INT’L. J. PSYCHIATRY IN MEDICINE, Vol. 5, No.

4,1974

PSYCHOLOGICAL STRESS AND COPING IN

ADAPTATION AND ILLNESS

Richard S. Lazarus, Ph.D.’

University of California, Berkeley, California
ABSTRACT-Research and thought in psychosomatic medicine must seek
understanding of the psychological processes making a person’s encounter with
the environment stressful, and how these encounters lead to a variety of coping
processes, emotional states, disease precursors, and stress disorders. One major
theme of this paper is that every instance of adaptive commerce between a person
and the environment is appraised cognitively as to its significance for the person’s
well-being. Such appraisals underlie the ebb and flow of emotional states, their
quality and intensity. A second theme is an analysis of the debate about whether
the bodily response t o stress emotions is specific to the psychodynamics of the
stressful encounter or general and non-specific. Third, it is argued that
self-regulatory processes as well as cognitive appraisals are key mediators of the
person’s reactions t o stressful transactions, and hence shape the somatic outcome.
Two types of self-regulatory processes are distinguished: 1) direct action,
which refers to any effort designed to alter the person’s troubled relationship
with the environment, and 2) palliative activities, including a) intrapsychic pro-
cesses such as denial, detachment and attention deployment, and b) somatic-
oriented devices such as drugs, relaxation training, biofeedback procedures, and so
forth, which are employed in an effort t o moderate the bodily concomitants of
stress emotion.

INTRODUCTION

Stress emotions play a key role in illness because under conditions of harm or
danger the body mobilizes as part of the effort to cope. Although this is an
adaptive, evolutionary mechanism of species survival, under conditions creating
excessive or prolonged bodily disturbances it also results in disease. Since tissue
systems may function in a less harmonious or integrated fashion under stress
than under normal circumstances, all or much disease could be stress-related.
Therefore, anything we can learn about the psychological processes concerned
with emotion, especially the stress emotions, contributes to and is in some
measure necessary to an understanding of illness.
Although we know much about what happens to the tissues when a person or
animal is undergoing a stress emotion, the psychological determinants of
emotion, its regulation, and the role of these processes in bodily disease have
remained somewhat elusive. Psychosomatic medicine as a research discipline goes
’ Professor of Psychology.
321
@ 1975. Baywood Publishing C o .

doi: 10.2190/T43T-84P3-QDUR-7RTP
http://baywood.com
322 Richard S. Lazarus

beyond the physiological processes involved in disease and tries to understand 1)

the psychological processes which make a person’s encounters with the
environment stressful, 2 ) the self-regulatory or coping processes brought to bear
in the management of stress, and 3) each step in the subsequent sequences
leading to those bodily states that Levi and Kagan [l] have called “precursors
of disease .”
Emotion arises from certain kinds of adaptive transactions or commerce a
person is having with his environment [2,3,4]. This implies a two way
interaction involving needs or motives and other psychological properties of
persons on the one hand, and environmental settings that provide opportunities
for gratification and potentials for frustration or harm on the other. The
intensity and quality of the consequent emotional reaction, as well as the nature
of coping activities designed to master the transaction, reflect the way this
adaptive commerce is evaluated cognitively by the person. The kinds of
evaluation relevant to emotions include 1) threat, 2 ) harm, 3) challenge, and 4)
positive well-being. The cornerstone of this psychological analysis of emotions is
thus the concept of cognitive appraisal which expresses the evaluation of the
significance of a transaction for the person’s well-being and the potentials for
mastery in the continuous and constantly changing interplay between the person
and the environmental stimulus configuration. In lower animals, for example
those studied by Tinbergen [S], the evaluative feature (appraisal) of the per-
ception that elicits the emotion is evidently built into the species’ nervous
system; in higher mammals such as man, symbolic thought processes and learning
play a predominant role.
Emotion is a complex disturbance that includes three loosely interrelated
components-namely, subjective affect (which includes the conscious features of
the cognitive appraisal), behavioral action impulses, and physiological changes
related to species-specific forms of mobilization for action. The action impulse
varies from one emotion to another. For example, in anger it is attack, while in
fear it is escape or avoidance. We must speak of impulse here because the action
may be inhibited by internal and social or physical constraints.
Notice that this way of looking at things is an attempt to specify some of the
mediating cognitive processes at work when a person perceives or senses danger,
for example, and reacts with a stress-emotion. When Freud, in his monograph,
The Problem of Anxiety [ 6 ] ,spoke of anxiety as arising from the perception of
danger, he was pointing toward such cognitive processes in emotion, though he
never really addressed himself to the rules by which such perception or appraisal,
as I would prefer to say, operates. Having such rules means that ultimately we
can say what it is about a given sort of person, having a particular transaction
with a specific environment, that leads to a specific emotional reaction. If we are
truly to understand diseases that have psychological determinants, then each
facet and stage of the emotional process from its initiation to its self-regulation
(e.g., coping) and its somatic effects must be understood. What is more,
 Stress and Coping in Adaptation and Illness / 323

consistent patterns of emotion in a person with stress-induced illness must also

be revealed since such disease involves repeated emotional disturbances over a
substantial period of time.

GENERALITY AND SPECIFICITY IN SOMATIC ILLNESS

Probably no man in recent decades has influenced theory and research on

stress disorders more than Hans Selye [7]. Selye has pressed the theme that
individual physiological reactions to noxious agents or “stressors” were actually
coordinated as part of a general syndrome of defense regardless of the type of
stressor. He called this syndrome of defense the General Adaptation Syndrome
(GAS), and proposed three stages in its operation: alarm, resistance and
exhaustion. If the noxious condition and the bodily defenses mobilized against it
persisted beyond the initial mobilization stage of alarm into the second stage of
resistance, various forms of tissue damage would occur. Selye referred to this
damage as the “diseases of adaptation.” The continuing process of resistance
would lead to depletion of bodily defenses and ultimately to the stage of
exhaustion and death. When the bodily defensive reaction is commensurate with
the seriousness of the environmental assault, the GAS is viewed as functioning
efficiently. Occasionally, however, the reaction is out of proportion to the
potential harm of the noxious agent, as in the case of allergy, in which case the
defense itself is more of a danger than the assault it was designed to overcome.
Selye has also maintained that aging represents the gradual wearing out of the
fixed adaptational resources of the system over its lifetime.
Selye brought a sense of integration into the arena of physiological stress and
disease by arguing the generalist position that any noxious agent could mobilize
the GAS, even purely psychological demands and threats. It did not matter what
noxious stimulus started the process since it would run off in essentially the
same way, involve essentially the same neuro-humoral mechanisms, and produce
the same tissue reactions regardless of the type of assault. The same theme is
found in Levi’s [8] research on catecholamine excretions (adrenal medullary
hormones). Levi showed that subjects would secrete adrenaline and noradren-
aline not only to threatening movies such as “The Devil‘s Mask,” “An
Occurrence at Owl Creek Bridge,” and “Paths of Glory,” but also to a comical
film ldce “Charley’s Aunt.” In commenting on this Levi states, “There seems to
be a positive correlation between the intensity of emotional arousal, whatever its
quality, and the urinary excretion of adrenaline and possibly of noradrenaline.”
Such a statement highlights the influence of Selye, although in Levi’s research
the focus is on secretions of the adrenal medulla, while Selye’s attention has
been focused mainly on pituitary-adrenal cortical hormones. Nevertheless, the
outlook is much the same, namely, that the hormonal reaction does not depend
on the particular nature of the stressful or arousing stimulus.
324 I Richard S. Lazarus

In a very recent book entitled Stress Without Distress [9], Selye seems to have
modified his position somewhat by suggesting that the GAS does not occur (or is
at least not destructive) in all kinds of stress but only in certain ones. He
acknowledges more fully that there are both specific factors in stress as well as
general (non-specific) ones, writing, “My work on stress . . . clearly indicates the
need to distinguish between nonspecific and specific features, since objective
experiments have shown that every stimulus or event (drugs, traumatic injury,
social problems) produces nonspecific stress, in addition to the specific effects
characteristic o f each one o f them” (p. 127, italics added). Thus, it is a matter of
emphasis whether one researches the specific or non-specific effects of stressors.
Moreover, Selye now maintains that only some forms of stress are to be avoided
since many are desirable and positive experiences in life. He writes, for example,
that “A better understanding of the natural basis of motivation and behavior . ..
should lead to choices most likely to provide us with the pleasant stress of
fulfillment and victory, thereby avoiding the self-destructive distress of failure,
frustration, hatred, and the passion for revenge” (pp. 131, 133-134). Selye
believes that such a distinction can provide moral guidelines to the person for
achieving healthy adaptation and enjoying a full life.
There is a position opposing Selye which emphasizes the other end of the
polarity between generality and specificity and argues that different stressors, or
the diverse adaptive processes that are generated by each, result in varying
specific patterns of somatic response. For example, a specificity position has
been emphasized both by this writer [3] and by Mason [ 101 and is expressed in
two interrelated themes. First, it is argued that the bodily response frequently
varies depending on the type of assault. Mason puts this as follows: “Along with
psychological stimuli such as conditioned avoidance and adaptation to the
restraining chair, physical stimuli such as cold and hemorrhage also do indeed
appear to elicit an elevation in 17-OHCS levels. On the other hand, exercise
appears to produce little or at least questionable changes, fasting even less
change, and heat actually suppression of 17-OHCS levels” (p. 328). The findings
cited by Mason (which he regards as somewhat tentative) suggest that Selye may
have overstated the generality of the stress response in asserting that all noxious
environmental conditions will produce the same general defensive response.
The second theme is that the GAS may depend on psychological mediators
rather than on physiologically noxious stimuli. Since it is extremely difficult in
the laboratory to isolate physiologically noxious stimuli, such as exercise,
fasting, heat, and cold from the psychological states that are apt to go along with
them (e.g., cognitive appraisals of threat or well-being), virtually all of the
research on the GAS has managed to confound the physiologically noxious with
the psychologically noxious. Selye has paid attention only to the bodily
defensive processes after they have been aroused neuro-humorally, and not to
the physiological and psychological signalling system that “recognizes” the
noxious effects or possibilities and distinguishes them from benign events. In an
 Stress and Coping in Adaptation and Illness / 325

earlier work [3] I made the comment that “It is altogether possible that the
extensive findings of stress biochemists that physiologically noxious agents
produce changes in the hormonal secretion of the adrenal cortex are the result of
their psychological impact” (p. 398). And Mason [lo] has put the matter
thusly :
While much more new research is needed before we know the full extent to which
psychological factors have entered into “physical stress” research, even those findings
on fasting, heat, and perhaps exercise are sufficient to cast serious doubt at present
upon the concept of physiological “non-specificity,” which is the very foundation
upon which much of stress theory rests. .. .
What I am suggesting, in other words, is that the “primary mediator” underlying
the pituitary-adrenal cortical response to the diverse “stressors” of earlier ‘‘stress’’
research may simply be the psychological apparatus involved in emotional or arousal
reactions to threatening or unpleasant factors in the life situation as a whole. The
“primary mediator” may simply be a common body mechanism brought into
operation by an experimental variable which was essentially overlooked or
underestimated in “stress research,” namely, the great sensitivity of the endocrine
systems to psychological influences which have contaminated many experiments of
“physical stressors.” Perhaps one of the principal points of historical importance
concerning “stress” theory will eventually prove to be in the early calling attention to
the sensitivity and ubiquity of psychoendocrine mechanisms (pp. 328-329).
There is some limited but provocative empirical evidence consistent with the
above assertion that the essential mediator of the GAS could be psychological.
Symington, et al. [ 113 suggest, for example, that an animal that is unconscious
can sustain bodily harm without the endocrine mechanisms of the GAS
becoming active. They observed that patients who were dying from injury or
disease, and who remained unconscious (comatose during this terminal
condition), showed a normal adrenal cortical condition as assessed by autopsy.
However, patients who were conscious during the fatal disease process did show
adrenal cortical changes during the autopsy. And as a partial control, Gray, et al.
[I21 provide evidence that anesthesia by itself does not produce a significant
adrenal reaction. Such studies support the possibility that it is the psychological
significance of the injury rather than the injury itself that produces the adrenal
cortical changes associated with the GAS.
Another version of the specificity position, centered however on autonomic
nervous system reactions, is that of Lacey [ 131,who has done extensive research
on beat to beat heart rate changes under divergent stimulating conditions. The
basic point is simple: the heart rate response is bidirectional, rising when a
person is oriented to shut out or ignore environmental input and dropping when
he is anticipating appearance of a stimulus. Such a decrease in heart rate occurs
even when the anticipated stimulus is threatening, as in the case of an electric
shock (e.g., Folkins [ 141). This “directional fractionation,” as Lacey referred to
it, is not seen in other autonomic nervous system end organ reactions such as the
electrodermal response which rises and falls solely in relation to level of
activation. The implications are clear. Autonomic nervous system activity does
not operate solely as a cnified expression of arousal under conditions of stress,
326 / Richard S. Lazarus

but rather it patterns itself in accordance with the nature of the demands or the
psychological process these demands generate. Although there may be some
degree of generality, as implied in the concept of activation or arousal, there is
also considerable specificity, with the bodily pattern of response varying
depending on the type of psychological activity generated under different kinds
of environmental load.
Recent biofeedback research further reinforces the view that there can be a
surprising degree of specificity even among autonomic nervous system end organ
responses that are normally somewhat interdependent in homeostatic regulation.
Shapiro, Tursky and Schwartz [15] have shown, for example, that subjects
rewarded only for increases or decreases in systolic blood pressure were able to
raise or lower their blood pressure while their actual heart rates (a related
cardiovascular function) remained unchanged. Moreover, when the procedure
was reversed so that only changes in heart rate were reinforced, subjects’ heart
rates were raised or lowered while systolic blood pressure remained essentially
unchanged. On the other hand, Schwartz [16] also reports that it is easier for
subjects to learn to make their systolic blood pressure and heart rate go up
together than to make them go in different directions, a finding which gives a
degree of support for a somewhat weak generality position. In any event, these
and other studies strongly suggest that there is a considerable degree of
specificity in the self-regulation of these response systems, though the limits of
such specificity have not yet been determined.
In one sense, the debate about generality or specificity is unproductive, since
it is reasonable to expect both principles to have some validity. Somewhat
different adaptive processes must be called into play to manage diverse demands,
and yet at the same time the person also operates as a psychobiological system
which responds in a highly integrated fashion. Our separate organ systems are
somehow pulled together in the service of the major adaptive requirements of
living rather than separately going their own way. Classically too, many writers
have emphasized health as the integration of a system and pathology as lack of
integration. Yet the debate is instructive in another sense because it has
important implications for the way the mechanisms underlying adaptation and
somatic illness can be viewed and studied. These implications can be made clear
by asking two questions: 1) “Given something like a General Adaptation
Syndrome, how might the various stress disorders come about in different
individuals or under different conditions?” and 2) “How might various stress
disorders be understood, given a degree of specificity in the stress reaction
pat tern?”

Stress Disorders from the Standpoint of Generality

Since the source of stress is givexilittle importance, and the reaction pattern is
always a uniform sequence of bodily defenses, that is, a syndrome which unfolds
epigenetically depending mainly on the severity and duration of the
 Stress and Coping in Adaptation and Illness / 327

environmental demands, differences in the type of disorder (e.g., migraine,

gastrointestional ulceration or mucous colitis, hypertension) are presumed to
depend on particular vulnerabilities of an individual's organs rather than on the
type of stressful transaction or emotional quality, say anger or guilt. Such
vulnerabilities could arise from genetic-constitutional factors or through
individual life experiences, or both. When the individual is exposed to any severe
or chronic stress, he will develop ailments that reflect the ravages of the GAS on
such vulnerable organs. The resulting disorder should have little to do with the
psychodynamics of stress itself, though certain psychologically related factors
such as differences in the severity of stress, its chronicity, and the stage of the
GAS, could lead to different somatic outcomes.
Of research on stress disorders adopting the generality position, the work by
Holmes and Rahe [17] and studies growing out of it seem to be the most
influential current example. These researchers developed a measure of life
changes and scaled it so that the changes, both positive and negative, requiring
the greatest adjustment effort (such as death of a spouse) were given high value
while those requiring little adjustment effort were given low value. Although
there are many methodological problems connected with this research (cf.
Sarason [ 181 for a review and analysis), Holmes and Rahe obtained evidence
that somatic and psychological illness is associated with a high life change score
for the time period immediately prior to the illness. This tends to support the
idea that stress of any kind, or more accurately, having to expend considerable
effort adjusting to it, leads to illness. Dohrenwend [19] recently has obtained
some evidence that it doesn't matter whether the stresses are viewed as desirable
or undesirable (distressing) by the persons involved, the magnitude of life
changes being the critical determinant. Nevertheless, the possible role of type of
life change and the type and effectiveness of coping remains at issue. In any
event, the life change approach has thus far implicitly adopted a generalist
position about the relationship between stress and disease.

Stress Disorders fhom the Standpoint of Specificity

Here the options are considerably more varied, as I see it, since the nature and
severity of the stress disorder could depend on at least three factors: 1) the
formal characteristics of the environmental demands, 2 ) the quality of the
emotional response generated by the demands, or in particular individuals facing
these demands, and 3) the processes of coping mobilized by the stressful
commerce.
With respect to the first option, some time ago Mahl [20-221 demonstrated
that hydrochloric acid secretion in the stomach was minimal or absent in acute
stress but marked in chronic stress. This would appear to be evidence that formal
characteristics of stress are relevant to the physiological reaction and
presumably, therefore, to the type of stress disorder produced.
The second option deals with the fact that stress emotions vary in quality
328 I Richard S. Lazarus

depending on the situation as well as on personality characteristics. Thus, given

some heavy environmental demand or set of demands, some individuals will
experience, say, mainly a sense of helplessness, anxiety, and depression, while
others might react with anger or some other emotional state. Although there is
at best only weak evidence that the adrenal medullary and autonomic patterns
vary with the quality of the emotion experienced, it is highly improbable that
the overall pattern of somatic reaction would fail to differ in important ways in
very different emotional states such as anger, fear, depression, and so on,
especially when one takes the position, as I have, that diverse emotions are
associated with different action impulses. From the perspective of specificity, we
must concern ourselves with the various types of environmental demands
generating the stress emotion in the first place, as well as the personality
characteristics that lead the person to appraise stressful situations in divergent
ways conducive to specific emotions.
With respect to the third option, coping processes are always involved in the
emotional. and somatic outcome of a stressful transaction. Thus if a person
successfully denies that he is in some kind of danger, or engages in other ways of
neutralizing the stressful demands, he shows a lessening or absence of the
expected stress emotion and the somatic disturbances related to it. I shall have
more to say about coping in the subsequent section.
It seems unnecessary to adopt an either/or position with respect to the
generality-specificity question. They are not mutually exclusive, and it seems
wise to entertain the likelihood of a degree of generality as well as specificity in
the sequence starting with disturbed commerce with the environment and
eventuating in somatic illness. However, given the psychological approach to
stress emotions with which I began this paper, I find the specificity arguments
richer in the range of potential factors that might account for variations in the
degree and type of somatic illness in different individuals and under different
environmental conditions. Personality factors can enter into the equation at a
number of places as the person addresses the demands and opportunities
afforded by his environment, for example, in the appraisal of threat and
challenge, and in the choice of coping processes whereby any stressful commerce
is managed.
It must be said also that there has been little interest on the part of
psychophysiologists in studying the activities of the various systems of neural
and humoral regulation simultaneously in stress situations and in attempting to
integrate them. Thus, almost never are autonomic reactions studied in
association with the adrenal medulla secretions which are closely linked with
them physiologically, or adrenal medulla and autonomic reactions in association
with the pituitary-adrenocortical axis. An exception is some research by
Frankenhaeuser [23] ; Mason [24] especially appears to be deeply impressed
with the complexity of hormonal mechanisms in stress and the interdependence
of various levels of response, including the physiological and psychological.
 Stress and Coping in Adaptation and Illness I 329

Limited understanding seems to encourage oversimplification of the integrative

mechanisms of various physiological systems, and we seem as yet to be a long
way from grasping how the many specific adaptive mechanisms are coordinated
in a single organism.

SELF-REGULATION IN THE STRESS EMOTIONS

As I have already noted, a key feature of stress emotions is coping or

.
self-regulation [4] The stress emotions (and emotions in general) are short-lived,
ebbing, flowing and changing over time as the transactions between the person
and his environment change. Changes in emotional states, including the lowering
or raising of their intensity and shifts in the quality of the emotional reaction
(say from fear to anger), depend on changes in cognitive appraisal. The person
obtains feedback from his own reactions and from cues in the environment, or
he engages in intrapsychic forms of coping (usually called defenses) in which he
redefines (reappraises) his relationship with the environment, and he constantly
strives to master the situation by overcoming the damage, postponing or
preventing the danger, or by tolerating it. This is a very important theme for
understanding the stress emotions and there are countless observations of the
important role that self-regulatory processes play.
In the psychosomatic arena one of the most frequently cited examples is the
research of the multidisciplined group studying the reactions of parents who
experienced the stress of a child dying of leukemia (cf. Wolff, et al. [2S]) in an
NIMH research hospital in Bethesda, Maryland. Parents who were “well-
defended,” that is, who coped by successfully denying the seriousness of their
child’s illness, were found to secrete far less 17 hydroxycorticosteroids than
those who faced the terminal nature of their child’s illness without the
protection of such defenses. Related observations have also been made by
Grinker and Spiegel [26] on combat air crews; by Hamburg, et al. [27] and
more recently by Andreason, et al. [28] on patients with severe burns; by
Visotsky, et al. [29] on paralytic polio victims; by Price, Thaler, and Mason
[30] on surgical patients; by Weisman [31] on terminally ill cancer victims; and
by many others [3,4]. My own laboratory research (see [2] for a review) has
made it clear that encouraging denial or detachment coping strategies in subjects
who watch disturbing motion picture films substantially lowers stress levels,
presumably by altering their cognitive appraisals of the stressful events thus
“short-circuiting” the film-induced threats.
Much coping or self-regulatory activity is also anticipatory-the person
anticipates a future harmful confrontation, such as failing in an examination,
performing in public, or whatever, and this leads him to prepare, often
successfully, against the future possibility of harm. This activity can alter the
stress emotion that would otherwise be experienced. Although anticipatory
coping itself may involve some mobilization, it need not (cf. Monat, et al. [32]),
330 / Richard S. Lazarus

and one must weigh the cost of such preparation against the lowered stress level
sustained in the actual confrontation when it occurs.
Recently I have distinguished between two types of such self-regulation [33] :
one which might properly be called direct action, the other involving palliative
modes involving attempts to control the emotion itself or its somatic correlates.
In direct-action, the person tries to alter or master the troubled commerce with
the environment, as, for example, when he attempts to demolish, avoid or flee
the harmful agent, or to prepare somehow to meet the danger. Thus if a student
faced with an important and potentially threatening examination spends the
anticipatory interval reading relevant books and articles, rehearses his
understanding of the subject with others, tries to find out or guess what
questions will be asked, and so forth, he is engaged in direct action forms of
coping, whether these are effective or ineffective. To the extent to which he
succeeds, he has also mastered the potential stress before it has to be faced. TO
the extent to which such activity leads to a more benign appraisal of the
potential outcome, say by giving him a sense of mastery and preparedness,
regardless of whether this appraisal is realistic or not, the stress reaction involved
in the troubled or threatened commerce with the environment is mitigated prior
to the ultimate occasion when the threat must be faced.
On the other hand,palliation occurs when direct action is either too costly to
undertake, or when the person is unable successfully to manage the environ-
mental transaction. Such modes of control include ego-defenses, selective
attention-deployment, taking tranquilizers, antispasmodics, alcohol, sleeping
pills, or engaging in a variety of other techniques such as muscle relaxation,
biofeedback therapy, and perhaps meditation, yoga, and hypnosis. Palliative
forms of coping are focused on possible ways of reducing the affective, visceral
or motor disturbances which are distressing the person, as opposed to attempts
to master the environmental transaction itself on which the stress emotion and
its distressing accompaniments depend. In helping the person control these
accompaniments which interfere with adaptive functioning or embarass him,
the prospects for coping with the basic problem too can sometimes be improved.
For example, by lowering the level of anxiety, the person may be able to think
better, rest better, and confront situations he would ordinarily avoid.
Self-regulatory processes are normal features of stressful transactions, a
continuous feature of living and adapting. As such they are key intervening
processes in the causation and prevention of stress-related somatic disorders. In
all likelihood, some of these will be effective under certain conditions, while
others will not. The problem is to understand the ways diverse forms of
self-regulation work, and to be able to specify the antecedent conditions
determining their use.
Unfortunately, the psychology of self-regulation is not very far advanced. We
 Stress and Coping in Adaptation and Illness / 33 1

are limited mainly to description rather than having predictive knowledge. A

wide variety of self-regulatory devices are employed by all of us throughout our
lives depending on personal characteristics, environmental demands and
contingencies, and the way our commerce with the environment is appraised. We
know little, however, about the conditions under which any given mode of
self-regulation will be successful in lowering stress levels or preventing somatic
illness and the relative costs of such processes, despite increasing research on the
problem.
Some recent studies have employed dispositional measures of coping
exclusively (e.g., Andrew [34])-that is, measures of coping styles or traits using
personality tests-in trying to predict their impact on the outcome, say, of minor
surgery. Other studies (e.g., Cohen and Lazarus [35] ) have examined the active
coping processes employed by the surgical patient the evening before the
operation. Although both types of research have demonstrated a relationship
between coping variables and indexes of recovery from surgery, their findings
have often been contradictory with respect to the relationship between actual
coping, coping dispositions and recovery. Moreover, there is evidence that a
coping strategy which works in one context, or for one type of person, might
have damaging consequences in another (cf. Speisman, et al. [36]; Gal,
unpublished study, discussed in [33]). The problem is clearly a complex and
difficult one, but it is central to the psychodynamics of stress disorders and
needs far more systematic attention than it has received.

SUMMARY

Since self-regulation is an integral part of the problem of stress, disease

precursors, and somatic disorder, we cannot hope to develop practical
understanding without taking it into account in stress-relevant environmental
transactions. Moreover, each psychological step in linking the external stressor
and the complex reaction needs to be spelled out and examined in the attempt
to understand stress-linked illness and its precursors. The rules needed in such
understanding begin with the moment a particular person appraises some given
commerce with the environment as harmful, challenging, threatening, or
positive, and they include how such appraisals persist or change as events
proceed, the manner in which the person chooses one or another process of
self-regulation, and finally, the costs and effectiveness of given self-regulatory
strategies in particular types of persons and environmental contexts. Above all,
we need to see somatic illness as an expression of repeated or persistent forms of
adaptive commerce with an environment of some kind. Such commerce and the
ways it is appraised depend both on the environmental characteristics and a
Particular personality, not on one or the other alone.
332 / RichardS.Lazarus

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