Coping 53processes. According to Monitoring Process Theory, there
are two characteristic ways of dealing with health threat,
monitoring, and blunting. Monitors scan for and magnify
threatening cues, and blunters distract from and downgrade
threatening information (Miller, 1995).
A similar coping style construct that has received theoret-
ical and empirical attention is coping with affective responses
to health threats. Two constructs, repressive coping styleand
emotional control,have been the most studied in the area of
health psychology. Repressive coping style, a construct de-
rived from psychoanalytic theory is based on the defense of
repression (e.g., Kernberg, 1982). Repressive coping style is
exhibited by individuals who believe they are not upset de-
spite objective evidence to the contrary. Thus, it is inferred
that they are consciously repressing threatening feelings and
concerns. This style has been variously labeled as attention-
rejection(Mullen & Suls, 1982) and repression-sensitization
(Byrne, 1961). A second, but related, coping style is the
construct of emotional control, which describes an individual
who experiences and labels emotions, but does not express
the emotional reaction (Watson & Greer, 1983). Both con-
structs have sparked particular interest in the area of psy-
chosocial oncology, where investigations have focused on the
role of emotional repression and suppression in cancer onset
and progression (e.g., Butow, 2000; Goldstein & Antoni,
1989; Kneier & Temoshok, 1984; Kreitler, Chaitchik, &
Kreitler, 1993). More recently, repressive coping has also
been associated with higher risk for poor disease outcome, as
physiological and immunological correlates of repressive
coping have been identi“ed, including high systolic blood
pressure (Broege, James, & Peters, 1997) and reduced im-
munocompetence (Jamner & Leigh, 1999). In addition, re-
pressive coping has been associated with lower ability to
perceive symptoms (Lehrer, 1998). Unfortunately, measure-
ment of this construct has been a challenge to behavioral
scientists.
Although the majority of coping theories treat coping as a
situational variable, a subset of investigators have conceptu-
alized coping behaviors as having trait-like characteristics.
That is, coping is viewed as largely consistent across situa-
tions because individuals have particular coping styles or
ways of handling stress. In general, the contribution of trait
versus states to the prediction of behavior has been a hotly
debated topic in the last several decades, starting with the
work of Walter Mischel (1968). One response to the trait-
situation debate was the development of the interactionist po-
sition, which postulates that all behaviors are a function of
both the person•s traits and the situation (e.g., Endler & Hunt,
1968). Recent studies investigating coping using daily as-
sessments suggest that coping, particularly avoidance and
religious coping, has a moderate degree of consistency when
multiple daily assessments are utilized (Schwartz, Neale,
Marco, Schiffman, & Stone, 1999). Interestingly, these ag-
gregated daily reports of coping activities using the Daily
Coping Assessment are only moderately associated with self-
report measures of trait coping (how one generally copes
with stress) (Schwartz, Neale, Marco, Schiffman, & Stone,
1999).Theories of Coping with Health RiskOne of the only health belief models that has incorporated
coping is Leventhal and colleagues• self-regulatory model of
illness behavior (Prohaska, Leventhal, Leventhal, & Keller,
1985). According to this model, symptoms are key factors in
how health threats are perceived. Symptoms are also the
main targets for coping and symptom reduction is neces-
sary for appraising progress with mitigating health threats
(Cameron, Leventhal, & Leventhal, 1993). There are multi-
ple components to this model: First, the individual perceives
a change in somatic activity or a symptom, such as pain.
Next, this symptom is compared with the person•s memory of
prior symptoms in an attempt to evaluate the nature of the
health threat. The person forms a symptom or illness repre-
sentation, which has several key components: (a) identity of
the health problem that includes its label and its attributes
such as severity, (b) duration„an evaluation of how long it
will last, (c) consequences„how much it will disrupt daily
activity and anticipated long-term consequences or severity
of the threat, (d) causes of the symptom, and (e) expecta-
tion about controllability of the symptom (Lau, Bernard, &
Hartman, 1989). Once the person completes this evaluation
then he or she decides how to cope with the symptom. Cop-
ing procedures are de“ned in two ways that correspond
roughly to Lazarus and Folkman•s emotion- and problem-
focused coping. Problem-solving behaviors include seeking
medical care and self-care behaviors (e.g., taking insulin for
diabetes), as well as attempts to seek information. This model
is innovative because care-seeking and self-care behaviors
such as adherence to medical regimens for chronic illnesses
are de“ned as coping behaviors. Thus, this model would in-
clude the study of determinants of adherence to medical reg-
imens under the rubric of coping literature. This literature is
beyond the scope of the present chapter, so we present only a
brief review on this topic.
The second aspect of coping is the manner in which the
person copes with the affective response to the symptom. An
innovative component of the self-regulatory model is that it
incorporates how people cope with emotional responses to
health threats. Emotional responses such as fear can be