Date of Graduation


Document Type


Degree Name

Doctor of Philosophy in Psychology (PhD)

Degree Level



Psychological Science


Ana J. Bridges

Committee Member

Jennifer C. Veilleux

Second Committee Member

Alex R. Dopp

Third Committee Member

Denise Beike


distress tolerance, exposure therapy, incarcerated women, sexual assault recovery


Incarcerated populations are disproportionately affected by traumatic experiences and symptoms of posttraumatic stress disorder (PTSD). Many effective treatments for PTSD utilize exposure-based techniques which require engaging with emotionally distressing content. However, individuals with PTSD and low distress tolerance (DT) are more likely than those with PTSD and higher DT to engage in avoidant coping behaviors and have relatively high treatment attrition rates in general. This study explored relations between DT and treatment persistence, engagement, and improvement in incarcerated women (N = 85) enrolled in an 8-week exposure-based sexual assault recovery group at a minimum-security prison. I hypothesized lower baseline levels of DT would be related to lower treatment persistence and engagement with distressing content during treatment. I also hypothesized lower baseline DT would be related to lower treatment gains and higher levels of post-treatment symptoms of PTSD and depression. Finally, I hypothesized completing exposure-based group therapy would be associated with increases in DT post-treatment. Contrary to hypotheses, no significant relation was found between baseline DT and treatment persistence. Furthermore, lower levels of baseline DT were associated with higher levels of emotional engagement during exposure, which was the opposite of what was predicted. Also contrary to expectations, non-linear effects were found for relations between baseline DT and improvements in internalizing symptoms: lower levels of baseline DT were associated with greater symptom improvement than moderate to high levels of baseline DT. Consistent with hypotheses, DT significantly improved from pre- to post-treatment. Qualitative analyses of respondents at post-treatment revealed concerns of dropping out related to fear of sharing (e.g., trust violations, increased symptoms) and motivations for staying related to healing and commitment. Themes did not vary by baseline DT. Overall, findings suggest participants with lower baseline DT can not only benefit from exposure-based therapy, but were more emotionally engaged in exposure and demonstrated greater internalizing symptoms improvement than those with moderate to high baseline DT.