Coping 55the palliative coping measure. While this is an extremely
interesting “nding, the underlying mechanisms were not
discussed.
Disease Progression
One of the most studied areas of psychosocial factors in dis-
ease outcomes is the link between coping and HIV outcomes.
The HIV to AIDS progression provides a model for studying
the connection between psychological factors and immuno-
logical outcomes, as well as disease progression. The majority
of studies have focused on some aspect of avoidant coping and
have yielded contradictory results. Reed and colleagues
(Reed, Kemeny, Taylor, Wang, & Visscher, 1994) found that
realistic acceptance as a coping strategy (de“ned as focusing
on accepting, preparing for, and ruminating about the future
course of HIV infection) predicted decreased survival time
among gay men who had clinical AIDS at study entry. This ef-
fect held after controlling for confounding variables such
as CD4 cell counts, use of azidothymidine (AZT), and alcohol
or substance abuse. These results are inconsistent with Ironson
and colleagues (Ironson et al., 1994) who found that use of de-
nial to cope with a newly learned HIV seropositive diagnosis
and poorer adherence to behavioral interventions predicted
lower CD4 counts one year later and a greater progression to
clinical AIDS two years later. Solano et al. (1993) found that
having a “ghting spirit was related to less progression to HIV
infection one year later, after controlling for baseline CD4 cell
count. Mulder, de Vroome, van Griensven, Antoni, and
Sanfort (1999) found that the degree to which men avoided
problems in general was associated with less decline in CD4
cells and less progression to immonologically de“ned AIDS
over a seven-year period. However, avoidance coping was not
signi“cantly associated with AIDS-de“ning clinical events
(e.g., developing Kaposi•s sarcoma). Contradictory “ndings
have been reported by Leserman and colleagues (1999). They
followed HIV-infected men for 7.5 years. Results indicated
that men who used denial to cope with the threat of AIDS had
faster disease progression. In fact, the risk of AIDS was ap-
proximately doubled for every 1.5 unit increase in denial. This
relationship remained signi“cant even after taking into ac-
count potential mediators such as age and number of biomed-
ical and behavioral factors (e.g., smoking, use of marijuana,
cocaine, and other drugs and having had unprotected
intercourse). The inconsistency in “ndings across studies is
dif“cult to explain. Because these studies are observational in
nature, causal inferences cannot be made.
Findings from studies linking coping with cancer pro-
gression have also been contradictory. Early studies by
Buddenberg and colleagues (1996) and Watson and Greer
(1983) reported an association between coping style and out-
come in early stage breast cancer. However, these early stud-
ies did not control for known prognostic indicators such as
tumor stage, disease site, and mood. Brown and colleagues
(Brown, Butow, Culjak, Coates, & Dunn, 2000) found that
melanoma patients who did not use avoidance as a coping
strategy experienced longer periods without relapse, after
controlling for tumor thickness, disease site, metastatic
status, and mood. A similar “nding was reported by Epping-
Jordan et al. (1999), who followed a group of cancer patients
over a one-year period. Longitudinal “ndings revealed that,
after controlling for initial disease parameters and age, avoid-
ance predicted disease status one year later; however, neither
psychological symptoms nor intrusive thoughts and emotions
accounted for additional variance in disease outcomes.Coping and Psychological Adaptation to DiseaseCross-Sectional Studies of Coping with Chronic IllnessEarly studies of coping using the stress and coping paradigm
were cross-sectional and used retrospective checklists such
as the Ways of Coping Checklist (WOC). The earliest studies
divided coping into the overly general categories of problem-
and emotion-focused strategies, and focused mostly on psy-
chological outcomes rather than pain and functional status
outcomes.
Later studies have investigated speci“c types of coping.
For example, Felton, Revenson, and Hinrichsen (1984)
examined two types of coping, wish-ful“lling fantasy and
information seeking, using a revision of the WOC. Wish-
ful“lling fantasy was a more consistent predictor of
psychological adjustment than information seeking. While
information seeking was associated with higher levels of pos-
itive affect, its effects on negative affect were modest, ac-
counting for only 4% of the variance. In a second study,
Felton and Revenson (1984) examined coping of patients
with arthritis, cancer, diabetes, and hypertension. Wish-
ful“lling fantasy, emotional expression, and self-blame were
associated with poorer adjustment, while threat minimization
was associated with better adjustment. Scharloo and col-
leagues (1998) conducted a cross-sectional study of individ-
uals with Chronic Obstructive Pulmonary Disease (COPD),
RA, or psoriasis. Unlike the majority of studies, this study
“rst entered illness-related variables such as time elapsed
since diagnosis and the severity of the patient•s medical con-
dition into the equation predicting role and social function-
ing. Overall, coping was not strongly related to social and