56 Coping and Social Support
role functioning. Among patients with COPD, passive coping
predicted poorer physical functioning. Among patients with
RA, higher levels of passive coping predicted poorer social
functioning.
Very few studies have examined coping with other chronic
illnesses. Several studies have investigated the association
between coping and distress among individuals with multiple
sclerosis (MS). Pakenham, Stewart, and Rogers (1997) cate-
gorized coping as either emotion- or problem-focused, and
found that emotion-focused coping was related to poorer ad-
justment, while problem-focused coping was associated with
better adjustment. In contrast, Wineman and Durand (1994)
found that emotion- and problem-focused coping were unre-
lated to distress. Mohr, Goodkin, Gatto, and Van Der Wende
(1997) found that problem-solving and cognitive reframing
strategies are associated with lower levels of depression,
whereas avoidant strategies are associated with higher levels
of depression.
As noted previously, most studies have used instructions
that ask participants how they coped with the illness in gen-
eral, rather than asking participants how they coped with spe-
ci“c stressors associated with the illness. Van Lankveld and
colleagues (Van Lankveld, Van•t Pad Bosch, Van De Putte,
Naring, & Van Der Staak, 1994) assessed how patients cope
with the most important stressors associated with arthritis.
When coping with pain was considered, patients with similar
degrees of pain who scored high on comforting cognitions
and diverting attention scored higher on well-being, and de-
creased activity was associated with lower well-being. When
coping with functional limitation was examined, patients
who used pacing reported lower levels of well-being, and op-
timism was associated with higher well-being after func-
tional capacity was controlled for in the equation. Finally,
when coping with dependence was examined, only showing
consideration was associated with higher well-being after
functional capacity was controlled for in the equation.
Cross-Sectional Studies of Coping with Cancer
The earliest work was conducted by Weisman and Worden
(1976...1977). In this study, patients were studied during the
“rst 100 days after diagnosis. Positive reinterpretation was
associated with less distress, and attempts to forget the cancer
were associated with high distress. Unfortunately, this study
did not evaluate the contribution of severity of disease.
Dunkel-Schetter and colleagues (Dunkel-Schetter, Feinstein,
Taylor, & Falke, 1992) administered the WOC Inventory,
cancer speci“c version, to a sample of patients with varying
types of cancer. Participants were asked to select a problem
related to their cancer and rate coping responses to that
problem. Coping through social support, focusing on the pos-
itive, and distancing were associated with less emotional
distress, whereas using cognitive and behavioral escape-
avoidance was associated with more emotional distress.
Although disease severity (e.g., stage) and demographic in-
formation were collected, these variables were not included
in the analyses.
Manne, Al“eri, Taylor, and Dougherty (1994) also admin-
istered the WOC to women with early stage breast cancer. In
this study, physical symptoms were controlled for in the
analysis of associations between coping and positive and neg-
ative affect, as measured by the Pro“le of Mood States. Phys-
ical symptoms had a greater in”uence on relations between
coping and negative affect than on coping and positive affect
relations. Escape-avoidance coping and confrontive coping
were associated with more negative affect, whereas distanc-
ing, positive appraisal, and self-controlling coping were all
associated with more positive affect.
Epping-Jordan and colleagues (1999) evaluated the associ-
ation between coping (assessed with the COPE) and anxiety
and depressive symptoms among a sample of 80 women
with all stages of breast cancer. Coping was evaluated as a
mediator of the relation between optimism and distress. Opti-
mism was predicted to predict less emotion-focused dis-
engagement, which, in turn, predicted fewer symptoms of
anxiety and depression. In addition, this study advanced the
literature because cancer stage, patient age, and education
were each incorporated into associations between coping and
distress rather than simply partialled out of associations. In
addition, cross-sectional associations at three separate points
were conducted (at diagnosis, three months after diagnosis,
and six months after diagnosis), which provided a picture of
how coping changed over the course of treatment. At diagno-
sis, low optimism predicted more distress, and the relation
between optimism and distress was mediated partially by
emotion-focused disengagement.
Relatively few studies have evaluated coping among
patients with advanced disease. Sherman, Simonton, Adams,
Vural, and Hanna (2000) used the COPE to study coping by
patients with late-stage cancers and found that denial, behav-
ioral disengagement, and emotional ventilation were associ-
ated with higher distress as assessed by the Pro“le of Mood
States.Longitudinal StudiesUnfortunately, relatively few studies have employed longi-
tudinal designs. Overall, passive coping strategies such as
avoidance, wishful thinking, withdrawal, and self-blame
have been shown to be associated with poorer psychological