Distress intolerance mediates attentional control on posttraumatic stress symptoms: Evidence from two clinical samples

Theoretical models emphasize the importance of both affective and cognitive risk factors in the development of posttraumatic stress symptoms (PTSS). Two such factors predicting PTSS have been studied extensively: distress intolerance (DI) - an affective factor indicative of the ability to tolerate negative affective states - and attentional control (AC), a cognitive factor reflecting the ability to flexibly shift and maintain attention to goal-relevant tasks. Previous work primarily highlights the independent contributions of DI and AC and their interaction to predict PTSS. Some models, however, suggest a mediational pathway such that AC indirectly affects PTSS via diminished DI. The current paper addressed this gap by first attempting to replicate prior findings, while also exploring this mediation model. Results were examined in two clinical samples - a trauma-exposed sample of adults (study 1; N = 73) and trauma-exposed treatment-seeking adults (study 2; N = 204). Results partially supported our hypotheses; both studies failed to replicate prior moderation findings, but our mediational hypothesis was supported in both samples. Low AC appears to decrease an individual's tolerance for distressing situations, which in turn increases the severity of PTSS. Results suggest that PTSD treatments may benefit by incorporating components of AC, DI, or a combination of the two to mitigate PTSS. Taken together, this study provides a novel examination of how cognitive and affective risk factors, namely AC and DI, work in tandem to increase PTSS.