progression. For the short term, however, the COPE denial scale may be associated with better functioning. Antoni, August, et al. (1990) found that those who use denial (as measured by the COPE) as a defense mechanism are less immunosuppressed on being informed of their seropositive status. The research findings on denial as a coping mechanism have been mixed. The mixed findings are probably attributable to conceptual categories that lump together diverse behaviors (for example, distraction and the COPE's denial operationalizations) that do not belong together in terms of their actual cooccurrence. Taylor, Collins, Skokan, and Aspinwall (1989) drew a distinction between optimism and denial. Those high in denial refuse to acknowledge threat or problem solve in the area of the threat. In contrast, optimists acknowledge threat and problem solve about ways to reduce threat. The coping mechanisms of optimists occur after they acknowledge the threat. The threat is interpreted in the most favorable way, minimizing the negative consequences predicted to result. Hence, denial defined as refusal to acknowledge threat can be distinguished from optimism. Littrell et al.'s (1996) findings suggest that distraction constitutes yet another form of coping that is conceptually distinct from denial and optimism. The opposite of denial is probably realistic acceptance and willingness to experience negative feelings. Some findings suggest that realistic acceptance may not be a useful strategy for people with HIV. Decreased survival time has been noted among those exhibiting greater realistic acceptance of the disease (Reed, Kemeny, Taylor, Wang, & Visscher, 1994). Focusing on or venting negative emotions predicts (albeit at marginal, p = .07 levels) lower natural killer cell activity (Goodkin et al., 1992). Informal observations by clinicians are consistent with the conclusions presented in the literature. Haney (1988), a social worker who himself lived wit...
