Beyond symptom severity: The differential impact of distress tolerance and reward responsiveness on quality of life in depressed and non-depressed individuals

Economic and patient-centered research highlights the role of quality of life outcomes above and beyond symptom severity as a key target of depression treatment. Thus, research investigating processes related to the etiology and treatment of depression needs to consider such outcomes in addition to symptom-specific measures. The current study evaluated two such processes, derived from operant conditioning principles of reinforcement: distress tolerance (DT) and reward responsiveness (RR). We examined the direct effects of these processes on quality of life in a sample of depressed (n = 34) and non-depressed (n = 33) participants, and conducted an exploratory analysis of their potential interaction. Results indicated that higher levels of RR and DT were associated with higher overall quality of life regardless of diagnostic status. We did not find the expected interaction between DT and RR, though results indicate a potential trend suggesting DT may provide a protective influence for individuals with low RR. Results highlight the importance of both tolerating distress and responding to rewards for individuals along the quality of life continuum. While this investigation focused on the highly heterogeneous diagnosis of depression, future investigations should extend such work to consider mixed diagnostic samples to further enhance the validity of such processes as potential treatment targets in real-world clinical settings.