since
only heterosexual couples were recruited for this study, dyads were treated as “distinguishable”
for all APIM analyses (members of each couple were “distinguishable” by their gender; Kenny
& Ledermann, 2010). Using the most widely used approach for analyzing dyadic data in daily
diary studies (Laurenceau & Bolger, 2005), we created male and female versions of predictor
and outcome variables and ran male and female models separately. This method was chosen for
ease of interpretation, and is mathematically equivalent to using a dummy-coded sex variable as
a moderator, as is sometimes done in dyadic research (Laurenceau & Bolger, 2005).
Bivariate analyses revealed no significant correlations between relationship length and
relationship autonomy, competence, or relatedness (r = .04 - .08, p = .62 - .78). Thus,
relationship length was not included as a covariate. We tested APIMs predicting satisfaction of
autonomy, competence, and relatedness in romantic relationships from daily levels of: 1) DT, 2)
DT while controlling for distress, and 3) the interaction of DT and distress. For each outcome,
actor and partner effects were computed separately with the following four models: 1) men’s DT
predicting men’s needs satisfaction, 2) women’s DT predicting men’s needs satisfaction, 3)
women’s DT predicting women’s needs satisfaction, and 4) men’s DT predicting women’s
satisfaction. See Table 3 for all APIM results.
Results
We calculated the reliability of the daily DT measure and all other daily measures within
each level of independent data (across each day for men and women). Alphas calculated by day
and sex for all measures ranged from .81 to .98. We calculated the intra-class correlation
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15
coefficient (ICC) using an unconditional model in HLM to examine the percentage of variance in
DT attributable to within-person changes across days (level 1) versus between-person differences
(level 2). The ICC showed that 52% of the variance in men’s and women’s DT was attributable
to between-person differences (ICC = .52). This means almost half of the variance (48%) was
attributable to within-person fluctuations in DT from day to day.
Relationship Autonomy
There was a significant actor effect for men such that greater DT was associated with
greater relationship autonomy for men (b = .15, SE = .05, t = 3.32, p = .001). This effect
remained significant (b = .10, SE = .04, t = 2.28, p = .024) after controlling for men’s distress,
which was also significantly associated with men’s relationship autonomy (b = -.43, SE = .14, t
= -3.17, p = .002). There was a significant actor effect for women such that greater DT predicted
greater relationship autonomy for women (b = .11, SE = .05, t = 2.01, p = .045). This effect was
no longer significant (b = -.02, SE = .05, t = -.40, p = .687) after controlling for women’s
distress, which was significantly associated with women’s relationship autonomy (b = -.64, SE =
.13, t = -4.79, p < .001). There were no significant partner effects in that men’s DT was not
associated with women’s relationship autonomy (b = .04, SE = .05, t = .68, p = .495) nor was
women’s DT associated with men’s relationship autonomy (b = -.02, SE = .05, t = -.38, p =
.707). DT x Distress interactions did not significantly predict relationship autonomy for men (b =
.09, SE = .07, t = 1.34, p = .182) or women (b = .01, SE = .12, t = .11, p = .916).
Relationship Competence
There was a significant actor effect for men such that greater DT was associated with
greater relationship competence for men (b = .16, SE = .07, t = 2.41, p = .017). This effect was
no longer significant (b = .08, SE = .05, t = 1.45, p = .148) after controlling for men’s distress,
DISTRESS TOLERANCE IN ROMANTIC RELATIONSHIPS
16
which was significantly associated with men’s relationship competence (b = -.65, SE = .12, t = -
5.35, p < .001). There was also a significant actor effect for women such that greater DT was
associated with greater relationship competence for women (b = .19, SE = .07, t = 2.71, p =
.007). This effect was no longer significant (b = .06, SE = .07, t = .91, p = .364) after controlling
for women’s distress, which was significantly associated with women’s relationship autonomy (b
= -.69, SE = .11, t = -6.05, p < .001). There were no significant partner effects in that men’s DT
was not associated with women’s relationship competence (b = .03, SE = .05, t = .58, p = .566)
nor was women’s DT associated with men’s relationship competence (b = .04, SE = .05, t = .96,
p = .337). DT x Distress interactions did not significantly predict relationship competence for
men (b = .13, SE = .08, t = 1.69, p = .092) or women (b = -.11, SE = .09, t = -1.31, p = .19).
Relationship Relatedness
There was a significant actor effect for men such that greater DT was associated with
greater relationship relatedness for men (b = .16, SE = .07, t = 2.29, p = .023). This effect was no
longer significant (b = .06, SE = .06, t = 1.03, p = .303) after controlling for men’s distress,
which was significantly associated with men’s relationship relatedness (b = -.72, SE = .22, t = -
3.30, p = .001). The actor effect for women was not significant (b = .11, SE = .07, t = 1.55, p =
.121). There were no significant partner effects in that men’s DT was not associated with
women’s relationship relatedness (b = .05, SE = .05, t = 1.08, p = .281) nor was women’s DT
associated with men’s relationship relatedness (b = .04, SE = .07, t = .58, p = .562). DT x
Distress interactions did not significantly predict relationship relatedness for men (b = .06, SE =
.10, t = .61, p = .545) or women (b = -.03, SE = .14, t = -23, p = .820).
Discussion
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This study adds to a growing literature on DT by investigating the association between
daily DT and daily psychological needs satisfaction in romantic relationships, and the influence
of daily distress as a covariate and moderator. Consistent with hypothesis 1, initial findings
suggest that DT is more variable over time than previously suggested, with 48% of the variance
occurring within-person. Findings also supported hypothesis 2, suggesting that the ability to
tolerate distress is associated with greater satisfaction of psychological needs in relationships for
men (autonomy, competence, and relatedness) and women (autonomy and competence). None of
these associations remained significant after controlling for daily levels of distress, however,
except for the association between men’s DT and men’s relationship autonomy. Thus, hypothesis
3 was only partially supported.
As for stability, while DT may be a trait-like construct when assessed over longer follow-
up intervals (e.g., Cummings et al., 2013; Bornovalova et al., 2012; Kiselica et al., 2014;
Sütterlin et al., 2013), DT fluctuates nearly as much between people as within people at the daily
level. However, important constraints on generalizability (see Simons, Shoda, & Lindsay, 2017)
should be noted. First, we assessed daily DT in a non-clinical sample of adults. It is possible that
DT may appear more trait-like (i.e., have greater between- relative to within-person variance
across days) when assessed in a sample of adults with chronic psychopathology – for example,
those with personality or long-standing substance use disorders. Second, it is possible that
expanding our assessment window from seven days to several weeks would lead to greater
between- and less within-person variability, as studies have shown DT to be stable over a 1-
month span (e.g., Macatee et al., 2015). Finally, our condensed, end-of-day version of the DTS
explicitly instructed participants to rate their DT levels from that day. Other studies using
standard self-report measures of DT ask participants to reflect on their beliefs and reactions to
DISTRESS TOLERANCE IN ROMANTIC RELATIONSHIPS
18
distress in general. It stands to reason why studies using the latter method fail to find meaningful
fluctuations in DT over time – one’s self-endorsed global approach to distress across life
contexts is unlikely to change markedly over an arbitrary span of months or even a few years. It
is possible that seemingly small differences in scale instructions may account for wide variation
in the stability of DT, perhaps even more so than the frequency and time frame of assessments.
Regarding the significant association between men’s DT and relationship autonomy
(while controlling for distress), it may be that on days when men are effectively tolerating
distress, they experience different types of social interactions. On days marked by higher DT,
men may feel more in control of their emotions and life circumstances and feel more capable of
making their own choices – regardless of how much distress they are experiencing. In turn, their
partners may perceive and reinforce this by acting in ways that preserve men’s autonomy. DT
may predict men’s autonomy above and beyond levels of distress in part due to the salience of
autonomy to men. Earlier theorists have defined autonomy as a more male-oriented concept and
suggested that men may value autonomy in romantic relationships more than women (Gilligan
1982; Jordan, 1997). While more recent data suggest that autonomy support is no more
beneficial for men’s well-being than women’s (Deci, La Guardia, Moller, Scheiner, & Ryan,
2006), it may be that compared to women, men are more sensitive to daily fluctuations in
perceived autonomy in the context of relationships.
In all other APIM models, daily distress emerged as the more potent predictor of daily
satisfaction of all three psychological needs compared to daily DT. Also, greater DT was not
associated with the psychological needs satisfaction of one’s partner (i.e., no significant partner
effects). Several theoretical and methodological considerations and limitations may help explain
these unexpected findings. First, high levels of distress may impede psychological needs
DISTRESS TOLERANCE IN ROMANTIC RELATIONSHIPS
19
satisfaction in relationships - placing a heavy strain on both partners that may not be mitigated by
high DT. High levels of distress on a given day may also lead to lower perceptions of
psychological need satisfaction in one’s relationship. It is possible that both distress and DT may
be more highly correlated with psychological needs frustration, rather than satisfaction, in
romantic relationships. Need frustration involves activity and directly undermining a partner’s
needs (Vansteenkiste & Ryan, 2013) and is negatively correlated with relationship satisfaction
(Vanhee, Lemmens, & Verhofstadt, 2016). It may be more challenging for individuals to tolerate
distress effectively when psychological needs are not only unsatisfied, but directly thwarted by
partners. Further, individuals with very low DT may be more inclined to thwart their partner’s
psychological needs as a destructive attempt at coping with distress. Future studies will benefit
from examining associations between distress, DT, and both psychological needs satisfaction and
frustration. Methodologically, since our analyses did not establish a clear temporal sequence of
effects, it may also be that low needs satisfaction in relationships triggers higher levels of
distress, rather than the other way around. Additionally, DT may not always be beneficial in
romantic relationships (Zvolensky et al., 2010). For instance, an individual with high DT may be
more likely to tolerate unhealthy levels of distress within a relationship (e.g., staying with an
abusive partner longer than one should - resulting in ongoing abuse and distress).
While DT was not a strong predictor of psychological needs satisfaction in romantic
relationships after accounting for distress (for all outcomes except men’s autonomy), other
studies found that DT does predict meaningful outcomes above and beyond levels of distress
(e.g., anxiety/depressive symptoms, anger, relapse; Cougle, Bernstein, Zvolensky, Vujanovic, &
Macatee, 2013; Hasan, Babson, Banducci, & Bonn-Miller, 2015; Macatee et al., 2013, 2015,
2016). A number of studies also suggest that behavioral measures of DT predict meaningful
DISTRESS TOLERANCE IN ROMANTIC RELATIONSHIPS
20
outcomes regardless of levels of emotional reactivity to the distress task (e.g., Ali, Seitz-Brown,
& Daughters, 2015; Anestis, Tull, Bagge, & Gratz, 2012; MacPherson, Stipelman, Duplinsky,
Brown, & Lejuez, 2008). More research is needed to disentangle the relative contributions of
distress and DT to romantic relationship functioning. Since our study only assessed daily
tolerance of general distress, future studies may benefit from examining how tolerance of
relationship-specific distress impacts relationship needs satisfaction and other important
relationship outcomes.
Additional caveats to the present study are warranted. To succinctly capture DT and its
daily fluctuations, we used a 4-item version of the Distress Tolerance Scale (Simons & Gaher,
2005). The full DTS has demonstrated strong internal consistency as a twice per week, end-of-
day assessment tool (Macatee et al., 2015; Hawkins et al., 2013). Our shortened, state version of
the DTS also demonstrated high reliability on a daily basis. Future studies may benefit from
including more items from each DTS domain (i.e., tolerating, appraising, absorbing, regulating)
to obtain a more robust assessment of momentary DT in naturalistic environments. It is also
possible that assessing distress and DT within the same survey may have inadvertently primed
participants to report levels of DT commensurate with distress (i.e., reporting lower levels of DT
after endorsing greater distress). With a moderately sized correlation of -.39 between distress and
DT, this alternative explanation lacks sufficient evidence.
Our daily DT scale is a measure of perceived distress tolerance, rather than an objective
measure of how much distress can be tolerated. It may be that perceived daily DT is particularly
difficult to disentangle from perceived daily distress compared to a behavioral index of DT. The
DTS in particular may have considerable conceptual overlap with distress. In our truncated
version of the DTS, we included the following item from the absorption subscale: “My feelings
DISTRESS TOLERANCE IN ROMANTIC RELATIONSHIPS
21
of distress were so intense that they completely took over.” This item, along with other
absorption items in the DTS, could be construed as an index of how much distress one is
experiencing versus how absorbed one gets in their distress. Using a behavioral measure of DT
might reduce conceptual overlap (Ameral, Palm Reed, Cameron, & Armstrong, 2014; Kiselica et
al., 2015). Data also suggest that behavioral DT measures show weaker associations with
theoretically relevant constructs, including well-being, harm avoidance, negative urgency, and
sensation seeking, compared with self-report DT questionnaires (Kiselica et al., 2015). Thus, it
may be that a behavioral measure of DT would have yielded different results in our study. We
would argue that perceptions are often more important than objective reality, particularly when it
comes to constructs like DT. If a person believes a situation will be too difficult to handle, they
are apt to avoid, escape, or engage in a range of emotion regulation strategies in hopes of
enduring.
Despite a few interpretative caveats, our results suggest multiple avenues for future
research and promising applications in clinical practice. To begin, DT varied considerably on a
daily basis, indicating that the ability to tolerate undesirable psychological states may not be a
stable characteristic at the daily level (at least among non-clinical samples). It stands to reason
that DT may be influenced by a number of features in the environment, and a more expansive
test of these influences is warranted at the daily/momentary level. For example, dire financial
circumstances may cause an individual to tolerate high distress and long hours at work in hopes
of earning a better living; however, the same individual may be less tolerant of distress at home
with their partner because he or she perceives it to be a place for relaxation only. DT may also be
influenced by cumulative distress whereby minor distressing incidents that would normally be
easily tolerated become more problematic when occurring in rapid, compounding succession. In
DISTRESS TOLERANCE IN ROMANTIC RELATIONSHIPS
22
this instance, the cumulative effect of everyday life stressors would be greater than any one
stressor in isolation. Clinicians should encourage couples to engage in open dialogs about the life
circumstances that impact their ability to tolerate distress, characteristic ways in which they react
to distress, and how these reactions then impact one another.
Our results suggest that men engaged in therapy may benefit from addressing the
influence of DT on their feelings of autonomy. Men with high, compared to low DT may be
more likely to feel as though partners do not support their autonomy, which could lead to general
relationship dissatisfaction. These men may find it helpful to explore how DT impacts thoughts
and emotions about their romantic relationships in daily life. They may benefit from learning
therapeutic techniques that allow them to better manage physiological symptoms of distress (e.g.,
diaphragmatic breathing or progressive muscle relaxation), evaluate inaccuracies in their
perceptions about their romantic relationships (e.g., cognitive restructuring), or view these
perceptions as simply words and images generated by the brain that do not require ample
attention or action (e.g., mindfulness, cognitive defusion). In this manner, addressing DT in
therapy may increase a man’s perceptions of autonomy and relationship satisfaction.
To our knowledge, this is the first study to examine the effects of DT in romantic
relationships, much less at the daily level from the perspective of both partners. Our findings
shed light on the importance of examining distress concurrently with DT and exploring the
effects of DT on different facets of romantic relationships and other interpersonal domains. Our
results add to a growing body of research with granular assessment approaches to capture the
causes, correlates, and consequences of DT in daily life.
DISTRESS TOLERANCE IN ROMANTIC RELATIONSHIPS
23
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Appendix
Table 1.
Participant Characteristics
Women N(%)
Men N(%)
Ethnicity
Asian
5(8%)
3(5%)
Caucasian
33(51%)
41(63%)
Hispanic
6(9%)
6(9%)
African American
8(12%)
5(8%)
Multiple/Other
13(20%)
10(15%)
Highest Level of Education
Less than High School
High School
Some College
Bachelor’s Degree
Graduate Degree
Current Living Arrangement
Alone
Roommate
Relationship Partner
Parents
Other
Main Social Support
Relationship Partner
Family Members
Other
0(0%)
1(2%)
30(46%)
18(28%)
16(25%)
3(5%)
10(16%)
32(49%)
14(22%)
6(9%)
51(79%)
4(6%)
2(3%)
1(2%)
5(8%)
17(26%)
25(39%)
17(26%)
5(8%)
9(14%)
35(54%)
12(19%)
4(7%)
53(82%)
8(12%)
0(0%)
Current Relationship Status
Dating
32(49%)
33(51%)
Engaged
11(17%)
10(15%)
Married
17(26%)
18(28%)
Other
5(8%)
4(6%)
Involvement with Partner
Seriously Involved
64(98%)
64(98%)
Casually Involved
2(2%)
2(2%)
DISTRESS TOLERANCE IN ROMANTIC RELATIONSHIPS
33
Table 2.
Means, standard deviations, and correlations for study variables
Variable
1.
2.
3.
4.
5.
6.
1. Rel. Autonomy
-
2. Rel. Competence
.71
-
3. Rel. Relatedness
.72
.67
-
4. Distress Tolerance
.24
.26
.19
-
5. Positive Affect
.43
.47
.48
.24
-
6. Negative Affect
-.48
-.54
-.47
-.39
-.47
-
M
5.95
5.74
5.49
4.28
3.38
1.57
SD
1.27
1.28
1.57
1.20
.90
.69
Note. All correlations significant at p < .01 level. “Rel.” = relationship.
... The sample size was defined based on debates about what is a sufficient sample size for multilevel model analyses (MLM) with repeated measures nested within a person (Hox & McNeish, 2020;Maas & Hox, 2005;Nezlek, 2020;Ohly, Sonn entag, Niessen, & Zapf, 2010). We have also consulted the following publications where the daily diary study design and MLM analyses were also applied to investigate variables associated with intimate relationships: Carton and Horan (2014), Doorley, Kashdan, Alexander, Blalock, and McKnight (2019), Gallaty and Zimmer-Gembeck (2008), and Kanat-Maymon et al. (2017). We aimed for a sample size of at least 100 participants, achieving a final sample of 133 participants. ...
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... Distress tolerance is typically investigated in an individual context, where it has been consistently associated with lower risk of psychiatric symptoms and maladaptive behaviors (e.g., Keough et al., 2010;Leyro et al., 2010). There is, however, evidence that distress tolerance in one person can impact the emotional functioning in another, at least in ongoing relationships like romantic partnerships or parent-child (Daughters et al., 2014;Doan et al., 2018;Doorley et al., 2019). While this effect has not been ...
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Introduction: Distress intolerance is an important risk factor for smokers. Smokers have greater problems tolerating distress than non-smokers, and distress intolerance is theoretically an important predictor of early lapse. However, much of the distress intolerance research has been conducted on daily smokers. Understanding distress intolerance in non-daily or intermittent smokers may help elucidate whether distress intolerance is a function of current smoking habits. Methods: Daily (n = 36) and intermittent (n = 28) smokers completed behavioral distress intolerance tasks (breath holding, mirror tracing persistence, and image persistence) along with self-report measures of both general and smoking-specific distress intolerance. They also completed one week of ecological momentary assessment where positive and negative affect were assessed along with momentary distress intolerance, at both random times (7x/day) and immediately prior to smoking a cigarette. Results: Results found no differences between intermittent and daily smokers on behavioral distress intolerance tasks or general self-reported distress intolerance. Daily smokers reported greater self-reported smoking-specific distress intolerance compared to intermittent smokers. In addition, across both smoker groups, momentary distress intolerance was higher at smoking compared to random sessions, and low positive affect predicted greater momentary distress intolerance specifically for intermittent smokers prior to smoking. Conclusion: The lack of differences between daily and intermittent smokers on general distress intolerance measures suggests that distress intolerance abilities and self-perceptions are not a function of higher levels of current smoking. However, the contextual variation in momentary distress intolerance is worth further exploration in both daily and intermittent smokers.
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Research indicates that spiritual struggles (i.e., tensions and strains associated with sacred issues) are associated with greater psychological distress and diminished levels of well-being. However, fewer studies have assessed the relationship between spiritual struggles and indicators of physical health. The purpose of the current study is to see whether spiritual struggles are associated with clinically higher levels of resting pulse rates. In addition, an effort is made to see if the effects of spiritual struggles on resting pulse rates are offset for individuals with a strong sense of distress tolerance. Data from a recent nationwide survey suggest that spiritual struggles are associated with higher resting pulse rates, but only among individuals who do not have a strong sense of distress tolerance.
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This study tested whether distress tolerance, body image, and body mass index (BMI) predicted adherence to a yoga intervention. Participants were 27 women who participated in a yoga intervention as part of a randomized controlled trial. Attendance and distress tolerance were assessed weekly, and body image and BMI were measured at baseline. Multilevel modeling revealed a three-way interaction of distress tolerance, BMI, and body image (p < .001). For participants with few body image concerns, distress tolerance was positively associated with adherence regardless of BMI (p = .009). However, for those with poor body image, increases in distress tolerance were associated with increases in adherence among overweight participants (p < .001) but lower adherence among obese participants (p = .007). Distress tolerance may be implicated in adherence to a yoga intervention, although its effects may be dependent on body image concerns, BMI, and their interaction. Research and clinical implications are discussed.
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Psychological scientists draw inferences about populations based on samples—of people, situations, and stimuli—from those populations. Yet, few papers identify their target populations, and even fewer justify how or why the tested samples are representative of broader populations. A cumulative science depends on accurately characterizing the generality of findings, but current publishing standards do not require authors to constrain their inferences, leaving readers to assume the broadest possible generalizations. We propose that the discussion section of all primary research articles specify Constraints on Generality (i.e., a “COG” statement) that identify and justify target populations for the reported findings. Explicitly defining the target populations will help other researchers to sample from the same populations when conducting a direct replication, and it could encourage follow-up studies that test the boundary conditions of the original finding. Universal adoption of COG statements would change publishing incentives to favor a more cumulative science.
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Despite existing theoretical and empirical grounds for a needs perspective on intimate relationship functioning, little is currently known about the role of relational need frustration, especially as compared to need satisfaction. Therefore, our aim in the present study was to investigate the relative value of the satisfaction and frustration of an individual's relational needs for autonomy, competence, and relatedness in predicting relationship satisfaction. Self-report measures were completed by 372 men and women, each of whom was involved in a committed heterosexual relationship. Results indicated that (a) need satisfaction and need frustration both contributed to relationship satisfaction, with need satisfaction being the stronger predictor of greater satisfaction, and (b) the satisfaction or frustration of the need for relatedness was the only significant predictor of relationship satisfaction. The results for both men and women were similar. In sum, these results imply that couple interventions should focus on reinforcing relatedness satisfaction as well as on reducing relatedness frustration in both male and female partners.
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Introduction: The majority of individuals who attempt to quit using cannabis do not seek formalized treatment. To better understand which malleable factors contribute to cannabis use following a self-guided quit attempt, two measures of distress tolerance (DT) were concurrently examined as prospective predictors of cannabis use post quit attempt. We hypothesized that veterans with higher relative to lower levels of DT would be less likely to use cannabis following a self-guided quit attempt. Method: 103 cannabis dependent veterans (Mage = 50, 95% male, 37% White, 36% Black, 14% Hispanic, 14% Other) who reported being motivated to quit using cannabis were included in the current study. Veterans completed two measures of DT, the Distress Tolerance Scale (perceived distress tolerance) and the Mirror-Tracing Persistence Task (laboratory analogue of distress tolerance). Results: Findings indicated that veterans with greater perceived distress tolerance used less cannabis over the quit period than veterans with less perceived distress tolerance. However, contrary to expectations, baseline performance on a laboratory analogue of distress tolerance was not related to cannabis use over the quit period. Conclusions: Results suggest veterans’ perceived ability to tolerate distress is an important predictor of cannabis use following a self-guided quit attempt. Thus, the Distress Tolerance Scale could serve as an important tool for helping to identify veterans at risk for cannabis use post-quit.
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The utility of distress tolerance (DT) as a transdiagnostic marker of psychopathology has been limited to date by a lack of consensus on how to measure DT. Closer examination of the measures used to capture the DT construct are needed for enhancing our understanding of extant and future DT research. Consistent with prior research, multi-modal assessment in a sample (n = 144) of undergraduate students revealed weak associations between self-report and behavioral measures of DT. Qualitative analyses of reported reasons for quitting the behavioral measures revealed variability in participants’ subjective experiences when performing these tasks. However, those who reported reasons consistent with the DT construct (e.g., to escape discomfort) did not show the hypothesized associations between self-report and behavioral measures. Results provided preliminary support for the importance of clarifying contextual factors (i.e., subjective reasons for quitting) when assessing DT, and suggested that self-report and behavioral measures of DT may indeed be capturing meaningfully distinct constructs for many individuals. Further implications and suggestions for future research are discussed.
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Pathological worry and generalized anxiety disorder (GAD) have been linked with low distress tolerance (DT), although questions remain including whether this association exists independent of depression and comorbidity, the directionality of the relationship between worry and DT, and DT's nonredundancy with other worry-relevant variables (i.e., emotional reactivity, stressful life events). Further, it is unclear whether DT is merely a correlate of excessive worry or acts as a risk factor for its development. Two independent studies were completed to evaluate these questions. In Study 1, DT was examined in patients with GAD and healthy controls. In Study 2, a nonclinical sample completed baseline measures of DT, negative affect, and worry, as well as daily assessments of these constructs and stressors for 1month. In Study 1, lower DT was associated with GAD diagnosis and greater worry symptoms independent of extent of comorbidity and depressive symptoms. In Study 2, lower baseline DT predicted unique variance in daily worry and increases in worry over time, whereas baseline worry did not predict daily DT or decreases in DT 1month later. Findings suggest that low DT plays a role in excessive worry independent of relevant covariates (i.e., comorbidity, emotional reactivity, stressful life events) and that this relationship is unidirectional. Further, preliminary evidence indicates that low DT may be an overall risk factor for the development of worry, particularly during periods of romantic stress, although further research and replication is required. Copyright © 2015. Published by Elsevier Ltd.