Coping 57adjustment (e.g., Scharloo et al., 1999), and problem-focused
coping efforts such as information seeking have been found to
be associated with better adjustment among MS patients (e.g.,
Pakenham, 1999).
Two studies have used longitudinal designs to study the re-
lation of coping to adaptation to cancer. Carver, Pozo, Harris,
Noriega, Scheirer, and Robinson (1993) evaluated coping
strategies used by early-stage breast cancer patients, evaluated
at two time points, and found that cognitive and behavioral
avoidance were detrimental to adjustment, whereas accep-
tance was associated with lower distress. Stanton, Danoff-
Burg, Cameron, Bishop, and Collins (2000) examined
emotionally expressive coping, de“ned as emotional process-
ing (delving into feelings), and emotional expression (ex-
pressing emotions) among 92 women with early stage breast
cancer. Women were assessed at two points, spaced three
months apart. The “ndings revealed that coping through emo-
tional expression was associated with decreased distress, even
after accounting for the contribution of other coping strate-
gies. In contrast, women who coped by using emotional pro-
cessing became more distressed over time, but only when
emotional expression was controlled for in the analysis. This
“nding suggests that active engagement in the attempt to talk
about cancer-related feelings may be bene“cial, but rumina-
tion may exacerbate distress.
Other Coping Processes: Social Comparison
Social comparison is a common but little-studied process in
the context of its use among individuals dealing with a health
problem. Stanton and colleagues (2000) evaluated the associ-
ation between both upward and downward comparisons and
affect among women with breast cancer by using an experi-
mental manipulation. Patients listened to tapes of other breast
cancer patients, which varied by level of disease prognosis
and psychological adaptation. Descriptive data indicated that
women extracted positive comparisons from both worse-off
and better-off women, reporting gratitude in response to
worse-off others and inspiration in response to better-off oth-
ers. Negative affect increased and positive affect decreased
after patients listened to audiotaped interviews with other pa-
tients. Those with better prognosis cancers had a greater
decrement in positive mood. These “ndings suggest that so-
cial comparison, at least in the short term, may result in mood
disruption.
Studies of Coping with Chronic Pain
The majority of these studies have used longitudinal designs.
For example, Brown and Nicassio (1987) studied pain coping
strategies among RA patients and found that patients who en-
gaged in more passive coping when experiencing more pain
became more depressed six months later than did patients who
engaged in these strategies less frequently. Keefe and col-
leagues (Keefe, Brown, Wallston, & Caldwell, 1989) con-
ducted a six-month longitudinal study of the relationship
between catastrophizing (negative thinking) and depression in
RA patients. Those patients who reported high levels of cata-
strophizing had greater pain, disability, and depression six
months later. Similar “ndings have been reported by other
investigators (Parker et al., 1989). Overall, studies have sug-
gested that self-blame, wishful thinking, praying, catastro-
phizing, and restricting activities are associated with more
distress, while information seeking, cognitive restructuring,
and active planning are associated with less distress.
Gil and colleagues (Gil, Abrams, Phillips, & Keefe, 1989;
Gil, Abrams, Phillips, & Williams, 1992) have studied Sickle
Cell Disease (SCD), which has not been given a great deal of
attention by behavioral scientists. Pain is a frequent problem
among SCD patients. Adults who used the cognitive coping
strategy of catastrophizing reported more severe pain, less
work and social activity, more health care use, and more de-
pression and anxiety (Gil et al., 1989). SCD patients who
coped with pain in an active fashion by using a variety of
strategies such as distraction were more active in work and so-
cial activities. These associations were signi“cant even after
controlling for frequency of pain episodes, disease severity,
and demographics. In their later studies, Gil and colleagues
(Gil, Phillips, Edens, Martin, & Abrams, 1994) have incorpo-
rated laboratory methodologies to provide a better measure of
pain reports.
Several recent studies have employed prospective daily
study designs in which participants complete a 30-day diary
for reporting each day•s pain, mood, and pain coping strate-
gies using the Daily Coping Inventory (Stone & Neale,
1984). These studies, which have been conducted with RA
and OA (Osteoarthritis) patients, have shown that emotion-
focused strategies, such as attempting to rede“ne pain to
make it more bearable and expressing distressing emotions
about the pain, predict increases in negative mood the day
after the diary report. The daily design is a promising new
method of evaluating the link between coping strategies and
mood. More importantly, these studies can elucidate coping
processes over time. For example, Tennen, Af”eck, Armeli,
and Carney (2000) found that the two functions of coping,
problem- and emotion-focused, evolve in response to the out-
come of the coping efforts. An increase in pain from one day
to the next increased the likelihood that emotion-focused cop-
ing would follow problem-focused coping. It appeared that,
when efforts to directly in”uence pain were not successful,