Distress tolerance mitigates effects of posttraumatic stress, traumatic brain injury, and blast exposure on psychiatric and health outcomes

Abstract

Background: Exposure to blasts is common among service members and history of these exposures has been associated with chronic psychiatric and health outcomes. Evidence suggests that distress tolerance (DT) may moderate this relationship and be a valuable treatment target in this population. The purpose of this manuscript was to evaluate DT as a modifying factor in the association between posttraumatic stress disorder (PTSD), mild traumatic brain injury (TBI), blast exposure, and functional indicators.

Method: Participants were 275 (86.55% male) combat veterans who served in Iraq or Afghanistan after September 11, 2001. Clinical interviews for PTSD diagnosis, TBI history, and blast exposure were administered, and participants completed self-report questionnaires (DT, PTSD symptom severity, depressive symptom severity, neurobehavioral symptom severity, sleep quality, pain interference, and quality of life).

Results: DT was significantly associated with all functional indicators beyond PTSD diagnosis, mild TBI, and blast severity. There were significant interaction effects between DT and PTSD diagnosis for posttraumatic stress symptom severity, sleep quality, and quality of life. Specifically, there were significant differences in these reported functional indicators between individuals with and without a PTSD diagnosis as DT increases, such that reported symptoms were lower (quality of life better) for individuals without PTSD as DT improved.

Conclusion: Our results demonstrate that DT might be a key factor in postdeployment function for military service members. Treatments targeting DT may be particularly effective in individuals who attribute psychiatric symptoms to history of blast exposure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Figure 1.

(a) Johnson-Neyman plot illustrating conditional effects of current PTSD diagnosis on posttraumatic stress symptom severity (PCL-5). Vertical reference line indicates the point at the moderator (Distress Tolerance Scale score of 28.66) that the effect of PTSD diagnosis is significant. Horizontal line references an effect of zero (i.e., no conditional effect). Shaded areas represent the 95% confidence interval for effects. (b) Bar graph illustrating PCL-5 scores by PTSD diagnosis at levels of distress tolerance.

Figure 2.

(a) Johnson-Neyman plot illustrating conditional effects of current PTSD diagnosis on sleep quality (PSQI). Vertical reference line indicates the point at the moderator (Distress Tolerance Scale score of 42.19) that the effect of PTSD diagnosis is significant. Horizontal line references an effect of zero (i.e., no conditional effect). Shaded areas represent the 95% confidence interval for effects. (b) Bar graph illustrating PSQI scores by PTSD diagnosis at levels of distress tolerance.

Figure 3.

(a) Johnson-Neyman plot illustrating conditional effects of current PTSD diagnosis on quality of life (QOLIBRI). Vertical reference line indicates the point at the moderator (Distress Tolerance Scale score of 42.20) that the effect of PTSD diagnosis is significant. Horizontal line references an effect of zero (i.e., no conditional effect). Shaded areas represent the 95% confidence interval for effects. (b) Bar graph illustrating QOLIBRI scores by PTSD diagnosis at levels of distress tolerance.