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Table of Contents

Introduction: The Researcher's Life 1

Chapter Summaries 9

Chapter 1 Coping and Health 13

Chapter 2 Personality Psychology: Havings, Doings, and Beings in Context 34

Chapter 3 Industrial/Organizational Psychology 2010: A Research Odyssey 59

Chapter 4 The Next Frontier in Neuroscience? Believe It or Not, It's Physiological Psychology 81

Chapter 5 Cross-Cultural Psychology in the 21st Century 112

Chapter 6 Dr. Jekyll Meets Mr. Hyde: Two Faces of Research on Intelligence and Cognition 133

Chapter 7 Social Psychology: Past, Present, and Some Predictions for the Future 152

Chapter 8 Psychology of Women and Gender in the 21st Century 189

Chapter 9 Sensation and Perception 206

Chapter 10 Trends in Human Development 250

Chapter 11 Psychology and Law, Now and in the Next Century: The Promise of an Emerging Area of Psychology 288

Chapter 12 Psychopathology 324

Chapter 13 Comparative Psychology and Animal Learning 353

About the Editors 379

Introduction: The Researcher's Life

Jane Halonen, James Madison University and
Stephen F. Davis, Emporia State University

Research is a mental groping by starlight

towards the daylight of clearer vision.
It begins in the slow laborious search for facts in a narrow field.
As material accumulates, relations appear.
The mass ferments, and finally organizes itself
into the semblance of a new living idea.
--Harry Kirke Wolfe, May 29, 1918

Harry Kirke Wolfe founded his teaching career in psychology on the principle that the training of the mind would be served best by actively involving his students in psychological research. The consummate teacher, Wolfe clearly understood the interrelation between teaching and research, an emphasis we appreciatively emulate in this volume. It is the preparation of those individuals who choose the rewarding path of careers in psychological research (and those who will be teaching them) that we had in mind when we conceived the idea for this book. Therefore, we thought it would be helpful to bring together researchers of distinction to discuss the origin, development, and implementation of their own research ideas in the context of the current status of research in their specialized fields. The stories of their professional lives amply illustrate the process Wolfe described in the opening quotation.

Our primary audience for The Many Faces of Psychological Research in the 21st Century is the psychology student who is considering a career in research. Although both undergraduates and graduates should find this book quite valuable as a course text or a reference work, we think the book's most important value will be to serve as a source of inspiration and guidance in becoming involved in the research process. We carefully selected our chapter authors based on their current contributions to, and knowledge of, their respective specialty areas and their acknowledged expertise as teachers. The teacher-researcher combination resulted in chapters that we think are very readable and representative of contemporary research. As students strive to identify where their own potential can be expressed to maximum impact, we think this volume can assist in refining their choices, concentrating their energies, and enriching their repertoire of research strategies. The chapter authors not only offer advice and inspiration about specific fields of research within psychology, but they also serve as inspiring models in their own right for the contributions they have made to understanding behavior.

This book serves other secondary audiences as well. Our chapter authors provide a substantial resource for current, lecture-enhancing material for teachers of introductory psychology, who want their courses to reflect cutting-edge research. Although it is easy to envision this book becoming a staple in the teaching resources of graduate teaching assistants and neophyte faculty, teachers at all levels of experience can use this text to make their aging lecture notes more contemporary. As psychology continues to fragment and splinter, the need to acquire a general overview of the field becomes apparent; this book serves that function. Professionals who want to achieve an overview of research in the various areas of their discipline can also benefit from the researchers' stories.

Harry Kirke Wolfe's wisdom about the nature of science faithfully captures the excitement of the challenge of research in psychology. Our chapter authors have exhibited this willingness to grapple with mystery, careful observation skills, patience and discipline, creativity, and the insight to recognize a sound conclusion when it ultimately emerges from the chaos. Despite the difference in their areas of specialization, their common struggles to understand human behavior emerge from a complex evolution of psychological research.

A Brief History of Research in Psychology

Historians routinely point to 1879 as the birth of scientific psychology when Wilhelm Wundt began conducting original scientific research on mental processes in Leipzig, Germany (Goodwin, 1999; Schultz & Schultz, 1996). Wundt and his first American student, James McKeen Cattell, purposefully emulated the established natural sciences in their research practices, a pattern that was enthusiastically adopted by the early structural psychologists. However, not everyone understood why adherence to scientific methods was such an important aspect of the emerging science of psychology. Wolfe, Wundt's second American student to receive a PhD in psychology, attempted to clarify the intentions of psychology researchers and the nature of psychological research in a description that he wrote to the Nebraska Board of Regents in 1891. He acknowledged that psychology was having difficulty gaining recognition as a science. He drew attention to the essential role of experimentation in helping to establish psychology as equivalent to any other branch of experimental science. He suggested,

The measurement of the Quality, Quantity, and Time Relations of mental states

is as inspiring and as good discipline as the determination of, say the percent
of sugar in a beet or the variation of an electric current. The exact determination
of mental processes ought to be as good mental discipline as the exact determination
process taking place in matter.
(Benjamin, 1991, p. 43)

Wolfe committed his own research energies to exploring mental processes as psychology in America continued to define its boundaries and its practices. Psychologists were not content to devote themselves solely to human mental processes. There were new and different worlds to conquer. Reports of animal research began to appear in the literature. In 1901, W. S. Small published the initial report of rat maze learning and Norman Triplett described the development of learned helplessness in perch. Within a few decades, the study of animal learning and behavior would become an integral component of the field of psychology, spearheaded by behaviorists Clark Hull, E. C. Tolman, Edwin R. Guthrie, Kenneth Spence, and B. F. Skinner.

The lure of applying psychology to practical human problems began to capture the imagination of other psychologists whose concerns were decidedly pragmatic. Lightner Witmer established the first psychological clinic in Philadelphia in 1896, ushering into being the largest specialty area in psychology, a specialization that continues to flourish. The pioneering work of Walter Dill Scott and Hugo Munsterberg in the early 1900s established the new specialty of industrial/organizational psychology. The development of the Army Alpha and Army Beta tests during World War I created a different kind of beachhead for psychology. The success of those assessment tools created many new opportunities for applying psychology to real world problems.

The Contemporary Landscape of Psychological Research

Subsequent decades have witnessed an explosion of specialized research interests in psychology. The American Psychological Association identified through its divisional affiliation structure at least 50 research communities devoted to unlocking the mysteries that remain unsolved in their chosen areas of inquiry. These areas include such broad-ranging specialties as military psychology, peace psychology, pediatric psychology, psychology and law, teaching of psychology, experimental analysis of behavior, and community psychology, among others.

It isn't just the topic areas that have changed and broadened since Wolfe's passionate defense of psychology as legitimate science. Research technology has undergone impressive changes. Puzzle boxes and brass instruments gave way to electromechanical relay racks, which, in turn, were replaced by a dazzling array of computers and computer-related devices used to create experimental conditions and record responses. The advent of electronic databases for psychological research facilitated faster and more efficient literature reviews contributing to the exponential growth of research across specialized discipline areas and, ironically, compounding the problem of "staying current" in one's own burgeoning research area. At the outset of a new century, we are likely to continue to see changes in technology that will compound the advantages and increase the hazards.

In a more literal sense, the "faces" of psychologists have also changed. Many textbooks have written extensively about scientific psychology as a white, male enterprise. Thanks to the splendid scholarship of historians, such as Laurel Furumoto and Elizabeth Scarborough, psychology has rediscovered the invaluable contributions of psychology's "foremothers." The research contributions of pioneering women, such as Mary Calkins and Christine Ladd-Franklin, provide exciting information not just about research on human behavior but about how human behavior among psychologists influenced the definition and evolution about how people gain acceptance as full-fledged members of the larger research community. Similar issues have challenged other minority constituents of psychology in the wake of the pioneering contributions by individuals such as Mamie and Kenneth Clark.

At the threshold of a new century, we recognize that the composition of faces of those persons who will be our future researchers is also shifting. The majority of students at the undergraduate and graduate levels of education are women. As attracted as women have become to the science and practice of psychology, we still have much work to do in helping psychology attract and retain ethnic minority researchers and practitioners.

We have also witnessed during the last decade some major changes and challenges to the values and ethical practices involved in research. Our growing expertise about the frailties of human observers led to a challenge related to the practice and value of objectivity. Captive in our own cultural constraints, we recognize the ease with which biases can filter even the most careful observations and research designs. Some researchers have begun to mount forceful arguments for revisiting the value of qualitative forms of research.

Most important, psychology has embraced the absolute necessity of enacting ethical safeguards for the protection of research participants. In psychology's earlier zeal for finding answers to behavioral questions, our community has enacted suspect, and in some instances, probably harmful actions to those we were trying to help with our research. Our widely-adopted institutional review practices have helped us choose a wiser and more humane path for answering the many mysteries that remain.

With the enterprise of scientific psychology continually expanding, it becomes increasingly challenging to identify where and how one should invest research energies. We asked for help from individuals who have carved out significant roles in various areas of research in psychology and typified the kind of spirit Harry Kirke Wolfe so eloquently described in the quote we used at the opening of this chapter. Each has a distinctive story to tell that explains their individual journeys in developing their distinctive niches in contemporary research.

Joining in the Research Enterprise

Beginning psychology students often seem mystified by the process of research. Students struggle to learn the rudiments of research processes from articulating an original idea through an elegant analysis of a sound research design. Neophyte researchers sometimes fret that the supply of good research opportunities may be exhausted before they get a chance to make meaningful contributions. Yet, many budding researchers learn to overcome their fears and discover that meeting the challenge is not only very rewarding, but life-defining.

To address how that process unfolds, we asked the authors to tell their individual stories. We prompted them to describe what forces drew them into the area in which they chose to specialize. Why would they choose one area and not another? For some researchers, early life experiences stoked natural curiosity about behavioral phenomena. For others, tutelage of a mentor inspired them to follow in the mentor's path. And for some, happy accidents helped them to identify the content that would give shape to their professional lives.

To model for beginning researchers how research gets underway, we asked the authors to describe how they get specific ideas for their research. What factors tend to inspire them when they derive testable hypotheses? How might that be process have changed over time? Most authors describe a process quite contrary to the stereotype of the lone scientist slaving away in a laboratory. They discuss the process as highly collaborative, regularly drawing inspiration from the energy of the students who move in and out of their research streams, mutually enriching each others' lives. Some authors describe how they overcame challenging problems in the development of their research. Many also describe how they maintain vitality in developing the research stream that has defined their professional contributions. As the authors dealt with these questions and issues, they also addressed the important issue of how aspiring researchers can learn to develop research questions. Their consistent use of specific, relevant examples brings this process to life in each of the research areas covered in this book.

We also asked our authors to capture the excitement of the fields in which they have become specialized. This background helps to establish the context in which the researcher's own work can be recognized as outstanding. Understanding the past and present also allowed our researchers to speculate about the most exciting directions that their specialized areas may move in the future. We think these speculations offer some of the most fertile suggestions for aspiring researchers who may be looking for just the right field that will give definition to their life's work.

Finally, we asked our authors to talk personally about the characteristics and skills that emerging researchers will need to make contributions in these specialized areas in the future. Their advice includes everything from the kinds of experience that you need to pursue to maximize the undergraduate experience through the qualities of personal discipline that will be necessary for a successful research career. We think their advice offers a well-tailored advising session, which addressed this important question: If this is the future I want, how do I get there?

Common Themes in Preparing for Life in Research

No matter what their specialization, our chapter authors consistently point to a number of general strategies that help them generate research ideas, design viable research strategies, and move ahead in the scientific understanding of behavior forward. We summarize many of those strategies here in the hopes that aspiring researchers can adopt the approaches that offer the greatest promise in getting them started.

  • Finding and developing research ideas. No, you will not have only one research idea and then never find another one. Ideas for good research projects are all around you! Here are a few suggestions for where to find them. One excellent place to look is in the psychological journals. After reading a published article ask some of the following questions; trying to answer them can lead to very fruitful research projects. Is there a different way to conduct the research? Will I obtain different results if I do this project on my own campus? What if I use different participants? What does this article suggest is the next step in the research process? Each journal article should be able to provide several potential research ideas. Your textbooks also offer an excellent source of research ideas. Jot down your ideas in the margins as you are reading your assignments. The same thing can be said for class lectures; if you are paying attention to and involved with the material, you should not leave a class session without at least one good research idea.

  • Look carefully at life around you. Every day occurrences also offer a wonderful source of research ideas. Here are just a few of the fascinating possibilities we came up with just by observing the world around us. What can restaurant waitstaff do to increase tips? Do store clerks discriminate against certain types of customers? Is student responsibility associated with certain personality types? Whatever the source, your supply of research topics is endless.

  • Be realistic about the ingredients of a good research project. In our technological age, it is easy to think that you must have lots of money and fancy equipment in order to conduct meaningful research. In some instances, such as conducting some research projects on the biological bases of behavior, money and equipment may be important. However, you will find that many excellent projects require no fancy equipment and very little financial support. The main ingredient of the good research project has always been, and remains, the good, creative research idea. You can conduct excellent research projects on a shoestring budget.

  • Research is not a one-shot endeavor. Be prepared to be hooked into a life-long passion. Once the research bug bites you, you will not be able to stop with one project. The results of your first project will lead to another project, which will prompt another, and so on. If you enjoy the ongoing challenge of solving riddles and answering question, you are going to love research.

  • Recognize why you should get an early start. Never has competition to get into graduate school been more fierce. If you are to fulfill your dreams of becoming a researcher in psychology, you must demonstrate your research imagination and skill during your undergraduate years. Good grades, high board scores, and enthusiastic letters of reference help establish your research potential, but having legitimate research experience as a team member, a co-author, or a poster presenter at a psychology conference offer the kind of evidence that admission committees find most useful. The more specifically you can articulate your research interests, the more likely you will have the keys to open the door to graduate school.

  • Learn the literature. Research ideas rarely spring fully formed from a simple observation Although you will see a few really great examples of just that process, it is much more likely that research ideas emerge from carefully study of existing literature. Researchers often find their best ideas in the discussion sections of published research that makes explicit suggestions for future refinements.

  • Identify the key players. As you read the literature, you will notice that some names begin to appear repeatedly in different sources that you read. This occurrence marks an individual whose research efforts have led to a concentration on a particular topic or issue. You may want to change search strategies from reading about a general concept to reading about the research history of a given individual in that area. Following the publication trail gives you a good sense of what that researcher's unique history has been in helping our understanding about a given concept unfold. Ultimately this strategy may prove helpful because you can define where the most exciting research is occurring. The result may shape your application strategies for graduate school.

  • Start small. As you begin to conceptualize new research avenues, you may fare best if you think in terms of small research ideas. Beginning researchers are sometimes tempted to want to solve enormous problems for which they have neither the time nor skill. Good research mentors will help you see how even small scale projects fit the overall growth of knowledge about human behavior.

  • Read beyond the boundaries. Read voraciously, not just in the psychology literature but other sources as well. Current events, research in other disciplines, and even good literature may provide just the inspiration you may need to develop a new twist.

  • Prepare for a full range of emotions in your chosen life. Research in psychology offer exquisitely exciting moments. For example, it is hard to characterize the thrill when an idea breaks out of the chaos or a statistical analysis confirms just the prediction you were seeking. However, some aspects of research are not only unexciting, they are downright tedious. Being successful in a research career means that you are willing to exercise self-discipline to weather the nonthrilling aspects of generating research.

  • Identify faculty whose interests match your own. Many of our authors spoke to the critical importance of finding a mentor in their chosen area. That connection routinely starts in advanced courses in which faculty members have the opportunity to explain research processes that have fueled their individual interests. You may be surprised to discover that material that you thought initially was not very appealing takes on much greater significance through the eyes of researchers genuinely excited about their work. In many cases, these faculty members may have research programs that would benefit from having a new team member. If you do secure a place on a research team, remember there is usually a clear hierarchy for the tasks that must be shared. Most researches expect that people new to the research enterprise need to start out with smaller responsibilities. Brand new members often face the work that requires the most drudgery. As you prove yourself to be a reliable assistant, you will be granted more independence and more exciting things to do.

  • Ask for help in finding a faculty mentor. If your faculty members are not actively engaged in research, they may be able to connect with others in the community who are doing research. If you haven't had the good fortune of identifying such an individual from class experience, visit your department's website. Typically departments will list faculty research interests. Some departments post research opportunities on the web or in the department newsletter.

  • Prepare to present yourself to potential mentors. Many researchers have an overfull agenda and will be very pleased at the prospect of a new team member. Others may initially respond to your request as though it is a burden. Either way, you should strive to create the most positive first impression possible. Be prepared to explain clearly why you wish to join a specific team. It will help if you are familiar with a researcher's accomplishments before you schedule your interview. Explain how refining your research skills fits into your future plans. If you reveal that you "have to do research for your requirements," chances are good the prospective mentor will not be terribly impressed with your personal motivation.

Our hope is that this text will contribute to keeping the science of psychology a vital research enterprise as we move into the 21st Century We thank the authors for their generosity and patience in developing this distinctive volume. We are also indebted to a hard-working corps of reviewers and editors to help us develop the right voice. We dedicate this book to the spirit of Harry Kirke Wolfe and all those reseacher/teachers who followed him by choosing to "grope by starlight towards the daylight of a clearer vision."

Notes on the E-Book Format

This electronic book represents an interesting experiment for the Society of Teachers of Psychology and the e-book editors. We wanted to bring you some fresh and personal perspectives primarily to assist people on the front end of their research journey as well as those teachers and researchers committed to helping them realize their dreams. Working in an e-book format can be a bit challenging. For example, you will note uniformity in the appearance of all the chapters but one. One set of authors (Woods and Krantz) delivered their chapter ina coherent HTML package so we chose to retain their original design choices. The other chapters have a more uniform and standard appearance. Because of some current peculiarities of HTML in dealing with italics, our references depart from APA format requirement in each chapter.

Despite those minor difficulties, we are very excited about the advantages of e-publishing. At the conclusion of each chapter, you will find a picture and biography of the authors of that chapter. We also provide a direct feedback capacity in which you can talk to the editors or the authors about your opinions of our work. You can also suggest other topics or authors that you think would make a good addition. And if the cyber-gods are willing, you should be able to download and keep copies of the chapters to help you at no cost to you. We intend to make the e-book available for three years from the date of launching the e-book website.

We also want to thank Vinny Hevern, STP Webmaster, and Dave Johnson and Bill Hill, who are currently sharing presidential responsibilities for STP. Their support has been outstanding in helping this project see daylight. We owean unpayable deb to Brian Halonen for long hours in helping us resolve endless problems with web site publishing.


Benjamin, L. T., Jr. (1991). Harry Kirke Wolfe: Pioneer in psychology. Lincoln, NE: University of Nebraska Press.

Goodwin, C. J. (1999). A history of modern psychology. New York: Wiley.

Schultz, D., & Schultz, S. E. (1996). A history of modern psychology (6th ed.). New York: Harcourt Brace.

Chapter Summaries

Chapter 1

Coping and Health 

Susan Folkman,
University of California, San Francisco

Susan Folkman's chapter provides an exceptional overview of current frameworks that explain what makes us resilient in the face of stress and what makes us crumble. Her chapter provides some practical direction about how health psychology theories can be applied to improve our ability to cope.

Chapter 2

Personality Psychology:

Havings, Doings, and Beings in Context

Brian R. Little

Carleton University and Harvard University 

Brian Little's sense of humor makes this chapter about personality theory a unique reading experience. He explains how three students with distinctive backgrounds illustrate various personality principles as they pursue admission to graduate school.

Chapter 3

Industrial/Organization Psychology 2010:

A Research Odyssey

Brian W. Schrader,

Emporia State University

Industrial/Organizational Psychology 2010: A Research Odyssey examines the many content and research changes that are set to happen in the next decade across the major areas of I/O Psychology: personnel selection, work motivation, leadership, training, work attitudes, organizational issues, and performance appraisal with a strong emphasis on the latter. The chapter also explores the current hot topics in I/O Psychology as well as provides advice for students interested in becoming an I/O Psychologist.

Chapter 4

The Next Frontier in Neuroscience?

Believe It or Not, It's Physiological Psychology

Timothy M. Barth,

Texas Christian University

Physiological psychology is one of the most enduring specialties in psychology. Yet, technological advances have made emerging studies in this area among psychologists most exciting adventures. This chapter explores many historical and contemporary aspects of physiological research including applications to behavioral assessment, neurodegenerative disease, and recovery.

Chapter 5

Cross-Cultural Psychology in the 21st Century

David Matsumoto,
San Francisco State University

Everything you thought you knew in psychology may or may not be true for all people of all cultures. Cross-cultural psychology challenges the very nature of truth and principle in all areas of psychology, and promises to change those truths in fundamental ways.

Chapter 6

Dr. Jekyll Meets Mr. Hyde:

Two Faces of Research on Intelligence and Cognition

Robert J. Sternberg,

Yale University

Robert Sternberg uses Robert Louis Stevensonís tale of Jekyll and Hyde to explore the advantages and disadvantages of intelligence testing. His work highlights the nature of creativity in research design and execution as an essential characteristic of successful research.

Chapter 7

Social Psychology:

Past, Present, and Some Predictions for the Future

Nyla R. Branscombe, University of Kansas and

Russell Spears, University of Amsterdam

Social psychology provides insight into how our behavior is influenced by our own identities, and which are salient at any given moment. We emphasize the social identity and self-categorization theoretical perspective, and show how it can be used to unify the empirical findings obtained in the field as a whole. Our discussion of identity processes emphasizes new topics that are likely to increasingly capture investigators' attention in the new millennium.

Chapter 8

Psychology of Women and Gender in the 21st Century

Janet Shibley Hyde & Amanda M. Durik,
University of Wisconsin

This engaging chapter interweaves three main themes: research focused on women and their psychological functioning; research on gender, both gender differences and gender as a stimulus variable; and feminist psychology. The authors offer solid advice for aspiring feminist scientists in carving our distinctive research careers.

Chapter 9

Sensation and Perception:
A Window into the Brain and Mind

Charles B. Woods, Austin Peay State University and
John H. Krantz, Hanover College

Contemporary research in these areas represents a blend of interest in low level sensory processing to high level perceptual mechanisms that give meaning to human experience. This chapter explores vision and visual perception as both a basic and applied science. The authors conclude with some speculation about virtual reality research as an exciting venue for understanding and applying knowledge in sensation and perception.

Chapter 10

Trends in Human Development

Laura E. Berk,
Illinois State University

Childhood specialist Laura Berk provides broad view of the nature of human development by examining major characteristics of this field of study. She highlights the theories of Vygotsky as an avenue for promoting integration across specialized fields in developmental psychology. She examines play, private speech development, and impulse control as just a few of the many exciting fields in which contemporary researchers do their work.

Chapter 11

Psychology and the Law,

Now and in the Next Century

Matthew T. Huss,

University of Nebraska at Lincoln

Forensic psychology stands at the intersection of clinical psychology and the law. This chapter details the manner in which basic psychological principles are applied to our legal system.

Chapter 12


Richard P. Halgin,
University of Massachusetts at Amherst

Richard Halgin speculates about the future of research in psychopathology based on the significant premise that the scientific truths of one era often become challenges and replaced through intellectual evolution in the field. He reviews major philosophical differences among perspectives that explain psychopathology and offers suggestions to neophyte researchers about the nature of graduate training that will help them achieve professional resilience even under the pressures of changing scientific truths.

Chapter 13

Comparative Psychology and Animal Learning

Jesse E. Purdy, Southwestern University and
Michael Domjan, University of Texas at Austin

Zoos and animals trained for entertainment have been popular for centuries, and nature shows dealing with animal behavior can be seen on TV virtually any time of day. Most of us know firsthand that animals can be fun, interesting, and emotionally satisfying, but nonhuman animals can also provide information about learning, cognition, and the evolution of intelligence. This chapter explores the study of comparative psychology and animal learning from three perspectives--past, present, and future. Readers will learn that persons who have a personal fascination with animals and nature can turn that interest into studying comparative psychology and animal learning and end up knowing more about the human animal as well.

Chapter 1
Coping and Health

Susan Folkman
Department of Medicine and Center for AIDS Prevention Studies
University of California - San Francisco

It is practically impossible to avoid daily advice on how to cope with stress. This advice is proffered almost nonstop by talk show pundits, authoritative writers in magazines and newspapers, ads for over-the-counter stress antidotes, friends, and of course family members. This barrage of advice is based on widely held assumptions that (1) stress is omnipresent in our lives, (2) stress can be harmful to health, and (3) these harmful effects can be avoided or reduced if we cope well.

Few would quarrel with the notion that stress, no matter how it is defined, is omnipresent. It is commonly experienced by most people on most days. But the generalizability of the effects of stress on health is not as broad as the media would have us believe. A review of the literature by Adler and Matthews (1994)shows that while there is evidence that stress can increase vulnerability to certain health problems including respiratory infections, infectious disease, and pregnancy complications, evidence is lacking that it affects the etiology of other diseases including cancer and endocrine disease. But even if stress affects only a subset of all health problems, that it does so at all is important. Respiratory infections and infectious diseases, for instance, affect virtually all of us at one point or another, and they are responsible not only for discomfort and misery, but for missed days at work or school and increased medical costs.

Just as we believe that stress affects health, so too do we believe that the harmful effects of stress can be mitigated if somehow we learn how to cope with it. Presumably, those who cope well with stress will have fewer illnesses, fewer infections, and fewer days lost from work than those who do not cope well. This argument is logical, and it is appealing because it gives us hope that even if we cant escape stress, there are things we can do to keep it from harming us. The burgeoning scientific literature on coping and health confirms that psychologists and other behavioral scientists find this idea appealing, too.

Studies of the relationship between coping and health can be placed in two categories. In the first, coping is looked at in direct relationship to health. Here the researcher is concerned with how the way an individual copes with a stressful situation or condition has a direct impact on his or her health. In the second, coping is looked at in indirect relationship to health. Coping, for example, is examined in relation to health behaviors or mood, with the idea that behaviors or mood in turn affect health; but coping is not expected to affect health directly. Instead, coping affects health through its impact on the }mediating" variable such as health behavior or mood.

In the first part of this chapter, I review a few selected studies to illustrate each of these perspectives and summarize what they do and do not tell us about the relationship between coping and health. In the second part of the chapter, I offer some thoughts on where I believe the field of coping needs to go next in order to increase our understanding of the relationship between coping and health. Before the review begins, I outline a few important conceptual issues regarding coping to provide a foundation for the rest of the chapter.

The Literature on Coping and Health

Conceptual Issues

Over the last twenty years most studies on coping and health have come to conceptualize coping in surprisingly similar ways. The conceptualization is based on a definition of coping as the changing thoughts and behaviors that people use to manage distress (emotion-focused coping) and the problem underlying the distress (problem-focused coping) in the context of a specific stressful encounter or situation (e.g. Moos 1974; Pearlin & Schooler 1978; Folkman & Lazarus 1980; Lazarus & Folkman 1984; Folkman & Lazarus 1985; Moos & Schaefer 1993).

Since this definition of coping is widely used, it is helpful to understand some of its nuances because they can complicate the study of the relationship between coping and health. First, the definition implies that coping is a dynamic process that changes as a single stressful encounter unfolds and across diverse encounters, depending on changes in what the person is coping with. The changing and variable nature of coping poses challenges for the researcher. If coping were stable, it would be easier to use it to predict health outcomes because a single assessment would be highly reliable. But coping is not stable; it is changeable. Its changeable quality was demonstrated in a number of early studies that showed, for example, that coping changes depending on whether the event is a harm, loss, or threat (McCrae, 1984) , the social role that is involved (Menaghan, 1982) environmental and social factors (Parkes, 1986) , and what is at stake and what the options for coping are (Folkman & Lazarus, 1980; Folkman, et al. 1986) .

Even a seemingly simple stressful event, such as taking a final exam, has different phases, each posing different demands for coping. Let’s say that the stakes are high: the course is an important prerequisite for graduate school, the exam is expected to be difficult, and the outcome is important because it determines the final grade. The encounter begins with a preparation phase, which requires organizing the environment so that it is possible to study, getting the right materials for study, and then actually studying. Then there is the exam itself, which requires managing anxiety so that it does not interfere with test taking, thinking clearly, and coming up with good answers. This is followed by a waiting period, while the exam is being graded. And then finally there is the outcome -- the grade itself. Each phase of the exam poses different coping demands, and as a consequence coping changes as the exam process moves from one phase to another (Folkman & Lazarus, 1985) .

Second, coping is multidimensional. Most coping measures include multiple kinds of problem- and emotion-focused coping, usually between 6 and 8, although sometimes more than 20 (McCrae, 1984). The multidimensional quality of coping poses challenges for analysis. Although the various types of coping are conceptually distinct, they tend to be related empirically. For example, in a study of men who had undergone coronary artery by-pass surgery, Scheier and his colleagues (1989) found that efforts to regulate distress, an emotion focused form of coping, interfered with making plans and setting goals for the future, a problem focused form of coping. As another example, the use of cognitive reframing or positive reappraisal is typically associated with planful problem-focused coping (e.g. Folkman, et al. 1986; Carver, et al. 1989) . This lack of independence makes it more difficult (although not impossible) for any one type of coping to stand out as a single, strong predictor.

Third, most coping scales are inherently less internally consistent than are measures of other constructs, such as attitudes. The internal consistency of a measure refers to the extent to which the items on a scale are measuring the same thing. The greater the internal consistency of a measure, the more reliable it is as a research tool. A person who responds to a questionnaire with good internal consistency about his or her attitude toward environmental preservation, for example, is likely to endorse all items that are consistent with that attitude. Unfortunately, it is difficult to achieve high levels of internal consistency with coping scales because of the nature of coping. If a specific coping strategy, e.g., turning to another task to get ones mind off the problem, is successful the person does not have to turn to other strategies within that category. The one strategy worked, and therefore there is no need to do more. This quality lowers the likelihood that an individual will check multiple strategies within a given category, thereby lowering the internal consistency of the measure of that category. This can be a problem because the coefficient that describes internal consistency puts a ceiling on the strength of the correlation that measure can attain with any other variable.

These quirky characteristics of coping create methodological obstacles in the study of the relationship between coping and health. Therefore, if a relationship is observed between coping, which is inherently variable and multidimensional, and a health outcome, such as recurrence of an illness, days in hospital, or recovery, that relationship should be taken seriously. It is there despite great odds.

The study of the relationship between coping and health also depends on characteristics of the dependent variable. The dependent variable must have the potential for change over the time of the study. General health status variables, for example, tend to be quite stable in the general population and the probability that such variables might change during a study period that is arbitrarily chosen is not great (Folkman, 1992) . On the other hand, health variables that are more changeable, such as upper respiratory infections, muscular and skeletal problems, and gastrointestinal infections are more likely to change over the course of several months and are more appropriate for the study of coping and health.

Fortunately, these conceptual and methodological issues have not brought research on coping and health to a halt. But it is helpful to understand these issues when reviewing the literature because they can help explain inconsistencies in findings across studies.

Questions about coping and health are generally asked in one of three ways: 1) Do the ways people cope with stress in their daily lives affect their health? 2) Do the ways people cope with a health problem affect outcomes related to the health problem such as illness progression or mortality? 3) Do the ways people cope with a health problem affect their mental health or adjustment to the health problem?

Coping with daily stress and health

Has research shown that the ways we cope with the stresses of our daily lives make a difference in our physical health? It would be nice if we could say }Yes, and heres how you should cope." Unfortunately, studies have not revealed any consistent insights about the direct effects of general coping with daily stress on general health in the general population. But coping with daily stress has been linked to health in the more specific cases of coping strategies that take the forms of injurious behaviors.

More than 40 years ago Conger (1956) formally proposed that people drink in response to stress as a method of reducing tension. Viewed from this perspective, drinking is a method of coping with stress. Drinking is normatively considered a maladaptive response because it neither helps resolve the underlying problems nor does it effectively regulate distress. In fact, alcohol use generally increases distress, and alcohol abuse has a deleterious effect on health.

That such behaviors are in fact often a response to stress was demonstrated in a study of abstinent male drinkers (Brown, et al. 1995) . Those abstinent drinkers who experienced high levels of stress were more likely to lapse than abstaining individuals not experiencing such stress. But whether or not drinking is the coping strategy of choice depends in part on the extent to which the individual generally relies on avoidant forms of coping, the availability of alternative ways of coping, social skills, and expectancies regarding the effects of alcohol (Cooper, et al. 1992) . A number of community studies have shown that avoidant coping in particular is strongly associated with alcohol use (Cronkite & Moos, 1984; Timmer, et al. 1985; Cooper, et al. 1988; Moos, et al. 1990) . For a review of research on coping and substance use, see Wills and Hirky (1996). Maladaptive health behaviors such as smoking and high risk sexual behavior (McKusick, et al. 1985; Chesney, 1988) and decreases in exercise (Ogden & Mitandabari, 1997) have also been interpreted as coping responses to stress. Alcohol, high-risk sexual behavior, and recreational drug use in particular are considered behavioral forms of escape-avoidant coping (Lazarus & Folkman, 1984) that can be directly injurious to health.

Coping with health problems and health outcome

The most fruitful explorations of the relationship between coping and health have taken place within the context of health problems. The literature is dominated by studies that explore the relationship from the two perspectives mentioned earlier: the effects of coping with a health problem on health outcomes related to that problem, and the effects of coping with a health problem on mental health.

Physical health outcomes. A number of studies have examined the relationship between coping with a disease such as cancer, myocardial infarction, rheumatoid arthritis, asthma, or HIV/AIDS, and a disease-related outcome such as recurrence, recovery, disease progression, or mortality. Rather than review all the studies in this area, I begin this section by describing a series of studies on coping with cancer that summarizes quite nicely what is known about coping and cancer and illustrates the complicated issues involved in investigating this question. Then I review a few selected studies from other diseases that illustrate other issues that are related to the question of coping and health in the context of specific disease.

A study by Epping-Jordan, et al. (1994) of the relationship between coping and disease progression demonstrates how the relationship between coping and health is ultimately quite complicated. They studied coping and health in a sample of 66 cancer patients diagnosed with a variety of different types of cancer including breast cancer, gynecologic cancers, hematological malignancies, brain tumors, and malignant melanoma. They focused on avoidance, which refers to efforts to suppress dysphoric feelings, because several studies had shown a relationship between avoidance and poor physical outcomes (Suls & Fletcher, 1985; Holahan & Moos, 1986) . Instead of relying on the self-report that has been used in earlier studies, Epping-Jordan and her colleagues measured disease variables by reviewing medical charts and patients reports of the prognosis they received from their oncologist. They measured disease status one year post diagnosis as a dichotomous variable: (a) no disease or (b) disease, including presence of original cancer, recurrence, of cancer, or death. Avoidance thoughts were measured with the Impact of Event Scale (IES) (Horowitz, et al. 1979) . They also assessed psychological symptoms. Participants answered the question on the IES with respect to their cancer.

One-year post-diagnosis, 48 patients (73%) were disease free, and 19 patients (27%) had their original cancers, had experienced a recurrence, or had died. After controlling for initial prognosis, avoidance predicted disease status one year later, but psychological symptoms did not. The authors commented that previous studies (e.g., Cassileth, et al. 1985; Jamison, et al. 1987) may have failed to find relationships between psychological symptoms and cancer progression because psychological symptoms did not clearly reflect the cognitive and emotional processes that are most closely related to subsequent disease progression in cancer patients. Presumably, avoidance -- the suppression of feelings -- is more closely related to subsequent disease progression than psychological symptoms.

The reasons avoidance might directly affect disease progression are not immediately clear. Epping-Jordan et al. (1994) offer two hypotheses: avoidance might affect immune functioning in cancer patients by contributing to continued high distress and emotional arousal; or avoidance might result in decreased compliance with cancer treatments, which in turn could lead to worsened disease status. We will return later to these hypotheses, because they are at the very core of the explanation about how coping might be related to health.

Other studies of coping and disease outcome in early breast cancer provide mixed support for the role of coping. A series of studies by Greer and his colleagues (Greer, et al. 1985; Greer, et al. 1990) and Dean and Suertees (1989, described by Buddeberg, et al., 1996) categorized patients as using one of four styles of coping assessed with structured interviews: denial (described as positive avoidance), fighting spirit, stoic acceptance, and helplessness/hopelessness. The earlier studies by Greer, et al. (1985) included longitudinal assessments of 62 women with nonmetastatic breast cancer. Fifteen years later, women who had used fighting spirit or denial were significantly more likely to be alive and free of recurrence than those with fatalistic or helpless responses. But as Buddeberg and his colleagues point out, the sample was small, and the histological node status, which is the best predictor of disease-free survival, was not documented.

Dean and Surtees (1989) replicated the study by Greer with a larger sample of 121 women. The women were interviewed twice, before and 3 months after mastectomy, and these data were related to disease outcome 6 to 8 years after the primary surgical treatment. Coping was assessed using the same method as Greer had used, only Dean and Surtees assessed coping twice. Dean and Surtees found a relationship between coping and disease outcome, but the relationship depended on when it was measured. The patients coping responses were not consistent over time, and no clear relationship could be determined.

Buddeberg et al. (1996) continued this line of research, focusing on the relationship between coping and survival in 107 breast cancer patients at a 5- to 6-year follow up. This study was strengthened by the inclusion of detailed medical data for each patient. Coping was assessed annually for the first three years. At the conclusion of the follow-up period, 25 patients had died, and 81 survived. (One patient was eliminated because she died of cardiac arrest.) Clinical variables, including tumor size and histological node status were related to survival. Coping was not.

These studies of coping and cancer illustrate the challenges in determining the role of coping in health outcomes. The changeable nature of coping makes it difficult to use it as a predictor of health outcomes. More important, the final study (Buddeberg, et al. 1996) shows that when dealing with a disease, biological variables rather than psychological ones are likely to have more influence on survival.

I would like to comment on a study by Reed, Kemeny, Taylor, Wang, and Visscher (1994) in which the focus is not cancer, but AIDS, because it reports some intriguing findings on coping and survival. From the early 1980s, when AIDS first appeared on the national public health agenda, until the mid 1990s when protease inhibitors and new antiretroviral treatments became available, the disease was largely untreatable. Most people who were diagnosed with AIDS died within a few years of that diagnosis. Although treatments became available to treat specific opportunistic infections, little could be done to significantly extend survival time.

During that period, Reed and his colleagues studied psychosocial factors that might affect survival time in a cohort of 74 gay men with AIDS. At the conclusion of their study in 1991, 61 had died of complications related to AIDS. The researchers found a relationship between realistic acceptance, a passive coping strategy, and decreased survival time in their prospective analysis. This study included a number of biological and medical measures (e.g., data from medical charts, measures of the immune system) and behavioral measures (e.g., smoking, alcohol use, and recreational drug use) in addition to psychosocial measures (e.g., optimism, distress, and coping). Six kinds of coping were assessed: community involvement and spiritual growth, active cognitive coping, avoidance and self-blame, seeking social support, realistic acceptance, and seeking information. Realistic acceptance (}Try to accept what might happen," }Prepare myself for the worst," }Go over in my mind what I would say or do about this problem") was associated with decreased survival time, even when the effects of other variables known to be important contributors to survival time were accounted for in the statistical models. These authors used only one assessment of coping in their predictions, so in this regard their study design was not as strong as others. On the other hand, they included a wide range of medical, biological, and behavioral variables in their analyses, and the coping variable still remained the most important predictor of survival time.

Reed et al. (1994) offer a number of possible explanations for the relationship between coping (realistic acceptance) and mortality, many of which will by now have a familiar ring. They suggest that men who report more accepting responses may engage in different behaviors relevant to health outcomes than their less accepting counterparts. Also though the study controlled for a number of such behaviors, other health-related behaviors, such as monitoring of relevant symptoms, seeking medical advice, and compliance with medical treatment may have been adversely affected by realistic acceptance. It is also possible that realistic acceptance was sensitive to unfavorable changes in health status that were too subtle to be captured by their measures. This would account both for realistic acceptance and increased mortality. Finally, they suggest that realistic acceptance may have an impact on immune or viral processes affecting health status in individuals diagnosed with AIDS. In short, Reed et al point out that realistic acceptance, rather than directly affecting health, probably operates through other mechanisms that affect health.

Occasionally we come across studies that illustrate how certain coping strategies may be maladaptive with respect to health in the contexts of certain diseases, but not in others. Studies of coping with coronary heart disease, for example, suggest that denial-like coping, which is traditionally considered maladaptive, can be health-protective at certain stages of disease. Meta-analyses by Suls and Fletcher (1985) were consistent with clinical observation that denial can be adaptive immediately following an acute myocardial infarction, but less adaptive in later stages. In their review of coping with chronic diseases, Maes, Leventhal and de Ridder (1996) summarize a number of studies that are consistent with this pattern. They cite studies, for example, reporting that strong deniers spend fewer days in the coronary care unit and have fewer signs of cardiac dysfunction during their hospitalization compared with weak deniers, but in the year following discharge they are less compliant with medical recommendations and are rehospitalized more often (Levine, et al. 1987) .

Studies of coping with chronic pain show that cognitive or behavior strategies that divert the patients attention from the pain to some other activity help reduce the patients awareness of pain (for review see Katz, et al. 1996) . Such strategies differ from denial in that diversion does not imply denial of what is happening. But diversion strategies are similar to denial in that they are a way of avoiding or reducing awareness of an aversive condition. Diversion types of coping, however, can be maladaptive if there are treatments or procedures that require the patients attention and effort. HIV+ individuals who are on complicated treatment regimens that require a great deal of vigilance, for example, would have adverse health outcomes if they engaged in diversion and denial (Ickovics & Chesney, 1997) . The same is true of diabetic patients whose disease requires close control.

As another example, information seeking is generally considered an adaptive form of coping. But information seeking is associated with adverse outcomes under certain conditions. For example, education and information were associated with increased reports of pain and disability in rheumatoid arthritis patients (Park, 1994) . Maes et al. (1996) explain this counterintuitive result by suggesting that the increase in education and information, which was provided through an intervention, increased the patients sense of vulnerability and diminished the adequacy of patients disability. A similar finding was reported by Chesney and her colleagues (1996) in a study of a coping intervention for HIV+ gay men. This study included a coping skills group, an HIV/AIDS education and information group, and a no-treatment control. The anxiety level of the HIV/ADS education and information group increased, suggesting that the additional knowledge, while possibly helpful with respect to strategies of the management of their illness, was also anxiety provoking, especially in the absence of training in skills for coping with the anxiety.

Finally, there is also a growing literature on the adverse health consequences of suppression of emotion, an emotion-focused coping strategy, such as that described by Epping-Jordan and her colleagues (1994) in the study of cancer that I mentioned earlier. Since 1983, James Pennebaker has conducted a number of studies based on a general theory of inhibition and confrontation. This theory assumes that inhibiting or holding back ones thoughts, feelings, or behaviors requires work. Over time, the work of inhibition can be viewed as a long-term form of low level stress that can create or exacerbate illness and health problems (Pennebaker, 1992) . In a number of studies, Pennebaker and his colleagues have found that individuals who suffered major trauma in childhood are far more likely to become ill if they never talked about the trauma (Pennebaker & Susman, 1988; Pennebaker, 1989) . Others have found that inhibiting forms of emotion-focused coping are also associated with poorer recovery from surgery. In their study of patients undergoing coronary artery bypass surgery, for example, Scheier and his colleagues (Scheier, et al. 1989) found that patients who tried to suppress emotion just before surgery had poorer recovery patterns six months later. This provocative line of research is still in its early and exploratory stages, but it has generated interest among health psychologists.

Mental health outcomes. Both acute and chronic illnesses and conditions create psychological stress for the individual. The most severe psychological challenges are posed by those illnesses or conditions that are painful, interfere with the individuals daily role functioning, disrupt personal relationships, cause disfigurement, and result in both temporary and permanent loss. Uncertainty, whether about test results, efficacy of treatment, recurrence of symptoms or the disease, effects of the disease, time until recovery, degree of recovery, and so on, is pervasive, and this is the source of a great deal of stress in any acute or chronic illness. To maintain well-being in the face of these kinds of stressors requires coping. The psychological stress caused by health problems is thus fertile territory in which to examine how coping with psychological health-related stress affects outcomes related to adjustment and mood. And, in fact, a great deal of research has been done to determine what kinds of coping seem to promote good adjustment outcomes to health-related problems and what kinds of coping seem to make things worse.

Mental health outcomes of coping with health-related stressors are important not only because they have inherent value with respect to patients well-being and quality of life, but also because they may be important mediators of the relationship between coping and physical health. For example, our study of the effects of the chronic stress of caregiving in the context of AIDS on the physical health of the primary informal caregiver showed that coping was not directly related to health symptoms, but it was related indirectly through its relationship to negative mood (Folkman, August, 1997) .

The findings regarding relationships among health problems, coping, and distress are quite consistent across diseases including cancer (e.g., Dunkel-Schetter, et al. 1992; Stanton & Snider, 1993; Chen, et al. 1996) , rheumatoid arthritis (e.g., Felton & Revenson, 1984; Zautra & Manne, 1992) , systemic lupus erythematosus (e.g., McCracken, et al. 1995) , myocardial infarction (e.g., Estreve, et al. 1992) , heart transplantation (e.g., Dew, et al. 1994) , and HIV/AIDS (e.g., Friedland, et al. 1996) . Avoidant forms of coping are generally associated with greater distress, and problem-focused coping and positive reappraisal are generally associated with less distress. The pattern is observed in both cross-sectional and longitudinal studies. This consistency of this pattern suggests that regardless of the disease, disease severity, or the specific kinds of adaptive tasks that confront the individual, taking an active stance and trying to look at the situation as positively as possible is beneficial in terms of mood, whereas engaging in cognitive and behavioral forms of escape and avoidance is detrimental.

The danger of making a sweeping generalization of this sort is that inevitably there are exceptions. In this case, the exceptions are found when characteristics of the person and the situation are taken into account. Both exceptions have to do with the fit between the personal or situational characteristic and the type of coping. With respect to person characteristics, for example, Suzanne Miller (e.g., Miller, 1987) has examined dispositional coping styles related to information-processing behavior. Monitors are disposed to seek information about threat, and blunters are disposed to avoid threat-relevant information. Miller and her colleagues have examined the relationship between preferences for monitoring and blunting, information, and health behaviors and distress and found that high monitors and low blunters fare better with more information and more attention and reassurance and low monitors and high blunters fare better without information, attention, and reassurance (for review, see Miller, et al. 1988) .

With respect to situational characteristics, the extent to which the situation is one that can be changed or that has to be accepted affects the relationship between coping and mood and behavioral outcomes, too. Theoretically, people fare better psychologically when there is a fit between options for coping and actual copingprocesses. Problem focused coping is more appropriate in situations where something can be done, less so in situations that have to be accepted; and emotion focused coping is more appropriate in situations that have to be accepted, and less so in situations where something can be done. This hypothesis, which has been called the }goodness of fit" hypothesis (Folkman, et al. 1979; Folkman, 1984) , has been examined in a variety of settings including natural disaster (Baum, et al. 1983) and stressful life events (Forsythe & Compas, 1987; Mattlin, et al. 1990; Vitaliano, et al. 1990; Conway & Terry, 1992) . With respect to health, Christensen, Benotsch, Lawton and Wiebe (1995) found that it helped explain adherence to fluid intake in hemodialysis patients. For controllable stressors related to hemodialysis, problem focused coping was associated with more favorable adherence, and for less controllable stressors, emotion focused coping was associated with more favorable adherence.

One of the unanswered questions is whether coping affects mood, or mood affects coping. Although longitudinal designs in which coping is used to explain changes in mood over time indicate that coping is associated with changes in mood (e.g., Felton & Revenson, 1984; Stanton & Snider, 1993; McCracken, et al. 1995; Folkman, et al. 1996) , this does not rule out the possibility that mood also influences coping. The relationship between escape-avoidant forms of coping and depressed mood, for example, suggests a bi-directional process in which depressed mood leads to escape-avoidant (passive) forms of coping, which in turn increases depressed mood (possibly because the underlying problem remains or even gets worse in the absence of more active coping). The vicious cycle between avoidant coping and negative mood was proposed by Felton and Revenson as a way of understanding deterioration in adjustment indices of patients with chronic illness.

To the extent that the relationship between depressed mood and escape-avoidant coping is indeed reciprocal, the causal relationships can be established in both directions. Why, then, do most researchers focus on the coping ----> mood direction rather than the mood ----> coping direction? One compelling reason is that coping is potentially amenable to change. Cognitive-behavior interventions, for example, that try to alleviate depressed mood involve the teaching of coping skills. The assumption is that the vicious cycle between escape-avoidant coping and depressed mood can be interrupted by reducing reliance on maladaptive escape-avoidant coping and increasing the use of adaptive problem-focused coping and strategies for reframing or reappraising a situation.


The vast literature on coping and health is evidence of the widespread belief that the ways people cope is somehow linked to their health. Direct effects of coping on health are probably relatively infrequent, and are most likely limited to behavioral forms of coping that can be injurious to health, such as substance use and high risk sexual behavior. Indirect effects of coping on health, on the other hand are probably relatively frequent. One likely causal pathway suggested by research is the pathway through mood. Coping is strongly associated with mood, which in turn can affect health behavior and ultimately health. Another pathway that merits consideration is when active and avoidant forms of coping directly influence health behaviors, such as entry into the medical system, adherence to a treatment program, or ordinary behaviors of eating and exercising. There are also hypotheses, largely untested, that coping can affect immune function, possibly through mood, and immune function can in turn affect resistance to infectious diseases.

Research on Coping and Health: Where to Go from Here?

The overarching conclusion that emerges from research on coping and health is that to the extent that such a relationship does exist, it is most likely mediated through behavioral, affective, or immunological pathways, or some combination of all three. I am not expert enough to comment on possible immunological pathways. For those interested in the specific relationship between immune function and coping I recommend the work of Margaret Kemeny, Janice Kiecolt-Glaser, and Arthur Stone.

One of the most obvious directions for research on coping and health has to do with the subject of adherence. Advances in treatment have transformed some diseases that were previously fatal, such as HIV/AIDS, into chronic diseases that require adherence to treatment regimens over many years, and they have increased the complexity of other treatment regimens, such as Type I diabetes. As more and more previously terminal illnesses are transformed into chronic diseases that require long-term management, adherence becomes an increasingly important mediator of the coping-health relationship. We need more research on factors that interfere with adherence and factors that promote adherence. Coping is implicated in this research to the extent that stress affects individuals motivation and capacity to adhere.

It is clear that research about the relationship between coping and health will be helped along by improved measures of coping and coping outcomes. With respect to coping, paper-and-pencil measures can always be improved, but I would like to suggest that we turn to more qualitative techniques. It is time to supplement what we can learn with paper-and-pencil measures of coping with the analysis of narrative data. Peoples stories can provide us with different ways of thinking about coping and how it might be related to health. Our study of caregivers of partners with AIDS contained narratives that gave us exciting insights into meaning-based coping. In fact, the narratives that the men provided at the time of their partners deaths were so rich that I believed no one set of analyses would do them justice. So I invited four sets of investigators, each with experience in narrative analysis in the areas of bereavement, or emotion, to analyze the same set of narratives from 30 men. This study resulted in four articles on the same data, each using a different theoretical framework and a different method of qualitative analysis, and each producing different insights into responses to bereavement (see Folkman, 1997; Pennebaker, et al. 1997; Stein, 1997; Weiss & Richards, 1997; Nolen-Hoeksma, et al 1997) .

The measurement of coping outcomes also needs improvement. Thought needs to be given to the domains of outcomes that coping can reasonably be expected to affect. Currently, little thought seems to be given to this question. Measures of distress or psychological symptoms seem to be included in most coping studies almost automatically, without a clear rationale. Likewise, measures of physical health are included without a clear rationale as to why or how coping might be related to them. One entire domain of coping outcome that is rarely assessed has to do with the individuals ability to sustain his or her social roles in the face of stress and distress. People who are in the midst of severe stress may have high levels of distress no matter how well they cope, but they may still need to be able to function in their roles at work, with their family, or in the community. A good measure of coping outcomes should therefore also include an assessment of role functioning (Folkman & Moskowitz, 1998) .

In this section, however, I want to discuss coping and positive affect in the context of stress, a topic that has intrigued me for years. Although positive affect is sometimes included in studies of coping and mental health, little thought seems to have been given to its significance in the coping process. The domain of positive affect holds the potential for an exciting expansion of our understanding of how coping affects health. Let me make my case.

Coping and positive affect: Future directions

My interest in positive affect was reinforced by findings from our study of caregiving partners of me with AIDS that we conducted from 1990 until 1997. The 253 participants were for the most part in their late 30s and early 40s when the study began. This is a time of life when most people devote themselves to establishing long-lasting relationships, not bringing such relationships to a close. The participants were their partners primary caregivers, and as such they were confronted with challenges that were extraordinary in their complexity, intensity, duration, and requirements for expertise. These caregivers needed empathy, clinical knowledge, technical expertise, advocacy skills in the formal health care system, and what seemed to be unlimited emotional, mental, and physical stamina (Wrubel & Folkman, 1997) . As if this were not enough, about one-third of the participants were themselves HIV+. We assumed that this group would be doubly stressed because of the double-whammy of the caregiving and their own vulnerability to AIDS. Participants were interviewed every two months for the first two years and then every six months for three follow-up years. In addition to caregivers, the study also included a comparison group of 61 HIV+ men who were in relationships with healthy partners. The inclusion of this group allowed us to specify effects in the HIV+ caregiver group that were attributable to their HIV serostatus vs. their caregiver status.

We used multiple measures of both positive and negative psychological states. We expected and found high levels of negative psychological states. Throughout caregiving, participants levels of depressive symptomatology were typically more than one standard deviation above the norm in the general community, rising to two standard deviations above the norm at the time of the ill partners death (Folkman, et al. 1996) . Among the 156 caregivers whose partners died, levels of depressive symptoms reported during their first seven months of bereavement were comparable to those of bereaved spouses, and at seven months following the partners death, mean scores for depressive symptoms were still one standard deviation above the general community norm (Folkman, et al. 1996) . We were not surprised by these findings, given the extensive literature on the profound and enduring effects caregiving and bereavement have on depressed mood.

What we did not expect was that participants also reported high levels of positive psychological states during the course of caregiving and bereavement (Folkman, 1997) . Caregivers whose partners did not die during the course of the study reported positive states of mind at a level that was comparable to a community sample of urban university students not experiencing unusual stress (Horowitz, et al. 1988) . Throughout this same two year period, caregivers whose partners did not die experienced positive affect with at least as much frequency as they experienced negative affect (Folkman, 1997 ). Among caregivers whose partners died during the two-year period, the death of the partner was associated with modestly lowered scores on measures of positive psychological states during the month leading up to the partners death and for the five after the partners death. But after five months, scores on measures of positive states returned to their pre-bereavement levels.

A number people suggested that our finding might be limited to the community of gay men living in San Francisco, possibly because of the social support network that evolved in this community during the 1980s and 1990s, and possibly because of the upbeat influence of }New Age" beliefs. We were offered the opportunity to include the measures of depressive mood (CES-D, Radloff, 1977) and positive and negative affect (modified Bradburn, 1969) that we had used in our study of AIDS caregivers in Dr. Miriam Stewart's study of mothers of chronically ill children (diabetes, spina bifida, or cystic fibrosis) at Dalhousie University, Halifax, Nova Scotia. Dr. Stewarts sample differed from the San Francisco sample of AIDS caregivers not only in that it was all female, but unlike the San Francisco sample, the Nova Scotia sample was not advantaged educationally or financially, and they lived about as far from San Francisco as is possible within the North American continent. Despite these demographic differences, we found the same patterns in the mothers of chronically ill children as we had in the sample of gay men in San Francisco: depressive mood was elevated, but at the same time the frequency of positive affect was not only comparable to the frequency of negative affect, it was even significantly greater .

Zautra and his colleagues (Zautra, et al. 1990) examined positive and negative events in a longitudinal study of mental health in disabled and bereaved older adults. Both kinds of events were reported, again indicating the co-occurrence of positive and negative events. Zautra and his colleagues also made the interesting observation that the value of daily positive events vis a vis mental health was variable across groups. Bereaved individuals showed no positive effects of these events on their mental health, whereas disabled individuals showed sizable impacts. These researchers suggest that the major loss suffered by the bereaved group may overshadow all other experiences, changing the way in which positive events are interpreted. In contrast, for those who are disabled, daily positive events can represent significant achievements that can boost morale.

Affleck and Tennen (1996) focus on the related question of discovery of benefits from living with adversity. This phenomenon has been documented in the context of numerous medical problems. Affleck and Tennen distinguish between benefit-finding, which refers to beliefs about benefits from adversity, and benefit-reminding, which is the use of such knowledge as a deliberate strategy of coping with the problem. Thus, a person with a new medical condition that limits her mobility might come to believe that this is an opportunity for her to develop new strengths (benefit-finding), and she might draw on this belief (benefit-reminding) in situations where the limits to her mobility are particularly stressful.

I go even further in considering co-occurrence of positive and negative events or moods in terms of coping. My colleagues and I have suggested that positive psychological states -- whether in the form of positive events or positive affect -- serve three important coping functions under conditions of chronic and severe stress (Lazarus, et al. 1980; Folkman, 1997; Folkman, et al. 1997) . Positive emotions, such as eagerness and excitement, help motivate people to initiate coping under adverse conditions. These emotions -- challenge emotions -- go hand in hand with threat emotions such as anxiety, fear, and worry. Positive emotions, such as pleasure in what one has accomplished, or love for the one is caring for, help sustain people when the going gets tough. Positive emotions such as happiness at seeing a beautiful sunset or the enjoyment of a humorous comment, provide relief from distress. Events that give rise to these emotions might ordinarily be considered unremarkable or unnoteworthy. The need for relief -- for a psychological time-out -- from distress is what motivates these emotion responses. All three functions could help explain the finding by Zautra, Reich et al. (1990) that positive events had a salubrious effect on the mental health of disabled individuals.

Further, I don't think people are passive with respect to generating these emotions. I think people generate these emotions through a deliberate and effortful coping process. A number of very fine scientists, including Shelly Taylor and her colleagues (e.g., Taylor & Brown, 1988; Taylor & Brown, 1994 ), Ronnie Janoff-Bulman (1989) , Roxane Silver and Camille Wortman (Silver & Wortman, 1980; Silver, et al. 1983; Wortman, et al. 1993) , and Glenn Affleck and Howard Tennen (Affleck & Tennen, 1996) have written about psychological and social processes that people use to generate positive states when bad things happen. In our own research, we identified four meaning-based coping mechanisms that help account for positive affect: positive reappraisal, which is cognitive reframing of what has happened or that which might happen; goal-directed problem-focused coping, which includes knowing when to abandon goals that are no longer tenable and substituting new goals that are both tenable and meaningful; using spiritual or religious beliefs to seek comfort; and the infusion of meaning into the ordinary events of daily life in order to gain a psychological time-out from distress (Folkman, 1997; Folkman, et al. 1997; Stein, et al. 1997) .

Because most coping research has focused on negative affective outcomes and states of mental health, we know only part of the story. We need to address this imbalance in coping research by researching questions related to positive outcomes, including the coping processes that sustain them, underlying characteristics of the person and the social environment that promote these coping processes, and the functions of positive affective outcomes in the overall process of coping with health-related stress. The methodological issues that both characterize and impede research on coping and health, including the variability of coping processes, the problems inherent in trying to measure appropriate health outcomes, and the measurement of coping itself, apply to the study of coping and positive affect every bit as much as they do to the study of coping and other health-related outcomes. There are some excellent discussions of these methodological issues (for reviews see Aldwin, 1994; Zeidner & Endler, 1996) . Taking these methodological problems into account, and with the belief that future researchers in this area will be creative and thoughtful enough to solve them, I strongly encourage researchers on coping and health to look more carefully at positive as well as negative affective outcomes, to understand the relationship of these outcomes to health related behaviors, and to identify the cognitive and behavioral coping processes that uniquely support positive outcomes.


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Susan Folkman, Ph.D., is the Director of the University of California-San Francisco Osher Center for Integrative Medicine and the Bernard Osher Foundation Distinguished Professor of Integrative Medicine. She was appointed to these positions in 2001. She has been Professor of Medicine at UCSF since 1990, and from 1994 until 2001 she was Co-Director of the UCSF Center for AIDS Prevention Studies (CAPS). Dr. Folkman received her Ph.D. from the University of California at Berkeley in 1979, where she remained as a research psychologist until coming to UCSF and CAPS in 1988. She is internationally recognized for her theoretical and empirical contributions to the field of psychological stress and coping, with several of her publications among the most widely cited in psychology. Her work over the past 12 years has focused on stress and coping in the context of HIV disease and other chronic illness, especially on issues having to do with caregiving and bereavement. Her research is supported by grants from the National Institute of Mental Health and the National Institute of Nursing Research.. She currently serves on the NIH/NIMH National Advisory Mental Health Council and the NIH/Office of AIDS Research Advisory Council. She has chaired or been a member of various NIH study sections, served on Institute of Medicine and NIH workgroups, and was co-chair of the American Psychological Association task force on ethics in research with human participants. In 1997, she was awarded an honorary doctorate from the University of Utrecht, The Netherlands, for her contributions to coping theory and research.

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