A Model of Distress Tolerance in Self-Damaging Behaviors: Examining the Role of Emotional Reactivity and Learned Helplessness

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Problem: Although the literature is clear that low emotional distress tolerance is associated with a myriad of self-damaging behaviors, very little is known about individual difference factors in distress tolerance. Both theoretical and empirical support suggest that emotional reactivity and learned helplessness may be individual difference factors in distress tolerance. Specifically, individuals with high emotional reactivity and high learned helplessness may be at risk for low distress tolerance. Further research was needed to clarify the role of emotional reactivity and learned helplessness in distress tolerance in the context of self-damaging behaviors. Method: Participants completed surveys which measured their (a) emotional reactivity, (b) learned helplessness, (c) distress tolerance, (d) two-week frequency of self-damaging behaviors, and (e) lifetime frequency of self-damaging behaviors. Structural equation modeling was used to test two models for the role of emotional reactivity and learned helplessness in distress tolerance. The first model was in the context of two-week frequency of self-damaging behaviors and the second model was in the context of lifetime frequency of self-damaging behaviors. Results: Structural equation modeling indicated that the original models were a poor fit for the data. So, both models were revised on the basis of theory and modification indices. The revised models revealed that emotional reactivity and learned helplessness had negative direct effects on distress tolerance. Together, emotional reactivity and learned helplessness explained 70% of the observed variance in distress tolerance. Distress tolerance had a negative direct effect on two-week frequency of self-damaging behaviors, explaining 7% of the observed variance. Distress tolerance had a negative direct effect and depression had a positive direct effect on lifetime frequency of self-damaging behaviors, together explaining 36% of the observed variance. Conclusions: This study confirmed emotional reactivity and learned helplessness as important individual difference factors in emotional distress tolerance. It suggests that high emotional reactivity and high learned helplessness contribute to low distress tolerance. This study also demonstrated that distress tolerance explains a small amount of variance in two-week frequency of self-damaging behaviors. Whereas, distress tolerance together with depression explains a larger amount of variance in lifetime frequency of self-damaging behaviors. These results have implications for researchers studying distress tolerance and self-damaging behaviors, clinicians treating clients with difficulty managing distress or with self-damaging behaviors, and individuals developing preventative initiatives to reduce the development of self-damaging behaviors. In particular, this study suggests that emotional reactivity may be an important target of clinical intervention and preventative education.
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ABSTRACT A MODEL OF DISTRESS TOLERANCE IN SELF-DAMAGING BEHAVIORS: EXAMINING THE ROLE OF EMOTIONAL REACTIVITY AND LEARNED HELPLESSNESS by Brittany Kay Sommers Chair: Ronald D. Coffen ABSTRACT OF GRADUATE STUDENT RESEARCH Dissertation Andrews University School of Education Title: A MODEL OF DISTRESS TOLERANCE IN SELF-DAMAGING BEHAVIORS: EXAMINING THE ROLE OF EMOTIONAL REACTIVITY AND LEARNED HELPLESSNESS Name of researcher: Brittany Kay Sommers Name and degree of faculty chair: Ronald D. Coffen, Ph.D. Date completed: June 2017 Problem Although the literature is clear that low emotional distress tolerance is associated with a myriad of self-damaging behaviors, very little is known about individual difference factors in distress tolerance. Both theoretical and empirical support suggest that emotional reactivity and learned helplessness may be individual difference factors in distress tolerance. Specifically, individuals with high emotional reactivity and high learned helplessness may be at risk for low distress tolerance. Further research was needed to clarify the role of emotional reactivity and learned helplessness in distress tolerance in the context of self-damaging behaviors. Method Participants completed surveys which measured their (a) emotional reactivity, (b) learned helplessness, (c) distress tolerance, (d) two-week frequency of self-damaging behaviors, and (e) lifetime frequency of self-damaging behaviors. Structural equation modeling was used to test two models for the role of emotional reactivity and learned helplessness in distress tolerance. The first model was in the context of two-week frequency of self-damaging behaviors and the second model was in the context of lifetime frequency of self-damaging behaviors. Results Structural equation modeling indicated that the original models were a poor fit for the data. So, both models were revised on the basis of theory and modification indices. The revised models revealed that emotional reactivity and learned helplessness had negative direct effects on distress tolerance. Together, emotional reactivity and learned helplessness explained 70% of the observed variance in distress tolerance. Distress tolerance had a negative direct effect on two-week frequency of self-damaging behaviors, explaining 7% of the observed variance. Distress tolerance had a negative direct effect and depression had a positive direct effect on lifetime frequency of self-damaging behaviors, together explaining 36% of the observed variance. Conclusions This study confirmed emotional reactivity and learned helplessness as important individual difference factors in emotional distress tolerance. It suggests that high emotional reactivity and high learned helplessness contribute to low distress tolerance. This study also demonstrated that distress tolerance explains a small amount of variance in two-week frequency of self-damaging behaviors. Whereas, distress tolerance together with depression explains a larger amount of variance in lifetime frequency of self- damaging behaviors. These results have implications for researchers studying distress tolerance and self-damaging behaviors, clinicians treating clients with difficulty managing distress or with self-damaging behaviors, and individuals developing preventative initiatives to reduce the development of self-damaging behaviors. In particular, this study suggests that emotional reactivity may be an important target of clinical intervention and preventative education. Andrews University School of Education A MODEL OF DISTRESS TOLERANCE IN SELF-DAMAGING BEHAVIORS: EXAMINING THE ROLE OF EMOTIONAL REACTIVITY AND LEARNED HELPLESSNESS A Dissertation Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy by Brittany Kay Sommers June 2017     ProQuest Number: 10604195     All rights reserved  INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted.  In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion.      ProQuest 10604195  Published by ProQuest LLC (2017 ). Copyright of the Dissertation is held by the Author.   All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code Microform Edition © ProQuest LLC.   ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, MI 48106 - 1346 © Copyright by Brittany Kay Sommers 2017 All Rights Reserved A MODEL OF DISTRESS TOLERANCE IN SELF-DAMAGING BEHAVIORS: EXAMINING THE ROLE OF EMOTIONAL REACTIVITY AND LEARNED HELPLESSNESS A dissertation presented in partial fulfillment of the requirements for the degree Doctor of Philosophy by Brittany Kay Sommers APPROVAL BY THE COMMITTEE: __________________________________ ______________________________ Chair: Ronald D. Coffen Dean, School of Education Robson M. Marinho __________________________________ Member: Bradly K. Hinman __________________________________ Member: Tevni E. Guerra Grajales __________________________________ ______________________________ External: Anne Carpenter Date approved To God be the glory, great things He has done! iii TABLE OF CONTENTS LIST OF FIGURES ..................................................................................................... ix LIST OF TABLES ...................................................................................................... x LIST OF ABBREVIATIONS ...................................................................................... xi ACKNOWLEDGMENTS ........................................................................................... xiv Chapter 1. INTRODUCTION ......................................................................................... 1 Background of the Problem.................................................................... 1 Statement of the Problem ....................................................................... 5 Purpose of the Study .............................................................................. 6 Hypotheses and Research Questions ...................................................... 6 Rationale................................................................................................. 8 Conceptual Framework .......................................................................... 10 Importance of the Study ......................................................................... 12 Definition of Terms ................................................................................ 13 Assumptions ........................................................................................... 15 General Methodology ............................................................................. 16 Limitations ............................................................................................. 17 Delimitations .......................................................................................... 20 Summary ................................................................................................ 20 2. LITERATURE REVIEW .............................................................................. 23 Background to the Problem .................................................................... 23 Distress Tolerance Introduction ............................................................. 24 Definition and Terminology of DT ................................................. 25 Inclusion in Literature Review ........................................................ 26 Measures of DT Overview .............................................................. 27 Factor Structure of Broad Distress Tolerance ................................. 28 Theoretical Framework .......................................................................... 31 Linehan’s BioSocial Theory of Emotion Dysregulation................. 31 Linehan’s Model of DT Skills Training .......................................... 33 Lynch and Mizon’s Three-Factor Model of DT ............................. 34 Lynch and Mizon’s Proposed Individual Difference Factors in DT ...................................................................................... 36 My Theoretical Model of Individual Difference Factors in DT ..... 37 iv Emotional DT Overview ........................................................................ 38 Factor Structure of Emotional DT................................................... 38 General Research on Emotional DT ............................................... 40 Stability of DT over Time ........................................................ 40 Longitudinal Study in Early Adolescents .......................... 40 Longitudinal Studies in Adults .......................................... 41 Evidence Supporting Modification Through Treatment .... 43 Evidence Opposing Modification Through Treatment ...... 46 Relationship Between DT and Related Concepts .................... 47 Relationship Between DT and Avoidance ......................... 47 Relationship Between DT and Urgency ............................ 49 Factors Known to Influence DT .............................................. 51 The Influence of Emotion Regulation and Attentional Control ...................................................................... 51 The Influence of Mindfulness and Rumination ................. 53 The Influence of Personality Traits.................................... 54 The Influence of Parenting................................................. 58 The Influence of Biological Factors .................................. 59 Emotional DT Summary ................................................................. 61 Emotional Reactivity Overview ............................................................. 62 History and Definition of Emotional Reactivity ............................. 62 Emotional Reactivity Factor Structure..................................... 63 Relationship Between Emotional Reactivity and Psychological Disorders..................................................... 64 Evidence Supporting Emotional Reactivity as an Individual Difference Factor in DT ........................................................... 66 DT and Emotional Reactivity in Borderline Symptoms .......... 67 DT and Emotional Reactivity in Depression Symptoms ......... 68 DT and Emotional Reactivity in Heavy Drinking ................... 70 DT and Emotional Reactivity in NSSI..................................... 71 DT and Emotional Reactivity in Obsessive-Compulsive Symptoms .......................................................................... 72 DT and Emotional Reactivity in Panic Symptoms .................. 74 DT and Emotional Reactivity in Research Response .............. 75 DT and Emotional Reactivity in Worry ................................... 76 Evidence Opposing Emotional Reactivity as an Individual Difference Factor in DT ........................................................... 77 DT and Emotional Reactivity in Anxiety ................................ 77 DT and Emotional Reactivity in Smoking ............................... 79 Emotional Reactivity Summary ...................................................... 80 Learned Helplessness Overview ............................................................ 80 History and Definition of Learned Helplessness ............................ 80 Learned Industriousness-Helplessness Continuum ......................... 83 Evidence Supporting Learned Helplessness ............................ 85 Evidence Supporting Learned Industriousness ........................ 86 Learned Industriousness-Helplessness Continuum Summary ........ 88 v Evidence Supporting Learned Helplessness as an Individual Difference Factor in DT ........................................................... 90 Learned Helplessness and Physical Pain Tolerance ................ 90 Emotion Regulation and Helplessness in NSSI ....................... 91 Evidence Opposing Learned Helplessness as an Individual Difference Factor in DT ........................................................... 92 Learned Helplessness and Physical Pain Tolerance ................ 92 DT and Negative Reinforcement ............................................. 93 Learned Helplessness Summary ..................................................... 95 Relationship Between DT and Covariates ............................................. 95 DT and Anxiety ............................................................................... 96 DT and AS ............................................................................... 96 DT and Health Anxiety ............................................................ 97 DT and Obsessive Compulsive Anxiety .................................. 97 DT and Panic............................................................................ 97 DT and Social Anxiety............................................................. 98 DT and Trait Anxiety ............................................................... 98 DT and Worry .......................................................................... 99 DT and Depression .......................................................................... 100 DT, AS, and Depression .......................................................... 100 DT Subscales and Depression .................................................. 102 DT and Covariates Summary .......................................................... 104 Relationship Between Distress Tolerance and Self-Damaging Behaviors ........................................................................................ 104 DT and Eating Disorders................................................................. 105 The Role of cDTS: Avoidance of Affect ................................. 105 The Role of cDTS: Behavioral Avoidance of Positive Affect ............................................................................... 107 The Role of DT in Anorexia Nervosa ...................................... 111 The Role of DT in Binge Eating and Overeating .................... 112 The Role of DT in Bulimia Nervosa ........................................ 114 DT and NSSI ................................................................................... 116 Role of DT in NSSI Lifetime Frequency ................................. 116 Role of DT in Number of NSSI Methods ................................ 117 Evidence from Treatment Outcomes ....................................... 118 DT and Suicide................................................................................ 119 Role of DT in Suicidal Desire .................................................. 119 Role of DT in Pain Tolerance .................................................. 120 Role of DT in Suicidal Ideation ............................................... 121 Role of DT in Past Suicide Attempts ....................................... 122 Role of DT in Suicide Potential ............................................... 122 Role of DT in Acquired Capability for Suicide ....................... 122 DT, NSSI, and Suicide Considered Together ................................. 124 DT and Self-Damaging Behaviors Summary ................................. 126 Summary ................................................................................................ 126 vi 3. METHODOLOGY ........................................................................................ 129 Introduction ............................................................................................ 129 Research Design ..................................................................................... 129 Population and Sample ........................................................................... 131 Hypotheses and Research Questions ...................................................... 134 Variables Definition ............................................................................... 136 Exogenous Variables ....................................................................... 136 Endogenous Variables ..................................................................... 139 Instrumentation....................................................................................... 140 Depression Anxiety Stress Scales ................................................... 140 Distress Tolerance Scale ................................................................. 143 Emotion Reactivity Scale ................................................................ 145 Learned Helplessness Scale ............................................................ 146 Self-Damaging Behaviors Questionnaire........................................ 147 SITBI........................................................................................ 148 EDE-Q...................................................................................... 149 Self-Damaging Behaviors Questionnaire ................................ 150 Data Collection ....................................................................................... 152 Treatment of Data................................................................................... 157 Data Analysis ......................................................................................... 158 Budget .................................................................................................... 161 Summary ................................................................................................ 161 4. RESULTS ............................................................................................................... 162 Introduction ................................................................................................... 162 Description of the Sample ............................................................................. 162 Discontinued Responses ......................................................................... 163 Data Screening ....................................................................................... 163 Participants Description ......................................................................... 164 Instrument Reliability .................................................................................... 166 Emotion Reactivity Scale Item Reduction .................................................... 167 Variables Description .................................................................................... 167 Normality ............................................................................................... 167 Variable Means and Standard Deviations .............................................. 168 Endorsement of Self-Damaging Behaviors ............................................ 170 Variable Description by Demographic Characteristics .......................... 171 Zero-Order Correlations ......................................................................... 173 Hypotheses Testing ....................................................................................... 181 Two-Week Frequency Model................................................................. 182 Original Two-Week Model ............................................................. 182 Fitted Two-Week Model ................................................................. 184 Intercorrelations Among Variables ................................................. 185 Lifetime Frequency Model ..................................................................... 187 Original Lifetime Model ................................................................. 187 vii Fitted Lifetime Model ..................................................................... 187 Intercorrelations Among Variables ....................
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