C 2005)

Journal of Behavioral Medicine, Vol. 28, No. 3, June 2005 (

DOI: 10.1007/s10865-005-4662-1

Stress-Resilience, Illness, and Coping: A Person-Focused

Investigation of Young Women Athletes
Joyce P. Yi,1,2 Ronald E. Smith,1 and Peter P. Vitaliano1
Accepted for publication: August 24, 2004

Coping correlates of resilience, defined as resistance to illness in the face of exposure to high
numbers of negative life events, were studied in a sample of 404 young women high school
athletes. Negative life events and coping strategies were assessed preseason, and daily illness
data were collected during the course of the season. Among athletes with high levels of exposure to negative life events, resilient (no illness time loss) and nonresilient (upper third of
time loss distribution) groups were compared on 6 scales of the Ways of Coping Checklist.
Coping profiles of the groups differed significantly, with resilient athletes favoring Problemfocused Coping and Seeking Social Support, and nonresilient athletes reporting greater use
of Avoidance and Blaming Others. Correlations among Problem-focused Coping, Seeking
Social Support, and Minimize Threat were higher in the resilient group. Results suggest that
certain coping strategies may contribute to illness-resistance in the face of high life stress.
KEY WORDS: resilience; coping strategies; illness; young women athletes.

INTRODUCTION

Although many correlates and outcomes of resilience have been posited, less is known about the
process of resilience (Egeland et al., 1993; Masten,
2001). Resilience has been studied most commonly
as a broadly defined latent variable, sometimes using
physical well-being and psychosocial outcomes such
as distress, depression, and quality of life to index
resilience in individuals exposed to severe stressors.
Unfortunately, defining resilience solely in terms of
salutary medical and psychosocial outcomes in the
face of stressors provides little information about the
processes of resilience that moderate and mediate
resistance to stressors. Potential protective factors
include rational appraisal, self-esteem, self-efficacy,
social support, positive life events, sense of control, temperamental attributes, and the types of coping strategies typically used to deal with stressors
(Beardslee, 1989; Rutter, 2000). Thus, it is important to distinguish the outcomes of resilience from
the processes that produce this outcome. An example of this distinction comes from the work by
Kobasa (1979) on hardiness. As an outcome, hardiness was operationalized in terms of high life stress
and low illness in middle and upper level executives. However, the executives sense of commitment,

The vast literature on stress and coping has

received empirical attention in many areas of
psychology, including behavioral medicine, social
and personality psychology, and developmental
psychology. One focus of this research pertains to
an individuals capacity to maintain psychological
and physical well-being in the face of adversity. This
phenomenon, termed resilience, has been the focus
of considerable research, particularly in the study of
children who appear to rise above severe environmental challenges (Masten, 2001). The combination
of an emerging emphasis in positive psychology
and recent methodological advances in the study
of coping in children and adults has suggested that
resilience may have much broader applicability, with
relevance to virtually any population that encounters
acute or chronic stress (Rutter, 2000).

1 Department

of Psychology, Box 351525, University of Washington, Seattle, Washington 98195.

2 To whom correspondence should be addressed; e-mail:
jyi@u.washington.edu.

257
C 2005 Springer Science+Business Media, Inc.
0160-7715/05/0600-0257/0

258
challenge, and control were presumably the personlevel factors that mediated positive adaptation in the
face of stress. When the same term is used to refer to
both an outcome and the processes that contribute to
that outcome, definitional ambiguity can result.
This study focuses on potentially adaptive and
maladaptive coping correlates of health and illness
outcomes in adolescents who have recently experienced high levels of life stress. Similar to research in
personality hardiness, resilience in this study is operationalized in terms of high life stress and low illness,
whereas coping strategies are investigated as the factors that contribute to a resilient outcome. Coping
involves cognitive and behavioral measures designed
to master, tolerate, or reduce external and internal
demands and conflicts. A sizeable body of research
has identified specific coping strategies, and a number of self-report measures have been devised to assess individual differences in coping strategies and
skills (e.g., Carver et al., 1989; Folkman and Lazarus,
1980).
Differences in self-reported coping strategies
are positively or negatively related to both physical and psychological well-being (Billings and
Moos, 1981; Lazarus and Folkman, 1984; Vitaliano
et al., 1990a). On the Revised Ways of Coping
Checklist (WOCC; Vitaliano et al., 1985), for example, adaptive coping patterns (particularly in
situations appraised as controllable) have typically
involved Seeking Social Support, Problem-focused
Coping, and Minimizing Threat through rational
thinking. Within the resilience literature, seeking
social support has been identified as a beneficial
contributor to stress-tolerance and has been shown
to function as both a moderator and a mediator of
stress-illness relations (DeLongis et al., 1988; Masten
and Coatsworth, 1998; Taylor et al., 2000). In fact,
Taylor and colleagues (2000) tend-and-befriend
response to stress suggests that womens patterns of
coping may involve more caring for and socializing
with others as a primary response to stress. Problemfocused coping has also been identified as a potential
resilience factor in the face of stress (Cederblad
et al., 1994; Vedhara and Nott, 1996). Likewise, the
development of problem-focused coping skills in
childhood has been tied to increased resilience to
stress later in life (Cederblad et al., 1994). Finally,
the ability to minimize the threat value of potential
stressors by rationally reappraising oneself or the
situation is well established as a contributor to
stress-tolerance (Isaacowitz and Seligman, 2003;
Lazarus and Folkman, 1984).

Yi, Smith, and Vitaliano

Coping strategies related to negative social and
health outcomes have also been identified. In some
cases, Avoidance, Blaming Others, and Wishful
Thinking, as measured by the WOCC, have been
shown to be maladaptive (Vitaliano et al., 1985; 1987,
1990a,b). In particular, avoidant coping, the tendency
to avoid a stressful event cognitively, behaviorally
or emotionally, has been linked to distress, depression, mood disturbance, lowered quality of life,
and increased pain perception in medical patients
(Carver et al., 1993; Culver et al., 2002; Penedo et al.,
2003; Swindells et al., 1999). To this point, avoidance
has not been shown to directly influence physical
health, although there is evidence that it functions
at least as a moderator variable (Penley et al., 2002).
Blaming others as a coping strategy is frequently
dysfunctional because it can replace more productive
approaches to dealing with a stressor and can alienate others, thereby reducing social support. Finally,
the unrealistic fantasies that constitute wishful thinking may not contribute much to managing a stressful
situation.
This study investigated resilience in young
women high school athletes. Athletes have frequently been the focus of research on psychosocial
factors, including coping, that moderate stress-injury
relations, but little is known about factors that may
influence a stress-illness relation in athlete populations. Further, evidence for distinct coping styles
in competitive athletes has also been established
(Anshel, 1996; Anshel et al., 2000). For these reasons,
we performed a longitudinal study to explore the
role of coping strategies in illness-related stressresilience. We compared WOCC coping profiles in
groups of athletes who had reported high levels of
recent life stress and who had subsequently experienced either low or high time loss due to illness.
This research strategy, termed a person-focused
approach, differs from a variable-centered strategy,
in which an outcome such as illness is regressed on
potential predictor variables such as life stress, coping strategies, and their interactions (Masten, 2001).
The person-centered approach focuses on groups of
participants already designated as resilient and nonresilient and allows one to identify variables that differentiate groups. The person-centered approach has
proven valuable in previous research on resilience
(e.g., Buckner et al., 2003; Masten et al., 1999).
On the basis of the theoretical proposition that
coping resources influence life events and stress responses (Anderson and Williams, 1988), we hypothesized that the resilient group would differ from

Stress-Resilience, Illness, and Coping

the nonresilient group in using more potentially
adaptive coping strategies (e.g., Problem-focused
Coping, Seeking Social Support, rational reappraisal
to Minimize Threat) and would be correspondingly
less likely to favor the potentially maladaptive ones
(e.g., Blaming Others, Avoidance, Wishful Thinking). Further, we expected that the interrelations
among the coping strategies between the two groups
would differ. Specifically, we expected stronger positive relations in the number of efforts of the potentially adaptive strategies among resilient athletes,
indicating a more coherent pattern of adaptive responses to stress.

METHOD
Participants and Procedures
The sample consisted of 404 young women athletes from 52 varsity sports teams (basketball, gymnastics, cross-country, and soccer) at 13 high schools.
Mean age for the sample was 15.76 years (SD =
1.08). All athletes completed a series of questionnaires in group sessions during the preseason, including measures of life stress and coping strategies. Once
preseason practices began, sport participation time
loss for each athlete was tracked on a daily basis for
the duration of the sport season.

Measures
Stressful Life Events
Life stress was assessed by a modified version
of the Adolescent Perceived Events Scale (Compas
et al., 1987; Smith et al., 1990). The scale consists of
198 non-sport related items that assess a wide range
of life events originally contributed by adolescents
(Compas et al., 1987). For each event, athletes indicated whether or not they had experienced the event
in the past 6 months. For each event they reported,
they also indicated (a) whether they considered the
event to be a positive or negative one at the time
it occurred, and (b) whether they now regarded the
event to have been a minor (day-to-day) event
with minimal or transitory impact, or a major one
that had significant impact on their life. Based on
previous findings that major negative events that produce distress are most likely to be significant precursors of health changes (e.g., Smith et al., 1990), the

259
life stress measure in this study was the total number
of experienced life events that were rated as major
negative events.

Coping Strategies
Coping strategies were assessed by the Revised
Ways of Coping Checklist (WOCC; Vitaliano et al.,
1985, 1987). The athletes were asked to identify the
event they perceived as most stressful within the past
year, and then to indicate the extent to which they
utilized 45 specific cognitive or behavioral coping
strategies in dealing with the event. Each item was
answered on a 4-point Likert scale ranging from 0
(never) to 3 (regularly).
We utilized 6 subscales derived from the
45 items of the WOCC. The scales hypothesized to
be more adaptive included Problem-focused Coping,
Seeking Social Support, and Minimize Threat. The
Problem-focused Coping items reflect direct efforts
to deal with stressors in an active fashion by attempting to change the situation or oneself (e.g., Made
a plan of action and followed it; Changed something about myself so I could deal with the situation
better). Seeking Social Support involves attempts
to seek tangible assistance or emotional support
(e.g., Talked to someone about how I was feeling;
Accepted sympathy and understanding from someone). Minimize Threat is a cognitive coping strategy in which the situation is rationally reappraised
to reduce negative affect or to prevent emotional
overreaction. Sample items include, Accepted it,
since nothing could be done and Didnt let it get
to me.
Wishful Thinking, Blame Others, and Avoidance were hypothesized to be potentially maladaptive strategies. Wishful Thinking is the tendency
to wish or pretend that things were different (e.g.,
Wished the situation would go away or somehow
be finished; Hoped a miracle would happen to
solve the problem). Blame Others externalizes the
problem in a hostile manner (e.g., Took it out on
others; Found out what other person was responsible). Avoidance involves cognitive and behavioral
responses that prevent the person from coming to
terms cognitively, behaviorally or emotionally with
the problem (e.g., Tried to forget the whole thing;
Refused to believe it had happened).
Scores were standardized by calculating mean
item scores for each subscale (raw scores divided by
number of items comprising each scale) in order to

260
correct raw scores for the differing number of items
per subscale (Vitaliano et al., 1987; Vitaliano et al.,
1990a).

Illness
Illness was defined as the inability to participate in practices or games due to sickness. To avoid
possible inaccuracies and biases due to athletes retrospective self-reports, illness data were assessed
daily through records kept by the athletes coaches,
who were hired as research assistants. The coaches
recorded excused illness-related absences as reported
by school nurses, parents, or outside physicians. Absences were only coded as illness-related based on
the schools definition of excused absences because
of illness. Thus, excused illness-related absences required a statement from a doctor or parent/guardian
that the athlete was sick, or the coachs in vivo assessment of illness. Absences due to illness were distinct from other absences; for example, the excuses
absent due to injury and absent for other reason
were also tracked. On a daily basis, the 52 coaches reported all absences (or inabilities to participate fully)
to the investigators by telephone.
Because the number of days of participation
varied by sport, illness assessment was exposurecorrected to reflect the total percentage time lost due
to illness, following a procedure used in previous epidemiological sport injury studies (e.g., Dunn et al.,
2001; Garrick and Requa, 1978; Smith et al., 1990).
Thus, an exposure value (opportunity for absence
due to illness) was defined as the total number of
days the team practiced or competed minus the total number of days the athlete failed to participate
for non-illness reasons (for example, injury or a personal absence). Exposure-corrected time loss due to
illness was computed by dividing the total number of
days an athlete missed due to illness by the exposure
value.

Definition of Resilience/Nonresilience
In person-centered resilience research, resilience and nonresilience are operationalized in
terms of a persons adaptive or maladaptive responses under highly stressful conditions. As in
previous person-centered resilience research (e.g.,
Kobasa, 1979; Luthar, 1991; Tiet et al., 1998), we selected those participants who reported high life stress

Yi, Smith, and Vitaliano

scores. In this case, athletes who scored in the upper third of the major negative life events distribution were selected for the study. These 127 athletes
reported between 17 and 46 major negative events
experienced during the previous year (M = 23.82,
SD = 6.33). Among these high-stress athletes, we
then selected those who experienced no time loss due
to illness and designated these 48 athletes as the resilient group. We then selected the high-stress athletes who scored in the upper third of the illness
time-loss distribution and designated these 31 athletes as the nonresilient group. The nonresilient athletes missed between 2 and 49% of potential participation days (M = 3.69; SD = 2.57; MDN = 8 days).
Of these, six of the resilient and three of the nonresilient athletes failed to complete all the items of
the WOCC and were therefore excluded from subsequent analyses; however, there was no difference in
data censoring for the two groups. Thus, the final resilient and nonresilient groups consisted of 42 and 28
athletes, respectively. The resilient athletes reported
a mean of 23.83 major negative events in the previous
year (SD = 6.83), whereas the nonresilient group reported a mean of 23.29 events (SD = 5.84). This difference was not significant.

ANALYSES AND RESULTS

Data analyses focused on two issues. First, we
compared the profiles of coping strategy choices between the resilient and nonresilient groups. Second,
we examined the correlations among the WOCC subscale scores individually for the two groups to determine if coping strategies were differentially related.

Profile Analyses
Mean item coping strategy scores for the resilient and nonresilient athletes are presented in profile form in Fig. 1. The resilient groups profile revealed higher scores in Problem-focused Coping and
Seeking Social Support, and lower scores in Blame
Others and Avoidance. No negligible group differences were observed in Minimize Threat or in Wishful Thinking.
To provide an overall test of a profile difference between the resilient and nonresilient groups,
we computed a one-way multivariate analysis of variance of the WOCC mean item subscale scores using the SPSS MANOVA program. This test yielded

Stress-Resilience, Illness, and Coping

261

Fig. 1. Coping mean item score profiles for the resilient and nonresilient groups.

a significant effect for Groups, F (6, 63) = 2.90, p <

0.05, indicating different patterns of coping in the two
groups. The most pronounced group difference occurred for Avoidance, and a univariate contrast revealed a significant group difference on this variable,
F (1, 68) = 9.11, p < 0.01.
Following Vitaliano et al., (1990a), who demonstrated the utility of comparing scores on Problemfocused Coping, Minimize Threat and Seeking Social
Support with those on Wishful Thinking, Avoidance,
and Blaming Others, we computed an adaptive
balance score. To do this, we subtracted the sum of
the mean item scores for Wishful Thinking, Blame
Others, and Avoidance from the sum of the mean
item scores for Problem-focused Coping, Seeking
Social Support, and Minimize Threat. A higher score
on this index indicates a stronger tendency to use the
hypothesized adaptive coping strategies. The mean
adaptive balance score for the resilient group
(M = 0.75, SD = 1.59) was significantly higher than
the mean score in the nonresilient group (M = 0.06,
SD = 1.18), F (1, 68) = 4.40, p < 0.05.
Group differences in strategy use were also evident at the level of the individual athlete. Table I indicates the percent of athletes in each group who reported using each coping strategy most extensively.
Idiographic inspection of the particular subscales
each athlete favored most revealed that 57.2% of the
resilient athletes had their highest score on either
Problem-focused Coping, Seeking Social Support, or
Minimize Threat, compared with only 34.5% of the

nonresilient athletes. This difference in percentages

was significant, z = 2.08, p < 0.05.
Correlations Among Coping Scales
We also predicted a stronger clustering of the
hypothesized adaptive coping strategies in resilient
athletes. Correlations among the WOCC subscale
scores within the resilient and nonresilient groups
are presented in Table II. Several differences in the
patterning of scores are evident. Although Problemfocused Coping and Seeking Social Support were
significantly correlated in both groups, Minimize
Threat, a proposed adaptive strategy, was significantly related to the other two proposed adaptive
strategies only in the resilient group. Thus, the resilient group exhibited a stronger patterning of the
hypothesized adaptive coping strategies. The strong
positive correlations found among these three subscales support the labeling of them as an adaptive
Table I. Percent of Resilient and Nonresilient Athletes Who
Reported Using a Given Coping Strategy Most Extensively

Problem-focused coping
Seeking social support
Minimize threat
Wishful thinking
Blame others
Avoidance

Resilient
(n = 42)

Nonresilient
(n = 28)

27.4
23.8
6.0
33.3
9.5
0.0

17.9
8.3
8.3
39.3
19.1
7.1

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Yi, Smith, and Vitaliano

Table II. Correlation Coefficients Among Coping Strategy Scales within the Resilient (n = 42) and Nonresilient
(n = 28) Groups, Respectively

Minimize threat
Problem-focused coping
Seeking social support
Wishful thinking
Blame others

Problem-focused
coping

Seeking social
support

Wishful
thinking

Blame
others

0.50 /0.11

0.43 /0.26

0.18/0.26
0.30/0.10
0.23/0.19

0.11/0.29
0.15/0.21
0.19/0.36
0.09/0.28

0.45 /0.39

Avoidance
0.34 /0.11
0.21/0.22
0.19/0.14
0.50 /0.50
0.06/0.09

Note. Resilient group correlation is to the left, nonresilient group correlation to the right.
p < 0.05; p < 0.01.

trio of strategies. Likewise, the strong positive correlations between Wishful Thinking and Avoidance
supports the assumption that they share substantial
variance.
DISCUSSION
Among people who experience high levels of life
stress, some exhibit negative health consequences,
whereas others seem resistant to negative health
changes. This phenomenon has stimulated considerable research in identifying characteristics that differentiate nonresilient and resilient individuals. Our
study expands on this research in several ways. First,
problems with self-reported health were avoided by
assessing illness from documented school records
through doctors, parents or the coaches themselves.
Second, our sample of young women represents a
population rarely studied in behavioral medicine research. However, research in other populations has
revealed correlates of coping strategies with illness,
as well as with psychological well-being (Penley et al.,
2002; Vitaliano et al., 1990b). Lastly, the personcentered approach to resilience used in this study
has not been applied to young women athletes, nor
has there been an empirical emphasis on psychosocial factors that might make athletes more or less susceptible to illness. Instead, the variable-centered approach has predominated, and the general focus of
research focusing on athletes has centered on psychosocial variables related to injury (e.g., Anderson
and Williams, 1988; Smith et al., 1990; Williams and
Andersen, 1998).
Our investigation of coping strategies in relation
to athletes illness revealed significantly different
profiles of coping in resilient and nonresilient athletes. Within this population, as in others previously
studied, resilience in the face of life stress may
therefore involve the selective use of certain coping
strategies. As resilience is defined in this sample,

those athletes who remained healthy despite an

elevated level of recent life stress generally favored
Problem-focused Coping and Seeking Social Support, whereas the profile for the nonresilient group
showed Blaming Others and employing Avoidance
strategies to be more dominant.
The use of avoidance coping was the most
notable difference between the resilient and
nonresilient groups. Several studies have shown
relationships between avoidance and health problems, but these relied on self-reports (Suls and
Fletcher, 1985; Holahan and Moos, 1986). In our
study, absenteeism due to illness was assessed by
means other than self-report, and avoidance was still
found to be the major differentiator between groups.
Avoidance may be related to health and absenteeism
by contributing to psychological distress and emotional arousal, which may in turn suppress immunity.
Avoidance could also relate to illness in terms of
self-care behaviors, such as not taking care of oneself
when one is ill. Finally, illness can itself serve as
a socially acceptable means of avoiding stressful
situations. Further research would be needed to
clarify these associations. For example, many studies
have looked at health and suppression of emotion, a
form of avoidance. Pennebaker and Susman (1988)
have reported that never discussing ones trauma in
childhood led to worse outcomes, and Scheier et al.
(1989) found that patients who suppressed emotion
before surgery had poorer recovery 6 months later.
In addition, although avoidance may be
temporarily adaptive in coping with certain uncontrollable stressors, its disadvantage is that by its
very nature, it prevents the use of more adaptive
problem- and emotion-focused strategies, as well as
proactive coping. As described by Aspinwall and
Taylor (1997), proactive coping involves gaining
the necessary resources and skills to prepare for
confronting and anticipating stressors. Proactive
coping provides more information about potential

Stress-Resilience, Illness, and Coping

stressors than avoidant forms of coping at preliminary coping stages. Proactive coping is generally
superior to avoidant coping because active coping
eliminates much of the stress before it ever occurs
(Aspinwall and Taylor, 1997). In a recent study, the
number of proactive coping strategies was found to
be significantly and positively correlated with social
functioning (Yanos, 2001). Interestingly, accessing
social support was the highest used proactive coping strategy in Yanos study, again suggesting the
importance of seeking social support as an adaptive
coping strategy. Thus, those who use avoidance
coping may in effect be preventing themselves from
being able to proactively cope, or from using other
coping strategies that may be of benefit to them.
The profile of the groups showed no distinction in their reported use of cognitive restructuring and rational thinking to Minimize Threat or in
the cognitive strategy of Wishful Thinking. The failure of Minimizing Threat in discriminating between
groups may be attributable to the relatively young
age of the sample. In a description of a cognitiveaffective stress management program applied to an
athletic population, Smith (1980) commented on the
challenges of using cognitive restructuring procedures with young athletes who are generally less
psychologically-minded than older populations. He
reported that self-instructional training seemed more
applicable to this population. Similar conclusions
concerning developmental constraints on the use of
cognitive restructuring have appeared in the cognitive psychotherapy literature (e.g., Vernberg and
Johnson, 2001). Consistent with this interpretation,
Minimize Threat was used far less than the hypothesized adaptive strategies of Problem-focused Coping
and Seeking Social Support in both groups.
Insights concerning resilience may also be found
in the differing patterns of coping preferences and
relations found between the resilient and nonresilient groups. At the individual athlete level, 57%
of the resilient athletes used Problem-focused Coping, Minimize Threat, or Seeking Social Support
most extensively. In contrast, 66% of the nonresilient athletes favored Avoidance, Blaming Others,
or Wishful thinking. Hence, Problem-focused Coping, Minimize Threat, or Seeking Social Support may
be adaptive strategies, as we hypothesized. Further,
in the resilient group, a cluster of coping strategies was evidenced, with Problem-focused Coping,
Seeking Social Support, and Minimize Threat significantly and positively correlated with one another. This adaptive trio was not found in the

263
nonresilient group. Conversely, in the nonresilient
group, Problem-focused Coping and Seeking Social
Support were more strongly correlated with Blaming
Others, perhaps suggesting that nonresilient athletes
use these seemingly adaptive strategies in maladaptive ways, perhaps in a hostile manner. Such suggestions, however, must be regarded as highly tentative,
as causality cannot be established from correlational
analyses alone. Further research is needed to clarify the directionality of the relation between adaptive
coping and health.
In our sample of 404 young women athletes,
234 (58%) did not miss a single day of participation because of illness. The low illness base rate left
us with relatively modest group sizes once we selected athletes from upper third of the life stress
distribution and then selected a nonresilient group
from the upper third of the illness time-loss distribution. Our nonresilient (high stress, high time loss)
group included fewer than 7% of the original sample. This may be one reason the variable-centered approach has predominated over the person-centered
strategy in resilience research, as large sample sizes
are required to do person-centered research, particularly if the base rate for the negative outcome is
low. However, despite a relatively modest level of
statistical power, our results still revealed a significant difference in resilient and nonresilient coping
profiles.
Stress can play an important role in the physical
well-being of athletes (Dunn et al., 2001; Mackinnon,
2000; Pedersen and Hoffman-Goetz, 2000; Shephard,
2000). Recent research concerning psychological influences on athletes physical health has focused on
stress-injury relations, and coping has been shown to
be a significant moderator of stress-injury relations
(e.g., Petrie and Falkstein, 1998; Smith et al., 1990;
Williams and Andersen, 1998). Our study, the first to
focus on illness, suggests that coping may also play
a significant role in illness-resistance in the face of
stress. However, although our study reports a correlation between coping and resilience, our results
are best regarded as exploratory. We focused on major life stressors that were not differentiated in terms
of such important factors as life domain (e.g., academic, interpersonal), controllability, and chronicity.
These and other important characteristics of stressors deserve future empirical attention, as does the
role of coping on biological processes that increase
or decrease illness vulnerability. Future resilience research, using both person- and variable-centered approaches, promises to advance our understanding of

264
the psychological and biological processes that mediate stress-resilience.

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