Smiling to Tolerate Distress: The Moderating Role of Attention to Emotion

Deficits in distress tolerance and heightened attention to emotion (ATE) have been linked to borderline personality disorder (BPD). Research has suggested that facial feedback, the bidirectional relationship between facial expression and experienced affect, may enhance distress tolerance; however, such enhancement relative to BPD features and ATE remains unclear. To clarify this relationship, the current study examined (a) effects of a facial feedback manipulation on distress tolerance and emotional reactivity, and (b) BPD feature severity and ATE as potential moderators of these effects. University students (N = 109) completed questionnaires assessing BPD features. current affect, and ATE. Subsequently, they engaged in a distress-eliciting task while covertly maintaining either a smile or neutral facial expression. Although BPD features did not influence the impact of facial feedback, ATE moderated these effects on both distress tolerance and midtask positive affect (PA). Among those with high ATE, smiling (vs. neutral facial expression) was linked to greater distress tolerance, while smiling among those with low ATE was associated with lower distress tolerance and midtask PA. Future facial feedback research should include ATE as a potential moderating variable.