Psychosocial Adaptation to Cancer: The Role of Coping Strategies

When confronted with traumatic life events, individuals normally resort to a wide range of coping strategies to alleviate the resultant stress. The conceptual underpinnings of much of the recent empirical developments in the field of coping with stress and trauma can be traced to the work of Lazarus and his coworkers (e.g. Lazarus, 1993; Lazarus & Folkman, 1984). These writers viewed the process of coping as comprised of two distinct phases: (a) primary appraisal, which refers to a set of cognitions concerning the significance or impact of the stressful event for the individual, and (b) secondary appraisal, which refers to a set of cognitions regarding the availability of resources or options (e.g., coping skills) for dealing with the stressful situation. These and other (e.g., Billings & Moos, 1981; Pearlin & Schooler, 1978) first generation coping theoreticians and researchers often viewed coping dimensions as comprised of two separate classes, namely, emotion-focused (i.e., efforts directed at affect regulation) and problem-focused (i.e., strategies directed at minimizing or solving the impact of the stressful event) coping. More recent efforts at conceptualizing coping included the addition of a third dimension (i.e., avoidance-orientated coping; Parker & Endler, 1992), as well as other two-dimensional configurations (e.g., approach vs. avoidance, engagement vs. disengagement coping)(Krohne, 1996; Parker & Endler, 1996; Tobin, Holroyd, Reynolds, & Wigal, 1989). With the advent of measures that sought to investigate the nature, structure, and correlates of coping, theoreticians and researchers alike have begun to shift their views to focus more on the hierarchical nature of coping. Three broad levels have been implicated: (a) coping styles that reflect global, dispositional, macroanalytic tendencies (e.g., monitoring-blunting, vigilance-avoidance, approach-avoidance); (b) coping strategies or modes that reflect an intermediate level in this hierarchy, and are typically indicated by summative scores on coping scales (e.g., confrontation, seeking social support, planful problem solving); and (c) coping acts or behaviors that reflect specific, situation-determined, microanalytic responses that are often indicated by individual item endorsement on a coping scale (Endler & Parker, 1990; Krohne, 1996; Schwarzer & Schwarzer, 1996). The literature on coping with chronic illnesses and disabilities has, likewise, generated much insight into the nature and structure of coping efforts directed at diffusing or removing the stress engendered by the associated trauma, loss, and pain. Among the more commonly investigated disability conditions are cancer, heart diseases, spinal cord injury, amputations, diabetes, rheumatoid arthritis, multiple sclerosis, chronic pain, traumatic brain injury, and asthma. Results from these and other studies strongly suggest that coping plays a significant role during the process of psychosocial adaptation to both sudden and gradual onset of chronic illnesses and disabilities. More specifically, these results indicate that: (a) a wide range of coping efforts has been employed by persons with disabilities to deal with the stresses engendered by their conditions; (b) these numerous efforts, both problem-solving and emotional-focused coping, as well as engagement- and disengagement- type coping have been found to be adaptive; (c) different coping efforts assume different roles and are, therefore, differentially employed to regulate stressful emotions and solve problems during the adaptation process; (d) coping efforts have played both a direct role (i.e., are directly linked to measures of psychosocial adaptation to disability) and a mediator role (i.e., act as mediators between sociodemographic variables, personality attributes, disability-related factors, environmental conditions, and outcomes of psychosocial adaptation); and (e) different disabling conditions imply different functional (e. …