(PS9-B39) Distress Tolerance Moderates the Effects of Safety Behavior Use on the Efficacy of Exposure Therapy

The ability to withstand negative emotional states, known as distress tolerance, is a transdiagnostic factor associated with the development and maintenance of numerous psychological problems, including anxiety disorders. Moreover, this trait-like characteristic has been identified as a factor that may make it more difficult to engage in exposure-based interventions for anxiety; low distress tolerance may prevent patients from approaching feared stimuli and fully engaging with exposure therapy. Rachman and colleagues (2008) proposed that using safety behaviors may facilitate approach toward a feared stimulus and thereby improve treatment outcomes; the proposal was that safety behaviors should be used judiciously, in the earlier and more challenging parts of exposure therapy, and then faded out over time. Relatedly, we hypothesized that spider fearful individuals low in distress tolerance would experience better outcomes after exposure therapy when they were allowed to use safety behaviors during treatment, particularly in the early phases of exposure therapy. We tested this hypothesis by randomizing spider fearful adults (N = 59) to a single, 30-minute session of exposure with different dosages of safety behavior use: 1) unfaded safety behavior use (used during all 30 minutes of exposure therapy), 2) faded safety behavior use (used during first 20 minutes of exposure therapy and not used during final 10 minutes), or 3) no safety behavior use at all. At baseline, participants completed a validated self-report measure of distress tolerance. Additionally, at baseline, post-treatment, and one-month follow-up, participants completed behavioral approach tests (BATs), which included subjective ratings of fear and disgust. We found that individual differences in distress tolerance moderated the effect of safety behavior condition on treatment outcomes, F(6,49) = 1.87 - 10.39, ps ≤ .04. More specifically, participants with low distress tolerance reported better outcomes (i.e., lower anticipated fear and disgust ratings on BATs), when they were able to use safety behaviors for longer during the one-session treatment, compared to those who were allowed to use safety behaviors for a shorter duration or not at all. Findings suggest that the effects of safety behaviors on exposure therapy outcomes may depend on the distress tolerance level of the anxiety patient. Moreover, these findings suggest a reason to be cautious about fading safety behaviors too rapidly within a single session of exposure therapy, for anxiety patients with low distress tolerance.