The CDC estimates that approximately 20.9% of U.S. adults currently smoke. Moreover, cigarette smoking continues to be the leading preventable cause of death and disability in the United States making it is a significant public health problem. Although 70% of smokers express a desire to quit, relapse is quite common, with rates as high as 60-90% depending on the method of quitting used. Moreover, many smokers who attempt to quit, lapse within a few days, and many of these individuals ultimately resume smoking and are not able to recover to achieve abstinence. The initial experience of smoking cessation is stressful and is associated with a number of unpleasant withdrawal symptoms. Therefore, one particular hypothesis suggests that how an individual reacts to and tolerates these uncomfortable feelings may be a key contributing factor of relapse. This threshold for tolerating physical and psychological stress is known as distress tolerance. While early evidence has suggested that distress tolerance is associated with duration of quit attempts, to date, no study has examined the effects of distress tolerance across physical, psychological and biological domains on a number of other relapse predictors (e.g. negative affect, anxiety sensitivity and withdrawal symptoms) in determining smoking outcome. Therefore, the following study looked at the role of these variables in predicting smoking outcome in a group of 58 adult smokers who entered a smoking cessation treatment study. As hypothesized, both measures of physical distress tolerance and one measure of psychological distress tolerance significantly predicted time to smoking lapse above and beyond other smoking related variables. There was no relationship between smoking abstinence and self-report and biological measures of distress tolerance. There were also no significant findings with respect to any affect related smoking variables. Implications and future directions are addressed.