This study tested the hypothesis that coping through emotional approach, which involves actively processing and expressing emotions, enhances adjustment and health status for breast cancer patients. Patients (n = 92) completed measures within 20 weeks following medical treatment and 3 months later. Women who, at study entry, coped through expressing emotions surrounding cancer had fewer medical appointments for cancer-related morbidities, enhanced physical health and vigor, and decreased distress during the next 3 months compared with those low in emotional expression, with age, other coping strategy scores, and initial levels on dependent variables (except medical visits) controlled statistically. Expressive coping also was related to improved quality of life for those who perceived their social contexts as highly receptive. Coping through emotional processing was related to one index of greater distress over time. Analyses including dispositional hope suggested that expressive coping may serve as a successful vehicle for goal pursuit.

Four studies demonstrate the psychometric adequacy and validity of scales designed to assess coping through emotional approach. In separate undergraduate samples, exploratory and confirmatory factor analyses of dispositional (Study 1) and situational (Study 3) coping item sets yielded 2 distinct emotional approach coping factors: emotional processing (i.e., active attempts to acknowledge and understand emotions) and emotional expression. The 2 scales yielded high internal consistency and test-retest reliability, as well as convergent and discriminant validity. A study (Study 2) of young adults and their parents established the scales' interjudge reliabilities. Longitudinal (Study 3) and experimental (Study 4) research supported the predictive validity of the emotional approach coping scales with regard to adjustment to stressful encounters. Findings highlight the utility of functionalist theories of emotion as applied to coping theory.

Two studies supported hypotheses that (a) published scales tapping coping through processing and expressing emotion are confounded with psychopathology; (b) previously demonstrated relations between emotional approach coping (EAC) and maladjustment are partially spurious; and (c) EAC, when tapped by items uncontaminated by distress, is beneficial under specific conditions. In Study 1, 194 psychologists rated a majority of published items, but no author-constructed EAC item, as indicative of pathology. Study 2 assessed relations of confounded and unconfounded EAC scales to 171 young adults' adjustment during stressful events. Confounded items evidenced weaker discriminant validity with distress measures than did unconfounded items, and they were weaker predictors of later maladjustment when initial adjustment was controlled than when it was not. Unconfounded EAC predicted improved adjustment for women and poorer adjustment for men over time.

This study monitored women (N = 76) with breast cancer from diagnosis through 1 year, and tested constructs from subjective expected utility theory with regard to their ability to predict patients' choice of surgical treatment as well as psychological distress and well-being over time. Women's positive expectancies for the consequences of treatment generally were maintained in favorable perceptions of outcome in several realms (i.e., physician agreement, likelihood of cancer cure or recurrence, self-evaluation, likelihood of additional treatment, partner support for option, attractiveness to partner). Assessed before the surgical decision-making appointment, women's expectancies for consequences of the treatment options, along with age, correctly classified 94% of the sample with regard to election of mastectomy versus breast-conserving procedures. Calculated from the point of decision making to 3 months later, expectancy disconfirmations and value discrepancies concerning particular treatment consequences predicted psychological adjustment 3 months and 1 year after diagnosis.

In a study designed to evaluate the divergence of social comparison activities under health threat, breast cancer patients (n = 94) were assigned randomly to listen to an audiotaped interview in which the target's psychological adjustment and disease prognosis were manipulated to reflect good, poor, and unspecified psychological and physical health status. Results supported hypotheses regarding downward self-evaluative and upward affiliative comparison activity, as well as predictions regarding the influences of comparison dimension. With regard to desire for affiliation, participants demonstrated a greater desire for information and emotional support from the well-adjusted target than from the poorly adjusted target. Self-evaluation of adjustment and prognosis varied as a function of target characteristics, although a pervasive tendency toward downward comparison in self-evaluation also was noted.