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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 2  |  Page : 84-90

The mediating role of emotional distress tolerance in relationship between self-discrepancy with anxiety in people suffering from special phobias


1 Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran
2 Department of Psychology, Teaching and Research Branch, Islamic Azad University, Tehran, Iran
3 Department of Psychology, Bandargaz Branch, Islamic Azad University, Bandargaz, Iran
4 Department of Psychology, Sari Branch, Islamic Azad University, Sari, Iran

Date of Submission19-Feb-2019
Date of Acceptance13-Apr-2019
Date of Web Publication31-May-2019

Correspondence Address:
Dr. Alireza Sangani
Golestan, Gorgan, GorganJadid, Alley 24, Sarv Apartments, First Floor
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JNMS.JNMS_7_19

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  Abstract 

Context: The basis of anxiety disorders in cognitive and emotional fields can be effective in coping strategies to anxiety.
Aims: This research aimed to investigate the mediating role of emotional distress tolerance in relationship between self-discrepancy with anxiety in people suffering from special phobias.
Settings and Design: The present study was a correlational research with structural equation modeling.
Materials and Methods: The statistical population of this study was all individuals suffering from specific phobia disorders in the 5th Azar Hospital in Gorgan City. The sample size selection, which was made by Loehlin method (2004), was 220 persons suffering from anxiety disorder referring to Psychiatric Clinics of 5 Azar Hospital in Gorgan City and was investigated by purposeful sampling. Data gathering tools included Distress Tolerance Scale, self-discrepancy questionnaire, and Spielberger State-Trait Anxiety Inventory.
Statistical Analysis Used: The collected data were analyzed using structural regression equations using SPSS 18 and Amos 23 software.
Results: The findings showed that the research model is fit and overall, 42% of the anxiety could be explained through emotional stress tolerance and self-discrepancy, and emotional distress tolerance has a mediating role in relationship self-discrepancy with anxiety.
Conclusions: The results of this research emphasized the necessity of self-discrepancy as well as the role of mediator of emotional distress tolerance in anxiety in people suffering from special phobias, which can provide applied templates for improving the psychological state of anxious individuals with therapists and counselors.

Keywords: Anxiety, Emotional distress tolerance, Self-discrepancy


How to cite this article:
Sangani A, Jangi P, Ramak N, Ahmadi A. The mediating role of emotional distress tolerance in relationship between self-discrepancy with anxiety in people suffering from special phobias. J Nurs Midwifery Sci 2019;6:84-90

How to cite this URL:
Sangani A, Jangi P, Ramak N, Ahmadi A. The mediating role of emotional distress tolerance in relationship between self-discrepancy with anxiety in people suffering from special phobias. J Nurs Midwifery Sci [serial online] 2019 [cited 2019 Nov 14];6:84-90. Available from: http://www.jnmsjournal.org/text.asp?2019/6/2/84/259503


  Introduction Top


Anxiety is a widespread, common, unpleasant, and obscure worriness beside of which there are often some autonomic nervous system effect and symptoms such as headache, sweating, and even psychological symptoms such as fear.[1] Anxiety has a significant effect on the Behavioral-cognitive function of individuals. In scientific terms, psychological well-being has significant influences on the cognitive performance of individuals as a universal concept that is related to perceptual ability.[2] Anxiety involves undesirable feelings that are inappropriately perceived.[3]

It is a cognitive bias that affects the ability to receive, interpret, and respond to an uncertain state of distress tolerance levels,[4] as well as tolerance of distress related to the ability to be aware of emotions, thoughts, and environment without changing or controlling any factor that is considered.[5] The distress tolerance is defined as the capacity to experience and tolerate the negative psychological states.[6],[7] Reitzel et al.[8] state that distress tolerance involves behavioral deterrence or failure to respond to negative empowerment opportunities. Distress tolerance is one of the common structures for research in the field of emotional disorder[9],[10] and is a person's ability to experience and endure negative emotional states.[11] In fact, distress tolerance refers to the capacity of experience and resistance to emotional distress.[12] According to recent researches, individuals with more mental distress complain physical symptoms of anxiety.[13],[14] In the meantime, what causes various individuals to respond to psychological distress is a set of basic mental schemas that focus on their own consistency.[15]

According to researches and the theory of self-discrepancy,[16] mismatches between one's real perception and what the individual considers as self-standards create unpleasant psychological and emotional outcomes[17],[18] and affect proper performance.[19] The theory of self-discrepancy expresses the framework in which individuals are considering two levels for themselves based on criteria and standards: self-must and self-ideal.[20] The self-ideal includes the criteria based on which a person evaluates himself/herself.[21] The self-ideal is a set of attributes that one must achieve.[22] The self-discrepancy between perceived self-actualization of the individual and self-ideal creates feelings such as sadness,[23] hopelessness,[24] depression,[25],[26] and guilty feelings,[27] and if there is inconsistency with items that must be done by person, we see unpleasant emotions such as distress, anxiety,[28],[29] and shame.[30]

According to Markus and Nurius,[31] there is another type of self-standard called self-denial, which includes a set of attributes such as jealousy, extremism, and being traitor. Studies have shown that there is a relationship among self-inconsistency with depression and anxiety and life satisfaction.[32] The self-discrepancy has a relationship with a variety of negative emotions and tolerance of emotional distress.[33] In other words, perceived self-discrepancy plays an important role in mental health.[19],[34],[35] Generally, the changes major of self-discrepancy in individual can causes distress and anxiety.[36] Recently, Phillips and Silvia[37] have linked the theory of “self-incompatibility” to meta-cognitive models of anxiety disorders, and according to them, “self-incompatibility” indirectly affects meta-cognitive processes on anxiety and depression and consequently, it can reduce the emotional distress.[38]

Considering that anxiety disorder plays an important role in the overall performance of individuals with specific phobias, the direct effect of these variables can lead to interpersonal and social problems and, on the other hand, can cause cognitive problems such as self-discrepancy and produce negative emotional reactions. Previous studies did not mention the role of emotional distress tolerance and self-discrepancy anxiety in individuals with a specific phobia in a single model [Figure 1]. Therefore, the purpose of this study is to determine the mediating role of emotional distress tolerance in relationship between self-discrepancy with anxiety in people suffering from special phobias.
Figure 1: The conceptual model of the research in variables; emotional stress tolerance, self-discrepancy and anxiety is according to the background of Higgins studies (1987)

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  Materials and Methods Top


The present study was a correlational research with structural equation modeling. The statistical population of this study was all individuals suffering from specific phobia disorders in the Psychiatric Center of the 5th Azar Hospital in Gorgan City, Iran, from April to September 2018. The number of sample was calculated according to the Loehlin method[39] and for each variable, 30 to 50 samples were selected, and according to the four hidden variables in the study, with the probability of some data being interrupted, 220 samples from persons suffering from anxiety disorder referred to the Psychiatric Centers of 5th Azar Hospital in Gorgan City were selected and investigated by targeted sample selection method. After selecting the number of samples for completing the tools, they were individually informed about the design of the research. Consent was obtained from the clients, and they were assured in keeping the personal information confidentially, and then the questionnaires were given to them. This research was also registered with the code IR.IAU.AK.REC.1397.006 at Gorgan Branch.

Study inclusion criteria

Patients referred to the 5th Azar Hospital in Gorgan City with the diagnosis of certain phobia disorders, residents of Gorgan City, those with the absence of significant physical illness based on physician examinations and routine tests that have been requested, those with the absence of syncope and psychological disorders in patients, and those with the absence of depressive and anxiety disorders.

Exclusion criteria

Those patients who were not completing all parts of the questionnaires and those who refused to cooperate in the implementation of the research process were excluded. In general, no one was excluded from the study.

The collected data were analyzed using structural regression equations using SPSS 18 and Amos 23 software (SPSS18, Amos 23, in the USA, California, Stanford University).

Distress Tolerance Scale

Distress Tolerance Scale is a distress tolerance self-assessment index, developed by Simons and Gaher in 2005,[10] which has 15 items and 4 subscales of tolerance (distress tolerance), absorption (absorption by negative emotions), evaluation (distress estimation in mind), and adjustment (adjusting efforts to relieve distress). The alpha coefficients for these scales in Alavi's research[40] were 0.72, 0.82, 0.78, and 0.70, respectively, and for the whole scale, it was 82.2. It is also clear that this scale has a good initial convergence and validity,[41] and the results of this study have obtained high internal consistency reliability for a total of 0.71.

Self-discrepancy questionnaire

The uniform self-discrepancy questionnaire, which was constructed by Hardin & Lakin[15] on the basis of Higgins's (1987) theory, has six subscales of self-discrepancy in self-ideal, self-must, self-unwelcome, ideal for others, must of others, and unwelcome for others. Based on the 5-degree Likert scale, 1 (does not describe me at all) up to 5 (describes me perfectly), they score the traits.[27] Hardin and Leong[27] reported the validity of subscales in different races and nationalities from 0.73 to 0.86. This test was implemented by Mirzahosieni[24] on 250 students who were suffering from social phobia, and exploratory factor analysis was used to calculate its validity. The reliability of the alpha Cronbach was reported to be 0.90, and that of one of the subscales ranged 0.77–0.85. In addition, the alpha Cronbach's coefficient for the whole scale was 0.88 and for the subscales, it was estimated to be 0.81–0.88.[24]

Spielberger State-Trait Anxiety Inventory

The Spielberger state-trait anxiety inventory was created in 1970 by Spielberger. The Spielberger trait-anxiety inventory questionnaire contains forty questions in which questions 1–20 are about the state anxiety and the ones 21–40 are devoted to trait anxiety. Questions about state anxiety in the Likert spectrum are four-choice answers: no way, sometimes, in general, and very much and questions about anxiety trait are also graded in the same way as four-choice answers: that is, almost never, sometimes, more often, and almost always.[41] Spielberger[42] reported that the alpha Cronbach's coefficient for the state anxiety and trait anxiety subscales was 0.92 and 0.90, respectively. In addition, the test-retest coefficient for the state anxiety and trait anxiety subscales was 0.62 and 0.68, respectively. Alpha Cronbach's coefficient in the state anxiety and the trait anxiety was 0.92 and 0.90, respectively.[13] In another study, the reliability of this questionnaire was obtained through alpha Cronbach's for the state anxiety and trait anxiety subscales which was 0.91 and 0.90, respectively, and for the total scale, it was 0.94.[43]


  Results Top


Initially, the data normalization has been confirmed by using kurtosis and skewness, box, and Kolmogorov–Smirnov tests. [Table 1] shows the demographic information of the sample group with the indicators of age, gender, educational status, and marital status. [Table 2] shows a significant correlation between self-discrepancy scale, and distress tolerance with anxiety, the significant level is 0.01. [Table 3] shows a significant correlation between self-discrepancy scale and distress tolerance with anxiety, and the significant level is 0.01. The value of RMSEA (Root Mean Square Error of Approximation) was 0.048 (less than 0.1), which indicates that the average square errors of the model are appropriate and the model is acceptable. In addition, the second Chi-square for degrees of freedom (2.72) was between 1 and 3, and the indexes of goodness of fit, comparative fit index, and normed fit index are approximately equal to or greater than 0.9, which indicates that the model of the research variable measurement is a suitable model. According to [Table 4], self-discrepancy and distress tolerance paths show a direct and significant effect on the anxiety. According to [Table 5], self-discrepancy by the mediating role of distress tolerance paths show indirect and significant effect on the anxiety. As it can be seen, there are indirect effect of self discrepancy on the anxiety through the mediating role of distress tolerance.
Table 1: Demographic information of the study group

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Table 2: Pearson's correlation matrix of the self-discrepancy, anxiety, and distress tolerance subscales

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Table 3: Fit indicators derived from the data analysis and variables after three correction steps

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Table 4: Model direct estimation according to exponential correct maximum method (maximum likelihood)

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Table 5: Indirect estimation of the model by using the estimation bootstrap method

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  Discussion Top


The purpose of this study was to analyze the mediating role of emotional distress tolerance in relationship between self-discrepancy with anxiety in people suffering from special phobias. According to the final model of the research, in general, the emotional distress tolerance and self-discrepancy variables have a predictive power of 42% of the anxiety variable [Figure 2]. In addition, the research model was approved. These findings are consistent with the results of Sadeghi Mansoureh et al.[21] that showed that the individuals with more self-discrepancy have more anxiety and distress in the family. SafaiJam[22] showed that there is a significant relationship between mental disorders and personality with self-discrepancy. Kaplan et al.[33] showed that there is a significant relationship between self-discrepancy, perfectionism, depression, and anxiety in individuals. Perez[44] showed that emotional distress tolerance is due to understanding of yourself and circumstances and can affect the amount of anxiety. In addition, Szuhany and Otto[45] showed that inability to tolerate stressful experiences has been linked to self-discrepancy and maladaptive coping patterns. Although emotional distress tolerance is often considered a trait-like variable, evidence indicates that self-report and behavioral indices of emotional distress tolerance can be manipulated by anxiety. Research by Watson et al.[36] shows that one of the causes of anxiety is the weakness of individual skills in controlling and solving the problems related to the excitement that leads to a weak cognitive function. In explaining these findings, it could be noted that, in anxious individuals, the interaction of cognitive problems such as self-discrepancy and low emotional distress tolerance leads to a persistent anxiety disorder in individuals with special phobias. In other words, emotional tolerance is referred to as the ordering and adjustment of emotional processes, so the difficulty in regulating refers to the irregularity of emotions, and this process causes the anxiety.[6] When the cognition and emotions of the individuals are disturbed due to anxiety, they suffer a lot of stress.[5] The experience of feeling the discrepancy is threatening and causes tension and anxiety to the individual, and in the event of such an inconsistency and contradiction, the individual would have a defensive reaction such as fear and avoidance.[3] A major self-discrepancy between behaviors makes a person fail to face his/her goals and desires, and this kind of self-discrepancy will make the person vulnerable to seductive emotions such as depression and anxiety[17],[36] and therefore, the emotional distress tolerance of person will be reduced and this anxiety causes one to fail to achieve his/her goals and a sense of frustration increases one's vulnerability to negative emotions and psychological harm such as anxiety.
Figure 2: the findings showed that the research model is fit and overall, 42% of the anxiety could be explained through emotional stress tolerance and self-discrepancy

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Limitation

This research is limited to individuals with specific phobia disorders in the Psychiatric Center of the 5th Azar Hospital in Gorgan City. Another notable limitation of this research was the use of self-report instruments, which were too long and too difficult to complete given the psychological condition of our patients.


  Conclusions Top


Based on the results of this study, it can be concluded that the distance between selves and realities can provide anxiety in people, and subsequently, emotional distress intolerance can follow. In other words, each person suffering from special phobias, based on certain patterns of self-discrepancy among aspects of selves, can experience different emotional consequences, so their anxiety can create problems for them. The relationship between self-discrepancy with emotional distress tolerance can effect the severity of anxiety in people suffering from special phobias so that it can lead to dissolution of social relationship.

Conflicts of interest

There are no conflicts of interest.

Authors' contribution

All authors contributed to this research.

Financial support and sponsorship

This is authors' independent research.

Acknowledgment

The authors thank all the participants in the research as well as the honorable staff of the 5th Azar hospitals.

 
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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