A multimodal investigation of distress intolerance and youth anxiety disorders
Elkins, Regina Meredith
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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.