The relationship between distress tolerance regulation, counterfactual rumination, and PTSD symptom clusters

Abstract Background Distress tolerance (DT) and rumination both influence the development and maintenance of posttraumatic stress disorder (PTSD). However, few studies have investigated these constructs simultaneously. We investigated whether the regulation dimension of DT was associated with PTSD symptom clusters (intrusions, avoidance, negative alternations in cognitions and mood, alterations in arousal and reactivity), and whether counterfactual rumination (CFT) mediated these relationships. Methods This cross-sectional study sampled trauma-exposed adults ( N  = 119) seeking mental health services at a community mental health center. Participants completed self-report measures of DT, rumination, and PTSD. Mediation analyses were conducted using the SPSS PROCESS Macro. Results Lower scores on the DT regulation dimension were associated with higher PTSD symptom severity for all four symptom clusters, controlling for depression and number of traumas. CFT significantly mediated this relationship between DT's regulation and PTSD's intrusions and avoidance symptoms. Limitations Limitations included use of self-report data and the cross-sectional nature of this data. Conclusions Clinically, this study highlights that difficulties with regulating negative emotions can result in the use of maladaptive cognitive strategies, such as CFT. This, in turn, may exacerbate PTSD symptom severity, particularly intrusions and avoidance. This study highlights the importance of understanding specific dimensions of DT, rumination, and PTSD symptom clusters to develop precise and efficient psychological interventions.