additional functional disability and further reducing patients’ motivation to change behavior.

Self-efficacy and emotional resilience contribute to greater engagement in health-promoting behaviors, including adherence to treatment regimens. Conversely, these behaviors can be undermined by ineffective coping with psychological distress. Optimism and positive coping also have been explored as mechanisms through which ill individuals can become more emotionally resilient and better able to cope with and manage the course of their disease. Coping (which involves seeking of social support, positive reframing, information seeking, problem solving, and emotional expression) can bolster one’s adjustment to chronic illness (Holahan et al., 1997), and improving patients’ coping strategies can be effective in reducing symptoms of psychological distress that hinder health behaviors and the management of illness (Barton et al., 2003). For patients with cancer, optimism also predicts improved quality of life and functional status and the effective management of pain (Astin and Forys, 2004).

Finding meaning in the illness experience is another coping mechanism that can improve a patient’s psychological adjustment (Folkman and Greer, 2000), contributing to a greater sense of control, improved psychological adjustment, and more positive focus (Fife, 1995). As many as 83 percent of patients with breast cancer come to realize at least one benefit following their diagnosis (Sears et al., 2003); such a realization involves positive reappraisal of their situation and results in better coping, mood, and health status. Research on patients with tuberculosis in South Africa found a significant relationship between assessment of meaning in life and adherence to treatment for the disease (Corless et al., 2006). Finding benefit also is linked to patients’ adherence to antiretroviral therapy for HIV (Stanton et al., 2001; Luszczynska et al., 2006).

Conversely, coping mechanisms that are less adaptive can help in dealing with the immediate emotional distress associated with illness but create longer-term problems. Avoidant coping, which involves denial, emotional instability, avoidant thinking (avoiding thoughts about the reality of the illness), and immature defenses, is associated with less engagement in healthy behaviors (e.g., healthy diet, exercise, adherence to treatment), as well as the adoption of unhealthful behaviors (e.g., smoking, drinking alcohol to excess, abusing psychotropic medications) in an effort to cope with emotional distress (Stanton et al., 2007). Avoidant thinking about the illness is considered “harmful coping” because problems are not faced and solutions are not found, contributing to unhealthy behaviors and nonadherence (Carver et al., 1993).