The Distress Tolerance in the Elderly: The Role of Experiential Avoidance, Rumination and Mindfulness

Field: Psychology (Social Sciences)

Distress tolerance seems to be one of the factors that can have a significant impact on mental health and quality of life in the elderly. Therefore, the present study aimed to investigate the role of experiential avoidance, rumination and mindfulness in predicting distress tolerance in elderly of Isfahan province (Isfahan and Kashan). The method of the present study was correlational and the statistical population included all elderly people aged 60 to 75 years living in Isfahan and Kashan nursing homes in 2020, of which 380 were selected using convenience sampling. Used to collect data were Simmons and Gaher’s distress tolerance, Bond et al.’s acceptance and practice, Nolen-Hoxma and Moro’s ruminant response style and Bauer et al.’s mindfulness questionnaires. Data were analyzed using correlation coefficient and linear regression analysis in SPSS software version 22. The results of correlation test showed that distress tolerance is negatively associated with experimental avoidance and rumination as well as positively associated with mindfulness (p≤0.05). Moreover, the results of enter regression analysis also showed that experimental avoidance (β=-0.11), rumination (β=-0.45) and mindfulness (β=0.11) can predict distress tolerance in the elderly. According to the results of the present study, promoting distress tolerance through the training of mindfulness skills and appropriate coping styles, we can empower the elderly against such problems as loss of physical strength, illness, loneliness and disability. References Alavi, K., Modarres Gharavi, M., Amin Yazdi, S., & Salehi Fadardi, J. (2011). Effectiveness of group dialectical behavior therapy (based on core mindfulness, distress tolerance and emotion regulation components) on depressive symptoms in university students. Journal of Fundamentals of Mental Health, 13(2), 124-135. [Persian] Alimohammadi, F., Setodeh-asl, N., & Karami, A. (2019). Designing a model of quality of life in elderly based on perceived stress and tolerance of distress. Journal of Health and Care, 21(1), 53-65. [Persian] Amirpour, B., & Zandi Payam, A. (2007). The effectiveness of mindfulness based cognitive therapy on distress tolerance and flourishing in methadone-treated male patients. Journal of Clinical Psychology Achievements, 3(2), 193-210. [Persian] Asgari, R., & Khaleghipour, Sh. (2020). The effectiveness of narrative memory specificity on experimental avoidance and distress tolerance of men in penitentiary with major depression. Psychological Studies, 16(2), 157-172. [Persian] Aslanifar, l., & Sodagar, S., & Bahrami Hidaji, M. (2019). Mediation role of cognitive regulation in predicting rumination based on distress tolerance in patients undergoing methadone maintenance therapy. Advances in Cognitive Science, 21(2), 41-51. [Persian] Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27-45. Bagherinejad, M., Salehi Fadardi, J, & Tabatabyi, S. M. (2010). The relationship between rumination and depression in a sample of Iranian student. Clinical Psychology Research and Counseling, 11(1), 21-38. [Persian]. Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., Segal, Z. V., Abbey, S., Speca, M., Velting, D., & Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11, 230-241. https://doi.org/10.1093/clipsy.bph077 Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676-688. https://doi.org/10.1016/j.beth.2011.03.007 Briggs, A. M., Cross, M. J., Hoy, D. G., Sanchez-Riera, L., Blyth, F. M., Woolf, A. D., & March, L. (2016). Musculoskeletal health conditions represent a global threat to healthy aging: a report for the 2015 World Health Organization world report on ageing and health. The Gerontologist, 56(2), 243-255. https://doi.org/10.1093/geront/gnw002 Carpenter, J. K., Sanford, J., & Hofmann, S. G. (2019). The effect of a brief mindfulness training on distress tolerance and stress reactivity. Behavior therapy, 50(3), 630-645. https://doi.org/10.1016/j.beth.2018.10.003 Eifert, G. H., Forsyth, J. P., Arch, J., Espejo, E., Keller, M., & Langer, D. (2009). Acceptance and commitment therapy for anxiety disorders: Three case studies exemplifying a unified treatment protocol. Cognitive and Behavioral Practice, 16, 368-385. https://doi.org/10.1016/j.cbpra.2009.06.001 Erwin, M. C., Mitchell, M. A., Contractor, A. A., Dranger, P., Charak, R., & Elhai, J. D. (2018). The relationship between distress tolerance regulation, counterfactual rumination, and PTSD symptom clusters. Comprehensive psychiatry, 82, 133-140. https://doi.org/10.1016/j.cbpra.2009.06.001 Feldman, G., Dunn, E., Stemke, C., Bell, K., & Greeson, J. (2014). Mindfulness and rumination as predictors of persistence with a distress tolerance task. Personality and individual differences, 56, 154-158. https://doi.org/10.1016/j.paid.2013.08.040 Fooladian, M., Amir, A., & Fatemi Amin, Z. (2020). Assessing the sense of social status of the elderly: A comparison of the elderly living in care centers in Mashhad with non-resident elderly. A Study of Social Issues in Iran, 10 (1), 145-165. [Persian] Ghane, S., Asadi, J., & Derakhshanpoor, F. (2018). Effect of mindfulness training on individual well-being and mental health of elderly women. Journal of Gorgan University of Medical Sciences, 20(1), 71-76. [Persian] Hayes, A. M., & Feldman, G. (2004). Clarifying the construct of mindfulness in the context of emotion regulation and the process of change in therapy. Clinical Psychology: science and practice, 11(3), 255-262. https://doi.org/10.1093/clipsy.bph080 Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of consulting and clinical psychology, 64(6), 1152–1168. https://doi.org/10.1037/0022-006X.64.6.1152 Heravi Karimooi, M., Andoosheh, M., Foroughan, M., Sheykhi, M., Hajizadeh, E., Seyed Bagher Maddah, M., Mohammadi, E., & Ahmadi, F. (2008). Loneliness from the perspectives of elderly people: A phenomenological study. Salmand: Iranian Journal of Ageing, 2(6), 410-420. [Persian] Imani, M. (2016). Assessing the factor structure of the psychological resilience questionnaire in students. Journal of Teaching and Learning Studies, 8(1), 162-181. [Persian] Jeffries, E. R., McLeish, A. C., Kraemer, K. M., Avallone, K. M., & Fleming, J. B. (2016). The role of distress tolerance in the use of specific emotion regulation strategies. Behavior Modification, 40(3), 439-451. https://doi.org/10.1177/0145445515 19596 Joormann, J. (2006). Differential effects of rumination and dysphoria on the inhibition of irrelevant emotional material: Evidence from a negative priming task. Cognitive and Research Therapy, 30, 149- 160. https://doi.org/10.1007/s10608-006-9035-8 Kazemi H, Shojaei F, & Soltanizadeh M. (2018). The effect of mindfulness-based stress reduction intervention on psychological flexibility, distress tolerance, and re-experiencing the trauma in veterans with post-traumatic stress disorder. Military Caring Sciences. 4(4), 236-248. [Persian] Khodamoradi, A., Hassanipour, S., Daryabeigi Khotbesara, R., & Ahmadi, B. (2018). The trend of population aging and planning of health services for the elderly: A review study. Journal of Torbat Heydariyeh University of Medical Sciences, 6(3), 81-95. [Persian] Khosravi, M., Mehrabi, H., & Azizi Moghadam, M. (2008). A comparative study of obsessive- rumination component on obsessive-compulsive and depressive patients. Koomesh, 10 (1), 65-72. [Persian] Khosravi, N., Kooshki, Sh., Oraki, M., & Nemattavousi, M. (2019). Structural patterns of personality characteristics and cognitive emotional regulation with distress tolerance in mothers with a child with cancer: Mediating role of coping strategies. Nurse and Physician Within War, 7 (24), 72-81. [Persian] Leyro, T. M., Zvolensky, M. J., & Bernstein, A. (2010). Distress tolerance and psychopathological symptoms and disorders: A review of the empirical literature among adults. Psychological Bulletin, 136, 576–600. https://doi.org/10.1037/a0019712 Magidson, J. F., Listhaus, A. R., Seitz-Brown, C. J., Anderson, K. E., Lindberg, B., Wilson, A., & Daughters, S. B. (2013). Rumination mediates the relationship between distress tolerance and depressive symptoms among substance users. Cognitive therapy and research, 37(3), 456-465. https://doi.org/10.1007/s10608-012-9488-x Marsa, R., Bahmani, B., & Barekati, S. (2020). Demoralization syndrome in elderly people living in nursing homes, community-dwelling elderly people and those receiving day care services from rehabilitation centers. Salmand: Iranian Journal of Ageing, 14(4), 436-449. [Persian] McHugh, R. K., Reynolds, E. K., Leyro, T. M., & Otto, M. W. (2013). An examination of the association of distress intolerance and emotion regulation with avoidance. Cognitive Therapy and Research, 37(2), 363-367. https://doi.org/10.1007/s10608-012-9463-6 Mellor, D., Russo, S., McCabe, M. P., Davison, T. E., & George, K. (2008). Depression training program for caregivers of elderly care recipients: implementation and qualitative evaluation. Journal of Gerontological Nursing, 34(9), 8-15. https://doi.org/10.3928/00989134-20080901-09 Morgan, N. L., Ransford, G. L., Morgan, L. P., Driban, J. B., & Wang, C. (2013). Mindfulness is associated with psychological symptoms, self-efficacy, and quality of life among patients with symptomatic knee osteoarthritis. Osteoarthritis and Cartilage, 21,