One potentially promising construct in this context is distress tolerance. Distress tolerance reflects the perceived or behavioral capacity to withstand exposure to aversive experiential states . specifically, distress tolerance has been conceptualized as: the perceived capacity to withstand aversive emotional or physical states assessed via self-report measures; e.g., Distress Tolerance Scale, and the ability to behaviorally withstand distressing internal states elicited by some type of stressor. The study of this construct may be important in the HIV? population because it could potentially amplify affective states and lead to more maladaptive coping behaviors . To date, only one study has explicitly tested the effects of distress tolerance among an HIV? population . In this investigation, poorer levels of perceived distress tolerance , under conditions of high degrees of self-rated life stress, were related to significantly greater endorsement of depressive symptoms, use of substances in a coping-oriented manner, as well as alcohol and cocaine use in the past month, and number of reported reasons for missing medication dosages . The results of this initial study highlight that there is indeed potential merit in further exploring the role of perceived distress tolerance among persons with HIV. Despite the observed association between perceived distress tolerance and some psychosocial factors among persons with HIV/AIDS reported by O’Cleirigh et al. , there is as of yet little understanding of possible factors that may explain the association between this construct and anxiety/depressive symptoms. This is an important next step in the scientific process,cannabis grow equipment as it is necessary to tease apart the specific mechanisms linking HIV and anxiety/depressive symptoms.
Indeed, the identification of potential mediating variables is notable for at least two key reasons. First, by developing an understanding of mediating processes, we can gain a clearer understanding of the pathway through which distress tolerance may affect anxiety/depressive symptoms. Second, explicating these explanatory mechanisms is essential to translating basic research knowledge about distress tolerance and HIV/AIDS to advances in specialized behavioral and pharmacologic interventions for persons suffering from anxiety and mood-related disturbances. Emotion dysregulation represents one promising, integrative construct of increasing scholarly interest in psychopathology and health comorbidity research . Emotion dysregulation is posited to be an integrative construct, reflecting difficulties in the self-regulation of affective states and in self-control over affect-driven behaviors . Gratz and Roemer developed a self-report scale, entitled the Difficulties in Emotion Regulation Scale , which measures emotion dysregulation as a higher-order construct involving multiple, internally consistent, lower-order dimensions. Emotion dysregulation , as measured by the DERS, is related to increased levels of negative emotional symptoms , coping-oriented substance use , self-harm , and sexual difficulties among non-HIV/AIDS samples. Thus, emotion regulation is a construct that reflects responding to emotional states through the identification, interpretation, and management of these states. Although poor emotion regulation is similar to purported emotional amplification variables such as distress tolerance, it differs in its broader focus on both implicit and explicit processes to alter affective states and has been empirically shown to be distinct from distress tolerance . For example, Brandt et al. found that emotional dysregulation and an index of distress tolerance shared only 3 % of variance with one another. One recent study found that emotion dysregulation, as measured by the DERS total score, was significantly related to anxiety and depressive symptoms, pain-related anxiety, and HIV-symptom distress among adults with HIV .
Moreover, the observed emotion dysregulation effects were evident above and beyond the variance accounted for by demographic and HIV-specific characteristics , as well as perceived distress tolerance . Yet, this investigation did not examine whether emotion dysregulation may mediate the relation between distress tolerance and anxiety or depressive symptoms. As informed by integrative theoretical models of HIV/AIDSpsychopathology comorbidity , individuals who are less tolerant of anxiety/depressive symptoms may be more likely to respond to such sensations with greater degrees of emotion dysregulation. For example, perceived distress tolerance may contribute to a failure to identify or implement emotion regulatory strategies in an effective manner. Thus, from this perspective, a formative next research step is to evaluate whether emotion dysregulation mediates the association between distress tolerance and anxiety and depressive symptoms among persons with HIV/AIDS. Together, the present study tested the hypothesis that, among individuals with HIV/AIDS, lower perceived distress tolerance would significantly predict greater anxiety , and depressive symptoms. It also was hypothesized that emotion dysregulation would mediate this association . For the current investigation we chose these particular criterion variables because there are elevated rates of anxiety and depression among people living with HIV/AIDS , and empirical work suggests that anxiety and depression are each associated with poor HIV management and risky sexual behaviors among people living with HIV/AIDS . We chose panic and social anxiety, specifically, as indices of anxiety because of their direct relevance to the HIV? population. For example, symptoms stemming from HIV infection and side effects of antiretroviral medications are similar to panic attack symptoms and social concerns often accompany infection . Additionally, we expected that the hypothesized associations would be significant above and beyond the variance accounted for by CD4 T-cell count, ethnicity, gender, and education level factors. specifically, CD4 T-cell count was chosen to control for disease stage, while ethnicity, gender, and education were included to adjust for common demographic factors that covary with psychopathology among this population .
The data for the current study were taken from a larger study examining the effects of cannabis use on antiretroviral medication adherence in the HIV population . The present data have not been reported previously. Interested persons, responding to flyers posted throughout a VA Medical Center, as well as in a number of community outpatient HIV clinics in the San Francisco Bay area, contacted the research team and were provided with a detailed description of the study via phone. Participants were then initially screened for eligibility and, if eligible, scheduled for an appointment. Upon arrival to the laboratory, each participant provided written consent to participate in the research study. Next, participants were administered the SCID I-N/P by trained interviewers and then completed a battery of self-report measures. At the conclusion of this appointment, participants were compensated $50 for their efforts. Following the appointment, medical records for each participant were accessed to obtain most recent CD4 T-cell counts. All study procedures were approved by the Stanford University and Mills-Peninsula Institutional Review Boards .First, a series of zero-order correlations were conducted to examine associations between study variables. Second, to test the association between perceived distress tolerance and each criterion individually, as well as the mediational effects of emotion dysregulation on this relation, Baron and Kenny’s recommended test of mediation was employed. specifically, the test requires a series of hierarchical multiple regressions including: the predictor variable must significantly predict the criterion variables ; the predictor variable must significantly predict the mediator ; the mediator must significantly predict the criterion variables ; and when the predictor and mediator are entered simultaneously into a multiple regression, the mediator must significantly predict the criterion variables, with the relation between the predictor and criterion variable significantly reducing or becoming non-significant . Separate regression analyses were conducted to examine the mediational effects of DERS-total score on the relation between DTS-total score and each of the three examined sub-scales of the IDAS. In each regression analysis, CD4 T-cell count, ethnicity, gender, education level,vertical grow system and cannabis use status were entered in Step 1 as covariates.As the mediational analyses were conducted among cross-sectional data, an additional analysis was conducted for each significant mediational model, where the proposed mediator and criterion variable were reversed . specifically, for each significant mediational analysis, we also evaluated whether each respective IDAS sub-scale mediated the relation between DTS total score and DERS total score. This additional test helps improve confidence in the directionality of the observed relations . Finally, both bootstrapping and Sobel tests were used to confirm findings from the Baron and Kenny mediational tests.The present study examined the association between perceived distress tolerance and anxiety and depressive symptoms among adults with HIV. As hypothesized, there was consistent evidence that perceived distress tolerance, as measured by the DTS, was significantly and uniquely associated with anxiety and depressive symptoms. The observed effects were moderate in size, ranging from -.31 to -.35 , with lower levels of perceived distress tolerance being incrementally associated with greater endorsement of the studied criterion variables.
Importantly, the effects for perceived distress tolerance were apparent over and above the significant variance accounted for by CD4 T-cell count, ethnicity, gender, education level, and cannabis use status. Thus, the results cannot be attributed to these factors . These findings replicate and uniquely extend those reported by O’Cleirigh et al. on the role of perceived distress tolerance among individuals with HIV in terms of a variety of negative health behaviors . Also consistent with prediction, DERS total score showed a significant mediational effect in terms of the relations between DTS total score and the studied anxiety and depression criterion variables. Although the cross sectional nature of the research design naturally does not allow us to disentangle the causal or directional nature between the predictor and criterion variables, the present findings suggest that difficulties self-regulating certain negative affective states may, at least partially, explain the previously observed relations between perceived distress tolerance and panic, social anxiety, and depressive symptoms. Importantly, we attempted to strengthen confidence in this observation by evaluating an alternative model, wherein each of the criterion variables mediated the relation between perceived distress tolerance and emotion dysregulation. No support was found for such a model. That is, perceived distress tolerance, emotion dysregulation, and the studied emotional symptom variables were not simply interrelated. Thus, the present findings suggest specificity in terms of the potential mediating role of emotion dysregulation. Accordingly, the current findings highlight that emotion dysregulation is an important construct to consider in the relations between perceived distress tolerance and a number of common and clinically significant anxiety and depressive symptoms among persons with HIV. Although not the primary aim of the present investigation, at least two other observations deserve brief comment. First, the sample was characterized by high rates of current and lifetime psychopathology . These findings are consistent with past studies documenting that psychological disorders are highly common among the HIV population and are apt to play important roles in HIV quality of life and disease management . Second, perceived distress tolerance and emotion dysregulation shared approximately 33 % of variance with one another among the present sample. Thus, while these constructs are related, they do not fully overlap. This observation is in accord with past work documenting the distinct construct validities of these two cognitive-affective factors . There are limitations of the present study and areas for future research. First, although the sample was diverse in terms of ethnicity, it was limited to an older adult, primarily male group of individuals living with HIV/AIDS who volunteered to participate in a study for monetary reward. While men comprise a large percentage of the HIV/AIDS population , future studies would benefit from examining more heterogeneous samples of persons with HIV/AIDS. Moreover, it may be advisable to offer other types of incentives instead of those that are financial in nature to ascertain whether there is any type of sampling bias. Second, the cross-sectional design of the present study does not allow for causal inferences. As such, we cannot infer the directionality between distress tolerance, emotion regulation, and anxiety and depressive symptoms. Future work should aim to test these relations prospectively to explicate their directional effects. Third, the variance shared between distress tolerance and emotion dysregulation could generally suggest some inherent interrelatedness of these constructs as opposed to mediational effects. Thus, future work could benefit from further teasing apart the purported mediational effects using alternative measurement approaches and designs for tests of these constructs. Fourth, self-report measures were employed to assess the primary study constructs. Findings based on this type of uni-method strategy are potentially influenced by shared method variance. Future research could decrease this risk by utilizing multi-method approaches . Indeed, self-report and behavioral indices of distress tolerance are often not highly related . Fifth, the study criterion variables were limited to anxiety/depression variables.