(PS3-C67) Just Do It? The Role of Inactivation, Avoidance, Distress Tolerance, and Symptom Severity in Anxious and Depressed Youth

Avoidance and inactivation are patterns of negatively reinforced behaviors designed to reduce short-term distress at the cost of sacrificing future opportunities and maintaining long-term problems. Though the roles of avoidance and inactivation in maintaining anxiety and depression is well documented, the reasons some are more prone to engage in these behaviors remains unclear. Considering the function of these behaviors, distress tolerance, or the ability to persist in goal-directed behavior while experiencing distress, is likely critical to overcoming both avoidance and inactivation. Despite the growing evidence linking distress tolerance, avoidant coping styles, and internalizing disorders, very little of the extant research has explored the specific ways in which these constructs interact, and even fewer investigate the role that race/ethnicity can play in defining these relationships. Additionally, to date, studies of distress tolerance have relied almost exclusively on self-report measures of adult populations, largely ignoring observable measures of distress tolerance and developmental factors in youth populations, particularly those from minority backgrounds. Therefore, the current study aims to 1) investigate the associations between processes of negative reinforcement (avoidance, inactivity) and youth anxiety and depression, 2) examine the mediating role of distress tolerance in the relationship between avoidant coping styles and symptom severity in youth, and 3) explore the moderating role of racial/ethnic minority status in the relationship between avoidant coping styles, distress tolerance, and symptom severity. 

Participants were 113 youth aged 9-17 years old recruited from a randomized control trial treating youth presenting with a primary anxiety and/or depressive disorder diagnosis. Distress tolerance was measured using two tasks from a behavioral assessment completed at intake, the mirror task (MTCP-C) and card sorting task (DTT). For youth-reported anxiety symptoms, when using the MTCP-C as the mediator, greater avoidance was significantly associated with greater anxiety symptom severity (β = .68, p < .001) and with lower distress tolerance (β = -.23, p = .023). Surprisingly, no significant associations were found between distress tolerance and anxiety symptom severity (p = .499). When using DTT as the mediator, greater avoidance was also significantly associated with greater anxiety symptom severity (β =.68, p < .001). However, there was no significant association found between avoidance and distress tolerance in this model (β = .012, p = .91) and no significant association found between distress tolerance and anxiety symptom severity (p = .93). Thus, distress tolerance was not found to be a significant mediator. 

Moreover, a secondary moderating analysis was completed to examine whether racial/ethnic minority status would impact the relationships found between these variables. This was achieved by categorizing the race/ethnicity of participants into 2 groups: “minority” vs “non-minority”. Results indicated that minority status did not have a significant moderating effect on any of the relationships found between avoidance, inactivation, distress tolerance, and symptom severity.