Journal of Rational-Emotive & Cognitive-Behavior Therapy, Vol. 23, No.

1, Spring 2005 (
2005)

DOI: 10.1007/s10942-005-0001-2
Published Online: July 12, 2005

DIMENSIONS OF FRUSTRATION
INTOLERANCE AND THEIR RELATIONSHIP
TO SELF-CONTROL PROBLEMS
Neil Harrington
University of Edinburgh and Stratheden Hospital, UK

ABSTRACT: Frustration intolerance beliefs are central to the theory and

practice of Rational Emotive Behavior Therapy. However, there has been little
investigation of the content of these beliefs, and empirical evidence linking
specific beliefs to distinct psychological problems is sparse. To redress this, the
Frustration Discomfort Scale has been developed as a multidimensional
measure. This was used to explore the relationship between the four dimen-
sions of frustration intolerance (emotional intolerance, demands for entitle-
ment, comfort, and achievement) and problems of self-control. Results
indicated that the Frustration Discomfort sub-scales showed differential
relationships with self-control problems, independent of self-worth beliefs.
This supported the validity and usefulness of the scale and the importance of
distinguishing between dimensions of frustration intolerance.

KEY WORDS: rational emotive behavior therapy (rebt); frustration intoler-

ance; self-control; self-harm.

Rational Emotive Behavior Therapy (REBT) argues that the

inability to tolerate frustration and discomfort is a core feature of
psychological disturbance (Ellis, 1979, 1980). More specifically,
REBT divides irrational beliefs into two categories: the intolerance
of frustration/discomfort and the evaluation of self-worth. It has
been proposed that these categories reflect different underlying cog-
nitive processes (DiGiuseppe, 1996). That is, frustration intolerance
represents a demand that reality should be how we want it to be,

This paper is based on research submitted to the University of Edinburgh in part fulfillment of a
Doctorate of Philosophy degree.
Address correspondence to Neil Harrington, Psychology Department, Stratheden Hospital, Cupar,
Fife, KY15 5RR, UK; e-mail: neil@nharr.freeserve.co.uk.

1
2005 Springer Science+Business Media, Inc.

2 Journal of Rational-Emotive & Cognitive-Behavior Therapy

whereas ego disturbance is based on the belief that self-worth is

dependent on meeting certain conditions. Several areas of research
support this model. For example, factor analytic studies indicate
that frustration intolerance and self-worth beliefs load on separate
factors (DiGiuseppe & Leaf, 1990). Likewise, frustration intolerance
and self-worth have been found to account for most of the variance
between irrational beliefs and negative affect (Kassinove, 1986).
Frustration intolerance is hypothesized to have greater importance
for some types of disorder, particularly self-control problems such as
procrastination (Ellis & Knaus, 1977). Yet, the empirical evidence as
to whether specific beliefs are associated with discrete disorders is
sparse (Kendall et al., 1995). One difficulty is that REBT theory has
tended to focus on belief processes, in particular demandingness,
rather than the content of beliefs. Whilst belief processes may prove
fundamental to emotional disturbance they are too generalized to dis-
tinguish between specific problems. Furthermore, recent experimen-
tal studies have suggested that emotional disturbance is primarily
determined by the content of secondary beliefs, such as frustration
intolerance (Bond & Dryden, 2000). However, frustration intolerance
and self-worth beliefs have been largely treated as one-dimensional
constructs leaving the content of these beliefs relatively unexplored.
Yet, the REBT literature describes a wide range of beliefs when
referring to frustration intolerance; including problem avoidance,
instant gratification, and intolerance of emotion (Dryden & Gordon,
1993). Therefore, the evidence suggests that a one-dimensional model
will be inadequate to investigate the relationship between irrational
beliefs and discrete disorders—a task highlighted as a priority for
REBT research (Kendall et al., 1995).
In comparison to REBT, Cognitive Therapy proposes that psycho-
logical disorders reflect specific patterns of belief content (Beck, 1976).
Even so, the evidence for cognitive specificity and vulnerability has
been inconsistent (Clark & Steer, 1996). As with REBT, researchers
have suggested that these difficulties are related to the use of global
measures, which may simply act as indicators of distress. In this
regard, Power (1990) has argued for the development of multidimen-
sional scales, with content domains based on theoretical as well as
statistical grounds. Similarly, Neenan and Dryden (1999) have high-
lighted the need for a multidimensional measure to investigate the
content and factor structure of frustration intolerance beliefs.
Neil Harrington 3

THE FRUSTRATION DISCOMFORT SCALE

The Frustration Discomfort Scale was developed as a multidimen-

sional measure of frustration intolerance beliefs (Harrington, 2003).
An exploratory factor analysis indicated that the Frustration Dis-
comfort Scale was best described by four factors: emotional intoler-
ance, and demands for comfort, entitlement, and achievement. The
emotional intolerance sub-scale reflected the belief that emotional
distress is unbearable and must quickly be relieved or avoided (e.g. ‘‘I
absolutely must be free of distressing feelings as quickly as I can. I
can’t bear for them to continue’’). REBT has long emphasized the
importance of emotional intolerance, particularly in regard to second-
ary disturbance (Ellis, 1979, 1980). However, factor analysis
indicated emotional intolerance loaded separately from demands for
comfort. This demand for comfort sub-scale included beliefs that life
should be free of hassles, effort, and inconvenience—beliefs also
traditionally central to the definition of frustration intolerance (e.g.
‘‘Tasks that I attempt absolutely must not be too difficult. Otherwise,
I can’t stand doing them’’).
The entitlement sub-scale reflected demands for fairness and
immediate gratification (e.g. ‘‘I absolutely must not be taken for gran-
ted. I can’t stand being unappreciated’’). The theme of this factor
could be summarized as ‘‘I must get what I want’’ (Dryden & Gordon,
1993, p. 23). That is, a sense of entitlement that desires must be met
and that other people should indulge and not frustrate these desires.
Finally, the achievement sub-scale reflected demands, rather than
preferences, for high standards, and intolerance of these standards
being frustrated (e.g. ‘‘If a job is worth doing, I absolutely must not
fall short. I cannot accept lower standards’’). Thus, the sub-scale
aimed to assess achievement beliefs related to frustrated intolerance
as opposed to those related to self-evaluation. The separation of these
categories is of interest, since research indicates that self-evaluative
perfectionism is consistently associated with psychological distur-
bance (Enns & Cox, 2002). On the other hand, although high
standards by themselves are associated with increased self-control,
the relationship between frustration intolerance achievement beliefs
and disturbance is less clear.
Whilst the present study uses the full Frustration Discomfort
Scale, a shortened version of the scale was also developed as part of
the research (Harrington, 2003). This employed only frustration
4 Journal of Rational-Emotive & Cognitive-Behavior Therapy

intolerance statements, whilst largely retaining the same content and

item wording. Confirmatory factor analysis using the shortened scale
supported the four-factor model, and replicated evidence showing
specific relationships with emotional disturbance. That is, the
entitlement sub-scale was a unique predictor of anger, comfort of
depression, and emotional intolerance of anxiety, even after control-
ling for self-esteem and negative affect.

RELATIONSHIP BETWEEN FRUSTRATION INTOLERANCE AND

SELF-CONTROL

There is considerable evidence that people do differ in their abil-

ity to delay gratification, and that these differences are stable over
time and across situations (Mischel, 1996). Furthermore, self-con-
trol problems are frequently associated with one another. For
example, 61% of self-harmers describe a history of eating disorder
(Favazza & onterio, 1989). Similarly, 46% of compulsive shoppers
report a history of alcohol abuse, and 21% of eating disorder
(Faber, 2000).
There are several theoretical explanations for self-control failure
and the association between these problems. Impulsiveness as an
underlying personality trait has been suggested, although the
evidence for a relationship between impulsiveness and self-control is
inconsistent (e.g. Stanford & Barratt, 1992). The concept of ‘‘will-
power’’ has also been employed although, as with impulsiveness, its
definition is unclear (Muraven, Tice, & Baumeister, 1998).
Certainly, behavioral theories have emphasized that self-control in-
volves the choice to tolerate costs, such as gratification delay, effort,
and punishment, to obtain longer-term reinforcement (Eisenberger,
1992).
Emotional discomfort can be said to represent one such cost, and it
has been argued that emotional regulation is central to self-control.
For instance, Heatherton and Baumeister (1991) suggest that
problems such as binge eating represent dysfunctional strategies
aimed at reducing distress, particularly negative self-awareness. Yet,
whilst there is evidence that tolerating emotional distress may be
more difficult for some individuals (Cooper, Frone, Russell, & Mudar,
1995), it is unclear if all emotions are implicated in self-control
failure, or if some are more problematic. Herpetz (1995) found that
Neil Harrington 5

‘‘intolerable tension’’ was the most frequently experienced emotion

reported by self-harmers, with self-harming serving to reduce
tension. The frequency of self-harm is also associated with chronic
anger (Simeon et al., 1992), but the evidence regarding depressed
mood is less clear. Some investigators have implicated depressed
mood in repeated self-harm (Hawton, Kingsbury, Steinhardt,
Anthony, & Fagg, 1999), although poor self-esteem has been
suggested as more important (Kent et al., 1997). Other self-control
problems, such as binge eating (Baumeister, Heatherton, & Tice,
1994) and compulsive shopping (Dittmar, 2000), have also been
linked to negative self-evaluation.
In summary, it seems unlikely that a single belief process, or broad
personality trait, will be sufficient to explain failures of self-control.
Rather, the present study proposes that the investigation of dimen-
sions of belief content, and their interaction across diagnostic catego-
ries, will be more useful in understanding these disorders. Previous
research has implicated a number of content areas, such as emotional
intolerance and immediate gratification, and these are reflected in
the Frustration Discomfort sub-scales. These sub-scales are pre-
dicted to show specific relationships with self-control problems. The
present study aims to investigate the relationship of frustration intol-
erance beliefs with self-control problems, and to present evidence for
the validity of the Frustration Discomfort Scale. Since frustration
intolerance and self-worth beliefs overlap, it is necessary to show
that any association between frustration intolerance and psychologi-
cal problems is not simply reflecting a shared relationship with self-
esteem or negative affect (Kendall et al., 1995). The relationship of
frustration intolerance beliefs with a range of self-control problems is
initially analyzed. Then, focusing on self-harming behavior, the inter-
action between beliefs is explored in more detail using structural
equation modeling.

METHOD

Participants and Procedure

Participants were 242 patients referred to the adult clinical psy-

chology department for therapy of nonpsychotic disorders (95 men
and 147 women, mean age = 38.77 years, SD = 13.22). A primary
6 Journal of Rational-Emotive & Cognitive-Behavior Therapy

diagnosis was given by the treating psychologist at the end of

therapy: 32% of clients suffered from anxiety, 23% depression, 14%
anger, with obsessional, addiction, marital/interpersonal, and eating
disorders each around 5%. Problems were relatively longstanding,
with 50% of clients reporting a history of 3 years or more. The use of
a clinical population representing a wide range of moderate to severe
problems was thought to be the most appropriate for investigating
cognitive specificity (Clark & Steer, 1996).
A questionnaire package was included with notification of first
appointment. Of 587 consecutive referrals there was a response
rate of 44%. A previous departmental study had obtained the same
response rate and had shown that non-responders did not differ
from responders on diagnostic or demographic characteristics
(Turvey, Humphreys, Smith, & Smeddle, 1998). Nevertheless,
further analysis was conducted since differences could exist in
terms of frustration intolerance (Harrington, 2003). Unsurprisingly,
a large proportion of non-replies came from individuals who failed
to attend (38%). Excluding these, non-replies were more likely to
drop out of therapy, with 48% dropping out compared to 30% in
the replying group (v2[1] = 9.4, p < .01). Therapy dropout was
defined as failure to attend the final session. For individuals who
replied, dropout was significantly related to higher emotional intol-
erance (t [224] = 1.97, p < .05) and entitlement (t [224] = 2.43,
p < .05). Given this, it might be expected that non-replies would
show higher scores on these two sub-scales, possibly attenuating
present results.

Measures

The Frustration Discomfort Scale. This contained 47 items rated

on a 5-point Likert-type scale with the following anchors: (0) absent,
(1) mild, (2) moderate, (3) strong, and (4) very strong. Each item
involved a demand belief and two sub-statements referring to self-
worth and frustration intolerance. This was based on the proposition
that irrational beliefs were best phrased as compound sentences,
consisting of a primary demand and a secondary belief (DiGiuseppe,
1996). The use of self-worth and frustration intolerance sub-state-
ments also aimed to improve discrimination between these categories
(Dryden, 1996). For example:
Neil Harrington 7

I absolutely shouldn’t have been treated so unfairly in the past

Because I can’t bear such injustice 0 1 2 3 4

It continues to totally lower my self-esteem 0 1 2 3 4

Subsequent analysis indicated that separate rating for both sub-

statements was unnecessarily elaborate, and only the frustration
intolerance scores were eventually used. The emotional intolerance,
entitlement, and comfort sub-scales contained 13 items each, and the
achievement sub-scale 8 items. Psychometric properties were very
good, with Cronbach alpha reliabilities for the respective sub-scales:
.91, .88, .90, and .82, and for the full scale, .95. There were no signifi-
cant relationships between Frustration Discomfort sub-scales and
age or gender.
The Rosenberg Self-Esteem Scale (Rosenberg, 1965) is a 10-item
Likert-type scale with good internal reliability (.87) and temporal
stability (.86). There was careful preliminary screening for ‘‘careless
responses’’ (Schmitt & Stults, 1985) resulting in nine cases being
removed, leaving 232 replies. Whilst in REBT theory self-esteem is
distinct from that of self-acceptance, the Rosenberg scale was
designed to measure global negative self-evaluation, which is a defin-
itive feature of ego disturbance. The Rosenberg scale is also highly
correlated (r = ).56) with an REBT measure of self-acceptance
(Chamberlain & Haaga, 2001).
The Hospital Anxiety and Depression Scale (HAD) (Zigmond &
Snaith, 1985) is a 14-item scale that includes two sub-scales measur-
ing anxiety and depression. It is a valid and reliable measure of the
severity of these problems, with cut-points of 11 obtaining the best
separation of cases from non-cases. The total HAD score was used as
a measure of negative affect.
Trait Anger Scale (TAS) (Spielberger, Jacobs, Russell, & Crane,
1983) is a 10-item scale 4-point Likert-type scale. The scale has good
reliability data, with a reported internal reliability from .81 to .91.
Cut-points of ‡21 for males, and ‡22 for females, are suggested as
indicative of clinical anger.
The Coping Inventory was designed for this study as a brief check-
list of dysfunctional behavior (Harrington, 2003). Eleven items were
included in the present analysis: (1) I avoid difficult tasks; (2) I men-
tally shut off; (3) I injure myself or overdose; (4) I put things off; (5) I
use alcohol for relief; (6) I restrict myself to familiar routines
8 Journal of Rational-Emotive & Cognitive-Behavior Therapy

(although I feel I’m in a rut); (7) I use recreational drugs for relief;
(8) I comfort eat; (9) I restrict my eating by vomiting or laxatives;
(10) I overspend on unnecessary things; (11) I rely on medication to
obtain symptom relief. Individuals were asked to rate each item in
terms of how well it described their method of coping with ‘‘distress,
discomfort, or frustration.’’ Items were scored on a 4-point Likert
scale ranging from 0 (‘‘not at all’’) to 3 (‘‘very much so’’). Whilst it
would have been preferable to use an existing coping measure, these
suffer from considerable methodological and psychometric problems
(De Ridder, 1997), and tend to focus on functional rather than
dysfunctional behavior.
Self-harm and alcohol use showed skewed distributions and non-
parametric tests were used for these items. The vomiting/purging
and drug use items had severe frequency problems, with less than
10% of individuals endorsing scale points 2 or 3. Therefore, these two
items were dropped from subsequent analysis. Internal reliability of
the remaining nine items was relatively low, with an alpha coeffi-
cient of .68. Since this might indicate multidimensionality, a Princi-
pal Components analysis using varimax rotation was conducted. A
scree plot indicated two factors accounting for 42% of the variance.
The first factor was composed of cognitive and behavioral avoidance,
procrastination, routine, and medication use. The second factor in-
cluded self-harm, alcohol, and overspending. Comfort eating loaded
on both factors. However, corrected item-total correlations for each
sub-scale remained low, with mean inter-item correlations of .24
(factor I) and .20 (factor II).
There was evidence that factor I reflected emotional distress and
avoidance. This showed a moderate correlation with HAD total score
(.45), whilst factor II had a weaker relationship (.26). On the other
hand, factor II appeared to reflect problems with frustration, and was
correlated with anger (.29), with factor I showing a nonsignificant
relationship (.09). Both factors were significantly correlated (.43 and
.47, p < .001, respectively) with the Schema Questionnaire impaired
limits sub-scales (Young, 1994). All the Coping Inventory items had
significant correlations with the two Schema sub-scales, which assess
problems with making commitments, setting goals, and tolerating
unpleasant emotions.
In summary, there was some evidence for the validity of the
Coping Inventory items. However, given the small number of items
in each factor, and relatively low intercorrelations, it was decided it
Neil Harrington 9

Table 1

Coping Inventory item correlations with Frustration Discom-

fort and Rosenberg scales

Coping Total Emotional

Inventory Self-esteem F D Intolerance Entitlement Comfort Achievement

Behavioral avoid ).24*** .18** .22*** .03 .27*** .04

Cognitive avoid ).25*** .24*** .31*** . .14* .21*** .09
Self harm (R) ).38*** .19*** .24*** .14* .17** .06
Procrastination ).28*** .18** .20** .11 .24** ).04
Alcohol (R) ).13* .02 .03 .06 .03 ).08
Routine ).31*** .31*** .23*** .17** .39*** .21***
Comfort eating ).38*** .28*** .27*** .23*** .24*** .19**
Overspending ).25*** .31*** .28*** .32*** .27*** .08
Medication ).25*** .34*** .39*** .20** .33*** .15*

Note. N = 232 (Self-esteem); N = 242 (Frustration Discomfort).

Items using Spearman’s rho marked (R).
*p < .05, **p < .01, ***p < .001.

would be inappropriate to use the Coping Inventory as an overall

measure of dysfunctional coping. Instead, individual items were used
in further analyses.

RESULTS

Relationship between Coping Inventory Items and the Frustration

Discomfort Scale

Correlations between individual Coping Inventory items, Frustra-

tion Discomfort sub-scales and the Rosenberg scale are shown in
Table 1. As expected, both self-esteem and frustration intolerance
beliefs were significantly associated with a range of dysfunctional
coping behaviors. There was also evidence of differential relation-
ships between specific problems and the dimensions of frustration
intolerance. To control for shared variance with self-esteem, multiple
regression and partial correlation analyses were conducted.
As might be expected, the comfort and emotional intolerance sub-
scales, reflecting intolerance of discomfort, were significantly
correlated with cognitive and behavioral avoidance. However, the enti-
tlement and achievement sub-scales, reflecting intolerance of frustra-
tion, showed a weak or negligible association with avoidance. Comfort
10 Journal of Rational-Emotive & Cognitive-Behavior Therapy

was most strongly correlated with restrictive routines, consistent with

the focus on avoidance of problems and hassle. Surprisingly, alcohol
use was not correlated with any of the Frustration Discomfort sub-
scales, and was only weakly correlated with self-esteem.
Overspending was significantly correlated to entitlement, comfort,
and emotional intolerance. Furthermore, entitlement (pr [229] = .27,
p < .001), comfort (pr [229] = .19, p < .05), and emotional intolerance
(pr [229] = .19, p < .05) all remained significant when controlling for
self-esteem in a partial correlation analysis. To control for the
overlap between variables a simultaneous multiple regression was
conducted with the relevant Frustration Discomfort sub-scales and
self-esteem entered as a block. Only entitlement (t [4,227] = 2.70,
p < .01, b = .23) and self-esteem (t [4,227] = 2.64, p < .01, b = ).19)
remained unique predictors of overspending.
Procrastination was significantly related to comfort and emotional
intolerance, as well as with self-esteem. However, when controlling
for self-esteem only comfort (pr [229] = .19, p < .01) remained
significantly related to procrastination. Likewise, a simultaneous
multiple regression showed that only comfort (t [3,228] = 2.23,
p < .05, b = .18) and self-esteem (t [3,228] = 2.93, p < .01, b = ).21)
were unique predictors of procrastination.
Reliance on medication had the strongest correlation with overall
Frustration Discomfort scores. Both emotional intolerance
(pr [229] = .34, p < .001) and comfort (pr [229] = .27, p < .001)
remained significantly correlated to medication when controlling for
self-esteem. Importantly, both emotional intolerance (pr [236] = .28,
p < .001) and comfort (pr [236] = .21, p < .001) also remained sig-
nificant when controlling for negative affect. This indicated that the
relationship did not simply reflect greater emotional distress in those
individuals taking medication. Furthermore, a simultaneous regres-
sion using the Frustration Discomfort sub-scales, self-esteem, and
negative affect, showed emotional intolerance as the only unique
predictor of reliance on medication (t [6,226] = 3.20, p < .001, b = .28).
Comfort eating was more strongly associated with self-esteem than
with frustration intolerance beliefs. However, when controlling for
self-esteem, both entitlement (pr [229] = .19, p < .01) and emotional
intolerance (pr [229] = .13, p < .05) remained significant. A simulta-
neous regression indicated that only entitlement (t [3,228] = 2.13,
p < .05, b = .11) and self-esteem (t [3,228] = 4.94, p < .001, b = ).33)
were unique predictors.
Neil Harrington 11

In summary, there is evidence of specific relationships between

frustration intolerance dimensions and self-control problems. The
interaction between these beliefs, and those of self-worth, was inves-
tigated further with reference to self-harm.

Analysis of Self-Harm

The self-harming distribution was positively skewed, with 56

patients (24%) indicating some degree of self-harm. All measures
were normally distributed in this self-harm group, although the TAS
and the HAD anxiety scale were slightly positively skewed in
the remaining non-harming patients. The male female ratio
corresponded to overall referrals, and there was no significant gender
difference between self-harming and other patients (v2[1] = 1.00, ns).
The self-harm group was significantly younger (t [236] = 3.16,
p < .01).
To compare overall levels of emotional distress, self-harmers were
classified on cut-points as to whether they had co-existing anger,
depression, or anxiety. There were substantial differences in the
proportion of self-harmers with two or more emotional problems.
Thus, 76% of self-harmers had two, and 36% had all three problems,
compared to 48% and 12% for non-harmers. Self-harmers were signif-
icantly more anxious than other anxious patients (t [181] = 3.61,
p < .001), although anger (t [121] = 1.18, ns) and depression scores
(t [80] = 1.77, ns) were similar to that of angry or depressed non-
harmers. Compared to non-harmers with emotional problems, self-
harmers had lower self-esteem (t [209] = 6.10, p < .001), higher
emotional intolerance (t [211] = 3.38, p < .001) and comfort
scores (t [211] = 2.21, p < .05), but similar levels of entitlement
(t [211] = .19, ns) and achievement (t [211] = 1.53, ns).
The question as to whether self-harmers have higher levels of emo-
tional intolerance, or simply higher amounts of distress, was also
explored. A logistic regression analysis was conducted in which nega-
tive affect and age were entered at step 1, and emotional intolerance
at step 2. Results showed that emotional intolerance remained a
significant predictor of self-harm when accounting for differences in
negative affect (Wald v2 = 4.27, b = .03, p < .05). Given that the self-
harm group were significantly more anxious and more likely to suffer
from a combination of disturbed emotions, this suggests that self-har-
mers do have higher levels of distress, but they are also less tolerant
of these emotions. However, self-esteem was the best overall
12 Journal of Rational-Emotive & Cognitive-Behavior Therapy

predictor of self-harm, accounting for 24% of the variance compared

to the 10% attributed to emotional intolerance.

Structural Equation Modeling

Structural equation modeling, employing the AMOS program

(Arbuckle, 1999), was used to investigate the interaction between
frustration intolerance beliefs and other variables. Model fit was
assessed by several indices: (1) the Model Chi-square, the most
frequently used measure of overall fit. A nonsignificant v2 indicates a
good fit, with a recommended ratio for v2 to the degrees of freedom of
less than 2 (Tabachnick & Fidell, 2000); (2) Root Mean Square of
Approximation (RMSEA: Browne & Cudeck, 1993). A non-incremen-
tal fit index representing the discrepancy per degree of freedom.
Values over .1 indicate a poor fit to the data, those from .05 to .08 are
acceptable, and values below .05 a close fit; (3) the Tucker Lewis
Index (TLI: Tucker & Lewis, 1973). This takes into account model
parsimony, so that an inconsequential path reduces the TLI value. A
score >.90 is considered acceptable.

Model Specification

Four models were tested based on the theoretical and empirical

literature. Age was included since this was significantly related to
self-harm and self-esteem. In all models, entitlement was fully medi-
ated by anger. In model A, depression and anxiety fully mediated the
relationship of self-esteem and emotional intolerance with self-harm.
In model B, self-esteem had a direct path to self-harm as well as
being partially mediated by depression. In model C, depression was
removed and self-esteem was only mediated by anxiety. Model D was
the same as model C except that self-esteem had an additional path
to anger.

Model Comparison

Fit statistics for each of the models are shown in Table 2. All path
coefficients were significant in model A. However, with a significant
v2 and an unacceptable discrepancy ratio and RMSEA score model A
was clearly an unacceptable fit to the data. Model B was also an
inadequate fit to the data. In this model, the path coefficient from
self-esteem to self-harm was significant (b = ).29, p < .001), but not
Neil Harrington 13

Table 2

Tests of Mediation: Fit Statistics

Model Chi-square df v2/df Sig. TLI RMSEA

Model A 78.38 15 5.23 .00 .964 .132

Model B 63.66 14 4.55 .00 .970 .121
Model C 11.33 10 1.13 .33 .999 .023
Model D 9.66 9 1.07 .38 .999 .017

the path from depression to self-harm (b = .36, p = .59). Models C

and D, which excluded depression as a variable, showed good fits.
However, in model D the path from self-esteem to anger was nonsig-
nificant, indicating a negligible relationship between self-esteem and
anger (b = ).07, p = .19). Since these two models are nested, they
were compared using the v2 difference test. This showed that model
C was statistically the better model (v2diff = 1.67, df = 1, ns), account-
ing for 19% of the variance in self-harming scores (Figure 1).
The possibility that emotional intolerance and entitlement were
directly related to self-harm was also examined. However, the path
coefficients were nonsignificant (b = ).04, p = .61 and b = ).03,
p = .71), indicating that these beliefs were fully mediated by anxiety
and anger. Similarly, paths from comfort to self-harm (b = .01,
p = .92) and to anxiety (b = .13, p = .07) were both nonsignificant.
In summary, self-harm was related to entitlement and emotional
intolerance beliefs, mediated by anger and anxiety respectively. Self-
esteem was directly related to self-harm, and had an indirect associa-
tion through anxiety. There was no significant relationship between
anger and self-esteem, and depression was not a significant
mediating variable. However, the HAD depression scale focuses on
motivational symptoms rather than self-depreciation, and this aspect
may be represented by the path between self-esteem and self-harm.

DISCUSSION

This study provides evidence of the validity and usefulness of a

multidimensional measure of frustration intolerance beliefs. The
separate dimensions of frustration intolerance were differentially
related to self-control problems, and showed unique relationships
14 Journal of Rational-Emotive & Cognitive-Behavior Therapy

.19
.30
.55***
.14*
Entitlement Anger

.60*** .29
.38***
.13*
Emotional Anxiety
Intolerance
-.15*
Self-harm
-.25***
-.43***

Self-esteem -.30***

.21***
-.11
Age

Figure 1. Self-harm model C showing standardized regression

weights (single arrow), correlations (double arrow), and squared mul-
tiple correlations (in bold). *p < .05, **p < .01, ***p < .001.

independent of self-worth beliefs. This highlights the importance of

distinguishing between belief content dimensions, as well as between
the processes of frustration intolerance and self-worth.
As such, the results help to clarify the relationship between
frustration intolerance and specific problems. For example, Ellis and
Knaus (1977) have argued that low frustration tolerance ‘‘constitutes
the main and the most direct cause of procrastination’’ (p. 19). How-
ever, their description of frustration intolerance included beliefs
regarding emotional intolerance, demands for comfort and immediate
gratification. Perhaps for this reason, empirical evidence has been
inconsistent, with some studies finding no relationship between
irrational beliefs and procrastination (Beswick, Rothblum, & Mann,
1988). The present results indicated that, once self-esteem had been
accounted for, only demands for comfort had a unique relationship
with procrastination. This finding is supported by research using a
student population, which also showed comfort and self-esteem as
unique predictors of procrastination (Harrington, 2003).
Neil Harrington 15

Overspending was associated with several frustration intolerance

dimensions, although only entitlement had a unique relationship.
This suggests that demands for immediate gratification, and beliefs
regarding relative deprivation and fairness, are central to overspend-
ing. There were also significant correlations with both emotional
intolerance and comfort. This supports the argument that overspend-
ing can be used to cope with uncomfortable emotions (Faber, 2000),
but also suggests that this is a strategy for reducing general discom-
fort, not just emotional distress. It was also interesting that the
correlations with these sub-scales remained significant when control-
ling for self-esteem, indicating that discomfort is not just related to
‘‘feeling better about oneself’’ (Faber, 2000, p. 35). Indeed, the regres-
sion analysis showed that the Frustration Discomfort sub-scales
accounted for twice the variance in overspending (12%) compared to
self-esteem (6%).
It was notable that there was no relationship between overspend-
ing and the achievement sub-scale, in spite of descriptions of compul-
sive spenders as perfectionistic (Faber, 2000). Similarly, although
procrastination has been linked to perfectionistic demands (Ellis &
Knaus, 1977), the correlation with achievement beliefs was negligi-
ble. More generally, the achievement sub-scale showed weak or
negligible correlations with self-control. This is perhaps unsurprising,
given that the sub-scale reflects intolerance of lapses in self-discipline
and control. Nevertheless, problems such as procrastination may still
be associated with self-evaluative perfectionism (Flett, Hewitt, &
Martin, 1995).
Frustration Discomfort scores were most strongly correlated with
reliance on medication, with emotional intolerance and comfort
remaining significant when controlling for negative affect. This sug-
gests the relationship is not simply reflecting greater emotional
distress in those individuals taking medication. Rather that, for
individuals with low tolerance for emotional distress, medication may
be used as a form of avoidance. This may have consequences regard-
ing treatment effectiveness. For example, Ellis (1994) has argued
that symptom intolerance is an important feature of post traumatic
stress disorder, and there is evidence that benzodiazepine use
reduces treatment outcome for this condition (Minnen, Arntz, &
Keijsers, 2002).
The structural equation modeling of self-harm enabled the interac-
tion between beliefs to be more fully investigated. The results add to
the evidence that tension/anxiety, and particularly intolerance of
16 Journal of Rational-Emotive & Cognitive-Behavior Therapy

these emotions, is an important factor in self-harm. Whilst anger is

also prominent, the lack of a significant path between anger and
emotional intolerance suggests that, unlike anxiety, anger is not
experienced as intolerable. This is consistent with descriptions of
anger as an empowering emotion, and one that individuals wish to
retain rather than remove (DiGiuseppe et al., 1994). Also notable by
its absence, was a relationship between anger and self-esteem. This
is somewhat surprising, given that self-harm tends to imply anger
directed towards the self. However, it is consistent with a substantial
body of research suggesting that anger and low self-worth are not
associated (e.g. Bushman & Baumeister, 1998). Clearly, the nature of
self-depreciation beliefs in regard to anger needs further exploration,
but it is possible these reflect personal frustration or deprivation,
rather than a sense of worthlessness.
The present findings have several implications for therapy. Clearly,
the effectiveness of therapy would be improved if specific beliefs could
be targeted for change. However, there has been a lack of empirical
evidence as to which beliefs are fundamental to particular disorders
(DiGiuseppe et al., 1994). The classification of frustration intolerance
beliefs into four dimensions enables a more detailed assessment of
these relationships and more focused interventions. For example, the
results indicate that procrastination is related to demands for com-
fort rather than emotional intolerance. More generally, the results
also highlight the importance of separately disputing frustration
intolerance and self-esteem domains. For instance, whilst both anger
and self-worth are factors in self-harm, they appear to be indepen-
dent of each other. Therefore, it cannot be assumed that increasing
self-acceptance will reduce levels of anger. Instead, self-worth and
entitlement beliefs require separate intervention. This is also rele-
vant to evidence that self-control problems may comprise sub-groups
reflecting either self-worth or frustration intolerance beliefs. For
instance, Solomon and Rothblum (1984) found two distinct groups of
procrastinators, one associated with fear of failure and the other with
task aversiveness.
There are several important limitations to this research. Firstly, it
is clear that the use of single questions to measure complex self-con-
trol behavior is inadequate for detailed analysis. For instance,
different forms of self-harming may vary in their relationships with
beliefs, with emotional intolerance having greater relevance to cutting
than to overdosing. Secondly, some problems were poorly represented
Neil Harrington 17

in the sample. In particular, the numbers of individuals with alcohol

problems was small, with just 10% rating this item as being ‘‘very
much’’ a means of coping. This may explain why the expected associa-
tion between alcohol use and frustration intolerance failed to emerge.
A further limitation concerns the difficulty in distinguishing between
functional and dysfunctional coping strategies. In this regard, it could
be argued that the alcohol item might be assessing non-problematic
alcohol use. If so, the results would be consistent with evidence that
irrational beliefs predict alcohol problems but not alcohol use per se
(Hutchinson, Patock-Peckham, Cheong, & Nagoshi, 1998). Similar
criticism may apply to other items, with the use of medication for
symptom relief clearly being functional in some circumstances.
However, the evidence that emotional intolerance and medication re-
mained correlated when, controlling for negative affect, suggests this
relationship is not simply a reflection of emotional distress. Neverthe-
less, future research would benefit from the investigation of specific
groups with more clearly defined dysfunctional behavior.

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