The relationship between distress tolerance and cigarette smoking: A systematic review and synthesis

Distress tolerance, the ability to withstand physical or emotional discomfort, is thought to be associated with cigarette smoking behavior and smoking cessation failure. A systematic review evaluated studies that linked distress tolerance to smoking. Central findings suggest that (a) distress tolerance can—but does not always—predict smoking cessation lapse, (b) treatments targeting distress tolerance are promising but need additional research, (c) lower distress tolerance does not seem to be associated with greater smoking frequency or longevity, and (d) limited work evaluates the effect of smoking context on distress tolerance. Gaps in our current knowledge are also identified, most notably the need to evaluate how links between distress tolerance and smoking develop across smoking escalation and maintenance stages, and the need to examine distress tolerance contextually. A model of momentary distress tolerance is proposed, where the key premise is to discuss the factors which could influence state or momentary distress tolerance and how habitual smoking may lower distress tolerance and reinforce the links between heightened distress and smoking behavior. Theoretical and measurement implications are discussed with the aim of extending future research on distress tolerance and smoking. •This paper synthesizes existing research on distress tolerance (DT) and smoking.•Measurement issues between self-report and behavioral tasks are considered.•Evidence reveals an inconsistent relationship between DT and smoking.•Several key gaps in the research are identified.•A model of momentary distress tolerance is advanced.