Background: Lower distress tolerance (DT) has been associated with higher experiential avoidance across clinical and community samples of adults and youth (McHugh et al. 2013; Daughters et al. 2013). These attempts to avoid or escape distress-provoking situations can be internal, in the form of rumination or worry (Daughters et al. 2013). Various treatments have been shown to explicitly or implicitly target DT in adults, including Dialectical Behavior Therapy and the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (DBT; Linehan, 1993; UP; Barlow et al. 2010). Improvements in DT during the course of such treatments may reflect potential mechanisms of change (Bardeen et al. 2013). However, little research has investigated whether treatments for anxiety and mood disorders improve DT in youth. Given that the UP has been shown to improve distress tolerance in anxious adults, we investigated whether youth DT improves as a result of 16 weeks of therapy using the Unified Protocols for the Treatment of Emotional Disorders in Children and Adolescents (UP-C and UP-A; Ehrenreich-May et al., in press).
Methods: We investigated levels of DT in a preliminary sample of 25 youth, aged 6-17 years (M=10.87, SD=2.51; 72% female) who presented at a University-based mental health program at baseline and 16 weeks following baseline (post-treatment) using the Distress Tolerance Scale (DTS; Simons & Gaher, 2005). All participants had a principal anxiety or depressive disorder. Participants were seen by pre-doctoral trainees under the supervision of a clinical psychologist and were administered either the UP-C, if between the ages of 6 and 12 (group or individual format), or the UP-A, if older than 12 (individual format). In addition to DT, child-reported anxiety was measured at both time points using the Screen for Child Anxiety and Related Disorders (SCARED; Birmaher et al. 1999) to assess treatment response. Paired samples t-tests to assess change from baseline were conducted on the DTS and the SCARED. A linear regression was utilized to assess predictors of DT improvement.
Results: Child-reported anxiety significantly improved from pre- to post-treatment (t (16) = 3.041, p = .008, mean improvement = 12.9). Similarly, child DT significantly improved (t (24) = -2.705, p = .012, mean improvement = 9). A linear regression was conducted to examine predictors of DT improvement. The overall model was significant (F (6, 9) = 3.549, p = .044). Child-reported baseline DT was a significant predictor, with lower DT predicting greater DT improvement (b = -8.15, t (9) = -3.334, p = .009). When controlling for baseline DT, gender, age, anxiety symptoms, and parent’s own DT or improvement in such were not found to be significant predictors. This latter finding will be revisited in light of a larger sample at the time of presentation.
Conclusion: Preliminary results provide support for the utility of the UP-C and UP-A in improving DT in clinically anxious youth. Given long-term negative outcomes related to poor DT, the potential for improvement in this individual difference variable is noteworthy within the child UP models. Future research should assess the temporal relationship of this change to improvement in anxiety symptoms using the UP-C and UP-A.