(PS5-B28) How Exposure to Personal Distress with and Without Self-compassion Affects Distress Intolerance: A Brief Randomized Controlled Trial

Emotional distress intolerance, defined as the perceived inability to tolerate negative emotions, is a transdiagnostic marker of psychopathology and associated with maladaptive coping such as substance use (Kiselica et al., 2015). The COVID-19 pandemic has led to a rise in distress, substance use, and psychological disorders (Clemente-Suárez et al., 2021). Decreasing distress intolerance may help individuals cope with stressors in more adaptive ways, reducing distress and psychopathology in future global emergencies. Cognitive-behavioural theories suggest that to overcome distress intolerance, individuals need to experience negative emotions and learn that doing so is more tolerable than they expected. However, those with difficulty tolerating distress interpret pure exposures during therapy as unbearable and terminate early (Belleau et al., 2017). Self-compassion involves enacting a caring, curious stance toward one’s own distress with the intention of alleviating it (Gilbert, 2014). Because practicing self-compassion has soothing physiological effects (Kim et al., 2020), we theorized that it may make the experience of feeling one’s negative emotions more bearable. Thus, we sought to test the hypothesis that exposure to negative emotions with self-compassion, as compared to a pure exposure without, would lead to lower distress intolerance via greater soothing affect.
We conducted a randomized control trial in a sample composed of international adults and North American undergraduates (n=350) with high distress intolerance. Negative emotions were induced through a prompt to think of a current distressing situation. Participants were then randomly assigned to one of three conditions: 1) pure exposure (writing about emotions in detail), 2) exposure with self-compassion (writing about emotions from the perspective of an inner compassionate observer), or 3) control (writing about plans for the week). Participants completed a measure of state soothing affect and distress intolerance immediately following the intervention and a measure of distress intolerance 1 week later. ANOCVAs revealed that controlling for trait levels of distress intolerance, condition significantly predicted distress intolerance immediately following the intervention and 1 week later, n²_p = .027-.031. At both timepoints, consistent with hypotheses, pairwise comparisons revealed that the self-compassion condition yielded lower post-task distress intolerance than the pure exposure condition (d=0.41-0.42) and control condition (d=0.25-0.31). Also in support of our theory, increased soothing affect during the intervention significantly mediated the effect of condition on distress intolerance both immediately and 1 week later (74% and 54% of the main effects were mediated, respectively). Results highlight the potential role that insufficient access to soothing affect plays in perpetuating distress intolerance. Findings also encourage the use of self-compassion in treatments that involve exposing distress intolerant individuals to their negative emotions as doing so may help them overcome their perceived inability to withstand distress and thereby improve their psychological and social functioning.