Integrating Anxiety Sensitivity, Distress Tolerance, and Discomfort Intolerance: A Hierarchical Model of Affect Sensitivity and Tolerance

Amit Bernstein, Michael J. Zvolensky, Anka A. Vujanovic, Rudolf Moos

Research output: Contribution to journalArticlepeer-review


The purpose of the present investigation was to concurrently examine the latent dimensional and hierarchical structure of anxiety sensitivity (AS) and two key theoretically relevant and related affect (in)tolerance and sensitivity constructs: distress tolerance and discomfort intolerance. These constructs were measured using the Anxiety Sensitivity Index (Reiss, Peterson, Gursky, & McNally, 1986), the Distress Tolerance Scale (Simons & Gaher, 2005), and the Discomfort Intolerance Scale (Schmidt, Richey, & Fitzpatrick, 2006). A total of 229 individuals (124 females; M age = 21.0 years, SD = 7.5) without current Axis I psychopathology participated by completing a battery of self-report questionnaires. A two-stage exploratory factor analysis was conducted to examine the lower- and higher-order latent structural relations among the variables. The factor solution was subsequently evaluated in relation to negative affectivity, anxious arousal, and anhedonic depression. AS and distress tolerance appeared to be related to one another as distinct lower-order facets of a common higher-order affect tolerance and sensitivity factor, whereas discomfort intolerance did not appear to demonstrate similar relations with either AS or distress tolerance at the lower-order or higher-order levels. A unique pattern of association with theoretically-relevant criterion variables was observed between the affect tolerance and sensitivity higher-order factor, the AS and distress tolerance lower-order factors, and the discomfort intolerance factor. Findings are discussed in the context of theoretical and clinical implications and future directions for the study of affect tolerance and sensitivity in relation to emotional vulnerability.

Original languageEnglish
Pages (from-to)291-301
Number of pages11
JournalBehavior Therapy
Issue number3
StatePublished - Sep 2009

Bibliographical note

Funding Information:
This work was supported by a National Research Service Award (F31 MH073205-01) awarded to Amit Bernstein. Dr. Bernstein also acknowledges that this research was supported in part by VA Office of Academic Affairs and Health Services Research and Development Service Research funds. This paper also was supported by National Institute on Drug Abuse research grants (1 R01 MH076629-01, 1 R01 DA018734-01A1, and R03 DA16307-01) awarded to Dr. Zvolensky and a National Research Service Award (1 F31 DA021006-01) granted to Anka A. Vujanovic.

ASJC Scopus subject areas

  • Clinical Psychology


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