52 Coping and Social Support
psychological adaptation. Two main dimensions of coping
are proposed, problem-focused and emotion-focused coping.
Problem-focused coping is aimed at altering the problematic
situation. These coping efforts include information seeking
and planful problem solving. Emotion-focused coping is
aimed at managing emotional responses to stressors. Such
coping efforts include cognitive reappraisal of the stressor
and minimizing the problem.
How the elements of coping unfold over time is a key the-
oretical issue involved in studies of coping processes. Al-
though the theory is dynamic in nature, most of the research
utilizing the stress and coping paradigm put forth by Lazarus
and colleagues (1981) has relied on retrospective assessments
of coping and has been cross-sectional. However, a team of
researchers, including Glen Af”eck, Howard Tennen, and
Francis Keefe (e.g., Af”eck et al., 1999) have utilized a daily
diary approach to assessing coping with pain, a methodology
that can examine the proposed dynamic nature of coping.
Cognitive Processing Theories
In recent years, there has been an expansion in theoretical
perspectives on cognitive coping. The literature on cognitive
processing of traumatic life events has provided a new direc-
tion for coping research and broadened theoretical perspec-
tives on cognitive methods of coping with chronic illness.
According to cognitive processing theory, traumatic events
can challenge people•s core assumptions about themselves
and their world (Janoff-Bulman, 1992). For example, the un-
predictable nature of many chronic illnesses, as well as the
numerous social and occupational losses, can cause people to
question the beliefs they hold about themselves. A diagnosis
of cancer can challenge a person•s assumptions about being
personally invulnerable to illness and/or providing for his or
her family. To the extent that a chronic illness challenges
these basic assumptions, integrating the illness experience
into their preexisting beliefs should promote psychological
adjustment. Cognitive processing is de“ned as cognitive ac-
tivities that help people view undesirable events in personally
meaningful ways and “nd ways of understanding the nega-
tive aspects of the experience, and ultimately reach a state of
acceptance (e.g., Greenberg, 1995). By “nding meaning or
positive bene“t in a negative experience, individuals may be
better able to accept the losses they experience. Focusing on
the positive implications of the illness or “nding personal
signi“cance in a situation are two ways of “nding meaning.
Coping activities that help individuals to “nd redeeming fea-
tures in an event must be distinguished from the successful
outcome of these attempts. For example, people may report
that as a result of a serious illness, they have found a new
appreciation for life or that they place greater value on rela-
tionships. Patients may also develop an explanation for the
illness that is more benign (e.g., attributing it to God•s will)
or make sense of the illness by using their existing views
of the world (e.g., assuming responsibility for the illness
because of a lifestyle that caused the illness). While cogni-
tive processing theory constructs have been applied to
adjustment to losses such as bereavement (e.g., Davis,
Nolen-Hoeksema, & Larson, 1998), these processes have re-
ceived relatively little attention from researchers examining
patients coping with chronic illness.
Another coping process that falls under the rubric of cog-
nitive processing is social comparison (SC). Social com-
parison is a common cognitive process whereby individuals
compare themselves to others to obtain information about
themselves (Gibbons & Gerrard, 1991). According to SC
theory, health problems increase uncertainty; uncertainty
increases the desire for information, and creates the need for
comparison. Studies of coping with chronic illness have in-
cluded social comparison as a focus. A certain type of SC,
downward comparison, has been the focus of empirical study
among patients with chronic illnesses such as rheumatoid
arthritis (RA) (Tennen & Af”eck, 1997). Wills (1981) has
suggested that people experiencing a loss can experience an
improvement in mood if they learn about others who are
worse off. Although there is little evidence that SC increases
as a result of experiencing health problems, there is consider-
able evidence to suggest this may be the case (Kulik &
Mahler, 1997). One proposed mechanism for SC is that
downward comparison impacts cognitive appraisal by reduc-
ing perceived threat. When another person•s situation appears
signi“cantly worse, then the appraisal of one•s own illness
may be reduced (Aspinwall & Taylor, 1993).Coping Style TheoriesAlthough the majority of coping theories focus on the trans-
actional, dynamic aspects of coping, there remains a group of
behavioral scientists who consider coping more of a disposi-
tion or trait. Although there has been some inconsistency in
the use of the term, coping styleis typically the term used to
refer to characteristic methods individuals use to deal with
threatening situations. Coping style theorists propose that in-
dividuals differ in a consistent and stable manner in how they
respond to threatening health information and how they react
to it affectively. Several coping style constructs have been ex-
plored in the health psychology literature. The monitoring
coping style construct,which has been put forth by Miller
(1980; 1987), proposes that individuals have characteristic
ways of managing health threats in terms of their attentional