DistressRx™ Assessment Tool
A Framework for Understanding and Transforming Physician Distress
Created by Ali Novitsky, MD — The FIT Collective®
© The FIT Collective®. All Rights Reserved 2025.
How to Use This Page
The DistressRx™ Assessment Page is designed to help you understand your unique distress pattern, apply practical tools, and share this learning with others.
Step 1: Learn Where the DistressRx™ Tool Comes From
The validation summary that follows explains the scientific and coaching foundations behind the DistressRx™ Assessment. It outlines the research supporting its six distinct distress-tolerance types.
Step 2: Take the DistressRx™ Quiz
Complete the online assessment to identify your primary DistressRx™ Type. Scan the QR code or visit thefitcollective.com/distressrx-tool.
Step 3: Review Your Type
Read the section that matches your identified DistressRx™ Type. Each profile includes insight into your strengths, challenges, and key transformation strategies.
Step 4: Explore Next Steps — Transform® or Podcast Episode
Deepen your understanding through the Transform® Program or listen to the related podcast episode.
Step 5: Share with a Colleague or Team
Discuss your insights within your medical team or organization. Collaborative reflection strengthens emotional safety and leadership culture.
Proceed to the next page to explore the validated framework behind DistressRx™.
Validation of the DistressRx™ Assessment Tool
Development and Psychometric Evaluation of a Framework to Identify Distress Tolerance Subtypes Among Women Physicians
Authors
Ali Novitsky, MD — Triple Board-Certified Physician; Master Certified Coach; CEO, The FIT Collective®; Creator of the Transform® Model and DistressRx™ Assessment Tool
Brooke Buckley, MD — Dual Board-Certified Surgeon and Lifestyle Medicine Physician; Specialist in Trauma-Informed Leadership and Workforce Resilience
Mark Novitsky, MD — Dual Board-Certified Psychiatrist; Diplomate, American Board of Obesity Medicine; Expert in Emotional Regulation and Cognitive Behavioral Integration
Abstract
Background: Physicians experience persistent cognitive and emotional load, yet few instruments capture the nuanced ways they internalize and transform distress. The DistressRx™ Assessment was developed to address this gap by operationalizing six distinct distress-tolerance subtypes within the Transform® Model.
Methods: Item development drew on eight years of qualitative coaching data from women physicians, guided by established emotion-regulation and stress-coping models. The instrument was refined to 18 items representing six subtypes and tested with N=350 women physicians using EFA/CFA for validity.
Results: Analyses supported a coherent six-factor structure with excellent fit indices (CFI=1.00, RMSEA=0.004) and strong subscale reliabilities (α=.73–.86).
Conclusions: The DistressRx™ demonstrates exceptional factorial validity and reliability, offering a developmental lens to interpret distress as data for transformation.
Theoretical Framework
The DistressRx™ integrates three foundational theories — stress appraisal (Lazarus & Folkman, 1984), emotion regulation (Gross, 1998), and distress tolerance (Simons & Gaher, 2005) — within a developmental coaching lens. Distress is treated as adaptive feedback, guiding awareness and evolution toward self-regulation and balance.
Subtypes Identified
- Isolation Distress: Emotional withdrawal as protection.
- Assertive Distress: Control or intensity as a guard against vulnerability.
- Validation Distress: Seeking reassurance to affirm worth.
- Control Distress: Overplanning to reduce uncertainty.
- Impulsivity Distress: Rapid action to avoid discomfort.
- Catastrophizing Distress: Anticipating worst outcomes to feel prepared.
Methods & Analysis
Sample: 350 women physicians from The FIT Collective® programs.
Design: Exploratory and confirmatory factor analyses confirmed a six-factor solution explaining 57% variance; subscale reliability α=.73–.86.
Results Summary
| Criterion | Benchmark | Result | Outcome |
|---|---|---|---|
| KMO | .70+ | .75 | Acceptable |
| Bartlett’s Test | p < .001 | < .001 | Pass |
| Variance Explained | ≥ 55% | 57% | Strong |
| Subscale α | .65–.85 | .73–.86 | Excellent |
| CFA Fit (CFI/RMSEA) | ≥ .94 / ≤ .06 | 1.00 / .004 | Excellent |
Discussion
The DistressRx™ bridges clinical psychology and coaching science, reframing distress as adaptive intelligence. It integrates psychometric precision with practical tools for leadership, coaching, and clinical growth.
Implications for Practice
- Individual Insight: Increases self-awareness and emotional agility.
- Coaching Integration: Enables subtype-specific reflection and regulation strategies.
- Organizational Leadership: Informs culture-wide well-being initiatives through real emotional data.
- Clinical Use: Enhances therapeutic frameworks such as CBT and DBT with subtype precision.
Conclusion
The DistressRx™ Assessment provides an evidence-based, developmentally grounded framework to transform distress into insight. It validates that resilience is not the absence of stress — but the integration of it.
Proceed to the next page to explore each DistressRx™ Type and its transformation pathway.
The Isolation Distress Type
“When you allow others to meet you where you are, isolation becomes intimacy.”
Introduction
The Isolation Distress Type embodies the deep ache of disconnection — a longing to belong while feeling unseen or misunderstood. When regulated, this type is profoundly reflective, authentic, and grounded in empathy. When dysregulated, isolation can become both shield and prison: a way to feel safe while unconsciously deepening separation.
Who Is the Isolation Type?
Those with Isolation Distress often appear introspective, independent, and self-reliant. Beneath that calm surface lies a sensitive soul attuned to emotional nuance and subtle energy shifts. Their nervous system craves safety and predictability, leading them to retreat inward when external dynamics feel overwhelming.
“The walls we build to protect ourselves can also become the walls that imprison us.” — Anonymous
Your Core Pattern
When overwhelm hits, you pull away. You tell yourself you just need “a little time to reset,” but the silence grows heavy. You crave closeness and space at once.
Try: Share one small truth daily — even a text to a trusted friend: “Today feels heavy.” Connection is regulation.
Purpose and Drive
At their core, Isolation Types seek authentic connection — the kind that honors truth, not performance. They are guided by the principle that relationships should feel safe, mutual, and emotionally consistent. Purpose arises when they channel solitude into wisdom. They thrive in roles where introspection and depth are valued — coaching, medicine, writing, therapy, and leadership through integrity.
Challenges and Growth Edge
Under stress, the Isolation Type’s instinct is to withdraw — physically, emotionally, or cognitively. What begins as healthy self-preservation can spiral into avoidance, reinforcing loneliness. Healing begins when they stop confusing solitude with safety and start seeing connection as nourishment, not threat.
Relationships and Connection
Isolation Types value depth over quantity. A few authentic relationships mean more than a hundred surface-level interactions. They’re deeply loyal and intuitive, often sensing what others feel before words are spoken. However, their high empathy can lead to emotional exhaustion, causing them to retreat to protect themselves — a pattern that can be misinterpreted as rejection.
“True belonging doesn’t require us to change who we are; it requires us to be who we are.” — Brené Brown
Personal Mission
Isolation Types carry a quiet mission: to bring depth, reflection, and compassion into a world that moves too fast. Their capacity for deep presence makes them powerful mentors, healers, and visionaries. They are here to teach that introspection and connection are not opposites, but complements.
Transformation Coaching Prompts
- Awareness: When I feel misunderstood, how do I protect myself — and what might I lose by doing so?
- Emotion: What emotion is underneath my need to retreat — fear, disappointment, or grief?
- Action: What one small act of openness could move me toward authentic connection today?
🔎 Blind Spots Across the 12 Pillars of Transform®
Pain Point: You try to self-regulate in isolation.
Shift: Safety rebuilds through gentle co-regulation.
Pain Point: You skip meals or rest until you “deserve” it.
Shift: Nourishment isn’t optional — it’s safety.
Pain Point: You numb emotions to stay functional.
Shift: Feeling doesn’t mean falling apart — it means integrating.
The Assertive Distress Type
“Your voice is powerful — when it speaks from truth instead of tension, it inspires rather than defends.”
Introduction
The Assertive Distress Type is driven by conviction and intensity. When regulated, this type channels passion into leadership, advocacy, and action. When dysregulated, assertiveness transforms into control, urgency, or frustration — an attempt to protect vulnerability by doubling down on strength. Beneath their armor lies a heart that deeply desires respect, safety, and harmony.
Who Is the Assertive Type?
Assertive Types are natural leaders — decisive, articulate, and purposeful. They thrive where clarity and competence matter. Yet when misunderstood or dismissed, they shift into overdrive, believing they must push harder to be heard or maintain control.
“Between stimulus and response, there is a space. In that space is our power to choose our response.” — Viktor Frankl
Your Core Pattern
When tension rises, you take charge. You fix, direct, or debate — not from dominance, but fear that things will fall apart without you.
Try: Before reacting, pause for three breaths. Ask, “Am I protecting my peace, or proving my point?”
Purpose and Drive
Assertive Types seek impact. They lead, advocate, and create change. Their drive comes from integrity — they can’t stand by and watch things go wrong. When regulated, they use influence to empower others. True purpose appears when leadership becomes collaboration, not control.
Challenges and Growth Edge
Under stress, Assertive Types experience tension between control and surrender. The more they fear losing influence, the more tightly they grip — which can alienate others or cause burnout. Growth begins when they realize that safety doesn’t come from control but from trust. True authority invites respect; it never demands it.
Relationships and Connection
In relationships, Assertive Types crave honesty and respect. They’re loyal and protective but may become defensive when hurt — not to wound, but to avoid vulnerability. Transformation begins when they allow tenderness without fear of weakness.
“Courage is what it takes to stand up and speak; courage is also what it takes to sit down and listen.” — Winston Churchill
Personal Mission
Assertive Types are born to lead through compassion. Their voice inspires when it’s grounded in empathy. Their mission is to model balanced power — firm yet kind, strong yet open. When they lead from presence instead of pressure, their influence becomes unstoppable.
Transformation Coaching Prompts
- Awareness: When do I mistake control for care?
- Emotion: What fear drives my need to be right or in charge?
- Action: How can I express my truth with curiosity instead of conviction?
🔎 Blind Spots Across the 12 Pillars of Transform®
Pain Point: You equate control with safety.
Shift: Regulation begins in release — not rigidity.
Pain Point: You push past fatigue.
Shift: Strength builds through recovery, not repetition.
Pain Point: You override body cues.
Shift: Listening to physiology is leadership from within.
Pain Point: You analyze others but avoid reflection.
Shift: Curiosity invites growth.
Pain Point: Anger feels safer than sadness.
Shift: Vulnerability expands your range, not weakens it.
The Validation Distress Type
“You give endlessly to be appreciated — yet the love you seek can’t arrive until you believe you’re already enough.”
Introduction
The Validation Distress Type is driven by connection, compassion, and the deep desire to be seen and valued. When regulated, this type is nurturing, encouraging, and inspiring — they make people feel understood and safe. When dysregulated, their empathy turns outward in overdrive. They give, please, and perform to earn love or worth, leaving little energy for themselves.
Their healing begins when they realize validation is not something received — it’s something reclaimed from within.
Who Is the Validation Type?
Validation Types are the encouragers — the ones who remember birthdays, check in after long days, and anticipate others’ needs before their own. They are magnetic and generous, often the emotional glue of teams, friendships, and families.
“You alone are enough. You have nothing to prove to anybody.” — Maya Angelou
But under the surface, they may feel unseen or unappreciated. Their strength lies in empathy; their challenge is believing that love doesn’t have to be earned.
Your Core Pattern
When distress arises, you give more. You over-function in relationships, workplaces, or families, hoping your effort will be met with appreciation or care. But the more you do, the more unseen you can feel.
Try: Before saying “yes,” pause and ask, “Am I connecting or compensating?” Choose connection — it nourishes both people. Compensation depletes both.
Purpose and Drive
Validation Types are here to heal through love. Their purpose is to remind others that kindness matters, that compassion transforms communities. Their drive is relational — they feel most alive when making a difference in someone’s day. Their next evolution comes when they extend that same kindness inward — realizing that their worth doesn’t grow through sacrifice, but through self-respect.
Challenges and Growth Edge
When dysregulated, Validation Types can lose boundaries, equating selflessness with virtue. They overextend, absorbing others’ pain until resentment builds. Their nervous system seeks external reassurance, but no amount of praise feels lasting. Their growth edge is self-validation — learning to anchor in their own approval, not the applause of others.
Relationships and Connection
Validation Types are generous partners, colleagues, and friends. They create belonging wherever they go, but often feel taken for granted or invisible when others don’t reciprocate. They sometimes mistake compliance for connection — harmony at the expense of honesty.
“When you say yes to others, make sure you are not saying no to yourself.” — Paulo Coelho
Connection deepens when they set boundaries rooted in love. Authentic relationships form not when they give everything, but when they share themselves fully — truth, needs, and all.
Personal Mission
Validation Types are the heart of healing. Their mission is to embody empathy with integrity — to show that love is powerful when it flows both ways. When they validate themselves, their compassion becomes contagious and their presence profoundly healing.
Transformation Coaching Prompts
- Awareness: When do I give to be seen rather than to connect?
- Emotion: What fear arises when I prioritize my own needs?
- Action: What loving boundary could honor me and others today?
🔎 Blind Spots Across the 12 Pillars of Transform®
Pain Point: You soothe others to avoid your own discomfort.
Shift: Self-compassion regulates the nervous system faster than people-pleasing.
Pain Point: You skip nourishment to meet others’ needs.
Shift: Feeding yourself first sustains everyone longer.
Pain Point: You normalize fatigue and ignore your body’s signals.
Shift: Listening to your physiology is an act of self-love.
The Control Distress Type
“You organize chaos so no one sees your fear — but safety was never found in perfection.”
Introduction
The Control Distress Type seeks steadiness in a world that often feels unpredictable. When regulated, they are calm, capable, and methodical — leaders who bring order to complexity. When dysregulated, control becomes a coping mechanism — an effort to guard against uncertainty or emotional pain. The more they tighten their grip, the more fragile their sense of safety becomes.
For the Control Type, transformation is not about losing structure — it’s about releasing rigidity to rediscover flow.
Who Is the Control Type?
Control Distress Types are dependable, disciplined, and deeply responsible. They excel in leadership, organization, and follow-through. Others trust them instinctively because of their reliability.
“You must learn to let go. Release the stress. You were never in control anyway.” — Steve Maraboli
Yet beneath their composed exterior lies a tender fear — that without control, everything might unravel. The work is learning that peace can exist even when outcomes can’t be predicted.
Your Core Pattern
When uncertainty rises, you plan, perfect, and manage harder. You organize your world to feel secure — but every unexpected moment reactivates the need for control.
Try: Choose one area to soften daily. Let someone else decide dinner, or allow a meeting to unfold without scripting your response. Trust that imperfection won’t erase safety.
Purpose and Drive
Control Types are natural stabilizers. They ground others through structure and clarity, often becoming anchors during crisis. Their purpose flourishes when they learn that leadership includes flexibility. They are driven by reliability — yet their true power is in balanced responsiveness.
Challenges and Growth Edge
When stressed, Control Types default to over-management — of themselves, others, or outcomes. This vigilance stems from love, not ego. But it can create tension, resentment, or burnout. Their growth edge lies in learning that release doesn’t mean recklessness. Allowing flow invites creativity, connection, and genuine safety — the kind that doesn’t depend on control.
Relationships and Connection
Control Types express love through caretaking, planning, and problem-solving. They keep relationships stable but may inadvertently create emotional distance by managing rather than relating. They struggle when others deviate from expectations, mistaking unpredictability for danger.
“To love is to let those we love be perfectly themselves.” — Thomas Merton
Connection deepens when they replace control with curiosity — listening without correcting, and allowing others to contribute to the plan.
Personal Mission
Control Types are meant to teach the world that structure and surrender can coexist. Their steadiness helps others feel safe, but their personal evolution comes from embracing adaptability. Their mission is to model calm confidence — rooted not in control, but in trust.
Transformation Coaching Prompts
- Awareness: What fear arises when I release control?
- Emotion: What would it feel like to trust instead of manage?
- Action: Where can I practice gentle flexibility today?
🔎 Blind Spots Across the 12 Pillars of Transform®
Pain Point: You over-manage emotions through control.
Shift: True regulation arises from trust, not tightness.
Pain Point: You follow rigid routines that stifle enjoyment.
Shift: Flexibility fuels sustainability — progress, not perfection.
Pain Point: You mistake planning for preparedness.
Shift: Presence creates clarity that planning alone can’t.
The Impulsivity Distress Type
“You move fast to feel free — but peace comes when you learn that stillness doesn’t mean stuck.”
Introduction
The Impulsivity Distress Type lives with a nervous system that equates speed with safety. When regulated, they’re bold innovators — spontaneous, passionate, and full of creative fire. When dysregulated, that same energy becomes chaotic — decisions made to escape discomfort rather than move toward alignment.
For this type, transformation isn’t about restraint — it’s about learning to pause long enough to choose, not react.
Who Is the Impulsivity Type?
Impulsivity Types are intuitive movers. They act from instinct, not hesitation, often sensing what needs to happen before others even see it. Their enthusiasm is contagious, their courage inspiring.
“Don’t confuse motion with progress. Sometimes stillness is the most powerful move.” — Unknown
But when stress hits, they move too quickly — buying, committing, quitting, or reacting before their intuition has a chance to speak clearly. Their nervous system craves relief, not reflection. Their deepest wish is to trust that nothing is lost in waiting — that patience is not punishment, but power.
Your Core Pattern
When tension rises, you act. The discomfort of uncertainty pushes you to “do something,” even if that action doesn’t serve your long-term peace. The quick fix — whether it’s a decision, purchase, or reaction — offers momentary calm but often leads to regret or depletion.
Try: When the urge to act hits, take one conscious breath and ask, “Is this relief or alignment?” Choose the one that will feel right tomorrow.
Purpose and Drive
Impulsivity Types are catalysts — they bring movement where others stay stuck. Their quick energy sparks change, innovation, and courage in teams and relationships. Their purpose flourishes when they learn to honor their inner rhythm — using speed when inspired and stillness when uncertain. Mastery comes from discerning between intuition and impulse.
Challenges and Growth Edge
Under stress, Impulsivity Types can seek stimulation to avoid stillness — food, screens, spending, or overcommitting. They may feel guilt after acting “too fast,” then swing toward avoidance or self-criticism.
Their growth edge lies in tolerating the pause — letting the nervous system settle enough to sense true direction. Regulation replaces reactivity. When they practice stillness, clarity naturally arises.
Relationships and Connection
Impulsivity Types bring fun, surprise, and depth to relationships — until stress flips spontaneity into volatility. Partners may feel confused by rapid changes or emotional swings. Beneath it all, the Impulsivity Type fears being trapped or controlled.
“Freedom is not the absence of commitment, but the ability to choose and commit to what is best for you.” — Paulo Coelho
Connection deepens when they learn to communicate before acting — sharing the emotion that drives the impulse. Vulnerability becomes their grounding anchor.
Personal Mission
Impulsivity Types are here to teach embodied freedom — that true liberation isn’t escape, but presence. Their energy ignites possibility when directed with purpose. When they learn to pause, breathe, and trust timing, their leadership transforms chaos into creation.
Transformation Coaching Prompts
- Awareness: When does urgency replace intuition?
- Emotion: What discomfort am I trying to outrun?
- Action: What practice helps me stay with the feeling instead of fixing it?
🔎 Blind Spots Across the 12 Pillars of Transform®
Pain Point: You act quickly to discharge stress.
Shift: Regulation happens through pause, not movement.
Pain Point: You start fast but struggle with consistency.
Shift: Progress is built in the pause between reps and routines.
Pain Point: You act before you feel.
Shift: Emotion becomes wisdom when it’s witnessed, not avoided.
The Catastrophizing Distress Type
“You prepare for the worst to protect your heart — but peace comes when you stop rehearsing pain that hasn’t happened.”
Introduction
The Catastrophizing Distress Type lives with a nervous system that’s always scanning for danger. When regulated, they’re insightful, analytical, and empathetic — able to anticipate problems and plan with precision. When dysregulated, their protective mind turns against them, spinning stories of what could go wrong until worry becomes a constant companion.
For this type, transformation is not about stopping thoughts — it’s about learning to feel safe enough to stop believing every one of them.
Who Is the Catastrophizing Type?
Catastrophizing Types are thinkers and protectors. They’re highly intuitive, conscientious, and alert — always considering every possible outcome. Their foresight helps them prepare, plan, and prevent. But when overactivated, this gift turns into anxiety — a mind that runs simulations of disaster instead of peace.
“Worry does not empty tomorrow of its sorrow. It empties today of its strength.” — Corrie Ten Boom
Their deepest wish is to feel safe enough to relax. Their healing begins when they learn that safety is felt, not calculated.
Your Core Pattern
When uncertainty rises, you forecast the worst. You replay scenarios, plan contingencies, and double-check every detail. This gives you a fleeting sense of control, but fuels the very stress you’re trying to avoid.
Try: When the spiral starts, ask: “What’s actually happening right now?” Ground yourself in reality — not probability.
Purpose and Drive
Catastrophizing Types are wise visionaries. Their ability to see multiple outcomes makes them brilliant strategists, physicians, and problem-solvers. They’re driven by responsibility and care — their minds race not because they’re irrational, but because they care deeply about what could go wrong. Their purpose flourishes when they learn to trust themselves and life’s uncertainty. Their wisdom shines brightest when it’s grounded in calm awareness instead of cognitive alarm.
Challenges and Growth Edge
Under stress, Catastrophizing Types can overanalyze, over-research, or mentally rehearse catastrophe. Their fear of loss or failure often masks deeper emotions — grief, guilt, or powerlessness. Their growth edge lies in nervous system regulation. Calm is not created by thinking differently — it’s embodied through breath, grounding, and trust. When they learn to return to the present moment, their mind becomes a tool for wisdom, not worry.
Relationships and Connection
Catastrophizing Types love deeply and protect fiercely. But their hypervigilance can make relationships feel heavy — partners may sense mistrust, or friends may feel like they’re always under evaluation. Beneath this, the Catastrophizer’s intentions are pure: they fear losing what they love.
“Faith is taking the first step even when you don’t see the whole staircase.” — Martin Luther King Jr.
Connection deepens when they replace worry with communication. Expressing fear as vulnerability — not control — opens the door to support and safety.
Personal Mission
Catastrophizing Types are here to teach emotional safety. Their sensitivity to potential harm is the same sensitivity that allows them to heal, protect, and advocate. When they learn to balance foresight with faith, their leadership becomes both grounded and visionary.
Transformation Coaching Prompts
- Awareness: When does my preparation cross into fear?
- Emotion: What feeling hides beneath my need for certainty?
- Action: What grounding ritual brings me back to now?
🔎 Blind Spots Across the 12 Pillars of Transform®
Pain Point: You mentally prepare for danger to feel safe.
Shift: Regulation begins in the body — not the mind.
Pain Point: You confuse thinking for problem-solving.
Shift: Awareness without attachment restores peace.
Pain Point: You analyze emotions instead of feeling them.
Shift: Emotions integrate through sensation, not explanation.
Moving Forward
The DistressRx™ Assessment invites you to move beyond labeling distress — and instead, learn from it. Each subtype offers a mirror, reflecting both your adaptive intelligence and your growth edge. As you continue exploring your DistressRx™ Type, remember that awareness is the first act of regulation.
Transformation begins when you choose curiosity over criticism, presence over perfection, and connection over control.
Your next step is simple — explore your unique profile, apply the reflection prompts, and integrate the insights into your daily life and leadership. Whether through the Transform® Program , the Metabolism, Muscles, and Mindset Podcast , or peer discussion within your medical community, the work of integration happens one conscious moment at a time.
DistressRx™ is more than an assessment — it’s a framework for emotional evolution, designed to help physicians transform distress into clarity, courage, and connection.