Cognitive-behavioural therapy (CBT) for anxiety disorders typically involves clients confronting the anxiety-inducing objects and situations they would typically wish to avoid. Through repeated exposure to anxiety, clients increasingly learn to question, review and correct their anxious appraisals and beliefs and gradually experience less anxiety over time. However, certain individual characteristics may influence the extent to which clients are able to participate in these anxiety-provoking aspects of therapy. For example, if clients have a low tolerance for distressing emotions they might be less willing to fully participate in CBT and may therefore benefit less from treatment. Similarly, participating in therapy can involve considerable uncertainty about what will happen in any given session, as well as uncertainty about the broader therapy outcome. Clients who find uncertainty distressing may also find participating in therapy to be more challenging and benefit less than clients with a greater tolerance for uncertainty.
In our study, “The interaction of distress tolerance and intolerance of uncertainty in the prediction of symptom reduction across CBT for social anxiety disorder,” we examined two types of client characteristics that might impact on responses to treatment: intolerance of distress, or the degree to which an individual is intolerant of distressing states, and intolerance of uncertainty, or the degree to which an individual finds uncertainty difficult to experience. We studied these variables in relation to how much clients benefitted from CBT for social anxiety disorder. We predicted that individuals who were very intolerant of distress or uncertainty would have more severe symptoms throughout therapy and that they would improve at a slower rate. We also predicted that being very tolerant of distress might reduce the impact of intolerance of uncertainty, such that a high intolerance of uncertainty would no longer predict greater symptom severity if an individual also was very tolerant of distress.
Our predictions that intolerance of distress and uncertainty would predict greater symptom severity throughout treatment were supported. However, our prediction that individuals who were very intolerant of distress or uncertainty would improve at a slower rate was not supported. Therefore, individuals who were intolerant of distress and uncertainty had consistently more severe anxiety symptoms throughout therapy compared to those who were more tolerant, but still experienced a reduction in symptoms over the course of therapy. As well, for individuals who were highly tolerant of distress, their lack of tolerance of uncertainty no longer predicted symptom severity. We hypothesize that their high distress tolerance allowed them to better cope with the uncertainty of therapy and to benefit accordingly. Based on the results of this study, it may be useful to identify clients with low tolerance for distress or uncertainty as individuals who might need additional support to target these factors throughout CBT for anxiety.
Read the full paper:
Katz, D., Rector, N. A., & Laposa, J. M. (in press). The interaction of distress tolerance and intolerance of uncertainty in the prediction of symptom reduction across CBT for social anxiety disorder. Cognitive Behaviour Therapy, 1-19. doi:10.1080/16506073.2017.1334087
Photo by: JD Hancock