3 - (IOP 8) A Within-person Model of Distress Tolerance and Non-suicidal Self-injury Among Recurrent Self-injurers

Motivation: Individual differences in distress tolerance (DT), willingness to face internal discomfort, predict who is vulnerable to non-suicidal self-injury (NSSI). However, it is unclear to what extent within-person differences in DT predict periods of peak NSSI risk. We used short-term variation in DT as a model of acute NSSI risk among people with recurrent NSSI.

Method: We sampled momentary DT and NSSI outcomes four times per day across 14 consecutive days in a group of 119 adults who had significant histories of NSSI behavior. Our participants, recruited from the New York City area, were sociodemographically diverse: They were 55.5% cisgender female, 9.2% cisgender male, 2.5% transgender female, 4.2% transgender male, and 28.5% nonbinary/agender/genderqueer. Regarding race/ethnicity, they were 62.2% White, 21.8% Asian, 11.8% Black, and 15.9% another race, and 21% identified as Hispanic or Latino/a/x. Regarding sexual identities, they were 37.8% bisexual, 23.5% heterosexual, 11.7% gay or lesbian, 7.6% questioning, and 19.3% preferred to self-identify.

Results: Most (70%) of the variability in DT in this study occurred at the within-person level. In turn, momentary DT ratings had robust within-person correlations with concurrent NSSI urges (r = -.43 ). They also predicted NSSI behavior: at typical DT levels, the probability of NSSI was 4.2%, but when a participant was 1 SD lower than their typical level of DT, the probability of NSSI behavior more than doubled to 9.1%. Further, DT was a statistically significant predictor of NSSI outcomes up to 3 hours later, even when adjusting for continuity in NSSI. Negative urgency and experiential avoidance—DT’s conceptual neighbors—added predictive utility in within-person models of NSSI thoughts and behavior.

Interpretation: DT was a temporally dynamic personality process that predicted when high-risk adults would experience more intense NSSI thoughts and behavior. We believe this result highlights the potential importance of attending to fluctuation in DT in clinical practice and exploring in experimental/treatment research the possibility that targeted DT interventions could avert or mitigate periods of highest NSSI risk.

Transparency/Openness: Our study’s dataset, analysis code, and materials are available at https://osf.io/nz5q4/. This study was a registered report, meaning that the rationale/justification and method were first approved during a Stage 1 journal review, and we later collected and analyzed data according to the peer-reviewed plan.