Distress tolerance and obsessions: an integrative analysis^†

Background: Recent research implicates a potential relationship between poor distress tolerance (DT) and obsessive–compulsive disorder (OCD) and obsessions in particular, though this evidence has been largely indirect. We sought to examine the incremental and specific associations between DT and obsessions using multiple methodologies. Methods: We conducted three separate studies using independent nonclinical samples (total N=558) that involved cross-sectional (Study 1) and prospective self-report designs (Study 2), as well as the use of an in vivo neutralization task (Study 3). Results: Poor DT was specifically associated with obsessing but not other OCD symptoms, even when covarying for several theoretically relevant constructs. Further, poor DT was predictive of residual change in obsessing symptoms 1-month later. Poor DT was also associated with neutralization in response to an OCD-like intrusion and postneutralization period anxiety. Conclusions: These consistent findings provide support for an important relationship between DT and obsessions and suggest that interventions targeting DT may have special benefit for the treatment of obsessions. Depression and Anxiety, 2011. © 2011 Wiley-Liss, Inc.