This article surveys the literature on social support and cancer and reports results from an empirical investigation of the factors that lead cancer patients to join social support groups. Although most cancer patients report high levels of social support following cancer, some patients experience isolated instances of rejection or do not receive the type of support they want from family, friends, and medical caregivers. This appears to be one impetus for joining cancer support groups. In addition, cancer support group attenders are more likely to be white middle-class females, to report having more problems, and to use social support resources of all kinds than are nonattenders. Implications for the study of social support and for outreach to cancer patients are discussed.

For many years, there has been interest in how people cope with cancer. Important descriptive studies were completed in the 1950s (e.g., Bard & Sutherland, 1955; Quint, 1965;Shands, Finesinger, Cobb, & Abrams, 1951) emphasizing unconscious defenses such as denial and maladaptive coping patterns (see Meyerowitz, Heinrich, & Schag, 1983, for a review). Weisman (1979) and Weisman andWorden (1976-1977) later conducted systematic research on coping with cancer using a variety of assessment methods and revealed relationships between patterns of coping and emotional distress. Weisman (1979) defined coping as "what one does about a perceived problem in order to bring about relief, reward, quiescence, or equilibrium" (p. 27). Lazarus and Folkman (1984) defined coping similarly-as cognitive and behavioral efforts to manage demands appraised as taxing or exceeding resources.Coping efforts may be distinguished from their effects on the stressful situation, on emotional well-being, and on subsequent health and adjustment. Such efforts have been shown to be a function of both person and situation factors (Fleishman, 1984;Holahan & Moos, 1987;Parkes, 1986). However, little is known about what predisposes individuals with cancer to cope in specific ways. Why does one cancer patient construe his or her situation in a positive light, whereas another does not? What predisposes a person to use avoidant coping strategies, such as fantasizing or social withdrawal, in response to cancer? Which individuals are most likely to respond by seeking and using available support? Such information would be valuable in cancer rehabilitation and in developing a further understanding of the determinants of coping in general.The goal of this research was to examine factors identified in the stress and coping literature that might predispose a person to cope with cancer in various ways. Past research has indicated that an individual will cope differently as a function of the particular stressful situation involved (Folkman & Lazarus, 1980;McCrae, 1984;Pearlin & Schooler, 1978). Cancer includes a wide range of situations with which to cope-such as painful or frightening symptoms, ambiguity about the prognosis, and changes in social relationships. An adaptive strategy for coping with physical discomfort might be problem focused (e.g., seeking the advice of one's physician or taking medication), whereas the best strategies for dealing with ambiguity about the future might be emotion regulating (e.g., distraction or avoidance).Situational factors-site of cancer, stage of the disease, time since diagnosis, Reprinted from Health Psychology, I I ( 2 ) , 79-87.

An important unanswered question about rheumatoid arthritis (RA) is how the patient's psychological or emotional state relates to disease activity and functional status. No controlled studies of psychotherapeutic interventions in RA have been reported. To test the hypothesis that a psychosocial intervention would lead to improvement in functional status or disease activity, 57 RA patients were randomly assigned to 1 of 3 groups, which received: 1) conventional group psychotherapy; 2) group assertionhelaxation training; or 3) no treatment (control group). Patient and physician questionnaires collected at baseline, immediately after the interventions, and 12 months after baseline provided outcome data on functional status, social and psychological adaptation, psychological symptoms, and disease activity. There were few outcome measures for which either treatment resulted in significantly higher scores

Through psychiatric interviews and psychological tests the authors studied 38 adults who reported experiencing at least one nightmare per week. Nearly all of the subjects had a lifelong history of frequent nightmares. Four of the subjects met DSM-III criteria for schizophrenia, 9 met the criteria for borderline personality, and 6 met the criteria for schizotypal personality. The others had no specific diagnosis, and none of the subjects had a diagnosis of typical neurosis. Many had mentally ill relatives. Most had artistic interests and talents. These nightmare sufferers may be seen as unusually vulnerable, with a potential for mental illness--especially schizophrenia--as well as a potential for artistic achievement.

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