The Gerontologist 40:327-334 (2000)
© 2000 The Gerontological Society of America
The Use of Preexisting and Novel Coping Strategies in Adapting to Age-Related Vision Loss
Mark Brennan, PhDa and
Gina Cardinali, MSWa
a Arlene R. Gordon Research Institute, Lighthouse International, New York, NY
Correspondence: Mark Brennan, PhD, Research Associate, Arlene R. Gordon Research Institute, Lighthouse International, 111 East 59th Street, 10th floor, New York, NY 10022-1202. E-mail: mbrennan{at}lighthouse.org.
Decision Editor: Vernon L. Greene, PhD
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Abstract
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Research has proposed that when faced with a stressor, individuals test novel coping strategies when preexisting strategies fail to reduce perceived threat. However, the utilization of novel coping strategies has received scant empirical attention. This study presents data in the form of spontaneous comments or responses to open-ended questions from three previous quantitative studies of adaptation to age-related vision loss 
. Self-reported coping strategies were identified using a "Grounded Theory" approach, and then examined for evidence of whether the strategy was recently utilized (novel) or whether it had been used prior to vision loss (preexisting). Results supported the utilization of novel coping strategies in the process of adaptation to a chronic impairment among older adults. Overall, the use of novel coping strategies was found to be associated with better adaptational outcomes, emphasizing the importance of novel coping in response to stressful life circumstances.
Key Words: Adaptation to vision loss • Person–environment perspective • Stress and coping
Stressful life events have been defined as occurrences that "are indicative or require significant life change in the ongoing life pattern of the individual" or "experiences involving a role transformation, changes in status or environment, or impositions of pain" (Hultsch and Plemons 1979
, p. 17). According to the life-span developmental perspective, change throughout the life course is both continual and embedded in multidimensional contexts (i.e., biological, psychological, sociocultural, and historical; Lerner and Busch-Rossnagel 1981, p. 4). In accordance with this person–environment perspective, it has been posited that it is this lack of fit between a person's abilities and needs and environmental conditions and demands that leads to variability in adaptational outcomes (Carp 1987; Kahana 1982; Wahl, Oswald, and Zimprich 1999). Adaptation is assessed, therefore, as the goodness of fit between an individual and the environment (Lerner and Busch-Rossnagel 1981).
From a life-span developmental perspective, coping with stressful life events comprises a subset of these ongoing adaptational transactions between the person and the environment (Stewart 1982). A stressful event, by its very definition, suggests a disruption between the person and the environment that becomes the focus of coping processes (Lazarus and Folkman 1984). The effects of stressful life events can be conceptualized as a disturbance in the equilibrium in an individual's life space, comprising a series of nested domains representing the biological, psychological, and socioenvironmental contexts (Horowitz et al. 1998; Lerner and Busch-Rossnagel 1981, p. 3).
Coping begins with an appraisal of the degree of perceived threat arising from a particular stressful event (Hultsch and Plemons 1979; Lazarus and Folkman 1984). Perceived threat may result from the extent to which one has had previous experience in dealing with a particular event and/or the extent to which the implications of the event are not congruent with extant "information, values, goals or behavior" (Hultsch and Plemons 1979, p. 27). These authors proposed that initial attempts at adaptation are made through the use of preexisting coping strategies following this appraisal. But, when such strategies are not adequate or bring only marginal improvement, novel ways of coping may be explored, "searching for new solutions, seeking out and evaluating new information, and reappraising current assumptions and life goals" (Hultsch and Plemons 1979, p. 29).
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Empirical Support for the Utilization of Novel Coping Strategies
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A review of the stress and coping literature identified relatively few studies that provide some, albeit indirect, empirical support for the notion of the utilization of novel coping strategies. Kuther 1997 studied 123 young adolescents to examine the relation between exposure to community violence and associated coping processes. Victims of violence were found not only to use a greater number of coping strategies, but also to use new strategies to cope with the stress of this experience. A second study focused on 23 "outstandingly successful" deaf high school students on their experience and coping with isolation (Charlson, Strong, and Gold 1992). Findings revealed that these students used novel positive strategies for dealing with isolation if they did not already have such strategies at their disposal, and suggest that individuals do implement new ways of coping when preexisting strategies are not effective or available.
Most evidence for the use of novel coping strategies in adulthood comes from a number of studies that have examined the effectiveness of targeted interventions on coping. For example, in a study of the effects of various interventions with a group of 39 cocaine-dependent patients, it was found that the types of coping skills exhibited were characteristic of the type of intervention received (Carroll, Nich, Frankforter, and Bisighini 1999). To illustrate, individuals who received cognitive–behavioral therapy (CBT) demonstrated a significant increase in CBT coping responses at follow-up compared to other groups. Because coping responses at follow-up demonstrated a significant congruence to the type of intervention received, one may reason that these coping strategies were a direct result of the type of intervention, and thus represent novel coping strategies.
Finally, Klein 1994 examined person–environment adjustments to the home in response to normative age-related physical and cognitive changes. A number of responses involved the use of novel coping strategies. For example, one older woman who found standing in the kitchen to be increasingly fatiguing made accommodations to allow her to sit while performing kitchen tasks. In another example, an older woman who was forced because of poor health to live on the first floor of her home focused instead on the "advantages of her newly organized space." Klein ascribed the ability of some individuals to cope successfully with age-related changes to their problem-solving ability, which she saw as an important prerequisite for improving the fit between person and environment.
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Coping With Age-Related Vision Loss
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Vision impairment has been identified as the second most prevalent disability among adults aged 65 years or more, affecting 13% of noninstitutionalized adults (National Center for Health Statistics 1985, National Center for Health Statistics 1986). Eye diseases typically reported by visually impaired older adults include macular degeneration, cataracts, glaucoma, and diabetic retinopathy (Podgor, Lesley, and Ederer 1983; Rosenthal and Cole 1995). Older people often experience multiple, concurrent eye diseases, and impairment severity tends to increase over time. The onset of vision impairment in late adulthood may significantly disrupt patterns of behavior and social interaction in a broad range of psychological domains (i.e., body image, self-concept, and other forms of self-awareness) and social domains, including communication, mobility, work, and recreation (Kirtley 1975). Age-related vision loss differs qualitatively from congenital or early-onset vision impairment because the elder's experience has largely been as a "normally" sighted person, with well-established familial, work, and other social roles. (Brennan and Silverstone in press). Stewart 1982 has suggested that these types of unfamiliar situations may provide the most powerful impetus for the use of novel coping strategies in the face of life stress.
Thus, age-related vision loss represents the type of unfamiliar and profoundly disruptive stressful situation that Stewart 1982 describes as most amenable to the utilization of novel coping strategies, and provides an excellent context for examining coping with stressful life circumstances. It should be noted that age-related vision loss has the characteristics of both a chronic stressor as well as a discrete stressful event. Because age-related eye diseases may develop gradually, vision impairment in late life has the characteristics of a chronic stressor. But when the disease progresses to the point of noticeable functional impairment and interference with daily activities, the older person may be abruptly labeled as "visually impaired" and referred for vision rehabilitation services. Thus, vision loss takes on the qualities of a discrete event because of the discontinuity experienced between one's previous identity as a fully sighted adult and one's new identity as a person with vision impairment.
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Purpose and Rationale
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Although some evidence for the utilization of novel coping strategies exists, this notion has largely been ignored in previous studies of coping in both the gerontological and general social science literatures. While previous research has examined adaptation to age-related vision impairment from the "stress and coping" perspective of Lazarus and Folkman 1984 (e.g., Horowitz, Reinhardt, McInerney, and Balistreri 1994), the issue of the use of novel coping strategies in response to this disabling condition has not been specifically examined. The purpose of the present study was to identify and examine the utilization of novel and preexisting coping strategies among adults with age-related vision loss using a combination of qualitative and quantitative analysis techniques. Qualitative analysis was used for the initial identification of self-reported coping strategies and the subsequent classification of these strategies as novel or preexisting. These qualitative results were then converted to numerical form and subjected to quantitative analyses to examine the following research questions:- Do older adults with age-related vision loss utilize novel coping strategies in adapting to this condition, and what is the relative distribution of novel versus preexisting strategies in terms of behavioral, psychological, and social life-space domains?
- Does the use of novel coping strategies remain stable over time, or will change be observed between the baseline assessment and 2-year follow-up after the receipt of vision rehabilitation services and the concomitant worsening of the eye condition?
- Are there age or gender differences in the relative utilization of novel and preexisting coping strategies in adapting to age-related vision loss?
- What is the relationship between the use of novel and preexisting coping strategies to long-term adaptational outcomes among older adults who are visually impaired?
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Methods
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Sample
Three previous quantitative studies of adaptation to age-related vision impairment provided narrative data for the present qualitative analyses. Two of the samples 
consisted of recent applicants for vision rehabilitation services (Horowitz et al. 1994; Reinhardt 1996). The third sample 
was a 2-year follow-up of the first 
sample, of which 81% had received some type of rehabilitation service (Horowitz et al. 1994). Overall, participants ranged in age from 65 to 99 years. Approximately two thirds of respondents were women, and the vast majority reported their race as White (see Table 1 ). The three samples were merged for the overall analysis of novel and preexisting self-reported coping strategies. For the within-case analyses of the use of coping strategies over time (longitudinal sample), only the baseline and follow-up data from the third sample were used. For these analyses, 30 cases were randomly selected.
Measures
In the studies described above, verbatim written recordings were made of spontaneous comments and responses to open-ended questions during the structured in-person interview. Respondents were not limited in terms of the length of their responses. However, because the interview procedure did not systematically prompt or probe respondents to provide narrative data, the amounts of these data vary from participant to participant. These recordings were then transcribed and constituted the qualitative data used in the present analyses, consisting of nearly 30,000 lines of text. Space does not permit a detailed description of the standardized interviews that elicited these data. However, the topics covered included: sociodemographic information, physical health status, vision status, subjective experience of vision loss, functional ability, social support, activity participation, the Elderly Care Research Center Coping Scale for the longitudinal sample only (Kahana, Fairchild, and Kahana 1982), and rehabilitation service use. Responses from all areas of the interview schedule were included in the qualitative data sets: many of these comments referred to coping activities directed at dealing with functional limitations or emotional sequelae of age-related vision loss.
In addition, two quantitative outcome measures were utilized for the within-case analyses: the Adaptation to Age-Related Vision Loss scale (AVL; Horowitz and Reinhardt 1998), and the Center for Epidemiological Studies Depression scale (CES-D; Radloff, 1997). The AVL is a 24-item instrument used to assess adaptation to age-related vision loss (e.g., "losing one's sight means losing one's self," "visual impairment is the cause of all my problems") and was scored in an agree/disagree format with higher scores indicating better adaptation. The CES-D is a 20-item instrument that assesses depressive symptomatology during the previous week (e.g., feelings of worthlessness, psychomotor retardation), with higher scores indicating greater levels of depressive symptoms. Inter-item consistency for both the AVL and CES-D with the Time 2 sample was high; 
, respectively.
Procedures
Initially, self-reported coping strategies were identified in the data sources named above using the "Grounded Theory" approach (Glaser and Strauss 1967), that is, the codes for the coping strategies were not constructed a priori, but were instead developed in the course of analysis based on the narrative data. Analyses were performed using the Atlas/ti qualitative analysis software program (Muhr 1997). One rater performed the initial coding of the text files. A codebook, which provided definitions and examples for each code, was then constructed. A second rater then reviewed the coded text and noted any disagreements. Disagreements were resolved through discussion. Interrater reliability for the coding of self-reported coping strategies (i.e., 3,410 quotations and 85 coping codes) with two raters was acceptable 
Coping strategies were then organized into behavioral, psychological, and social domains in line with the life-span developmental perspective of adaptation being embedded in multidimensional contexts (Lerner and Busch-Rossnagel 1981, p. 3). Behavioral coping was defined as overt, observable actions. Psychological coping was defined as involving emotions or cognitions. Social coping was conceptualized as involving members of the informal social network or formal service providers.
Next, individual coping strategies were examined for evidence of whether the strategy was novel or preexisting, with the following criteria. Coping strategies were considered novel if the narrative information indicated that the strategy was implemented in response to vision impairment or there was an indication that it was a recently adopted activity. Additionally, coping strategies that could be reasonably assumed to be only applicable to visual impairment (e.g., using optical and nonoptical devices) were coded as novel unless otherwise indicated. This assumption was made because all respondents had experienced recent, age-related vision impairment and therefore were unlikely to have used such strategies in the past (see Table 2 ). Coping strategies were coded as preexisting if the narrative indicated that (a) the strategy was used prior to the onset of vision loss or (b) was described as an enduring state/quality of a person/situation (see Table 3 ). Those coping strategies that could not be determined to be either novel or preexisting using the above criteria were excluded from the present analyses. Interrater reliability for the coding of coping strategies (i.e., 3,410 quotations) as novel and preexisting by two raters was also acceptable 
.
Design and Analysis
Qualitative data analyses were conducted using the methods of constant comparisons, counting, and the construction of conceptual matrices (Miles and Huberman 1994). Counts of the number of different novel and preexisting coping strategies used, both overall 
and within-subject 
, were subjected to statistical testing in order to verify patterns noted in the qualitative analysis. These tests included chi-square analysis, repeated-measures multivariate analysis of variance (MANOVA; i.e., Time 1 to Time 2 comparisons), one-way analysis of variance (ANOVA; i.e., age and gender comparisons) and Pearson correlations (i.e., relation of coping strategies to psychosocial outcomes). The latter two analyses employed quasi-experimental (i.e., preexisting age and gender groups) and correlational designs, respectively. Because of the exploratory nature of this study and the small sample size for the within-case analyses (
), probability levels of p < .10 were considered to be statistically significant.
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Results
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Examples of novel and preexisting coping strategies are presented in Table 2 and Table 3 , respectively. Of the 3,410 coded coping strategies examined, 1,489 (44%) were identified as novel, 596 (17%) were determined to be preexisting, and the remaining 1,325 (39%) could not be classified. Although nearly two in five self-reported coping strategies could not be distinguished as either novel or preexisting, our goal was to be conservative in our coding of these data and to make these distinctions only when we had reasonable certainty.
Both novel and preexisting coping strategies were noted in all three life-space domains (i.e., behavioral, psychological, and social). However, preexisting coping strategies were most likely to be found in the psychological domain 
, followed by the social domain 
, and the behavioral domain 
. In contrast, novel coping strategies were most likely to be in the behavioral domain 
, followed by the psychological (34%) and social (17%) domains 
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Within-Case Analyses
To better understand the selection of novel and preexisting coping strategies used in adapting to age-related vision loss, the constellations of coping strategies used by individual older respondents were explored. Additionally, it was of considerable interest to examine the process of coping with vision impairment over time. As noted above, the present data set included follow-up information from 95 individuals 2 years after receipt of vision rehabilitation services. For these within-case analyses, 30 individuals, or approximately 30% of cases, were randomly selected, which provided data at both baseline and follow-up. Time 1 and Time 2 qualitative analysis matrices of individual self-reported coping strategies were constructed for each case in order to analyze any patterns regarding novel versus preexisting coping with late-life vision impairment over time.
Results of the within-case analyses found a pattern for greater use of both novel and preexisting coping strategies at the Time 2 follow-up compared with baseline. At baseline, the average number of novel strategies reported by each respondent was 2.9, increasing to 3.3 on average at Time 2; however, this change was not statistically significant 
. A similar, but statistically significant, trend was observed in the case of preexisting coping strategies, which increased from an average of 0.6 at baseline to 1.4 at Time 2 
Second, there were significant differences in the likelihood of coping strategies being classified as novel or preexisting at baseline compared with Time 2 in terms of the life-space domains. At baseline, preexisting strategies were most likely in the behavioral domain (e.g., seeks advice or help from doctor) and psychological coping domains (e.g., relies on positive attitude or personality), 44% and 44%, respectively. Only 11% of preexisting strategies involved social coping (e.g., relies on spouse). However, at Time 2, preexisting strategies were most likely to be in the psychological domain (63%), followed by the behavioral (27%) and social (10%) domains, and these differences were significant (see Table 4 ).
In terms of novel strategies, at both baseline and Time 2, the majority were in the behavioral domain (55% and 55%, respectively; e.g., seeking services to learn skills, seeking or using adaptive or optical devices). Thirty percent of novel coping strategies at Time 1 were in the psychological domain. However, at Time 2, there was an upsurge in novel psychological coping strategies (37%) relative to baseline (30%) (see Table 4 ). In many cases, the Time 2 psychological strategies concerned either the acceptance of vision loss, or a greater emphasis on abilities rather than limitations. With regard to the social domain (e.g., activating informal or formal instrumental and emotional supports), these types of coping strategies were the least frequently classified as novel at both baseline and 2-year follow-up (16% and 8%, respectively).
This pattern is illustrated by the following case of a 68-year-old female. Novel coping strategies reported at Time 1 included relying on both memory and touch to compensate in the behavioral domain, feeling vision impairment was not as bad as other problems in the psychological domain, and activating informal support to obtain visual information in the social domain. Preexisting strategies at Time 1 were only reported in the behavioral domain, namely, seeking a low vision exam and seeking an optical device. At Time 2, no preexisting coping strategies were reported. In the behavioral domain, as was the case for Time 1, she reported two novel strategies; use of an optical device and use of a nonoptical adaptive device. Furthermore, she reported using two novel psychological coping strategies: actively avoiding negative feelings and planning for the future regarding vision impairment.
Age and Gender Differences in Use of Preexisting and Novel Strategies
One-way ANOVAs were performed comparing younger (age 65 to 74 years) and older (75 years or more) adults, and men and women in the total number of novel and preexisting strategies reported at baseline and 2-year follow-up (see Table 5 ). The only significant difference by age group was observed for novel coping strategies at Time 2; adults 75 years and older reported a greater number of novel coping strategies at follow-up 
compared to their peers 65 to 74 years of age 
. There were no significant differences based on age in terms of the use of preexisting coping strategies (see Table 5 ). Although the finding that adults 75 years and older reported greater numbers of novel strategies at follow-up as compared with their younger peers was somewhat unexpected, this does suggest that age is not a barrier to utilization of novel coping strategies.
With regard to gender, there were no significant differences in the number of novel coping strategies reported; however, there were significant differences in reliance on preexisting strategies. Older women reported a greater number of preexisting coping strategies compared to men both at baseline 
. Thus, older women, particularly in the early stages of adjusting to age-related vision loss, were found to be more likely to rely on preexisting coping strategies compared to their male peers.
The Relationship of Coping Strategies to Long-term Adaptation
At baseline, the number of novel social coping strategies demonstrated a significant, positive correlation with AVL scores, indicating that individuals who used greater numbers of such strategies reported better adaptation to vision loss. No other baseline indicators were significantly correlated with the Time 2 outcomes (see Table 6 ). However, a number of Time 2 measures of novel and preexisting coping strategies were significantly correlated with Time 2 dependent measures. The total number of novel coping strategies used was positively associated with AVL scale scores, and negatively associated with CES-D scores, indicating that the use of novel coping at Time 2 overall was associated with better adjustment to vision loss and fewer depressive symptoms (see Table 6 ). Additionally, behavioral coping strategies at 2-year follow-up demonstrated a differential effect on adaptation depending on whether the strategies were novel or preexisting. Novel Time 2 behavioral strategies were significantly associated with better outcomes, whereas the use of preexisting behavioral strategies was associated with poorer outcomes on both the AVL and CES-D. In terms of psychological coping, novel strategies were significantly associated with lower levels of depression and showed a positive, albeit nonsignificant, relation to AVL scores. However, in terms of social coping, Time 2 preexisting strategies were significantly associated with higher AVL scores. In summary, novel coping strategies, particularly those reported at 2-year follow-up and involving behavioral and psychological forms of coping, were related to better adaptation to age-related vision loss. Preexisting strategies at Time 2 were also related to outcomes, but the effect varied by domain, with poorer adaptation associated with preexisting behavioral strategies, and better adaptation associated with preexisting social coping strategies.
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Table 6. Correlations of Coping Strategy Counts with Adaptation to Vision Loss (AVL) and Center for Epidemiological Studies-Depression (CES-D) Scales (n = 30)
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Discussion
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Results of the present analyses provide, to our knowledge, the first direct support of Hultsch and Plemons 1979 description of coping with life stress: when faced with stressful life events, individuals begin to implement alternative, novel coping strategies when preexisting strategies fail to restore equilibrium to the life space (Hultsch and Plemons 1979; Stewart 1982). This position was supported by findings that older adults with vision loss do explore novel ways of coping in the process of adaptation, and that novel strategies overall were more strongly related to positive adaptation over time. Furthermore, there was a trend for novel coping strategies to be more frequently reported by respondents at 2-year follow-up relative to baseline, which suggests that these individuals were exploring other options as vision continued to worsen and previous methods for coping were no longer adequate. However, the finding that preexisting coping strategies also increased over time would suggest that novel coping strategies may serve to complement, rather than replace, habitual ways of coping. The upsurge in both novel and preexisting coping strategies in the psychological domain over time suggests that psychological adjustment is the key to that long-term adaptation to age-related vision loss. This is congruent with both clinical observations and empirical studies that have found that long-term adaptation to vision loss often hinges on psychological acceptance of the visual impairment (Cholden 1958; Conrod and Overbury 1998; Fitzgerald, Ebert, and Chambers 1987; Kirtley 1975).
Results found that behavioral coping strategies were the most likely to be novel, followed by psychological coping strategies. Strategies in the social coping domain were the least likely to be novel. This finding would suggest that the behavioral and psychological life-space domains, which are most directly under an individual's control, might be the most amenable to experimentation and modification. In contrast, in the social life-space domain over which the person has limited control, there may be a greater tendency to rely on preexisting coping mechanisms. Gender and age did not appear to be a barrier to the utilization of novel strategies. The finding of a greater reliance on preexisting strategies on the part of older women is not easily explained and should be explored in future research.
Novel coping strategies may stem from a variety of sources. In some instances, individuals spontaneously used novel strategies, such as the older man who reported developing a system for crossing streets on his own, and later, when he met with his vision rehabilitation therapist, found out he was crossing streets correctly. A second catalyst for the utilization of novel coping strategies lies in the social domain of interaction with peers who may or may not be visually impaired, and who share knowledge of available rehabilitation services, or who foster psychological acceptance of the impairment by providing emotional support. The influence of social support in the use of novel coping strategies may also be linked to participation in support groups, in which other individuals with vision loss share their behavioral, psychological, and social strategies for coping with vision impairment. In other instances, being a consumer of vision rehabilitation services may lead to the utilization of novel coping strategies. Responses at the Time 2 follow-up tended to show a greater (and novel) interest in accessing various services as compared with Time 1, which may be partially explained by the fact that 81% of these individuals had received some form of rehabilitation services in the interim (Horowitz et al. 1994). Use of these services was also reflected in greater optical and nonoptical adaptive device use as a novel coping strategy. These findings underscore the importance of targeted interventions for older individuals who are experiencing major stressful life events.
Limitations to the Study
There are a number of limitations to the current study. Because respondents were not probed to provide comments following the interview items, qualitative information was not obtained systematically from each respondent. This may have biased results in terms of persons who were more talkative versus those who were more taciturn. Additionally, responses may have been biased in terms of the nature of the particular question from the interview. But it should be noted that information regarding self-reported coping was obtained from all areas of the interview schedules, and coping codes were generalizable across two independent samples with somewhat different interview schedules. However, we felt that the opportunity to explore these unique qualitative data outweighed these weaknesses. Obviously, replication of the current findings using a more systematic data collection strategy is recommended.
Future Research
Future research should also attempt to replicate these findings on the use of novel coping strategies in the face of stressful life events among other elderly populations to test the generalizability of current findings. It would be of interest to understand if the utilization of new ways of coping was more common with chronic conditions such as vision impairment or arthritis as compared with acute conditions or life changes, such as stroke or loss of spouse. While the focus of the present study was on vision impairment, many of the coping strategies identified as novel, such as psychological acceptance and the activation of social support resources, are not unique to vision impairment per se. As we increase our understanding of how older adults cope and adapt to the stressors of late adulthood, we will also learn more about what is necessary to both maintain and regain well-being in the face of both normative and nonnormative challenges of later life.
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Acknowledgments
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Portions of this article were presented at the symposium, "The Context of Well-Being in Later Life: Psychological and Social Perspectives," organized by D. K. Mroczek, Fordham University, and M. Brennan, Lighthouse International, at the 51st Annual Scientific Meeting of The Gerontological Society of America, November 22, 1998, Philadelphia. The original study upon which this research is based, "In Their Own Words: Strategies Developed by Visually Impaired Elders to Cope With the Emotional and Functional Consequences of Vision Loss," was funded in part by the Macular Disease Foundation of Virginia Beach, VA. The authors extend their thanks to Amy Horowitz, DSW, senior vice president for research and evaluation, and Joann P. Reinhardt, PhD, senior research associate, the Arlene R. Gordon Research Institute of Lighthouse International, for the use of the qualitative data that were the basis for the present analyses, and for their assistance in the original analyses of self-reported coping strategies. The authors also thank Jessica McIlvane, MA, and Verena Cimarolli, MA, for their assistance in the original coping strategy analyses.
Received for publication May 19, 1999.
Accepted for publication December 28, 1999.
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Abstract
Empirical Support for the...
