Distress Tolerance Mitigates Effects of Posttraumatic Stress, Traumatic Brain Injury, and Blast Exposure on Psychiatric and Health Outcomes.

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. Impact and Implications: Distress tolerance (DT) mitigated the relationship between posttraumatic stress disorder (PTSD) and functional outcomes of posttraumatic stress symptoms, sleep quality, and quality of life. Effects of DT were exacerbated in veterans without a PTSD diagnosis, suggesting that DT may be a key protective factor against the development of PTSD, and individuals with a higher baseline level of DT may be less likely to develop clinical symptomology in response to stressors. Addressing DT in treatment may lead to better functional outcomes, especially in veterans without a PTSD diagnosis and/or subclinical PTSD symptoms. [ABSTRACT FROM AUTHOR]