(PS2-B42) The Short-term Relationship Between Distress Tolerance and Non-suicidal Self-injury in Adults with a History of Self-harm

Approximately 13% of young adults (18-24 years old) and 5% of adults (≥ 25) report engaging in non-suicidal self-injury (NSSI), or deliberate damage to one’s own body without suicidal intent (e.g., Swannell et al., 2014). NSSI is a risk factor for a number of negative outcomes, including suicidality (Nock et al., 2006). It is essential to better understand the psychological factors implicated in NSSI in order to advance NSSI treatment and prevention. Previous research has found that individuals who engage in NSSI have lower distress tolerance (i.e., ability to focus on goals and values in the face of discomfort) than their peers (e.g., Nock & Mendes, 2008). However, virtually all of the previous research on NSSI and distress tolerance is cross-sectional. The present study aimed to describe the temporal dynamics of this relationship by assessing distress tolerance and NSSI several times per day using ecological momentary assessment (EMA).

A sample of 60 community adults from the Bronx, NY (56% female, 85% people of color, M_age=36.2 years) who reported attempting suicide or engaging in NSSI in the past month completed a 10-day EMA study. They responded to smartphone-based surveys 4x/day that queried both distress tolerance (e.g., “I want to stop what I am doing right now so I can feel better”) and NSSI cognitions (i.e., “I thought about hurting myself without meaning to killing myself”). We hypothesized that higher levels of distress tolerance at one time point would predict lower cognitions of NSSI at the next.

We used multilevel modeling to examine how subjective reports of distress tolerance at one assessment point are associated with NSSI cognitions over the next three hours (i.e., the next assessment point). Our results revealed that lagged within-person correlation between distress tolerance and NSSI cognitions was statistically significant and negative (r = -.16, p < .001). At the between-person level, the (inverse) correlation between NSSI cognitions and DT was approximately twice as large (r = -.38, p = .001). More than half of the variability in NSSI cognitions was due to between-person differences (ICC = .57), while one-third of the variability in distress tolerance was due to between-person differences (ICC = .33).

Our findings imply that daily fluctuations in distress tolerance have a slight but significant effect on near-term daily NSSI cognitions, suggesting that distress tolerance could be a relevant component of predictive and clinical models of NSSI. In particular, our results could inform applications of dialectical behavioral therapy (DBT), a therapy that targets self-injurious thoughts and behaviors, in minority populations. That is, our data reinforce the idea that distress tolerance is relevant to predicting within-person variation in NSSI risk.