At diagnosis, 59 breast cancer patients reported on their overall optimism about life; 1 day presurgery, 10 days postsurgery, and at 3-, 6-, and 12-month follow-ups, they reported their recent coping responses and distress levels. Optimism related inversely to distress at each point, even controlling for prior distress. Acceptance, positive reframing, and use of religion were the most common coping reactions; denial and behavioral disengagement were the least common reactions. Acceptance and the use of humor prospectively predicted lower distress; denial and disengagement predicted more distress. Path analyses suggested that several coping reactions played mediating roles in the effect of optimism on distress. Discussion centers on the role of various coping reactions in the process of adjustment, the mechanisms by which dispositional optimism versus pessimism appears to operate, third variable issues, and applied implications.

The authors tested effects of a 10-week group cognitive-behavioral stress management intervention among 100 women newly treated for Stage 0-II breast cancer. The intervention reduced prevalence of moderate depression (which remained relatively stable in the control condition) but did not affect other measures of emotional distress. The intervention also increased participants' reports that having breast cancer had made positive contributions to their lives, and it increased generalized optimism. Both remained significantly elevated at a 3-month follow-up of the intervention. Further analysis revealed that the intervention had its greatest impact on these 2 variables among women who were lowest in optimism at baseline. Discussion centers on the importance of examining positive responses to traumatic events--growth, appreciation of life, shift in priorities, and positive affect-as well as negative responses.

A good deal of research now indicates that the personality dimension of optimism-pessimism plays an important role in a wide range of behavioral and psychological outcomes when people confront adversity (reviewed in Scheier & Carver, 1992). What is less clear is the mechanism (or mechanisms) by which the beneficial effects of optimism take place. One possibility is that optimists do better than pessimists because they cope more effectively.' There is an abundance of evidence that they at least cope differently. Optimists and pessimists differ from one another in reports of their general coping tendencies (Carver, Scheier, & Weintraub, 1989) and in the coping responses they bring to mind when considering hypothetical situations (Scheier, Weintraub, & Carver, 1986), recalling a stressful situation from the recent past (Scheier et al., 1986), dealing with infertility problems (Litt, Tennen, Affleck, & Klock, 1992), managing a life transition (Aspinwall & Taylor, 1992), coping with a serious disease (Friedman et al., 1992), and dealing with worries about specific health threats (Stanton & Snider, 1993;Taylor et al., 1992).Far less information is available, however, concerning the hypothesis that these differences in coping serve as the vehicle by which optimists experience better eventual outcomes. Three studies in the literature are relevant to the question. One of them (Scheier et al., 1989) examined men undergoing coronary artery bypass surgery. These subjects did not complete a full measure of coping but indicated their use of several cognitive-attentional strategies before and after the surgery. Although optimism was related to several of these strategies, there was scant evidence that the strategies mediated the beneficial effect of optimism on subsequent outcomes. The second study (Aspinwall & Taylor, 1992) assessed optimism and coping in a group of students entering college and assessed well-being 3 months later. In this case, the beneficial effects of optimism appeared to operate at least in part through differences in both active coping and avoidance coping.Both of these studies have an important limitation, however. Neither included an initial measure of the variables that served as the later outcome measure. Thus,

Body image is often thought of in terms of physical appearance, but there is also a body image pertaining to integrity, wholeness, and normal functioning. People who are greatly concerned about either aspect of their body image are vulnerable to poorer psychosocial adjustment when confronting treatment for breast cancer. The poorer adjustment takes a different form, however, depending on the nature of the patient's body-image concern.