Handbook of Psychology

Social Support 59

of design might help clarify whether coping in”uences dis-
tress or whether coping is merely a symptom of distress, a crit-
icism frequently raised in critiques of coping (e.g., Coyne &
Racioppo, 2000). Second, longitudinal studies may clarify the
role of personality factors in coping (Zautra & Manne, 1992).
While some investigators suggest that personality factors play
a limited role in predicting coping, other investigators argue
that coping is a personality process that re”ects dispositional
differences during stressful events.
Although the lack of progress in the area of coping is fre-
quently attributed to methods of assessment and design, the
relatively narrow focus on distress outcomes may also ac-
count for some of the problem, particularly when coping with
chronic illness is being evaluated. Chronic illness does not
ultimately lead to psychological distress for the majority of
patients. Indeed, many individuals report psychological
growth in the face of chronic illness, and they are able to “nd
personal signi“cance in terms of changes in views of them-
selves, their relationships with others, and their philosophy of
life (Tennen, Af”eck, Urrows, Higgins, & Mendola, 1992).
While positive affect is included as an adaptational outcome
in some studies (e.g., Bendtsen & Hornquist, 1991), the ma-
jority of studies do not include positive outcomes. Positive
affect is a particularly important outcome to evaluate when
positive coping processes such as cognitive reappraisal and
“nding meaning in the experience are examined, as these
types of coping may play a stronger role in generating and
maintaining positive mood than in lowering negative mood.
Relatively few studies have focused solely on coping and
distress, ignoring potential moderators such as level of pain,
appraisals of controllability, gender, and personality. A care-
ful evaluation of potential moderators will provide both
researchers and clinicians with information about the most
effective coping strategies.

Conclusions and Directions for Future Research

As Richard Lazarus points out in his commentary in
American Psychologist, •A premise that occurs again
and again...isthatforquiteafewyears research has disap-
pointed many who had high hopes it would achieve both fun-
damental and practical knowledge about the coping process
and its adaptational consequences. I am now heartened by
positive signs that there is a growing number of sophisticated,
resourceful and vigorous researchers who are dedicated to the
study of copingŽ (Lazarus, 2000). It is clear that, despite the
multiple methodological problems this area of research has
faced, a heightened awareness of these limitations has led to
the application of sophisticated methods that might help ful-
“ll the high hopes for this research. If investigators in the

“eld of coping with illnesses can adapt daily diary methods to

their populations, focus on speci“c stressors related to the ill-

ness when instructing participants to answer coping ques-

tions, include coping appraisals and the perceived ef“cacy of

coping efforts, and carefully delineate illness-related, contex-

tual and dispositional moderators, the “ndings may lead to

the development of effective interventions for clinicians hop-

ing to improve the quality of life for these individuals.

SOCIAL SUPPORT

Introduction

The role of social support in adaptation to illness and in

health outcomes is one of the most studied topics in health

psychology. Social relationships have been posited to in”u-

ence the maintenance of health and well-being by scientists

and practitioners in both behavioral science and medical dis-

ciplines. A comprehensive review of all of the studies of the

role of social relationships in health is beyond the scope of

this chapter. Comprehensive reviews of speci“c topics such

as the role of social relationships and cancer can be found in

other sources (e.g., Berkman, Vaccarino, & Seeman, 1993;

Helgeson, Cohen, Schulz, & Yasko, 1999). In this chapter,

we review key de“nitions of social support and health and

empirical studies linking social relationships with a variety of

health outcomes.

Social Support Definitions

Paper-and-pencil, interview, and observational methods have

been used to measure social support. Measurement methods

are guided by the perspectives taken on understanding

support mechanisms, as different types of support are hy-

pothesized to exert their effects in different ways. The most

common distinctions made in social support measurement

are the distinctions between perceived support, received sup-

port, and social integration (Cassel, 1976; Cobb, 1976;

Weiss, 1974). Perceived support,which is actually more of

an appraisal than an actual support-related interaction, is the

perception that speci“c types of social support would be

available if needed. The proposed mechanism for perceived

support is protection of the individual by altering his or her

interpretation of the threat or harm posed by situations

(Cohen & McKay, 1984). Received supportis de“ned as ac-

tual supportive behaviors. The majority of investigators

studying received support hypothesize that it exerts a bene“-

cial effect because it promotes adaptive coping (Cutrona &

Russell, 1990). A third method of measuring support, social