Coping Pitfalls and Promise

2 Dec 2003 18:53 AR AR207-PS55-26.tex AR207-PS55-26.sgm LaTeX2e(2002/01/18)P1: GCE10.1146/annurev.psych.55.090902.141456

Annu. Rev. Psychol. 2004. 55:745–74doi: 10.1146/annurev.psych.55.090902.141456

Copyright c© 2004 by Annual Reviews. All rights reservedFirst published online as a Review in Advance on November 3, 2003

COPING: Pitfalls and Promise

Susan Folkman and Judith Tedlie MoskowitzOsher Center for Integrative Medicine, University of California, San Francisco,California 94143-1726; email: [email protected], [email protected]

Key Words coping critique, coping measurement, positive emotion, copingeffectiveness, coping and meaning

■ Abstract Coping, defined as the thoughts and behaviors used to manage the inter-nal and external demands of situations that are appraised as stressful, has been a focusof research in the social sciences for more than three decades. The dramatic prolifera-tion of coping research has spawned healthy debate and criticism and offered insightinto the question of why some individuals fare better than others do when encounter-ing stress in their lives. We briefly review the history of contemporary coping researchwith adults. We discuss three primary challenges for coping researchers (measurement,nomenclature, and effectiveness), and highlight recent developments in coping theoryand research that hold promise for the field, including previously unaddressed aspectsof coping, new measurement approaches, and focus on positive affective outcomes.

CONTENTS

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 746Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 746The Contextual, Cognitive Model of Coping. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 747What Have We Learned?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 747

CHALLENGING ISSUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 748Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 748Coping Nomenclature: Conceptual and Empirical Approaches. . . . . . . . . . . . . . . . 751Coping Effectiveness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 753

NEW DEVELOPMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 756Future-Oriented Proactive Coping. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 757Dual Process Model of Coping. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 757Social Aspects of Coping. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 758Religious Coping. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 759Emotional Approach Coping. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 761Emotion Regulation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 762Coping and Positive Emotion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 764

CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 768

0066-4308/04/0204-0745$14.00 745

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746 FOLKMAN ¥ MOSKOWITZ

INTRODUCTION

The past 35 years have seen a dramatic proliferation of coping research across socialand behavioral science, medicine, public health, and nursing. Research rangesfrom small-sample qualitative studies to large-scale population-based studies, withcontent ranging from the exploration of abstract theoretical relationships to appliedstudies in clinical settings. Many investigators undertook this research with thehope that the concept of coping might help explain why some individuals farebetter than others do when encountering stress in their lives. Many other concepts,such as culture, developmental history, or personality, can also help explain theseindividual differences, but coping is unlike these other concepts in that it lendsitself to cognitive-behavioral intervention. As such, its allure is not only as anexplanatory concept regarding variability in response to stress, but also as a portalfor interventions.

Background

A large proportion of contemporary coping research can be traced back to thepublication of Richard Lazarus’s 1966 book,Psychological Stress and the CopingProcess. Previously, most research on coping had been couched in the frameworkof ego-psychology and the concept of defense, as exemplified by the work of Haan(1969), Menninger (1963), and Vaillant (1977). This research was often concernedwith pathology and depended on the evaluation of unconscious processes. In hisbook, Lazarus presented a contextual approach to stress and coping that helped seta new course. Lazarus’s formulation expanded the boundaries of coping beyonddefense and an emphasis on pathology to include a wider range of cognitive andbehavioral responses that ordinary people use to manage distress and address theproblems of daily life causing the distress. Lazarus’s theory placed great emphasison the role of cognitive appraisal in shaping the quality of the individual’s emotionalresponse to a troubled person-environment relationship and to the ways in whichthe person coped with the appraised relationship. His cognitively oriented theoryof stress and coping occurred within the context of the “cognitive revolution” andits intense interest in the relation between cognition and emotion (e.g., Mandler1975, Simon 1967) and information processing under conditions of stress (e.g.,Horowitz 1976, Janis & Mann 1977, Leventhalet al. 1980). This historical contextundoubtedly helped create the fertile environment in which Lazarus’s theory ofstress and coping took root.

Coping as a distinct field of psychological inquiry emerged during the 1970s and1980s. By 1974 publications included a major book edited by Coelho, Hamburg,& Adams titled Coping and Adaptation, as well as scholarly books on copingwith illness (Antonovsky 1979, Moos & Tsu 1977) and coping with childhoodand adolescence (Murphy & Moriarty 1976). Lazarus & Folkman (Folkman &Lazarus 1980, Lazarus & Folkman 1984) defined coping as thoughts and behaviorsthat people use to manage the internal and external demands of situations that

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COPING 747

are appraised as stressful. This definition became widely accepted (Tennen et al.2000) and tools with which to measure these coping thoughts and behaviors weredeveloped (e.g., Billings & Moos 1981, Folkman & Lazarus 1980, Pearlin &Schooler 1978). By the early 1980s, reports of empirical studies of coping began toappear in growing numbers. Since then many new measures have been developedand tens of thousands of studies have been published (Somerfield & McCrae2000). Major books on coping were published, includingStress, Coping, andDevelopment(Aldwin 1994) andThe Handbook of Coping(Zeidner & Endler1996). Although defense-focused research continued throughout this period withinpsychology (e.g., Vaillant 2000, Cramer 2000), cognitive approaches prevailed.

The Contextual, Cognitive Model of Coping

Coping is a process that unfolds in the context of a situation or condition thatis appraised as personally significant and as taxing or exceeding the individual’sresources for coping (Lazarus & Folkman 1984). The coping process is initiatedin response to the individual’s appraisal that important goals have been harmed,lost, or threatened. These appraisals are characterized by negative emotions thatare often intense. Coping responses are thus initiated in an emotional environment,and often one of the first coping tasks is to down-regulate negative emotions thatare stressful in and of themselves and may be interfering with instrumental formsof coping. Emotions continue to be integral to the coping process throughout astressful encounter as an outcome of coping, as a response to new information,and as a result of reappraisals of the status of the encounter. If the encounterhas a successful resolution, positive emotions will predominate; if the resolutionis unclear or unfavorable, negative emotions will predominate. To date, empha-sis has been given to negative emotions in the stress process. However, new re-search about the role of positive emotions in the stress process and the role ofcoping in generating and sustaining these emotions has been prompted by re-cent evidence that positive and negative emotions co-occur throughout the stressprocess.

What Have We Learned?

In the years since the early 1980s, we have learned that coping is a complex,multidimensional process that is sensitive both to the environment, and its de-mands and resources, and to personality dispositions that influence the appraisalof stress and resources for coping. We have found that coping is strongly asso-ciated with the regulation of emotion, especially distress, throughout the stressprocess. We have found that certain kinds of escapist coping strategies are consis-tently associated with poor mental health outcomes, while other kinds of coping—such as the seeking of social support or instrumental, problem-focused forms ofcoping—are sometimes associated with negative outcomes, sometimes with posi-tive ones, and sometimes with neither, usually depending on characteristics of theappraised stressful encounter. We have learned about the development of coping

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over the life span. And we have learned that coping skills can be taught throughcognitive-behavioral therapies.

Despite the substantial gains that have been made in understanding coping perse, we seem only to have scratched the surface of understanding the ways in whichcoping actually affects psychological, physiological, and behavioral outcomes bothin the short- and the longer-term. The discovery task is not simple. Coping is nota stand-alone phenomenon. It is embedded in a complex, dynamic stress processthat involves the person, the environment, and the relationship between them.

Our goals in this chapter are twofold: first, to review central issues in copingresearch, and second, to review recent developments in coping theory and researchthat hold promise for the field. The literature on coping is vast, and we found itnecessary to limit our review in several ways. We focus on coping research that isconsistent with the cognitive, contextual approach as opposed to trait approachesor approaches based primarily on defense processes. We also focus on researchwith adults as opposed to children, and on populations that are not impaired bysevere psychopathology.

CHALLENGING ISSUES

Numerous articles have been published that contain forceful criticisms of copingresearch, especially methodology (for review, see Somerfield & McCrae 2000). Inthis section we discuss three major issues that are widely debated in the copingliterature: measurement, nomenclature, and the determination of effectiveness.

Measurement

The widespread interest in a contextual approach to stress and coping of the 1970sand 1980s motivated the development of new measures to assess coping in spe-cific stressful situations. For the most part, the first generation of these new copingmeasures took the form of a checklist of thoughts and behaviors that people use tomanage stressful events. Respondents were usually asked to provide a retrospec-tive report of how they coped with a specific stressful event or they were askedto respond to vignettes that portrayed stressful situations. Answers were scoredYes/No or on Likert scales. Examples of inventories intended to be applicablein general populations include the Ways of Coping (Folkman & Lazarus 1980,1988); the COPE (Carver et al. 1989); Coping Response’s Inventory (Moos 1993);the Coping Strategy Indicator (Amirkhan 1990); and the Coping Inventory forStressful Situations (Endler & Parker 1990; see Schwarzer & Schwarzer 1996 fora comprehensive review of coping measures).

These inventories are helpful in that they allow multidimensional descriptionsof situation-specific coping thoughts and behaviors that people can self-report(Stone et al. 1992). Nevertheless, the inventory approach has many limitations,including:

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COPING 749

■ potentially burdensome length (Stone & Neale 1984)■ inadequate sampling of coping inherent in checklist approaches and response

keys that are difficult to interpret (Stone et al. 1992)■ variations in the recall period (Porter & Stone 1996)■ changes in meaning of a given coping strategy depending on when it occurs

(e.g., logical analysis before the problem would be constructive thinking,afterward it could be rumination)

■ unreliability of recall (Coyne & Gottlieb 1996), and■ confounding of items with their outcomes (Stanton et al. 1994).

The most prominent of all the criticisms of the checklist approach concerns theproblem of retrospective report and the accuracy of recall about specific thoughtsand behaviors that were used one week or one month earlier. Stone & Neale (1984)developed the Daily Coping Inventory, a measure of daily coping efforts, to remedythe problem of recall. Instead of asking subjects to recall their most stressfulevent retrospectively across one week, two weeks, or a month, as most inventoriesrequest, subjects are asked to think about the most bothersome event that occurredthat day. A study by Ptacek et al. (1994) provided support for shortening therecall period to one day. They compared brief daily coping reports completed bycollege students over seven days with retrospective reports of coping over the sameperiod. Correlations between daily coping measures (averaged across days) andthe retrospective measures ranged from 0.47 to 0.58.

Stone and his colleagues subsequently developed momentary coping assess-ments using ecological momentary assessment techniques (Stone et al. 1998) in astudy that compared the “real-time” approach of the momentary assessments withone- and two-day retrospectively reported coping. Approximately 30% of the par-ticipants failed to retrospectively report items they had reported on the momentaryassessments, and conversely, approximately 30% of the participants retrospectivelyreported items that were not reported on the momentary assessments.

Momentary and retrospective accounts yield different information about cop-ing. Approaches with short recall are especially useful in intraindividual designsto study the relationship between changes in coping and changes in proximal out-comes such as mood or illness symptoms (Tennen et al. 2000). Some suggest thatintraindividual designs are by far the preferred way to understand how copingaffects physical and emotional well-being (Lazarus 2000). The momentary as-sessment procedure, however, has its own shortcomings. As Stone et al. (1998)point out, their subjects were asked repeatedly to recall their coping efforts, whichmay have resulted in some coping not being reported, perhaps because participantsthought they already had reported it. Further, the momentary focus may result inreports of very concrete, discrete events, thereby missing ongoing problems ormore abstract, complex problems. The momentary assessments might also elicitliteral reports of specific thoughts and actions, and miss the broader conceptual-izations of coping that are better perceived with the benefit of some retrospection,

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such as those that involve finding meaning. Conversely, retrospective accountsmay be more subject to distortion associated with participants’ efforts to create acoherent narrative of what happened or to find meaning in the event. Stone et al.point out that retrospective accounts may actually be better predictors of futureoutcomes than the momentary assessments. One explanation for this may be thatwhat participants report as coping has become the “true story” for them and thuspredicts future actions.

Narrative approaches provide an interesting alternative to checklist approaches.A great deal can be learned by asking people to provide narratives about stressfulevents, including what happened, the emotions they experienced, and what theythought and did as the situation unfolded. Narrative approaches are helpful inunderstanding what the person is coping with, which is especially important whenthe stressful event is not a specific event named by the investigator, such as copingwith exams, or a particular health-related procedure, such as an endoscopy. Forexample, Folkman et al. (1994) analyzed the narratives of the caregiving partnersof men with acquired immunodeficiency syndrome (AIDS) who had been asked toreport the most stressful event related to caregiving. Within the general category ofcaregiving, narratives revealed many different sources of stress, including adjustingto illness progression, the shifting of responsibilities from the caregiver to thepatient, unexpected improvement in the patient’s health, and role conflict. Theseinsights were helpful in understanding the caregivers’ perspectives regarding whatthey were actually coping with in their daily lives.

Narrative approaches are also useful for uncovering ways of coping that arenot included on inventories. In their analysis of narratives provided by caregiversof people with dementia, for example, Gottlieb & Gignac (1996) identified waysof coping not included on most inventories, such as ways of making meaning(normalizing experiences and feelings, “reading” cognitions and internal states ofthe care recipient) and vigilance (continuous watchfulness). Moskowitz & Wrubel(2000) analyzed 246 stressful event narratives in a sample of 20 human immuno-deficiency virus positive (HIV+) men who each had up to 13 interviews over a two-year period. They coded the narratives for coping thoughts and behaviors and triedto match them to the eight categories of coping contained in the Ways of Coping(Folkman & Lazarus 1988). Moskowitz & Wrubel identified coping processesnot included on the Ways of Coping inventory, such as offering support, mentallypreparing for what was coming, and venting emotion through crying or writing.

Moskowitz & Wrubel also examined the overlap between a quantitative measure(the Ways of Coping, Folkman & Lazarus 1988) and their narrative analysis. Firstthey examined the extent to which the eight kinds of coping measured by the Waysof Coping appeared spontaneously in the narratives and found the proportion ofmatches ranging from 8% to 42%. They then looked in the opposite direction andfound that spontaneous accounts of the eight kinds of coping that appeared in thenarratives were matched by reports on the Ways of Coping much more consistently,the proportion of matches ranging from 57% to 100%. These findings suggest thatnarrative and quantitative approaches overlap, but are not equivalent.

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COPING 751

There is no gold standard for the measurement of coping. Momentary accountsaddress the problem of bias due to recall, but they may underrepresent the com-plexity of coping over time and the complexity of what people actually cope with.Retrospective accounts address the problems of complexity, but introduce the ef-fects of coping processes that take place in the interim. Retrospective accounts, in asense, may be telling us what the person is doing now to cope with what happenedthen, as well as what the person did then to cope with what happened then. Somemight call this “error” or “noise.” We consider it another aspect of coping. Finally,narrative methods generate ways of coping that are not contained in checklists.However, without the prompting of a checklist, people may overlook some of theways they coped.

The measurement of coping is probably as much art as it is science. The artcomes in selecting the approach that is most appropriate and useful to the re-searcher’s question. Sometimes the best solution may involve several approaches.A narrative approach with a small sample can be very useful in defining the do-mains of stressors that are relevant for the study population. This information canthen be used to define a limited range of stressors to be used with a quantitativemeasure. This approach is also useful for uncovering ways of coping that are notincluded on standard coping inventories Momentary and retrospective accountsprovide different perspectives on coping. One or the other may be preferable,depending on whether the outcome of interest is proximal (such as mood), a be-havioral outcome (such as resolution of interpersonal conflict or performance ona test), or more distal (such as recovery from surgery or recurrence of mental orphysical illness).

Coping Nomenclature: Conceptual and Empirical Approaches

Coping inventories usually contain several dozen specific thoughts and behaviors.If one counted the unique items on all inventories there would probably be hun-dreds. A challenge for coping researchers is to find a common nomenclature forthese diverse coping strategies so that findings across studies can be discussedmeaningfully.

Researchers have generally clustered coping responses rationally, using theory-based categories; empirically, using factor analysis; or through a blend of bothrational and empirical techniques. One of the earlier nomenclatures, proposedby Folkman & Lazarus (1980), used a rational approach to distinguish two ma-jor theory-based functions of coping: problem-focused coping, which involvesaddressing the problem causing distress, and emotion-focused coping, which isaimed at ameliorating the negative emotions associated with the problem. Someexamples of problem-focused coping are making a plan of action or concentratingon the next step. Examples of emotion-focused coping are engaging in distractingactivities, using alcohol or drugs, or seeking emotional support.

The theoretical distinction between problem-focused and emotion-focusedcoping provides a useful way of talking about many kinds of coping in broad

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brushstrokes and it is used extensively in the coping literature. Other conceptu-alizations of coping functions often fit these categories. For example, Billings &Moos (1981) proposed a three-factor conceptualization of coping consisting ofActive Cognitive (e.g., tried to see the positive side; considered several alterna-tives) and Active Behavioral (e.g., talked with a friend, tried to find out more aboutthe situation), which are problem-focused coping, and Avoidance (e.g., tried toreduce tension by eating more, got busy with other things to avoid thinking aboutthe problem), which is a form of emotion-focused coping.

Several investigators found that the problem-focused and emotion-focused dis-tinction was a good starting point, but they identified meaning-focused coping as adifferent type of coping in which cognitive strategies are used to manage the mean-ing of a situation. Pearlin & Schooler (1978), for example, included the responsesof positive comparisons or selective ignoring in this category. Park & Folkman(1997) also proposed a meaning-making factor as a useful way to think aboutcoping efforts in which the person draws on values, beliefs, and goals to modifythe meaning of a stressful transaction, especially in cases of chronic stress thatmay not be amenable to problem-focused efforts. Gottlieb & Gignac (1996) foundthat meaning-making coping, including making causal attributions and searchingfor meaning in adversity, was caregivers’ most frequently reported way of copingwith demented care recipients’ behavior.

Empirically derived categories of coping usually include the three theoreticallyderived factors mentioned above—problem-focused coping, emotion-focused cop-ing, and meaning-focused coping—but also often include a social factor. In de-veloping the Coping Strategy Indicator, Amirkhan (1990) started with 161 copingresponses. Principal-factor analysis produced a three-factor solution of Problem-Solving, Seeking Support, and Avoidance that provided a good fit to the data.Zautra et al. (1996) compared several empirical structures of coping based on an11-subscale dispositional version of the COPE inventory (Carver et al. 1989) in asample of 169 recently divorced women. A four-factor solution that reflected thenow-familiar pattern of problem-focused, emotion-focused, social coping, andmeaning-focused coping provided an adequate fit to the data: Active (active,restraint, planning), Avoidance (denial, drugs, mental disengagement), Support(seeking instrumental support, seeking emotional support), and Positive CognitiveRestructuring (positive reinterpretation, humor, acceptance).

Although nomenclature such as problem-focused, emotion-focused, social cop-ing, and meaning-focused coping helps the synthesis of findings across studies,it also runs the risk of masking important differences within categories. For ex-ample, distancing, which is a form of coping in which the person recognizes aproblem but deliberately makes efforts to put it out of his or her mind, and escape-avoidance, which is more of an escapist flight that can include behaviors such asdrinking, are both avoidant forms of coping that are usually grouped together under“emotion-focused coping.” Distancing, however, is often adaptive when nothingcan be done, such as when waiting for the outcome of a test, whereas escape-avoidance is usually a maladaptive way of coping with the same kind of situation.

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COPING 753

Sometimes this kind of distinction is important to retain. If sample size allows,statistical techniques such as structural equation modeling can be used to examineunique effects of individual coping responses even though they are grouped intolarger latent factors (Hull et al. 1991).

A second set of issues related to the grouping of coping responses concerns theevaluation of the psychometric qualities of coping scales based on the groupings.Usually we expect measures of psychological constructs to have high levels ofinternal consistency, with alphas typically above 0.85 or 0.90. This standard isnot necessarily appropriate for coping scales. Billings & Moos summarized thisproblem more than 20 years ago: “. . .typical psychometric estimates of internalconsistency may have limited applicability in assessing the psychometric adequacyof measures of coping. . . an upper limit may be placed on internal consistencycoefficients by the fact that the use of one coping response may be sufficient toreduce stress and thus lessen the need to use other responses from either the sameor other categories of coping” (Billings & Moos 1981, p. 145).

Another psychometric issue has to do with the expectation that a multifactorialscale should have factors that are independent of one another. Conceptually andempirically, however, distinct kinds of coping seem to travel together. Problem-focused coping, for example, is usually used in tandem with positive reappraisalor meaning-focused coping. This partnership suggests that these two forms ofcoping facilitate each other. Looking for the positive in a grim situation, for ex-ample, may encourage the person to engage in problem-focused coping. Con-versely, effective problem-focused coping can lead to a positive reappraisal of theindividual’s competence (or luck), or it may lead to an appreciation of anotherperson’s contribution to the solution. To insist that coping factors be uncorrelatedin order to achieve a psychometric purity by, for example, eliminating items thatcorrelate across factors, may actually result in a reduction of the validity of themeasure.

Coping Effectiveness

An important motivation for studying coping is the belief that within a givenculture certain ways of coping are more and less effective in promoting emotionalwell-being and addressing problems causing distress, and that such informationcan be used to design interventions to help people cope more effectively with thestress in their lives. Despite the reasonableness of this expectation, the issue ofdetermining coping effectiveness remains one of the most perplexing in copingresearch (Somerfield & McCrae 2000).

The contextual approach to coping that guides much of coping research statesexplicitly that coping processes are not inherently good or bad (Lazarus & Folkman1984). Instead, the adaptive qualities of coping processes need to be evaluated inthe specific stressful context in which they occur. A given coping process may beeffective in one situation but not in another, depending, for example, on the extentto which the situation is controllable. Further, the context is dynamic, so that what

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might be considered effective coping at the outset of a stressful situation may bedeemed ineffective later on. Thus, in preparing for an examination, it is adaptiveto engage in problem-focused coping prior to the exam and in distancing whilewaiting for the results (Folkman & Lazarus 1985). Conversely, when dealing witha major loss, such as the death of a spouse, it may be adaptive initially to engagein some palliative coping to deal with the loss and then later, after emotionalequilibrium is returning, to engage in more instrumental coping to deal with futureplans (Stroebe & Schut 2001).

The evaluation of coping in a contextual model requires a two-pronged ap-proach. First, appropriate outcomes must be selected. Second, attention must begiven to the quality of the fit between coping and the demands of the situation.

OUTCOMES Broadly viewed, outcomes refer to the status of diverse goals that arepersonally significant to the individual or that are selected by the researcher onan a priori basis for their relevance to the question at hand. Several investigatorshave identified coping goals that are fairly generic, such as solving the problemand feeling better (Cummings et al. 1994, McCrae & Costa 1986), or problem-solving, managing emotional distress, protecting self-esteem, and managing socialinteractions (Laux & Weber 1991). Zeidner & Saklofske (1996) name eight goals:resolution of the conflict or stressful situation, reduction of physiological andbiochemical reactions, reduction of psychological distress, normative social func-tioning; return to prestress activities, well-being of self and others affected by thesituation, maintaining positive self-esteem, and perceived effectiveness.

These lists are helpful, but they mask important complexities. First, some out-comes tend to be proximal and are probably influenced by momentary coping (e.g.,biochemical reactions) and others are more distal and are probably influenced bycoping over time (e.g., normative social functioning, return to prestress activities).These distinctions actually make it useful to consider both distal and proximaloutcomes in the same study so that we can learn more about how coping worksboth in the short- and long-term. Menaghan (1982), for example, used distress asan indicator of emotional well-being in the near term and numbers of life problemsas an indicator of longer-term effectiveness.

Second, coping responses that are effective with respect to one outcome mayhave a negative impact on another (Folkman 1992, Zeidner & Saklofske 1996). In astudy of physicians’ mistakes, for example, Wu et al. (1993) found that physicianswho coped by accepting responsibility for the mistake made constructive changesin their practice (problem-solving), but also experienced more distress.

A third point has to do with an assumption that a successful goal outcomeinvolves mastery or resolution. Zeidner & Saklofske (1996, p. 158) for example,state that adaptive coping “should lead to a permanent problem resolution with noadditional conflict or residual outcomes while maintaining a positive emotionalstate.” This approach does a disservice to the chronic, inherently unresolvablesituations and conditions that characterize the stress most people are most troubledby such as chronic illness, caregiving, unemployment, and bereavement, and whichare the most challenging in terms of coping (Mattlin et al. 1990). Gignac & Gottlieb

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(1997) make the interesting observation that research on coping effectiveness isvirtually nonexistent in the area of chronic stress.

A fourth issue has to do with who evaluates the status of the goal. Is it anobserver or is it the person doing the coping? A number of investigators (e.g.,Aldwin & Revenson 1987, Gignac & Gottlieb 1996, Ntoumanis & Biddle 1998)ask participants to appraise the efficacy of their own coping efforts. In their studyof caregivers of patients with dementia, for example, Gignac & Gottlieb (1996),assessed caregivers’ appraisals of their coping efficacy in response to the symptomof their family member’s dementia they found most upsetting. Importantly, theseefficacy appraisals were made in terms of progress toward goal outcomes identifiedin qualitative analysis of interview data (a problem-solving/instrumental goal, themaintenance of self-esteem, the regulation of emotional and physiological arousal,the development of greater self-understanding, and the preservation of harmoniousrelations with relatives) rather than in terms of mastery or resolution. Observer rat-ings of coping efficacy are used less frequently, and usually in relation to behavioraloutcomes such as performance on an exam (Carver & Scheier 1994, Folkman &Lazarus 1985) or on a laboratory-based task (Aspinwall & Richter 1999), or tobiological outcomes, such as immune markers of HIV disease progression (e.g.,Ironson et al. 2002).

COPING-ENVIRONMENT FIT A full account of coping effectiveness must considercharacteristics of the context and the fit between those characteristics and varioustypes of coping. Several approaches have been taken to characterize situations.One is to classify stressful situations in terms of what they are about in objectiveterms, such as illness, death, or children (Billings & Moos 1981, Mattlin et al.1990). This approach ignores psychological dimensions that are theoretically rel-evant to a contextual approach to coping. The approach in which the investigatorcharacterizes situations as a threat, loss, or challenge (McCrae 1984) is closer tothe contextual theory in that it uses dimensions to classify situations that reflect dif-ferent kinds of stress and that suggest different coping approaches (e.g., approachversus avoidance; problem versus emotion-focused). However, the classificationis made by someone who may not share the individual’s history, dispositions, orgoals, all of which are relevant to the appraisal of threat, loss, and challenge.

The approach to characterizing the context most consistent with a contextualformulation is to obtain the individual’s own appraisal of the situation, event, orcondition in relation to a theoretically relevant dimension. The most frequentlyassessed dimension is the opportunity for personal control, or the appraisal of con-trol or changeability. The fit between the appraisal of controllability and copingis sometimes referred to as the goodness of fit (Conway & Terry 1992, Folkman1984, Zeidner & Saklofske 1996). Theoretically, appraisals of control call forgreater proportions of active, instrumental problem-focused forms of coping, andappraisals of lack of control call for more active or passive emotion-focused cop-ing. Presumably, people who choose coping strategies that fit the appraised con-trollability of a task will have better outcomes than people who do not. Thereis mixed support for this hypothesis. In a study of hemodialysis patients and

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adherence, Christensen et al. (1995) found that coping involving planful problemsolving was associated with more favorable adherence when the stressor involveda relatively controllable aspect of the hemodialysis context. For stressors that wereless controllable, emotional self-control, a form of emotion-focused coping, wasassociated with more favorable adherence. Terry & Hynes (1998) made distinctionsamong problem- and emotion-focused kinds of coping in a study of women copingwith a medical procedure, in vitro fertilization, which they considered uncontrol-lable. Direct attempts to manage the problem were related to poorer adjustment,which supported the goodness-of-fit hypothesis. They also found that emotion-focused approach to coping was better related to adjustment. Escape, another formof emotion-focused coping, was not. Park et al. (2001) found support for the fitbetween problem-focused coping and controllability in a sample of HIV+ men,but the evidence for a fit between emotion-focused coping and lack of controlwas less strong. Conversely, Macrodimitris & Endler (2001) found evidence fora fit between lower perceived control and high emotion-oriented coping for thepsychological adjustment of people with type 2 diabetes, but did not find evidencefor the fit between higher perceived control and instrumental coping.

People’s ability to modify their coping according to the situational demandsis sometimes referred to as coping flexibility, which involves the systematic useof a variety of strategies across different situations rather than the more rigidapplication of a few coping strategies (Lester et al. 1994). Flexibility has beenmeasured in three different ways: through a card sorting procedure in which theindividual places cards containing descriptions of coping into categories that rangefrom “most like me” to “least like me” (Schwartz & Daltroy 1991), by countingthe number of coping options selected from a coping inventory for each of severalscenarios (Lester et al. 1994), and by examining the flexibility of appraisals ofcontrollability and the flexibility of coping in relation to the appraisal (Cheng2001). The study by Lester et al. suggested coping flexibility using the card sortmethod and the inventory count method is associated with greater well-being.Cheng tested her hypotheses about appraisal in a laboratory study and found thatthe results predicted flexible appraisal processes in a real-life setting. However,Cheng did not relate flexibility to relevant outcomes.

Theoretically, the concept of goodness of fit and the related notion of copingflexibility make sense. The studies to date suggest, however, that these conceptsneed to be tested with more refined categories of coping. It also may be necessaryto take into account additional situational characteristics, such as whether or notit involves a goal of such significance that it cannot be easily relinquished (Carver& Scheier 1998, Stein et al. 1997).

NEW DEVELOPMENTS

Coping research is itself dynamic and new directions are emerging that are help-ing the field move forward, including future-oriented proactive coping, a dual-process model of coping, social aspects of coping, and three new directions that

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are tied closely to emerging emotion research: emotion-approach coping, emotion-regulation, and positive emotion and coping.

Future-Oriented Proactive Coping

Although the concept of threat—anticipated harm or loss—is central to cognitivetheories of stress, most studies of coping focus on how people cope with eventsthat occurred in the past or that are occurring in the present. One of the newdevelopments in coping has to do with ways people cope in advance to prevent ormute the impact of events that are potential stressors, such as a pending lay-off, amedical procedure that has been scheduled, or having to deal with the results of atest that is scheduled in the near future (Aspinwall & Taylor 1997).

Aspinwall & Taylor (1997) refer to these responses to potential stressors as“proactive coping.” Their model defines five interrelated components of the proac-tive coping process: (a) the importance of building a reserve of resources (includ-ing temporal, financial, and social resources) that can be used to prevent or offsetfuture net losses (see also Hobfoll 1989), (b) recognition of potential stressors,(c) initial appraisals of potential stressors, (d) preliminary coping efforts, (e) andthe elicitation and use of feedback about the success of one’s efforts (Aspinwall2003).

Schwarzer & Knoll (2003) distinguish among reactive coping, which alludes toharm or loss experienced in the past; anticipatory coping, which refers to effortsto deal with a critical event that is certain or fairly certain to occur in the nearfuture (e.g., preparing for an exam); preventive coping, which foreshadows anuncertain threat potential in the distant future (e.g., beginning an exercise programto prevent an age-related medical condition such as osteoporosis); and proactivecoping, which involves upcoming challenges that are potentially self-promoting.According to Schwarzer & Knoll the proactive person creates opportunities forgrowth, and though like Aspinwall & Taylor (1997), they emphasize the importanceof accumulating resources, the purpose of these resources is to enable the individualto move toward positively valanced goals that are challenging and associated withpersonal growth.

Future-oriented coping, including anticipatory, preventive, and proactive cop-ing, deserves attention. This type of coping may be a particularly good candidatefor inclusion in cognitive-behavioral or psychoeducational interventions. Measuresneed to be developed that tap coping methods that are distinctly future-oriented sowe can learn how people manage to reduce the potential adverse impact of futureevents and maximize opportunities for benefit.

Dual Process Model of Coping

In general, we are not highlighting models of coping that are condition-specific inthis review, but we have chosen to discuss Stroebe & Schut’s (1999, 2001) DualProcess Model of Coping (DPM) because it illustrates a theoretically based cog-nitive model of coping designed for an important context that has broad relevancein the social, behavioral, and health sciences, namely, bereavement.

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The DPM specifies a dynamic process of coping whereby the bereaved personoscillates between two orientations: loss and restoration. Loss-oriented copingincludes grief work, breaking bonds and thinking of the deceased person in adifferent place, and denying and avoiding changes associated with restoration.Restoration-oriented coping includes attending to secondary stressors that comeabout as a consequence of the bereavement, such as changing identity and role from“wife” to “widow,” or mastering new skills and responsibilities that had previouslybeen the provenance of the deceased. Each of these orientations can be thought ofas a set of related goals. Importantly, the DPM defines adaptive coping as involvingoscillation between loss- and future-orientations, between approach and avoidantcoping, and between positive and negative reappraisals. Thus, the DPM specifiesthe major adaptive tasks associated with bereavement, specific cognitive processesassociated with each adaptive task, and describes what “effective” coping mightlook like in this context. Several studies have tested various aspects of the model,and findings suggest that the DPM, with its characteristic pattern of oscillation, ishelpful in explaining adjustment to bereavement (for review see M.S. Stroebe, H.Schut, & W. Stroebe, under review).

Social Aspects of Coping

Although most models of coping view the individual as embedded in a socialcontext, the literature on coping is dominated by individualistic approaches thatgenerally give short shrift to social aspects. Themes of personal control, personalagency, and direct action are central to most theories of coping (e.g., Lazarus &Folkman 1984, Pearlin & Schooler 1978), all of which reflect the emphasis on theindividual. Dunahoo et al. (1998) have described these individualistic approachesas “Lone Ranger, ‘man against the elements’ perspective,” but as they point out,“Even the Lone Ranger had Tonto” (p. 137).

Recent discussions of social aspects of coping include the impact of individualcoping on social relationships and vice versa (e.g., Berghuis & Stanton 2002,Coyne & Smith 1991, DeLongis & O’Brien 1990, O’Brien & DeLongis 1997) andthe notion of communal, prosocial coping (e.g., Wells et al. 1997).

INDIVIDUAL COPING AND SOCIAL RELATIONSHIPS O’Brien & DeLongis (1997)summarize some of the main issues related to the coping of couples. Their re-view indicates that strategies that may be beneficial to the individual’s well-beingare not necessarily beneficial to the individual’s spouse, and vice versa. Further,an individual’s strategies that may be beneficial to the spouse may be hurtful to theindividual. For example, Coyne & Smith (1991) studied coping strategies intendedto buffer or protect another person from stress. In a study of myocardial infarctionpatients, they found that the use of such strategies by wives resulted in improvedself-efficacy for the husbands, but diminished self-efficacy for the wives.

Berghuis & Stanton (2002) evaluated infertile couples’ coping with a failedattempt to inseminate. They found that the individual’s level of distress was

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influenced both by the individual and the spouse. The pattern of findings suggeststhat women and men tend to experience each other’s coping strategies differently.Women, for example, benefited from their male partner’s problem-focused cop-ing, but the converse was not true, and avoidance by female partners contributedto distress in men, but the converse was not true.

COMMUNAL COPING As a counterpoise to the emphasis on individualistic cop-ing, Hobfoll and his colleagues have developed a multiaxial coping model thattakes both individualistic and communal perspectives into account. It includes aprosocial-antisocial dimension and a passive-active dimension (Wells et al. 1997).The communal perspective is contained in the prosocial-antisocial dimension andrefers to coping responses that are influenced by and in reaction to the social con-text. Thus, a person may delay or not engage in a direct action to solve a problemif that action is perceived as causing distress to another member of the social en-vironment. Communal coping can be prosocial (e.g., “Join together with others todeal with the situation together,” “Think carefully about how others feel beforedeciding what to do”), or antisocial (e.g., “Assert your dominance quickly,” “Befirm, hold your ground”) (Monnier et al. 1998). In a series of studies, Hobfolland his colleagues found that active prosocial coping was associated with betteremotional outcomes (Wells et al. 1997), and that women use more prosocial andmen use more antisocial coping (Dunahoo et al. 1998).

Religious Coping

Religious coping received little attention until relatively recently. Now it has be-come one of the most fertile areas for theoretical consideration and empiricalresearch. The interest in religious coping is spurred in part by evidence that reli-gion plays an important role in the entire stress process, ranging from its influenceon the ways in which people appraise events (Park & Cohen 1993) to its influenceon the ways in which they respond psychologically and physically to those eventsover the long term (Seybold & Hill 2001). But people also use religion specificallyto help cope with the immediate demands of stressful events, especially to helpfind the strength to endure and to find purpose and meaning in circumstances thatcan challenge the most fundamental beliefs.

The recent interest in religious coping has been fueled by increasing evidencethat religious involvement affects mental and physical health (Seybold & Hill2001). Religious involvement is not synonymous with religious coping. Religiousinvolvement can be a part of an individual’s life independent of stress in thatperson’s life. However, some people do become involved with religion as a wayof coping with stress. Further, studies by Holland et al. (1999) and Baider et al.(1999) show a relationship between a measure of religious and spiritual beliefsand practices and active forms of coping.

Kenneth Pargament (1997) has articulated complicated conceptual issues inher-ent in the study of religious coping in his seminal book,The Psychology of Religion

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and Coping, and in subsequent publications. One issue is the need to distinguishreligious coping from religious dispositions and psychological and religious out-comes (Smith et al. 2000) that parallel similar issues in the conceptualization andmeasurement of coping more generally (cf. Lazarus & Folkman 1984, Stantonet al. 1994). A second issue is the need to define methods of religious coping thatare distinct from methods of secular coping. Pargament et al. (1988), for example,defined three such methods: the self-directing approach, in which people rely ontheir God-given resources in coping; the deferring approach, in which people pas-sively defer the responsibility for problem solving to God; and the collaborativeapproach, in which people work together with God as partners in the problem-solving process (preprint, ms pp. 6–7). A third issue has to do with the potentialconfounding between religious and nonreligious coping. Religious methods ofgaining control, for example, could be just a reflection of a basic nonreligiousdesire for control. A fourth issue has to do with the fuzzy boundaries between con-cepts of religiosity and spirituality (Zinnbauer et al. 1997). Many diverse pointsof view are expressed in the literature on this issue. Spirituality can exist outsidethe boundaries of formal religion, but spirituality is also a part of religion. In thissection, when we refer to religious coping, we also include spiritual coping, suchas efforts to find meaning and purpose, or efforts to connect with a higher order ordivine being that may or may not be religious.

Until the late 1990s, most measures of religious coping relied on just one or twoitems that asked about religious involvement, religiosity, or prayer. For example,one of the earliest coping measures, the Ways of Coping (Folkman & Lazarus 1980,1988), has just one item that is clearly religious, “I prayed.” The COPE (Carveret al. 1989), another widely used measure of coping, has a religious coping subscalethat consists of four items: “I seek God’s help,” “I put my trust in God,” “I try tofind comfort in my religion,” and “I prayed.”

In the late 1990s, Pargament and his colleagues developed the RCOPE, animportant contribution to the measurement of religious coping (Pargament et al.2000). The RCOPE is designed to assess five religious coping functions: (a) find-ing meaning in the face of suffering and baffling life experiences, (b) providing anavenue to achieve a sense of mastery and control, (c) finding comfort and reducingapprehension by connecting with a force that goes beyond the individual, (d) fos-tering social solidarity and identity, and (e) assisting people in giving up old objectsof value and finding new sources of significance. Specific religious coping methodswere defined for each of these religious functions, and subscales were created. Inother work, Pargament and his colleagues grouped religious coping methods intopositive and negative patterns (Pargament et al. 1998). Positive religious copingmethods are an expression of “a sense of spirituality, a secure relationship withGod, a belief that there is meaning to be found in life, and a sense of spiritualconnectedness with others” (Pargament et al., p. 712). Benevolent religious reap-praisals, collaborative religious coping, and seeking spiritual support are examplesof coping methods that fall within this category. Negative religious coping is anexpression of “a less secure relationship with God, a tenuous and ominous view of

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the world, and a religious struggle in the search for significance” (Pargament et al.,p. 712). It includes punitive religious reappraisals, demonic religious reappraisals,reappraisals of God’s powers, and spiritual discontent.

Pargament et al. (2001) conducted one of the few studies to examine religiouscoping (as opposed to religious involvement) as a predictor of mortality. The studyproduced mixed findings. The authors used items from the RCOPE (Pargamentet al. 2000) to measure positive religious coping and religious struggle in a two-year longitudinal study of 596 hospitalized persons 55 years of age or older. Theyfound that religious struggle items (e.g., “Wondered whether God had abandonedme,” “Questioned God’s love for me”), but not positive religious coping, predictedmortality after controlling for demographic, physical health, and mental healthvariables. The authors point out that their study was the first empirical study toidentify religious variables that increase the risk of mortality. Their study showsthe importance of using measures of religious coping that include methods thatare potentially maladaptive as well as those that are potentially adaptive.

Emotional Approach Coping

In the majority of studies of coping and adjustment, emotion-focused coping hasbeen associated with higher levels of distress. Stanton and colleagues (Stanton et al.1994, Stanton et al. 2000, Stanton et al. 2002) suggest that this is due to severalflaws in the way emotion-focused coping is usually measured and analyzed. First,emotion-focused coping can include many different types of coping depending onthe study. Second, emotion-focused items that indicate approach (e.g., “I get upsetand am really aware of it”) and items that reflect avoidance of emotions (e.g., “Itry not to think about it”) are often combined into a single scale when, in fact, theireffects may be very different and they may actually be inversely correlated. Third,many of the emotion-focused items on the most commonly used coping scales areconfounded with distress (e.g., “I get upset and let my emotions out,” “I becomevery tense”) and therefore the correlations with distress outcomes are likely to beinflated. Stanton and colleagues set out to address these issues by developing ascale to assess coping through emotional approach that was uncontaminated bydistress and focused only on emotional approach types of coping.

Coping through emotional approach involves actively processing and express-ing emotion (Stanton et al. 1994, Stanton et al. 2000). The emotional approach scaleconsists of two subscales: emotional processing (e.g., “I realize that my feelingsare valid and important,” “I take time to figure out what I’m really feeling”) andemotional expression (e.g., “I feel free to express my emotions,” “I let my feelingscome out freely”) (Stanton et al. 2000). The subscales have acceptable reliabilityand validity and are relatively distinct from other forms of coping (Stanton et al.2000).

In one of their earlier studies, Stanton et al. (1994) demonstrated that emo-tional approach coping (which combined expression and processing items) wasassociated with decreased depression and hostility and increased life satisfaction

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over a one-month period for women but increased depression and decreased lifesatisfaction for men. In a subsequent set of studies in which emotional processingand expression were analyzed as separate subscales, neither was associated withdepression but emotional expression was associated with life satisfaction for bothmen and women. In addition, emotional processing and emotional expression wereassociated with hope in women (but not in men). In a study of women with stageI or II breast cancer (Stanton et al. 2000), coping with cancer through emotionalexpression was associated with improved perceptions of health, decreased dis-tress, fewer medical visits, and increased vigor at a three-month follow up. Copingthrough emotional processing, however, was associated with increases in distressover the three-month study period. Stanton et al. (2000) suggest that althoughemotional processing appears to be adaptive in the shorter term, if it continuesover the longer term may become ruminative and therefore less beneficial in termsof adjustment.

Work by Nolen-Hoeksema and her colleagues supports this possibility. Rumina-tion, the tendency to passively and repeatedly focus on negative emotions and thepossible consequences of those negative emotions, is associated with increasedsymptoms of depression and anxiety and onset of major depressive episodes(Nolen-Hoeksema 2000, Nolen-Hoeksema & Davis 1999, Nolen-Hoeksema et al.1999). Future work on emotional approach coping should explore the point atwhich emotional approach coping may become rumination.

Emotion Regulation

Emotion regulation is the process “by which individuals influence which emotionsthey have, when they have them, and how they experience and express these emo-tions. Emotion regulatory processes may be automatic or controlled, consciousor unconscious, and may have their effects at one or more points in the emotiongenerative process” (Gross 1998b, p. 275). To the extent that coping is aimed atameliorating negative emotions or promoting positive emotions, it falls under therubric of emotion regulation. However, emotion regulation also includes noncon-scious processes that, according to our definition, do not fall under the purview ofcoping. In addition, since the coping process is prompted by negative emotion, ithappens after the occurrence of emotion in the stress process, not prior, as withsome forms of emotion regulation (but see our discussion of proactive and antici-patory coping). Eisenberg et al. (1997) classify both coping and emotion regulationunder the larger category of self-regulation and note that coping involves the regu-latory processes that occur in stressful contexts. Finally, although problem-focusedcoping is initiated by the occurrence of a negative emotion, problem-focused formsof coping do not fall under the category of emotion regulation in the sense thatthey are aimed at changing the source of the stress and, therefore, can be seen asnonemotional actions (Gross 1998b).

Eisenberg et al. (1997) identify two types of emotion regulation: one that in-volves regulating the internal feeling states and associated physiological processes

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(what they label emotion regulation) and the second that involves regulating thebehavioral concomitants of emotion (labeled emotion-related behavior regulation).Gross (1998b) distinguishes two general classes of emotion regulation dependingon where they occur in the emotion-generating process. Antecedent-focused regu-lation includes situation selection, situation modification, attentional deployment,and cognitive change. Response-focused regulation includes response modulation.

In a series of lab studies (e.g., Butler et al. 2003; Gross 1998a; Gross & John2003b; Gross & Levenson 1993, 1997). Gross and colleagues have comparedreappraisal, an antecedent-focused form of regulation to suppression, a response-focused form of regulation. They found that reappraisal and suppression havedifferent affective, cognitive, social, and physiological consequences (see Gross& John 2003b for a review). For example, compared to participants in a controlcondition who were instructed to simply watch a distressing film clip, participantswho were told to inhibit their emotional expression while watching the clip (thesuppression condition) had poorer recall for details of the clip in an unexpected testat the end of the session (Richards & Gross 2000). In a second study, one group ofparticipants was instructed to reappraise a set of emotionally evocative slides byviewing them as medical professionals would. When compared to the suppressiongroup, which was instructed to suppress their emotional expression in response tothe slides, the reappraisal group had better performance on a subsequent test inwhich they were asked to write down information associated with each slide asthe slides were viewed again (Richards & Gross 2000).

Gross & John (2003a) developed the Emotion Regulation Questionnaire, ameasure of individual differences in the tendency to reappraise or suppress. Whencompared to those who report using less suppression, those individuals who re-port using higher levels of suppression also reported having poorer memory forconversations and performed more poorly when asked to recall events they hadreported in a daily diary a week earlier. Reappraisal was not related to either formof memory test.

Butler et al. 2003 examined the social consequences of reappraisal and suppres-sion by having unacquainted female dyads watch an upsetting film, then discusstheir reactions. One of the pair was given a secret instruction to suppress, reap-praise, or interact naturally with the other member of the pair. Interestingly, thepartners of the suppressors had greater increases in blood pressure than the partnersof the reappraisers or those who acted naturally. It appears that interacting with apartner who suppresses emotional reactions is stressful for the person with whomhe or she is interacting.

The work on emotion regulation adds to the coping literature by providing anin-depth look at the effects of some forms of emotion-focused types of coping.The forms of emotion regulation that Gross and colleagues are studying in the labcan be considered emotion-focused coping because they are elicited in responseto the depiction of disturbing, stressful events that the individual is unable tocontrol or change. One challenge for future work in this area is to delineate theextent to which these lab studies generalize to more applied stressful contexts. For

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example, when receiving frightening news such as the diagnosis of cancer, wouldsuppressing one’s emotional reaction lead to poorer recall for the information fromthe physician than immediate reappraisal of the news?

Coping and Positive Emotion

An exciting new development in the field of coping has to do with the growingawareness of the presence of positive emotion in the stress process (Bonanno &Keltner 1997, Folkman 1997, Folkman & Moskowitz 2000). This awareness hasbeen fueled by growing interest in positive emotion more generally among emotionresearchers (e.g., Danner et al. 2001; Fredrickson & Joiner 2002; Fredrickson &Levenson 1998; Fredrickson et al. 2000; Haidt 2000; Harker & Keltner 2001; Isen1993, 2002) and a trend in psychology in general to focus on positive traits andconcepts (e.g., Aspinwall & Clark 2003, Major et al. 1998, O’Leary & Ickovics1995, Seligman & Csikszentmihalyi 2000). Interest in positive emotion in thestress process has opened a new avenue for coping research.

A number of studies have documented that positive emotion can occur withrelatively high frequency, even in the most dire stressful context, and can occurduring periods when depression and distress are significantly elevated. Silver &Wortman (1987; as reported in Wortman 1987), assessed positive and negativeemotions in a sample of people who had severe spinal cord injuries and a sampleof parents who had lost a child to sudden infant death syndrome. In both samples,despite the severity of the loss and the high levels of negative emotions reported,positive emotions occurred with surprising frequency. In the sample of peoplewith spinal cord injury, happiness was reported more frequently than negativeemotions by the third week after injury. In a sample of parents who lost a childto sudden infant death syndrome, positive and negative emotions were reportedwith approximately the same frequency three weeks after the child’s death, andby three months positive emotions were reported more frequently than negativeemotions.

Westbrook & Viney (1982) interviewed a sample of patients who were hos-pitalized with a chronic or disabling illness and a comparison group of healthyadults regarding their “life at the moment, the good things and the bad; what it’slike for you” (p. 901). As expected, when compared to the control group, patients’responses revealed significantly more anxiety, depression, anger, and helpless-ness. However, their responses also showed significantlymorepositive feelingsthan did the responses of the comparison group. Viney et al. (1989) also foundco-occurrence of positive and negative emotions in a sample of chronically ill men.Although the negative emotions of anxiety, depression, and helplessness were morefrequent in the chronically ill groups when compared to a healthy control group,the positive emotion of enjoyment was also more frequent in the ill groups.

A similar co-occurrence of positive and negative emotion was found in a sampleof caregiving partners of men with AIDS. Although the depression scores of thecaregivers in the study were in the range that would classify them as at risk for

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clinical depression, when asked to report how often they experienced variouspositive and negative emotions in the previous week, the participants reportedexperiencing positive emotion as least as frequently as they experienced negativeemotion, with the exception of the time immediately surrounding the death of thepartner (Folkman 1997). Three years after the death of the partner, although themean depression score of the bereaved caregivers was still significantly higherthan the general population mean, positive emotions were reported significantlymore frequently than negative emotions in the past week (Moskowitz et al. 2003).

The co-occurrence of positive and negative emotion has important implicationsfor coping. On the one hand, if positive and negative emotions are simply bipolaropposites, then coping that reduces distress should simultaneously increase posi-tive emotion, and vice versa. On the other, the co-occurrence phenomenon suggeststhere may be a degree of independence, in which case different kinds of copingmay be associated with the regulation of positive and negative affect.

There is mounting evidence that although some coping strategies affect bothpositive and negative emotion, a number of strategies are related to just one orthe other. Stone et al. (1995) examined the association of distraction, situationredefinition, direct action, catharsis, acceptance, seeking social support, relaxation,and religion with positive and negative affect as reported in end-of-day diaries.They found that relaxation and direct action were uniquely associated with positiveaffect, whereas distraction and acceptance were also associated with lower levelsof negative affect.

Carver & Scheier (1994) studied the associations of coping with positive andnegative emotion over the course of an exam. None of the coping responses mea-sured prior to the exam was associated with positive challenge or benefit emotionsduring the postexam, pregrade period. However, use of problem-focused copingand positive reframing after the exam predicted challenge emotions (e.g., excited,eager) after the grades were announced.

Prospective data from a study of 110 caregiving partners of men with AIDSassessed bimonthly pre- and postbereavement indicated problem-focused copingand positive reappraisal were consistently associated with increases in positiveaffect, but only inconsistently related to decreases in negative affect (Moskowitzet al. 1996).

Analyses of narrative data from the AIDS caregiver study indicated that othertypes of coping, not captured by traditional checklist measures of coping, are likelyto be related to positive emotion in the context of ongoing stress (Folkman 1997).At the conclusion of the interview, participants were asked to describe a positivemeaningful event about “something that you did, or something that happened toyou that made you feel good and that was meaningful to you and helped you getthrough the day.”

This question was posed to 1794 participants, and 99.5% were able to reporta positive meaningful event. In an in-depth analysis of 215 events reported by 36participants, Folkman et al. (1997) found that the events often concerned some-thing other than caregiving or bereavement (the subject of the focal stressors)

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and instead were associated with other roles that participants had (e.g., coworker,family member). In addition, they often concerned what on the surface appeared tobe comparatively minor events (e.g., a beautiful sunset, a kind word from a friend,a good grade on a test). These findings suggested that under enduring stressfulconditions such as caregiving or bereavement, people consciously seek out posi-tive meaningful events or infuse ordinary events with positive meaning to increasetheir positive affect, which in turn provides respite from distress and thereby helpsreplenish resources and sustain further coping.

COPING, THE SEARCH FOR MEANING, AND POSITIVE EMOTION One of the centraltasks in coping with severe stress is to integrate the occurrence of the stressor withone’s beliefs about the world and the self (Janoff-Bulman 1989, 1999; Park &Folkman 1997). A common theme in the coping processes related to positiveemotion is their link to the individual’s important values, beliefs, and goals thatcomprise the individual’s sense of meaning (Folkman 1997).

Positive reappraisal, for example, involves a reinterpretation of the event interms of benefits to one’s values, beliefs, and goals. Problem-focused coping, wheneffective, is associated with feelings of mastery and control, goals that are generallyvalued in Western culture. Positive meaningful events are linked to positive emotionprecisely because they reaffirm what one values and help one to focus on thosevalues while coping with the ongoing stressful event.

PERCEIVING BENEFIT AS A COPING STRATEGY Individuals who have experienceda severe stressful event such as a tornado or hurricane, being diagnosed with cancer,or losing a loved one to AIDS, often report that something positive has come out ofthe experience, such as closer relationships with family and friends, reprioritizingof goals, and greater appreciation of life. These benefits and personal changeshave been called stress-related growth (Park et al. 1996), post-traumatic growth(Tedeschi et al. 1998), and benefit finding (Affleck & Tennen 1996, Tennen &Affleck 2002).

The perception of growth after a stressful experience is generally examinedas an outcome. Efforts have been made to study the process by which personsexperiencing stress arrive at the conclusion that they have experienced benefitsfrom the stress. Park et al. (1996) examined stress-related growth in response toa recent stressful event in a sample of college students. The coping responses ofacceptance (“I get used to the idea that it happened,” “I accept the reality of the factthat it happened”) and positive reinterpretation (“I look for something good in whatis happening,” “I learn something from the experience”) were cross-sectionallyrelated to stress-related growth.

Another approach links cognitive processing and the discovery of meaning. Ina qualitative analysis of the bereavement narratives of HIV+ gay men who hadlost a close friend or partner to AIDS, Bower et al. (1998) studied the associationof cognitive processing and finding meaning with the decline of CD4 cells (T-helper cells that are attacked by the HIV virus) and mortality. Cognitive processing

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was defined as “deliberate, effortful, or long-lasting thinking about the death”(p. 980), which could be considered a form of coping with the friend’s death.Statements coded as cognitive processing included “I keep thinking about whatlessons are for me, what can I learn,” “I’m muddling through my own feeling of. . . what could have been, what was, and what is, and. . . I’m more thinking of myfuture.” Discovery of meaning was defined as a “major shift in values, priorities, orperspectives in response to the loss” (p. 980). Statements classified as discovery ofmeaning included “In one way I suppose that his passing influenced me to believemore strongly about the quality of life and living life in a satisfying way as much aspossible,” “I certainly appreciated more the friends that I have and became muchcloser with them,” and “I would say that (his) death lit up my faith.”

Sixty-five percent of the sample was classified as having engaged in cognitiveprocessing about the death and 40% of the sample reported finding meaning intheir bereavement. Cognitive processing was significantly associated with find-ing meaning, and although the majority of participants who found meaning wereclassified as high in cognitive processing, less than half of the participants whodid not find meaning were classified as high in cognitive processing. Furthermore,participants classified as finding meaning had a less-rapid decrease in CD4 countcompared to participants who did not find meaning. Discovery of meaning wasalso associated with lower risk of mortality.

Tennen and Affleck (Affleck & Tennen 1996; Tennen & Affleck 1999, 2002)examined a slightly different question. They studied a coping response called ben-efit reminding, which they define as effortful cognitions in which the individualreminds himself or herself of the possible benefits stemming from the stressfulexperience. The assumption is that benefit reminding can only be used as a copingstrategy by those who have already found some benefit or perceived some pos-itive consequences from the stressor. Thus, rather than being a coping strategythat precedes finding meaning or perceiving benefits in response to stress, bene-fit reminding is conceptualized as a form of coping that follows the perception ofbenefits. In a study of women with fibromyalgia, an illness associated with chronicpain, Tennen & Affleck (1999) demonstrated that benefit reminding was uniquelyassociated with pleasant mood. Their data, which included daily ratings of pain,mood, and coping, demonstrated that although benefit reminding was as prevalenton high-pain days as on lower-pain days, benefit reminding was significantly as-sociated with increased pleasant mood (e.g., happy, cheerful) but not necessarilydecreased negative mood. “Thus, on days when these chronic pain sufferers madegreater efforts to remind themselves of the benefits that have come from their ill-ness, they were especially more likely to experience pleasurable mood, regardlessof how intense their pain was on these days” (p. 297).

The emerging interest in positive emotions in the stress process and copingprocesses associated with them is one of the most exciting developments in copingtheory and research. What is needed is a clearer delineation of the interplay betweenpositive and negative emotions and research to identify coping processes associatedwith positive emotions during both acute and chronic stress.

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CONCLUSIONS

Thirty-five years ago, when coping research was just emerging, the concept ofcoping was still somewhat akin to a black box in the stress process. Over subsequentyears, we have begun to see what’s inside the black box. Throughout this period,there has also been extensive and sometimes contentious debate about the meritsof coping research. Healthy debate and thoughtful criticism are signs that a field ismaturing. At the same time, new methodologies and new ways of thinking aboutcoping are emerging. Despite the complexities inherent in the study of coping,the area continues to hold great promise for explaining who thrives under stressand who does not, and it continues to hold great promise for informing effectiveinterventions to help people better handle both acute and chronic stress.

The Annual Review of Psychologyis online at http://psych.annualreviews.org

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P1: FDS

December 9, 2003 14:49 Annual Reviews AR207-FM

Annual Review of PsychologyVolume 55, 2004

CONTENTS

Frontispiece—Walter Mischel xvi

PREFATORY

Toward an Integrative Science of the Person, Walter Mischel 1

LEARNING AND MEMORY PLASTICITY

On Building a Bridge Between Brain and Behavior, Jeffrey D. Schall 23

The Neurobiology of Consolidations, Or, How Stable is the Engram?,Yadin Dudai 51

BRAIN IMAGING/COGNITIVE NEUROSCIENCE

Understanding Other Minds: Linking Developmental Psychology andFunctional Neuroimaging, R. Saxe, S. Carey, and N. Kanwisher 87

SLEEP

Hypocretin (Orexin): Role in Normal Behavior and Neuropathology,Jerome M. Siegel 125

SPEECH PERCEPTION

Speech Perception, Randy L. Diehl, Andrew J. Lotto, and Lori L. Holt 149

DEPTH, SPACE, AND MOTION

Visual Mechanisms of Motion Analysis and Motion Perception,Andrew M. Derrington, Harriet A. Allen, and Louise S. Delicato 181

ATTENTION AND PERFORMANCE

Cumulative Progress in Formal Theories of Attention, Gordon D. Logan 207

MEMORY

The Psychology and Neuroscience of Forgetting, John T. Wixted 235

FORM PERCEPTION AND OBJECT RECOGNITION

Object Perception as Bayesian Inference, Daniel Kersten,Pascal Mamassian, and Alan Yuille 271

ADULTHOOD AND AGING

Development in Midlife, Margie E. Lachman 305

vii

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viii CONTENTS

DEVELOPMENT IN SOCIETAL CONTEXT

The Intergenerational Transfer of Psychosocial Risk: Mediators ofVulnerability and Resilience, Lisa A. Serbin and Jennifer Karp 333

DEVELOPMENT IN THE FAMILY

Development in the Family, Ross D. Parke 365

SCHIZOPHRENIA AND RELATED DISORDERS

Schizophrenia: Etiology and Course, Elaine Walker, Lisa Kestler,Annie Bollini, and Karen M. Hochman 401

SUBSTANCE ABUSE DISORDERS

Clinical Implications of Reinforcement as a Determinant of SubstanceUse Disorders, Stephen T. Higgins, Sarah H. Heil,and Jennifer Plebani Lussier 431

Motivational Influences on Cigarette Smoking, Timothy B. Baker,Thomas H. Brandon, and Laurie Chassin 463

INFERENCE, PERSON PERCEPTION, ATTRIBUTION

Self-Knowledge: Its Limits, Value, and Potential for Improvement,Timothy D. Wilson and Elizabeth W. Dunn 493

GENDER

Gender in Psychology, Abigail J. Stewart and Christa McDermott 519

MASS MEDIA

Mediated Politics and Citizenship in the Twenty-First Century,Doris Graber 545

NONVERBAL AND VERBAL COMMUNICATION

The Internet and Social Life, John A. Bargh andKatelyn Y.A. McKenna 573

SOCIAL INFLUENCE

Social Influence: Compliance and Conformity, Robert B. Cialdiniand Noah J. Goldstein 591

SMALL GROUPS

Group Performance and Decision Making, Norbert L. Kerrand R. Scott Tindale 623

PERSONALITY PROCESSES

Creativity, Mark A. Runco 657

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CONTENTS ix

PSYCHOLOGY AND CULTURE

Psychology and Culture, Darrin R. Lehman, Chi-yue Chiu,and Mark Schaller 689

TEACHING OF SUBJECT MATTER

Teaching of Subject Matter, Richard E. Mayer 715

PERSONALITY AND COPING STYLES

Coping: Pitfalls and Promise, Susan Folkman and Judith Tedlie Moskowitz 745

SURVEY METHODOLOGY

Survey Research and Societal Change, Roger Tourangeau 775

Human Research and Data Collection via the Internet,Michael H. Birnbaum 803

INDEXES

Author Index 833Subject Index 877Cumulative Index of Contributing Authors, Volumes 45–55 921Cumulative Index of Chapter Titles, Volumes 45–55 926

ERRATA

An online log of corrections to Annual Review of Psychology chaptersmay be found at http://psych.annualreviews.org/errata.shtml

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Documents

Coping Pitfalls and Promise