Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill.
Department of Psychological Sciences, College of William and Mary.
J Consult Clin Psychol. 2019 Jul;87(7):645-656. doi: 10.1037/ccp0000403. Epub 2019 Apr 22.
Distress tolerance (DT), the ability to withstand aversive internal states, represents an important risk factor for substance use relapse and a potential treatment target. Neurobiological research in substance using populations suggests that continued substance use could erode DT, whereas abstinence could bolster it. The current study characterized trajectories of behavioral and self-reported indices of DT and examined the prospective effect of substance use on DT trajectories among those seeking treatment for substance use.
Individuals (N = 263, Mage = 42.68, SD = 11.8, 70.7% male, 94.7% African American) in residential substance use treatment completed subjective (Distress Tolerance Scale) and behavioral (Mirror Tracing Persistence Task-computerized version) DT measures, as well as report of daily substance use (timeline follow-back) over 5 assessment time-points from pretreatment to 12 months posttreatment. Latent curve modeling estimated DT trajectories and their associations with substance use behavior, including abstinence duration (days until first use) and substance use frequency (percentage of substance use days between assessments).
Self-reported and behavioral DT indicators both exhibited positive, nonlinear change over time (standardized slope parameter estimates: Distress Tolerance Scale β = 0.61, p < .01; Mirror Tracing Persistence Task β = 0.34, p < .01). Abstinence duration was associated with greater improvement in behavioral (β = .20, p = .03) DT specifically. Frequency of use was statistically significantly associated with attenuated behavioral DT at 6-month (β = -.12, p = .03) and 12-month follow-ups (β = -.08, p = .045).
DT appears to improve appreciably posttreatment, and return to substance use may shape the degree of this improvement. Collectively, these findings support the conceptualization of DT as a malleable treatment target and emphasize the benefit of abstinence on improvement in DT. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
耐受痛苦（DT），即承受痛苦情绪的能力，是物质使用复发的重要风险因素，也是一种潜在的治疗靶点。在使用物质的人群中进行的神经生物学研究表明，持续使用物质会削弱 DT，而戒断则会增强它。本研究描述了行为和自我报告的 DT 指标的轨迹，并考察了物质使用对寻求物质使用治疗者的 DT 轨迹的前瞻性影响。
参与住院物质使用治疗的个体（N=263，Mage=42.68，SD=11.8，70.7%为男性，94.7%为非裔美国人）完成了主观（痛苦耐受量表）和行为（镜像追踪坚持任务-计算机化版本）DT 测量，以及在治疗前至治疗后 12 个月的 5 次评估时间点上的每日物质使用报告（时间线回溯）。潜在曲线模型估计了 DT 轨迹及其与物质使用行为的关联，包括戒断持续时间（首次使用前的天数）和物质使用频率（评估之间的物质使用天数的百分比）。
自我报告和行为 DT 指标均表现出随时间的正向、非线性变化（标准斜率参数估计：痛苦耐受量表β=0.61，p<.01；镜像追踪坚持任务β=0.34，p<.01）。戒断持续时间与行为 DT 的改善程度显著相关（β=0.20，p=.03）。使用频率与 6 个月（β=-.12，p=.03）和 12 个月的随访（β=-.08，p=.045）时的行为 DT 衰减显著相关。
DT 在治疗后似乎有明显的改善，而恢复物质使用可能会影响这种改善的程度。总的来说，这些发现支持将 DT 概念化为一个可塑的治疗靶点，并强调了戒断对 DT 改善的益处。
