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Chapter 4

Social Support and Health

Like most people, you probably feel better when you are experiencing problems at school, work, or in relationships, when you have friends or family members to talk with. Sometimes these individuals give us good advice or they help us to forget our problems for a while by involving us in activities, such as playing golf or going to the movies. At other times you may feel that your friends and family members will not understand the problem you are facing, or they give you bad advice, so you may turn to other sources of information to help you cope with the problem, such as looking up information on the Internet. According to Goldsmith and Albrecht (2011), supportive communication is “a necessary condition for the quality of life and for healthful living” (p. 335). In addition, communication plays a key role in the support process, whether it involves finding the best ways to discuss problems and obtain support, finding information about a problem on-line or through interpersonal relationships, or by empathically listening and finding the best way to support someone who is struggling with a health-related problem.

Our relationships with family, friends, and even acquaintances can have a positive effect on our physical and mental health throughout our lives through the various types of social support they offer us. We, in turn, can influence the health of our social network members through the support we provide them. This is true not only during times when we face a health crisis, but also when we are coping with everyday stressful events. Moreover, research suggests that our social network members can be beneficial in helping us to avoid stressful situations that could adversely affect our health, and the companionship of significant others can help us to be more resistant to certain types of illness. However, the relationship between social support and health outcomes is extremely complicated, and some types of support (or sources of support) can actually negatively affect health. Communication plays an important role in these processes (Goldsmith, 2004), and while the relationship between social support and health appears to be simple, we will see that it is actually a quite complex process.

This chapter will examine the concept of social support, the various ways in which support networks can impact health, the central role of communication in social support, and benefits and problems with supportive messages. In addition, it discusses characteristics of support networks and support groups for people with health concerns.

History of Social Support and Health Research

In the early 1970s researchers from a number of disciplines began to focus their attention on how social support and relationships affect health (Goldsmith & Albrecht, 2011). Over the past several decades, across numerous studies (Cohen & Wills, 1985; House, Landis, & Umberson, 1988), researchers have been able to build empirical evidence for a link between social support and a variety of health outcomes (see Berkman & Syme, 1979; House, Landis, & Umberson, 1998; Uchino, Cacioppo, & Kielcolt-Glaser, 1996; Uchino, 2006), including improved immune system functioning, reduced stress, lower depression, shorter recovery times from illness and surgery, increased sense of well-being, and reduced mortality rates (i.e. longer life). Social support has even been linked to increased cardiovascular functioning and resistance to the common cold.

A variety of social scientists (such as psychologists) added to this body of research by examining personality traits, reactions to stress, coping strategies, and a host of individual variables that mediate the relationship between social support and health (see Sarason, Sarason, & Pierce, 1990; Turner, King, & Tremblay, 1992). Communication scholars have also made significant contributions to social support and health research over the years by conducting studies that examine relational issues and message characteristics that influence social support processes (see Albrecht & Adelman, 1987; Burleson, 1994). Today, social support researchers are attempting to understand how access to extended social networks through computer-mediated communication (i.e. social networking sites and on-line support groups) impact health outcomes (Tanis, 2008; Rains & Young, 2009; Walther & Boyd, 2002; Wright, 2000). In addition, there are many unanswered questions about the relationship between social support and health that will likely spur research in this area for many years to come.

Types and Functions of Social Support

Types of Support

Social support is “an umbrella term for various theories and concepts that link involvement with social relationships to health and well-being” (Goldsmith & Albrecht, 2011, p. 335). However, within this larger definition are many other terms that reflect the complexity of social support. The reason for this is due to the fact that our social networks, such as friends, family members, and co-workers, and even acquaintances on social networking sites like Facebook, often provide us with many different types of social support (Goldsmith, 2004). In the following section, we examine several different types of social support and other related terms.

According to Goldsmith and Albrecht (2011), instrumental support refers to tangible types of assistance, such as when parents give children money so they can go to the movies with friends, or when a friend helps another friend with a household project. Emotional support refers to such diverse activities as listening to a person’s troubles, validating his or her problems, offering encouraging words when someone is not feeling well, and simply “being there” during a time of need. Esteem or appraisal support deals with efforts to make a person who is facing a stressful situation feel validated, or that their problems are legitimate. Informational support can take many forms, such as when you receive good advice about a relationship problem from a close friend or if a person with pancreatic cancer receives information about medications in an Internet support group. Enacted support has to do with the conditions under which communication facilitates beneficial outcomes for people facing stress (Wills & Shinar, 2000). Companionship is a variation of social support in that it is typically entered into for the sake of enjoyment as opposed to social obligation (Rook, 1995). Companions tend to be friends who elevate our mood by just being with us, but they can also provide support in times of need.

Social support can also be proactive or reactive (Sarason, Sarason, & Pierce, 1990). Proactive support is any type of assistance that helps an individual to circumvent problems, such as if a doctor recommends a diet that helps a patient lower his or her risk of hypertension. Reactive support is usually assistance that is provided in response to some crisis a person is facing or a disruption of normal life events. For example, a diagnosis of cancer is a major crisis event, and members of the social network of a person with cancer typically provide emotional support or some other type of assistance to help him or her cope with the disease.

Social support takes place in some type of social network, or sets of overlapping relationships among people (Penner, Dovidio, & Albrecht, 2000). Social networks can be as small as family or close circle or friends, or they can be as large as an extended Facebook network of close friends, family members, coworkers, and acquaintances. Social networks serve as the context for the support we receive and provide to others, and patterns of communication within social networks tend to vary depending upon social norms. When network members engage in frequent overlapping communication, this is known as density. When people within social networks are similar to each other in terms of demographics, background, and attitudes, this is homogeneity, and when people are different from each other it is called heterogeneity. Finally, social networks can be bounded or unbounded, meaning that they can have strict or permeable boundaries. For example, a close-knit family might not interact with outsiders (bounded), whereas all of your Facebook friends may let you “friend” their friends (unbounded). Social support researchers who are interested in social networks frequently examine these and other characteristics of social networks in an attempt to assess how they influence social support processes.

Positive and Negative Functions of Support

The various types of support mentioned above have been linked to positive psychological and physical health outcomes as well as improved quality of life (Cobb, 1976; Goldsmith, 2004; Hughes, 2005). However, people often differ as to the types of support they find useful due to factors such as the context of the stressful situation they are facing, their perceived coping skills, and their relationship with the support provider (La Gaipa, 1990). Depending upon the situation, a recipient of support may perceive some types of support negatively, and this may negate the positive effects of the supportive attempt or it may actually have a negative impact on health or quality of life.

For example, instrumental support is a common type of support that people provide individuals with health problems, and it is crucial for people who require long-term care due to an illness. In these situations, individuals who are sick often rely heavily on others to take care of physical needs, such as preparing meals, transportation, and basic daily tasks such as going to the bathroom, bathing, and providing medications. While individuals typically appreciate the support they receive in these situations, inappropriate instrumental support can be perceived negatively.

When people feel that they can successfully perform physical tasks, they may perceive tangible assistance negatively, especially if it is viewed as patronizing or if it undermines their sense of competence. People with disabilities often resent others who go out of their way to open doors or who engage in other types of instrumental support when they feel that they could accomplish these tasks themselves. In some cases, such as within nursing homes, older residents may initially resent some types of instrumental support, but they may eventually accept it if they feel they have little control over their situation. Older nursing home residents have been found to acquire a “learned helplessness” when it comes to many physical tasks as a result of workers engaging in over-accommodating behaviors when they provide tangible assistance (Grainger, 1995).

In cases when informational support is perceived as useful, people with health problems may feel they have more control over their situation (Roter & Hall, 1992). However, too much information about a disease or condition from a physician or other healthcare provider can be perceived negatively if the information overwhelms the patient or causes him or her to worry (Brashers, Neidig, & Goldsmith, 2004). For example, if a physician gives a patient a large amount of information about treatment options, side effects, and the progression of symptoms after an HIV-positive diagnosis, all of this information is likely to be perceived as overwhelming to the patient, particularly if he or she has not had a chance to think about all of the implications of the diagnosis. In this type of case, patients are often unable to cognitively process the information they receive from their doctor.

Informational support from family members and friends during times of stress can also be seen as inappropriate, especially when it takes the form of unwanted advice (Goldsmith & Fitch, 1997) or if it is perceived as patronizing or intrusive. For example, a caregiver who reminds a sick spouse that he needs to eat something prior to taking his medication might think that she is being helpful, while the spouse may see it as “butting in.” As you can see, the provision of informational support can be quite complicated, depending upon how it is perceived. Albrecht and Goldsmith (2003) point out other complications when providing informational support:

One may receive information and advice about how to cope with a health problem and yet find that the advice is uninformed and therefore of little use. Worse yet, the advice others give might lead an individual to feel that others are critical of his or her own coping efforts or that others are condescending by providing information that the individual already knows. (p. 270)

Emotional support is often perceived as more beneficial than informational support among people with health concerns, particularly in helping them to cope with the emotional distress of illness (Cwikel & Isreal, 1987; Magen & Glajchen, 1999). However, emotional support can also be perceived negatively, especially when the support provider denies or draws attention away from the feelings that the support recipient is experiencing or if the type of emotional support offered is perceived as inappropriate in other ways (Burleson, 1994). For example, a woman with breast cancer may want her partner to simply listen to and accept her fear about an upcoming mastectomy, but rather than acknowledging this fear the partner might say “Try not to worry so much—these operations are usually very successful.” In this case the partner, while most likely having the best of intentions, is attempting to minimize the woman with cancer’s fear by implying that she is perhaps worrying too much.

Esteem support is an important type of support in helping distressed individuals who feel socially stigmatized as a result of their health condition (e.g. people with HIV or people with visible disabilities) to feel valued at times when their self-esteem is low as a result of struggles dealing with their daily lives (Wills, 1985). As we will discuss in greater depth in Chapter 5, stigma refers to negative feelings attached to a health condition or a group of people who are living with it. Disabilities, HIV, cancer, and eating disorders are a few of the many health conditions that carry a social stigma, and the individuals who are living with them often experience communication problems with people who do not share their condition. Both the negative societal per­ceptions of these diseases and the communication problems associated with these perceptions may lead a person with one of these conditions to feel socially isolated or depressed. Esteem support or validation may help individuals increase their sense of self-worth when it is provided by an understanding loved one or others facing similar circumstances.

Not surprisingly, issues of social support are also important when it comes to family decision-making. Sparks (2008) posits that decisions within families can be classified into types such as: instrumental, affective, social, economic, and technical. Instrumental decisions are those that focus on issues of money, health, shelter, and food for the family members (Epstein, Bishop, & Baldwin, 1982). Affective decisions deal with choices related to feelings and emotions such as deciding about getting married, whereas social decisions are usually decisions related to the values, roles, and goals of the family (see e.g. Noller & Fitzpatrick, 1993). Such decisions may include whether the children will be raised going to one church or another or whether one parent will stay at home while the children are preschool age. Economic decisions focus on choices about using and gathering family resources such as whether an adolescent should get a job and contribute to the family income or buy his or her own car. Technical decisions consist of the smaller decisions that must be made to carry out a larger decision. For instance, if a family decides that one member must stop working in order to go back to school for an advanced degree, then a series of technical decisions must be made so the larger decision will materialize (Noller & Fitzpatrick 1993). Families use a variety of decision-making processes ranging from taking the same approach day in and day out with daily decision-making to more varied methods depending on the type of decision, their emotional state, and most often their stage of development across the life span from when the children are babies to when they are in school to mid-life and later-life issues (Sparks, 2008).

Family decisions are negotiated every day from family decisions in the childhood and adolescent years to middle and later life family decisions, many of which occur in healthcare environments (Sparks, 2008). Family decision processes in the healthcare environment are particularly difficult and complex because of the uncertainties, emotions, technical language, and subsequent health outcomes (e.g. Harzold & Sparks, 2007; Sparks, 2003). Conflicting information from various sources can be difficult to navigate and process to make the most informed healthcare decisions. Families make decisions about health issues using information from a variety of sources including insurance provider lists, Internet research, recommendations from primary care physicians and specialists, interpersonal communication with friends and family members, and mediated messages (see Pecchioni & Sparks, 2007).

However, support providers do not always view a person’s situation as a legitimate problem, and they may not be able to adequately provide esteem support. For example, a father might see his daughter’s struggle with anorexia as something that is within her control rather than as a psychological disorder. While wanting to be supportive, his perception of his daughter’s condition may lead him to say things that reflect an inaccurate understanding of anorexia or that do not legitimize her condition or her feelings. When people have a better understanding of a health condition and see it as a legitimate concern, they are often better able to provide esteem support. This is one of the reasons why members of peer support groups are often able to provide a person with esteem support. Because members of peer support groups are facing a health condition themselves, it is often easier for them to validate the feelings of other members of the group. (See the discussion of support groups later in this chapter.)

Models of Social Support and Health

Stress and Health

In order to understand the relationship between stress and psychological/physical health, it is important to have a basic understanding of the physiology of stress. While the general association between stress and physical health is easy to understand, researchers have actually found this relationship to be extremely complex. Similar to many species of animals, the physiological responses to stress have evolved in human beings to promote survival during times of crisis. Essentially, the body’s response to a stressor prepares it for rapid physical action (fight or flight). In others words, the brain helps to ensure that there is sufficient oxygen and energy to the brain and muscles so that a person can survive a crisis situation by either fighting or running. Unlike the stressors that many animals face in the wild, such as encountering predators, few aspects of modern life are immediately life-threatening to human beings. However, exposure to everyday stressors, such as threats to our sense of financial security, a heavy workload at the office, relationship problems, and minor hassles such as traffic jams, taxes, and household chores, all trigger physiological responses from the body.

At the psychological level, people appraise stressful events in terms of their severity and duration (i.e. short-term problems and long-term problems) as well as their available resources and abilities to cope with or manage the stressor. The central nervous system plays an important role when people encounter stressful situations. The central nervous system consists of millions of specialized cells known as neurons. Sensory neurons sense changes to the body due to environmental stimuli such as stressors and relay information to the brain. The brain makes sense of this information, and if a situation is perceived as threatening, emotional responses to the stressor trigger physiological reactions from the body’s limbic system. The limbic system can activate an area of the brain known as the hypothalamus. The hypothalamus regulates the body’s stress response systems, which include the sympathetic adrenal medullary (SAM) response system and the hypothalamic–pituitary–adrenal (HPA) system (Clow, 2001). Neurons associated with both systems regulate cardiovascular activity, such as heart rate and blood pressure, and the immune system by releasing chemicals into the blood­stream known as neurotransmitters. These neurotransmitters stimulate the release of other chemicals into the bloodstream. For example, they activate the release of adrenaline from our adrenal glands (located above the kidney), known as the sympathetic adrenal medullary response system. Adrenaline provides the needed energy to the brain and muscles to make quick decisions in the face of threatening situations. It is likely that you have experienced an “adrenaline rush” after a stressful episode such as nearly hitting another vehicle while driving, being startled by someone, or after engaging in a conflict with a friend or family member.

Over time, when our body’s stress response system is repeatedly activated, this can lead to wear and tear on the body’s cardiovascular system (Clow, 2001). For instance, the increase in blood pressure and the release of cortisol associated with stress response (both of which are associated with the release of adrenaline) can damage certain blood vessels. When these blood vessels are damaged, it allows for the build-up of fatty nutrients within the damaged walls of the vessels, a condition known as atherosclerosis. When this process occurs within blood vessels located in the arteries supplying the heart, it can lead to heart disease (such as heart attacks). Moreover, the frequent release of cortisol into the bloodstream can disturb the balance of the body’s immune system and make us more susceptible to disease. The release of cortisol (over an extended period of time) has also been linked to negative psychological states, such as depression (Clow, 2001). In short, our body’s physiological response to stressful situations can lead to a variety of physical and mental health problems.

Stress and Social Support

Researchers have focused on the relationship between social support and health outcomes for several decades, and study findings indicate benefits to both mental and physical health (Aneshensel & Stone, 1982; Berkman & Syme, 1979; Cohen, 1988; Krause, 1990; Wills, 1985). In terms of specific health outcomes, a variety of studies have found a relationship between social support and stress (Aneshensel & Stone, 1982; Ballieux & Heijen, 1989; Berkman & Syme, 1979; Billings & Moos, 1981; Dean & Lin, 1977).

Two models explaining this relationship have emerged from the social support literature: (i) the buffering model and (ii) the main effects model. The buffering model suggests that social support shields individuals from the negative effects of stress, such as weakened immunity and depression, over time (Cohen & Wills, 1985; Dean & Lin, 1977; La Rocca, House, & French, 1980). The main effects model asserts that there is a direct rather than buffering relationship between social support and physical and psychological outcomes (Aneshensel & Stone, 1982; Thoits, 1982).

Researchers have linked both models to positive effects in terms of morbidity and mortality (Berkman & Syme, 1979; Cohen, 1988; Uchino, Cacioppo, & Kiecolt-Glaser, 1996). The reduction of stress associated with supportive behaviors appears to affect physical health in a variety of ways. As we have seen, prolonged exposure to stress has been found to impair immune system response (Ballieux & Heijen, 1989), and it can create damage to internal organ systems through the production and maintenance of chemicals such as cortisol. Elevated levels of other chemicals, such as adrenaline, have been found to be associated with colds and flu, tension and nervousness, and elevated systolic blood pressure (Kohn, 1996). In addition, physiological responses to stress may exacerbate other physical problems that a person is currently experiencing. Lockenhoff and Carstensen (2004) posited that “an intact social network serves as a buffer against physical and psychological stressors” (p. 1402). However, there are a number of variables that make the relationship between social support and health more complicated. These include differences in individual coping styles and adaptation to stressful situations (Kohn, 1996; Pierce, Sarason, & Sarason, 1996), and perceptions of support providers and recipients within the context in which support takes place (Barbee, 1990; Edwards & Noller, 1998).

Coping Strategies and Health Outcomes

People cope with stressful situations in a variety of ways, and these individual differences in coping styles have been linked to health outcomes. For example, suppose a young man suspects there is a possibility that he has HIV given his sexual history. He may decide to avoid getting tested for HIV or obtaining information about the disease as a way of coping with this particular stressful situation. However, his partner might have similar suspicions regarding her HIV status, and she might obtain as much information about the disease as she can from her physician or she might get tested to resolve the uncertainty over her HIV status. This example shows two radically different ways of coping with a health-related stressful situation. The man chose to avoid the situation as a coping strategy whereas his partner chose a more active set of actions for coping with it.

Kohn (1996) identifies three general types of coping strategies that individuals use when confronted with a stressful situation. Problem-focused coping is a strategy that is “directed at remedying a threatening or harmful situation” (Kohn, 1996, p. 186). When people engage in active behaviors they think will reduce a threatening situation or at least help them to deal with it better, they are using problem-focused coping. For example, if a person gets tested for HIV, learns that she has the disease, and attempts to find as much information about it as possible, she might find ways to reduce the threat of the disease. In recent years, early diagnosis of HIV and advances in HIV medication have made it possible for HIV-positive individuals to live without HIV-related medical problems (or with minimal problems) for many years. By choosing a problem-focused coping strategy such as early diagnosis and treatment, a person with HIV might actually prolong his or her life. Problem-focused coping has been linked to positive adaptation to stressful situations in a variety of studies, and it is thought to reduce psychological and physical stress (Endler & Parker, 1990; Heady & Wearing, 1990).

Emotional-focused coping refers to behaviors such as venting frustrations about a stressful situation or expressing some type of emotional response to it rather than making an attempt to remedy or improve the situation (Kohn, 1996). For instance, a person who discovers that he has hypertension might complain about having the disease or his doctor’s request to make changes to his diet (e.g. avoiding salt and foods with high fat content) rather than taking active steps to manage it. Not surprisingly, emotional-focused coping has been linked to negative adaptation to stressful situations (Edwards & Trimble, 1992; Turner, King, & Tremblay, 1992), although some of the research has produced mixed findings.

Finally, avoidance-focused coping refers to an “attempt to disengage mentally or even physically from threatening or damaging situations” (Kohn, 1996, p. 186). Many people choose to avoid threatening situations, particularly when dealing with health issues. Our mortality and susceptibility to illness are difficult concepts for most people to deal with, and many people use avoidance-focused coping when confronted with stressful health-related situations. Rather than actively obtaining information about diseases such as diabetes or breast cancer, some people would rather avoid talking about them or engage in some type of diversion as opposed to dealing with the threat of illness. Researchers have found mixed results for avoidance-focused coping strategies in terms of adaptation to stressful situations. For some people, avoiding stressful situations actually helps them to cope with them, while others find that avoidance leads to negative adaptation. In other situations, people may feel that they have no control over their health status, and this might lead to an avoidance-focused strategy.

For example, an individual who is facing a terminal illness might find that spending more time with family and friends serves as a diversion to thinking about the illness, and this actually helps to reduce stress. Sometimes dwelling upon problems that are out of our control leads to additional stress, and we find it less stressful when we divert our attention from the problem. However, some individuals who choose avoidance strategies when dealing with a stressful health situation might better adapt to it if they were to choose a more problem-focused coping strategy, such as seeking information about treatment options for a disease that might help their prognosis over time. Problematic integration theory helps to explain both how people engage in information-seeking behaviors and manage uncertainty when coping with an illness and why people may or may not choose information and other types of support. Babrow (2001) argued that the meaning of uncertainty is largely dependent on the values of the individual who is experiencing an illness, and those values guide the ways that information is used to manage uncertainty. For example, a person with cancer may decide to gather certain types of information about the most aggressive forms of chemotherapy if he or she primarily values stopping the progression of cancer, regardless of the side effects of the treatment, whereas another person might be more concerned with acquiring information that enhances the quality of his or her life.

Humor as a coping mechanism is receiving increased research attention in recent years (Wanzer, Sparks, & Frymier, 2009). Research on the benefits of humor for aging adults seems to support the premise that humor can assist in the aging process in a number of positive ways (Sparks-Bethea, 2001; Houston, McKee, Carroll, & Marsh, 1998; Nahemow, McCluskey-Fawcett, & McGhee, 1986; Richman, 1995; Ryff, 1989; Solomon, 1996; Wanzer, Sparks, & Frymier, 2009; Westburg, 2003). Humor can help facilitate successful aging when used as a means of coping with the challenges associated with aging (Pfeifer, 1993). Older adults who used humor to cope often report less distress or negative stress in their lives (Pfeifer, 1993). Similarly, older adults who can reframe and label stressful occurrences as beyond their control are able to manage stress more effectively by identifying comical distractions (Folkman, Lazarus, Pimley, & Novacek, 1987). Richman (1995) describes the “lifesaving” function of humor for the severely depressed and suicidal elderly. As a therapist who regularly treats severely depressed elderly patients, Richman feels that encouraging patients to laugh and use humor to cope may relieve depressive affective states. These studies have primarily exposed participants to humorous stimuli (e.g. movies or jokes) and then examined the outcome of that exposure to humor.

As Wanzer, Sparks, and Frymier (2009) explain, the relationship between humor production and coping effectiveness in everyday interaction has not received a great deal of research attention by communication scholars, particularly within the older adult segment of the population (see also McGhee, 1986; Sparks, 1994; Sparks-Bethea, 2001). Researchers have examined humor production as a coping strategy that affects life satisfaction and the role humor plays in coping with the aging process and ultimately improving residents’ psychological well-being (Celso et al., 2003; Houston et al., 1998; Westburg, 2003). Houston and colleagues research found that when residents of a residential facility engaged in funny sing-alongs and similar humorous activities, they were less likely to report depression and anxiety than residents who did not participate in humorous activities (Houston et al., 1998). Similarly, Westburg (2003) used the Funny Bone History to obtain residents’ and care providers’ perceptions of the importance of humor and sources of humor in an assisted living facility. Residents and staff members identified a variety of health-enhancing benefits from humor and laughter and revealed that interacting with family, friends, and younger people were valuable sources of humor. Thus, humor serves as a means of helping people relate effectively to one another as well as helping older adults to cope with stresses associated with aging and the assisted living environment.

Sparks-Bethea’s (2001) study of older adults’ use of humor further supports this finding. She found that nearly 95 percent of the older adult participants noted the importance of possessing a sense of humor throughout one’s life. Sparks-Bethea (2001) noted that older adults seemed to strategically employ humorous communication as a means of coping with life stress, easing tensions, and increasing solidarity during social interaction. Similarly, Ryff (1989) interviewed groups of middle aged and older adults about their perceptions of factors related to psychological well-being. Both groups indicated that a heightened awareness of others and humor use were important components of good mental adjustment. The significance of humor production as it relates to our ability to cope and adapt throughout our lives, therefore, may be revealed through an examination of more mature personalities, who have developed a broader perspective of life and the self over time (see e.g. Nussbaum, 1989; Nussbaum, Pecchioni, Robinson, & Thompson, 2000; Sparks, 1994; Sparks-Bethea, 2001). Further, Wanzer, Sparks, & Frymier (2009) found a significant relationship between older adults’ humor production, coping abilities and life satisfaction. Results of their study overall indicated these four variables function in communicatively complex ways for older adults. As predicted, humor-oriented individuals were more likely to use humor as a coping mechanism and reported greater coping efficacy. When examining individuals who varied in age (under 50, 51–74 and 74+ years), differences in humor orientation scores emerged among the three groups. As predicted by Folkman and Lazarus’s (1987) transactional theory of coping and emotion, the relationship between self-reported humor orientation and life satisfaction was mediated by coping efficacy. In attempting to determine which variables best predicted life satisfaction, coping efficacy and health status explained unique variance in life satisfaction scores.

Because individuals vary greatly in their appreciation, propensity, and ability to communicate humorous messages (Booth-Butterfield & Booth-Butterfield, 1991), it is likely that these differences affect both coping effectiveness and life satisfaction. Booth-Butterfield and Booth-Butterfield (1991) developed the concept of humor orientation, which enables researchers to investigate individual differences in humor production as well as outcomes associated with the communication of humor.

Perceptions of Support Providers

In addition to individual differences in coping with stressful situations, our perceptions of our social support network members during times of stress influence whether or not we find helpful a person’s attempts to be supportive. Support appraisals, or the perceptions of the appropriateness of social support behaviors (such as the degree to which an individual is satisfied with the support he or she receives), influence how people adjust to stressful situations (Albrecht, Burleson, & Goldsmith, 1994). In this section, we will examine perceptions of support providers and situations where supportive attempts can be perceived negatively and have negative effects on our stress levels.

Social Comparison Theory and Social Support

Our social networks provide many opportunities to give and receive social support, and while expanding our social networks is thought to increase opportunities for social support, our perceptions of others within these networks influence our evaluations of supportive behaviors. Social comparison theory (Festinger, 1954) is a useful framework for examining perceptions of people within our support networks and for understanding why support from these individuals may not always lead to positive outcomes. According to social comparison theory, individuals make assessments about their own health and coping mechanisms by comparing them to others in their social network (Helgeson & Gottlieb, 2000).

Helgeson and Gottlieb (2000) mention that lateral comparisons, comparisons to similar others, may normalize people’s experiences and reduce uncertainty and stress for those dealing with health concerns. However, when individuals compare themselves to others, their self-assessment could be either positive or negative. For example, if a person with cancer feels that he is coping with problems less effectively than others in his network (such as a friend or relative who has or had cancer or a similar life-threatening illness), this may create upward comparisons, which could produce feelings of frustration or serve as a source of inspiration to the person to cope more effectively by emulating the successful behaviors of those other members. Conversely, downward comparisons to others in the social network, such as when an individual feels that he or she is coping better than other members, can lead to positive self-assessments and/or to negative feelings about people if interaction with the other members is perceived as being unhelpful.

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