Anxiety, Stress, & Coping,January 2008; 21(1): 3Á14STAR 2006 CONFERENCEÁINVITED ARTICLEThe case for positive emotions in the stress process*SUSAN FOLKMANUCSF Osher Center for Integrative Medicine, University of California San Francisco, San Francisco,CA, USAAbstractFor many decades, the stress process was described primarily in terms of negative emotions. However,robust evidence that positive emotions co-occurred with negative emotions during intensely stressfulsituations suggested the need to consider the possible roles of positive emotions in the stress process.About 10 years ago, these possibilities were incorporated into a revision of stress and coping theory(Folkman, 1997). This article summarizes the research reported during the intervening 10 years thatpertains to the revised model. Evidence has accumulated regarding the co-occurrence of positive andnegative emotions during stressful periods; the restorative function of positive emotions with respectto physiological, psychological, and social coping resources; and the kinds of coping processes thatgenerate positive emotions including benefit finding and reminding, adaptive goal processes,reordering priorities, and infusing ordinary events with positive meaning. Overall, the evidencesupports the propositions set forth in the revised model. Contrary to earlier tendencies to dismisspositive emotions, the evidence indicates they have important functions in the stress process and arerelated to coping processes that are distinct from those that regulate distress. Including positiveemotions in future studies will help address an imbalance between research and clinical practice due todecades of nearly exclusive concern with the negative emotions.Keywords: Stress, meaning-focused coping, positive emotion, coping theory, beneﬁt ﬁnding, adaptivegoal processes, reordering priorities, positive meaningful eventsOne of the most exhilarating aspects of research is coming upon an unexpected finding thatprompts a new direction in thinking. In my case, the unexpected finding was theobservation that positive emotions and negative emotions co-occurred during the intenselystressful experiences of caring for a dying loved one and then actually losing that person.This finding first appeared in our longitudinal study of gay men who were the caregivers oflife partners dying of AIDS. The study took place in the 1990s, when AIDS was basically anuntreatable terminal illness with a horrific clinical course. I published these findings in 1997(Folkman, 1997) and suggested revisions to the stress and coping theoretical model to*This article was invited by the editors following Professor Folkman’s address at the 27th Stress and AnxietyResearch Conference held in July 2006 in Rethymnon, Crete, GreeceCorrespondence: Susan Folkman, UCSF Osher Center for Integrative Medicine, Box 1726, UCSF, San Francisco,CA 94143, USA. Tel: 1 415 353 7719. Fax: 1 415 353 7554. E-mail: firstname.lastname@example.orgISSN 1061-5806 print/ISSN 1477-2205 online # 2008 Taylor & FrancisDOI: 10.1080/10615800701740457
4 S. Folkmanincorporate positive emotions. In the interim, a number of studies produced findings thatare relevant to the revised model. In this article, I revisit the propositions set forth in themodel in light of these findings. My overall goal in this is to advance stress and copingtheory and help establish directions for research and clinical care.Positive and Negative Emotions Co-occur During Stressful PeriodsSome may still question whether our observation that positive emotions co-occur withnegative ones during intensely stressful periods was anomalous. It was not. As noted inFolkman (1997), positive emotions during stressful periods were observed in earlier studies(Viney, 1986; Wortman & Silver, 1987), and others have since observed the samephenomenon (e.g., Bonanno & Keltner, 1997; Larsen, McGraw, & Cacioppo, 2001;Zautra, Affleck, Tennen, Reich, & Davis, 2005). Stress researchers’ lack of attention to the occurrence of positive emotions may havestemmed from an assumption that positive emotions do not have adaptational significance,as opposed to negative emotions, which are well known for mobilizing the fight/flightresponse (Cannon, 1939) and focusing attention on the problem at hand (Frijda, 1988).Interest in negative emotions has also been motivated by the accumulating body of researchshowing their deleterious effects on health and well-being over the life span. Fredrickson’s (1998) ground-breaking ‘‘Broaden and Build Model’’ of positive emotionshas done a great deal to stimulate interest in the positive emotions. Her model provided theframework for studies showing that positive emotions broaden the individual’s attentionalfocus and behavioral repertoire, thereby replenishing the person’s social, intellectual,and physical resources. The recent interest in positive psychology (e.g., Seligman &Csikszentmihalyi, 2000) has also fuelled interest in positive emotions, with many reportsabout their benefits now in the literature. A major review by Pressman and Cohen (2005) shows that positive emotions matter withrespect to morbidity, independent of negative affect. Positive emotions also matter withrespect to risk of mortality with several studies showing positive affect, and not negativeaffect, predicting survival (e.g., Moskowitz, 2003; Ostir, Markides, Black, & Goodwin,2000). In a series of six studies, King, Hicks, Krull, and Del Gaiso (2006) demonstratedthat positive moods may predispose people to feel that life is meaningful and increase theirsensitivity to the meaning relevance of a situation. Steptoe, Gibson, Hamer, and Wardle(2007) found that positive affect is related to biological responses, including diurnal cortisolpatterns and systolic pressure. They concluded that ‘‘positive affect is related to biologicalresponses in the laboratory and everyday life that may be health protective’’ (p. 56). In contrast to the above studies, the revised stress and coping theoretical model focusedthe question about positive emotions on their role in the stress process. That positive emotionsmight have something to do with the stress process is an idea that has intrigued me for manyyears. I remember posing this possibility to Richard Lazarus when I was a new graduatestudent at Berkeley in the 1970s. His first response was surprise, and perhaps puzzlement.However, Dick Lazarus was always ready to explore ideas, and in 1980, Lazarus, Kanner,and I published a chapter in which we speculated that positive emotions might serve as‘‘sustainers’’ that help motivate coping, ‘‘breathers’’ that provide momentary respite fromdistress, and ‘‘restorers’’ that replenish coping resources (Lazarus, Kanner, & Folkman,1980). This long standing interest in positive emotions in the stress process led to theinclusion of measures of positive affect in the longitudinal studies of caregivers that weconducted at UCSF during the 1990s.
Positive emotions in the stress process 5 Studies about the beneficial effects of positive emotion in the context of stress are still fewin number and found mainly in the resilience literature. Fredrickson and her colleaguesfound that positive emotions buffered resilient people against depression and fuelledthriving in the aftermath of 9/11 (Fredrickson, Tugade, Waugh, & Larkin, 2003),accelerated cardiovascular recovery from laboratory-induced negative emotional arousalin people high and low in trait resilience, and helped individuals find positive meaning innegative situations (Tugade & Fredrickson, 2004). Bonanno and his colleagues (Bonanno &Keltner, 1997; Keltner & Bonanno, 1997) found that bereaved individuals who showedlaughter at least once during a narration about their lost relationship also reported betteradjustment. Interestingly, when untrained observers viewed video tapes of the narrationswith the sound off, the observers experienced more positive emotion and less frustration inresponse to bereaved participants who laughed compared with bereaved participants whodid not laugh.Stress and Coping ModelThe Cognitive Theory of Stress and Coping (Lazarus, 1966; Lazarus & Folkman, 1984)has always been and continues to be an appraisal-based model. In its earlier formulation,the appraisal process was most heavily implicated during the outset of an event in theevaluation of its personal significance (primary appraisal) and the evaluation of options forcoping (secondary appraisal). Together, the two forms of appraisal were said to determinethe extent to which the transaction was appraised as a harm, threat, or challenge. Harmappraisals were accompanied by negative emotions such as sadness or anger and threatappraisals were accompanied by negative emotions such as anxiety or fear. Positiveemotions such as excitement, eagerness, and confidence appeared in relation to challengeappraisals (Folkman & Lazarus, 1985). Coping processes were initiated in response to theappraised demands of the specific situation. Ideally, instrumental kinds of problem-focusedcoping were used more in situations where something could be done, and emotion-focusedcoping to regulate distress was used more in situations that had to be accepted. Positiveemotions such as happiness, relief, or pride also appeared when a situation was resolvedfavorably (Lazarus & Folkman, 1984). The original model had little to say about what happened when the outcome wasunfavorable except that the appraisalÁemotionÁcopingÁreappraisal process would repeatitself, thus producing the conditions of chronic stress. It was at this unlikely point Á whensituations are not favorably resolved Á that the revised model introduced a new category ofcoping, meaning-focused coping, and positive emotions. The model hypothesizes thatfollowing a failed resolution, the need to try again triggers meaning-focused coping.Meaning-focused coping is said in turn to generate positive emotions and their underlyingappraisals, and these emotions and appraisals influence the stress process by restoringcoping resources and providing motivation needed in order to sustain problem-focusedcoping over the long term. In addition, positive emotions were hypothesized to providerelief from distress. The original model is shown in Figure 1 and the revised model is shownin Figure 2. How have these propositions fared since 1997? What evidence is there for meaning-focused coping in terms of its content, its timing in the stress process, and its relation topositive emotions; do these coping processes and emotions have salubrious effects onresources, appraisal, and well-being during stressful periods? To the extent possible in a
6 S. Folkman Appraisal Coping Event Emotion Outcome Outcome Event Problem- Favorable Positive emotion Harm focused Threat Emotion- Challenge focused Unfavorable Distress Person: Situation: Dispositions Demands Beliefs Resources Goals Negative EmotionFigure 1. Original stress and coping model (Lazarus & Folkman, 1984).brief review that covers diverse topics, I try to highlight what has been found and some ofthe key issues that need to be considered.Coping and Positive EmotionsOne of the first questions we addressed in our caregiver research asked whether positiveemotions were associated with the same coping strategies people use to regulate distress.The first inkling that some of the coping processes associated with the generation of positiveemotion were different from those associated with the regulation of distress came from ananalysis of positive and negative moods before and after bereavement in our study of AIDS Appraisal Coping Event Emotion Outcome Outcome Event Harm Problem- Favorable Positive emotion focused Threat Emotion- Challenge focused Unfavorable Distress Mean- Positive Restores Emotion Resources ing Sustains focused Coping Coping POSITIVE EMOTION Negative EmotionFigure 2. Revised stress and coping model (adapted from Folkman, 1997).
Positive emotions in the stress process 7caregivers. Moskowitz, Folkman, Collette, and Vittinghoff (1996) found that some kinds ofcoping were associated with negative and positive moods pre and post-bereavement, butother kinds were associated primarily with either positive mood or negative mood. Problem-focused coping and positive reappraisal, for example, were consistently associated withpositive mood, but inconsistently and more weakly associated with negative mood. It wasour qualitative analyses of narratives of stressful events, however, that took us to the nextlevel of understanding about coping and positive emotion and to our decision to define acategory of ‘‘meaning-focused’’ coping.Meaning-focused CopingMeaning-focused coping is, in its essence, appraisal-based coping in which the persondraws on his or her beliefs (e.g., religious, spiritual, or beliefs about justice), values (e.g.,‘‘mattering’’), and existential goals (e.g., purpose in life or guiding principles) to motivateand sustain coping and well-being during a difficult time (Park & Folkman, 1997; see alsoAldwin, 2007 for her discussion of transformational coping). In general, meaning-focused coping tends to be less situation-specific than both problemand emotion-focused coping. In our first effort to distinguish among types of meaning-focused coping, we identified four categories based on analyses of both quantitative datafrom the Ways of Coping (Folkman & Lazarus, 1988) and qualitative data drawn fromnearly 2000 interviews about recently experienced stressful events. These categories werepositive reappraisal, revision of goals, spiritual beliefs, and the infusion of ordinary eventswith positive meaning (Folkman, 1997; Folkman, Moskowitz, Ozer, & Park, 1997). Welater modified the list to include findings from reports in the rapidly expanding literatureand our own subsequent work, resulting in five categories: benefit finding, benefitreminding, adaptive goal processes, reordering priorities, and infusing ordinary eventswith positive meaning (Folkman & Moskowitz, 2007). Here, I briefly summarize what hasbeen learned by other researchers as well as our own research group about each of theseways of generating positive emotion.Benefit FindingAffleck and Tennen’s seminal research on benefit finding (see Tennen & Affleck, 2002 forreview) and the growing interest of others in the related topic of stress-related growth(Tedeschi, Park, & Calhoun, 1998; Park & Ai, 2006) has resulted in a substantial literature(for reviews see Linley & Joseph, 2004; Helgeson, Reynolds, & Tomich, 2006). Benefitfinding is often assessed in terms of growth in wisdom, patience, and competence; greaterappreciation for life, greater clarity about what matters, strengthened faith or spirituality;and improved quality of social relationships. It is by far the most commonly reported kindof meaning-focused coping. Helgeson et al. (2006) published a meta-analysis of the relationship of benefit finding tomental and physical health. Their definition of benefit finding was quite broad: ‘‘thepositive effects that result from a traumatic event’’ (p. 797). Within this broad definitionthey make an important distinction between benefit finding as coping that reduces distress,which refers to an ongoing difficult situation, and benefit finding as an outcome, whichrefers to ‘‘actual change or growth’’ (p. 798). The meta-analysis showed that the only effect that approached a moderate size was therelationship between benefit finding and positive well-being. At the level of small effectsize, benefit finding was associated with some negative states as well as some positive
8 S. Folkmanones. This is consistent with other reports, indicating a consistent association withpositive affect and an inconsistent and usually weaker association with negative affect(Linley & Joseph, 2004). Helgeson et al.’s (2006) review also provided intriguing findings regarding the timing ofbenefit finding and its effects. The beneficial effects were greater when the time since thetraumatic event was more than 2 years. In contrast, when the event was less than 2 years inthe past, benefit finding was associated with increased distress. Based on this observation,one could conclude that benefit finding caused distress. Another explanation suggested bythe revised stress and coping model is that meaning-focused coping such as benefit findingcomes into play when things are going badly. What we would expect to see when thesituation continues to be unresolved over time is a co-occurrence of positive emotionsgenerated by benefit finding and the negative emotions associated with the unwantedoutcome. In major stressful events, such as loss of a loved one, distress is likely to remainelevated for several years (Carnelley, Wortman, Bolger, & Burke, 2006). Over time, wewould expect to see negative emotions decline and positive emotions get stronger. A clear sign that the literature on benefit finding is maturing is the controversies that areappearing in the literature. Butler (2007) summarizes some of the key issues, namely,whether to conceptualize the report of benefits as a means of coping as an adaptivemechanism or a defensive, self-protective maneuver, as an outcome in and of itselfrepresenting true change, or as something else altogether. Whether or not benefit finding is a defensive, self-protective maneuver is a question thatis asked more generally with respect to research on positive aspects of psychology. ‘‘Evenwhen positive aspects of human functioning are studied, negative motives are frequentlyascribed to them, resulting in some fundamental misunderstandings of positive phenom-ena’’ (Aspinwall & MacNamara, 2005, p. 2549). Benefit finding could be maladaptive if itimpedes important problem-focused coping such as information gathering and evaluating,decision-making, or relationship repair. However, research by Aspinwall and her colleaguesindicates that positive beliefs and states serve as resources that actually facilitate theseprocesses, allowing people to consider negative information appropriately, and further,fostering greater selectivity in the allocation of effort to problems, based on whether theproblems are controllable (Aspinwall & MacNamara, 2005). The question about whether the benefits that are appraised at the outcome are actual alsoseems to reflect many psychologists’ general suspicion about positive states of mind inthe stress process. Whether or not the benefits are actual, which is probably difficult todetermine in many instances, seems less important than whether the person believesthe benefits are actual, especially when such benefits relate to psychosocial resources. Theperception of benefit, for example, can restore self-confidence, which is an importantresource for both appraisal and coping. An inaccurate estimate of some perceived benefits,however, such as the acquisition of skill, could prove detrimental in future outcomes. Anoverestimation of one’s medical knowledge following extensive caregiving, for example,could result in harm to another person.Benefit RemindingTennen and Affleck (2002) distinguish benefit reminding from benefit finding as effortfulcognitions in which the individual reminds himself/herself of the possible benefits stemmingfrom the stressful experience. Benefit reminding is a form of meaning-focused coping thatoccurs during the stressful situation. Tennen and Affleck’s research on benefit remindinginvolved patients suffering from fibromyalgia who were asked to keep a daily diary and to
Positive emotions in the stress process 9indicate how much that day they had reminded themselves of the benefits of their chronicpain. On days when these patients made greater efforts to remind themselves of the benefitsthat had come from their illness, they were more likely to experience pleasurable mood,regardless of the pain they had experienced that day. The distinction between benefit reminding and benefit finding becomes blurred unlessbenefit finding is labelled as an outcome. However, as noted above, the distinction may bearbitrary and depends on where in the stress process the variable is measured.Adaptive Goal ProcessesGoals are involved in many meaning-focused functions. As noted in Folkman (1997), thesimple act of creating a to-do list when things feel completely out of control is not onlyuseful for instrumental coping, but it also creates a sense of mastery and control, even ifonly for a few moments. Higher order goals provide a sense of meaning and purpose(Baumeister, 1991; Park & Folkman, 1997) and structure and unity to people’s lives(Baumeister, 1991; Emmons, Colby, & Kaiser, 1998). Goals motivate choices people make,and reminding oneself of these higher order goals can help sustain efforts to achieve them,even when those goals are threatened. Under ordinary circumstances, the pursuit of meaningful, realistic goals is a basis ofthe appraisal of challenge, flavored with positive emotions. However, stressful situationsare often stressful precisely because they threaten or harm valued goals. Elsewhere wehave stated that a central tenet of effective coping is the ability to determine when a goalis no longer tenable, relinquish that goal, and substitute a new goal that is bothmeaningful and realistic (Stein, Folkman, Trabasso, & Richards, 1997). Carver andScheier (1998) and their colleagues speak of adaptive self-regulation, which they haveexplored in a series of fascinating studies (e.g., Wrosch, Scheier, Miller, Schulz, &Carver, 2003). Wrosch et al. proposed ‘‘that in situations in which people are confrontedwith unattainable goals, benefits accrue from the capacities to abandon goal-directedactivities and to reengage in valued alternative goals. By having new goals availableand reengaging in those new goals, a person can reduce the distress that arises from thedesire to attain the unattainable while continuing to derive a sense of purpose in life byfinding other pursuits of value’’ (pp. 1494Á1495). In a series of studies, they found thatdisengagement from unattainable goals was independently associated with high levels ofself-mastery and low levels of depressive symptoms, and the tendencies to reengage innew goals predicted subjective well-being beyond what was explained by relinquishingunattainable goals. Wrosch et al. (2003) stated that the key to maintaining well-being comes not just fromgiving up goals that do not work, but in substituting new ones that are meaningful, or‘‘valuable’’ to use their word, which closely parallels our concept of adaptive goal processes.In both cases, the meaning attached to the new goal is motivational. Brunstein andGollwitzer (1996), for example, found that failure on tasks that involved a self-defining goalled to enhanced performance on a subsequent task as long as that task also involved a self-defining (i.e., meaningful or valued) goal, but if the goal was not self-defining (i.e., notmeaningful), the performance was inferior. While the concept of adaptive self-regulation is very pertinent to the discussion of copingthat sustains people when situations go badly, it does raise some interesting and provocativequestions. The focus on relinquishing untenable goals glosses over the often profoundlydifficult question: How do we know when to give up? Sometimes information is so clear thatthere is no question about whether a goal is tenable: ‘‘You are fired’’ usually means that you
10 S. Folkmanneed to give up the goal that you had with respect to having that particular job. However,what about ‘‘You need to improve your work’’ or ‘‘I am not happy in this marriage.’’ Theevaluation of threats to goals involves a psychological calculus that weighs odds of successand failure; the value attached to the goal (e.g., where threatened goal sits in the goalhierarchy), which affects the costs of giving up or persisting; and the availability of goals thatcan be substituted for the one that is threatened. Giving up a goal prematurely can be asdamaging as persisting too long. A rich and well-established literature on goals originally focused largely on the structureof goal hierarchies, substitutability, and complexity (e.g., Miller, Galanter, & Pribram,1960). Although more recently, goals have been examined in relation to their motivational(e.g., Kruglanski, Shah, Fischbach, Friedman, & Chun, 2002) and self-regulatory proper-ties (Carver & Scheier, 1998), the issue of when to give up a valued goal in real life involvesa complex calculus that probably eludes neat, structural models. A second issue has to do with what happens after a goal is in fact appraised as unrealisticand the decision is made to relinquish it. Yielding goals that were previously valued is astressful process that involves loss and the distress associated with that loss (Klinger, 1977).The process of disengaging is analogous to the process of coming to terms with the loss of aloved one. In their dual process model of coping with bereavement, Stroebe and Schut(2001) described a process of oscillation between loss-oriented coping and restoration-oriented coping. The oscillatory pattern of coping is also consistent with Carver andScheier’s (1998) self-regulatory theory. The process of goal revision is obviously complexand as a consequence we should expect it to generate a complex and dynamic picture ofpositive and negative emotions. The oscillation described by Stroebe and Schut, as well asCarver and Scheier can explain variability in the mix of positive and negative emotions whilethe disengagement process is still underway. Sometimes goals are tied to fundamental beliefs that shape the person’s way of viewinghimself or herself and the world around. To give up a goal also means giving up the belief.Consider decisions to emigrate from one’s country because one is no longer safe there, ormaking the decision to stop seeking treatment for cancer. Relinquishing the goal ofremaining in one’s country or giving up the goal of finding an effective treatment for cancereach involves changing beliefs about oneself and the world (Park & Folkman, 1997), andthis can be a shattering experience (Janoff-Bulman, 1992). Fascinating questions concernhow positive emotions help a person navigate the recovery from shattered beliefs and themovement toward new goals.Reordering PrioritiesThe recognition that priorities need to be reordered is one of the more common responsesto serious stressful events, both acute and chronic. Comments such as ‘‘my perspectivechanged’’ or ‘‘I focused on what really matters’’ reflect the coping response to a changedreality. The reordering of priorities is a value-based process. Things that now matter more moveup the ladder; things that now matter less move down. This reordering process can bedeliberate or it can seemingly ‘‘just happen.’’ The reordering of priorities can be a very stressful process in itself. To acknowledge thatpriorities need to be reordered involves an acceptance by the individual that his/her worldhas changed, that things are not as they were or as they were expected to be. The personappraises his or her world differently now than before.
Positive emotions in the stress process 11 However, the process should also provide the basis for a renewed sense of purpose(Stroebe & Schut, 2001). Knowing what matters most now, in this changed reality, is anessential ingredient for formulating goals, allocating resources, and determining strategiesfor moving forward. The reordering process can also lead to increased coping efficiency by narrowing theperson’s focus: ‘‘I decided that the most important thing in my life was to get better, andthat is what I am concentrating on.’’ For example, in a study of maternal caregivers ofchildren with chronic conditions, there was evidence of a major shift in priorities: 47% ofthe maternal caregivers quit working outside the home in order to care for their child(Wilson et al., 2005) Similar to the process of giving up meaningful goals, the reordering of priorities can exacta toll. A decision to quit work in order to take care of a sick child, for example, can lead toloss of income and increased financial strain. Thus, in real life, the reordering of prioritiesmay improve well-being because values and goals are aligned meaningfully for theindividual, but at the same time, the realignment process can lead to secondary stressorsand negative emotions. Accordingly, we would expect to see both negative and positiveemotions.Infusing Ordinary Events with Positive MeaningWe first observed this form of coping in the study of gay caregivers mentioned earlier.Participants requested that we interview them about positive aspects of their lives as well asthe stressful aspects, and so we inserted a question in the interview that asked for anaccount of a positive event that helped the person get through the day (Folkman et al.,1997). What struck us was not the content of the events, which were just ordinary eventssuch as receiving a word of gratitude or praise, taking care of business, enjoying a goodmovie, or watching a beautiful sunrise, but that these events were reported even under themost dire circumstances. It was as if people took ordinary events and deliberately infusedthem with positive meaning in order to experience a positive moment, providing the‘‘breather’’ hypothesized by Lazarus et al. (1980). The creation of positive moments out of ordinary events is consistent with Tugade andFredrickson’s (2006) observation that people generally want to feel good. Tugade andFredrickson also pointed out that it is common for people to try to prolong pleasant feelingsby, for example, sharing their news with close friends and loved ones (for review, see Isen,2000) or by savoring (Bryant, 1989). Our studies indicate that the same motive is operativewhen times are difficult, and in fact I suggest that the desire to feel good takes on criticalimportance for maintaining mental and physical well-being during difficult times.Where We Are NowThe revised stress and coping model (Folkman, 1997) made a place for positive emotions inthe stress process. There is now substantial evidence that positive emotions are a normativeaspect of the stress process and that they help restore physiological and psychosocial copingresources. Less is known about the full range of coping processes, including their content,timing, and duration, which are associated with the regulation of positive as opposed tonegative emotions. However, what evidence we do have suggests that underlying beliefs,values, and goals are heavily implicated in these coping processes and that the regulation ofmeaning is the key common theme.
12 S. Folkman We have only begun the work of defining and systematizing meaning-focused coping. Itis important to be more comprehensive in its exploration than studies have been thus far.For example, in addition to the types of coping summarized in this article, religious andspiritual coping processes are involved in meaning-based coping, as are strategies relatedto forgiveness and gratitude. Which of these are related primarily to positive emotions?What coping processes have we overlooked? What is the best way to classify thesemeaning-focused strategies? And, of course, what is the best way to measure them? Thedifficulties in measuring coping are well known (for review, see Folkman & Moskowitz,2004; Schwarzer & Schwarzer, 1996) and there is no reason to think the measurement ofmeaning-based coping will be different. For both researchers and clinicians, it is important to maintain a balanced perspectiveregarding the role of positive emotions in the stress process. This stress process isstrongly characterized by negative emotions and the inclusion of positive emotions in themodel is just that, inclusion. However, the evidence suggests that the positive emotionshave important adaptational significance and that these emotions are generated byidentifiable coping processes. Stress researchers need to include positive emotions in theirstudies to learn more about how people generate and sustain them and to further exploretheir adaptational significance in relation to physiological, psychological, and socialoutcomes. Clinicians need to give attention to positive emotions with their clients, andexplore the sources of such emotions and how to generate and sustain them. Thisattention to positive emotions will address the imbalance between stress research andclinical practice that has resulted from decades of nearly exclusive concern with thenegative emotions.AcknowledgementsThe writing of this article was supported in part by NIH PO1 AT2024. I thank JudyMoskowitz for her comments on a previous version of this article.ReferencesAldwin, C. M. (2007). Stress, coping, and development (2nd edn). New York: Guilford.Aspinwall, L. G., & MacNamara, A. (2005). Taking positive changes seriously. Cancer, 104(11 Suppl.), 2549Á2556.Baumeister, R. F. (1991). Meaning of life. New York: Guilford.Bonanno, G. A., & Keltner, D. (1997). Facial expressions of emotion and the course of conjugal bereavement. Journal of Abnormal Psychology, 106, 126Á137.Brunstein, J. C., & Gollwitzer, P. M. (1996). Effects of failure on subsequent performance: the importance of self- deﬁning goals. Journal of Personality and Social Psychology, 70, 395Á407.Bryant, F. B. (1989). A four-factor model of perceived control: Avoiding, coping, obtaining, and savoring. Journal of Personality, 57, 773Á797.Butler, L. D. (2007). Growing pains: Commentary on the ﬁeld of posttraumatic growth and Hobfoll and colleagues’ recent contributions to it. Applied Psychology, 56, 367Á378.Cannon, W. B. (1939). The wisdom of the body (2nd edn). New York: W.W. Norton.Carnelley, K. B., Wortman, C. B., Bolger, N., & Burke, C. T. (2006). The time course of grief reactions to spousal loss: evidence from a national probability sample. Journal of Personality and Social Psychology, 91, 476Á492.Carver, C. S., & Scheier, M. F. (1998). On the self-regulation of behavior. New York: Cambridge University Press.Emmons, R. A., Colby, P. M., & Kaiser, H. A. (1998). When losses lead to gains: Personal goals and the recovery of meaning. In P. T. P. Wong, & P. S. Fry (Eds.), The human quest for meaning (pp. 163Á178). Mahwah, NJ: Lawrence Erlbaum Associates.Folkman, S. (1997). Positive psychological states and coping with severe stress. Social Science and Medicine, 45, 1207Á1221.
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