Distress Tolerance and Social Support in Adolescence: Predicting Risk for Internalizing and Externalizing Symptoms Following a Natural Disaster

  • Joseph R. Cohen
  • Carla Kmett Danielson
  • Zachary W. Adams
  • Kenneth J. Ruggiero


The purpose of the multi-measure, multi-wave, longitudinal study was to examine the interactive relation between behavioral distress tolerance (DT) and perceived social support (PSS) in 352 tornado-exposed adolescents aged 12–17 years (M = 14.44; SD = 1.74). At baseline, adolescents completed a computer-based task for DT, and self-report measures of PSS, depressed mood, posttraumatic stress disorder (PTSD), substance use, and interpersonal conflict. Symptoms also were assessed 4 and 12 months after baseline. Findings showed that lower levels of DT together with lower levels of PSS conferred risk for elevated symptoms of prospective depression (t(262) = −2.04, p = .04; reffect size = 0.13) and PTSD (t(195) = −2.08, p = .04; reffect size = 0.15) following a tornado. However, only PSS was significant in substance use t(139) = 2.20, p = .03; reffect size=0.18) and conflict (t(138) = −4.05, p < .0001; reffect size=0.33) in our sample. Implications regarding adolescent DT, the transdiagnostic nature of PSS, and the clinical applications of our findings in the aftermath of a natural disaster are discussed.


Distress tolerance Perceived social support Natural disasters Adolescence Internalizing symptoms Externalizing symptoms 



The National Institute of Mental Health supported this study and the team of collaborators: data collection occurred via grants R01MH081056 to KJR and R21MH086313 to CKD. The preparation of this manuscript was partially supported by grant R01DA031285 to CKD, grant K12-DA031794 which supports ZWA, and T32MH18869 which supported JRC.

Compliance with Ethical Standards

Conflict of Interest

Joseph R. Cohen, Carla Kmett Danielson, Zachary W. Adams and Kenneth J. Ruggiero have no conflict of interest to report.

Experiment Participants

All procedures and protocols for this study were approved by the Institutional Review Board (IRB) at the MedicalUniversity of South Carolina.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Joseph R. Cohen
    • 1
  • Carla Kmett Danielson
    • 2
  • Zachary W. Adams
    • 2
  • Kenneth J. Ruggiero
    • 3
    • 4
  1. 1.Department of PsychologyUniversity of IllinoisChampaignUSA
  2. 2.National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharlestonUSA
  3. 3.Technology Applications Center for Healthful Lifestyles, College of NursingMedical University of South CarolinaCharlestonUSA
  4. 4.Health Equity and Rural Outreach Innovation CenterRalph H. Johnson VAMCCharlestonUSA

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