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      Cognitive appraisal is a mental process an individual may use to assess whether a stressor is threatening or if he or she has the means to deal with that stress. Some examples of cognitive appraisal are, controlling negative feelings and retaining a positive outlook, maintaining a satisfactory self image, and or preparing for an uncertain future. Cognitive appraisal outcomes for individuals with physical illnesses may lead a person to formulate an array of adaptive tasks such as, adjustment to the hospital environment and medical procedures or cope with symptoms of disabilities. Emotions tend to accompany stress, and people often use their emotional states to evaluate their stress. Emotion focused coping is directed at governing the emotional response to these stressful situations. People can regulate their emotional responses through behavioral and cognitive approaches. For chronic pain suffers or those experiencing physical problems, emotion focused coping strategies are more effective in situations where one has little on no control.

      Spiritual and social support both, are ways that can effect or enhance these coping strategies. Social support refers to the perceived comfort, caring, esteem, or help a person receives from other people or groups which makes them less vulnerable to stress (Sarafino, 1993). Spiritual Support is another intervention that can lead us through coping. Spiritual support has similarities to socially supported coping mechanisms; however, it can offer support in situations where people or social support have little or no control. Spiritual support also offers more in traumatic life events because it can answer questions beyond human reasoning or at least make sense of them. Spiritual support and social support research have been shown to reduce the negative effects of stress. These studies have been developed in an attempt to negatively correlate the stress buffering effects of high levels of either support.

      Theoretical definitions and empirical measures of support have varied, among the stress buffering components often emphasized have been the perception that one is cared about, loved, esteemed, and valued, and the perception that support is readily available when needed (Maton, 1989). Maton found in persons with higher levels of perceived spiritual support that these individuals coped better with uncontrollable life events (high stressors) compared to those with no support. No significant relationships were found between well being and low stress individuals. He concluded that spiritual support influences health by directly enhancing self esteem and reducing negative affect, and through enhancing positive cognitive appraisals of the threatening stressor.

      Evidence shows that various aspects of religious involvement may enhance subjective states of well being and longevity. Ellison and George, (1994) stated that religiosity may lower levels of depression, psychological distress, and may reduce the risk of certain types of serious chronic physical conditions. Religiosity or spiritual support provides a sense of meaning, coherence, and self esteem.

      Spiritual support enables individuals to develop friendship networks where they befriend persons who share values, interests, and activities. Ellison and George (1994) also stated, "Religious institutions offer fertile ground for the initiation of friendships that may be cultivated more extensively in secular social contexts" (p 47).

      Community mental health surveys have found among Christians that spiritual support was associated with, lower levels of psychological distress, happier individuals who adjusted better and worried less about stressors, and lower levels of psychological impairment (Ross, 1990). It was found that individuals who believed strongly in their religion had lower distress levels than those who professed a weak belief. The highest distress levels were found in individuals who had no commitment. They were people who belonged to a religion not out of choice but by default or indifference. Hannay (1980), as cited by Ross (1990) found that while active religious allegiance was associated with decreased mental symptoms, passive allegiance was associated with increased symptoms. Spiritual support or social support, by choice versus by default, may be an important factor in psychological well being.

      Inspirit - an index of core spiritual experiences, is used to measure levels of spiritual support, it has found to show a strong degree of internal reliability and concurrent validity. Kass, Friedman, Leserman, Zuttermeister, and Benson (1991) developers of Inspirit, found that Inspirit was correlated to increased life purposes and satisfaction and that this suggested that core spiritual experiences may contribute to positive psychological attitudes. This health promoting attitude may buffers individuals from stress related components of illness.

      Social support has been found to play a positive role in psychological adjustment. This type of support contributes to positive personal development and provides a buffer against the negative effects of stress. How inclined individuals are to associate with others and how comfortable they feel with others may influence the number of supports they receive. Their satisfaction of perceived support and availability of it also may influence factors such as, self esteem and control. Sarason, Levine, Basham, and Sarason (1983) developed the SSQ - the social support questionnaire to access the amount of social support received and the individuals satisfaction with that support. They empirically found that people with high social support appear to experience more positive events in their lives, have higher self esteem, and take a more optimistic view of life. This was in contrast to persons with low social support, for these individuals support was related to an external locus of control. They were relatively dissatisfied with life, and had a lower level of motivation. The psychometric properties of the social support questionnaire showed that it is a highly valid and reliable instrument.

      In a confirmation study of the stress buffering effects of social support Dahlem, Zimet, and Walker (1991) found significant negative correlations in individuals with high social support and high (not low) stressful negative events. This lends to their buffering hypothesis. They distinguished between support from family, friends and significant others. Family support was found to be more stable over time; whereas, friends and significant others support was more variable over time and more dependent on one another.

      The effectiveness of social support for an individual depends upon his or her willingness to use the available support resources. One of the reasons support fails and research becomes inclusive is that individuals do not accept such assistance. Toldsdorf as cited by Pretorius (1993), referred to this as "negative network orientation", which involves a set of expectations or beliefs that it is inadvisable, impossible, useless or potentially dangerous to draw on network resources.

      Winemiller, Mitchell, Sutliff and Cline (1993) present valid criticisms of social support measures. Operational definitions of social support are to globally to describe what appears to be many different aspects of a multidimensional construct. In addition social support literature tends to look at people's perceptions of support available to them rather than what they are likely to utilize. Discerning between what people perceive is available and what is used may facilitate clearer operational definitions thus developing better tests and hypotheses. The social support questionnaire was reared by (Winemiller et al., 1993) as one that had methodological soundness.

      The idea that spiritual support may be strongly related to well being for individuals under high (as opposed to low) levels of recent life stress may help to explain some of the inconsistency in research findings relating religiosity to well being (Maton, 1989).

      It appears that for many religious people, religion becomes a guiding principle in many situations. These principles may be cognitive attributions or behavioral activities. Authors Shortz and Worthington (1994) preliminarily research found positive cognitive coping was attributed to known causes of stressful events, such as God's will. Negative cognitive coping was attributed to unknown causes or God's wrath. Their work however, was limited because it was retrospective and included a low sample of religiosity. They suggested for a better understanding of religion's role in coping with stress, future research is needed to build upon current understanding, and how these attributions influence coping.

      Social support is a major area of research within psychology, especially in counseling psychology. Spiritual support is also an area of research but more for its functional components. Their relationships to psychological health and, in particular, the extent to which support adds to or interacts with the effects of life stress is what interests psychologists most.

      Significant correlations may be found in a multitude of research studies; however, for empirically sound conclusions to be drawn, two issues need further investigation. The first issue to be considered is a clearer, operational and conceptual definition of both types of support. Secondly, the functional aspect of current measures of support need to address the type of support one receives and if it matches the needs that the stressor produces.

      Limited research has been done in the area of gender differences. Future studies in this area and studies on the homosexual population can only help to increase the benefits derived from support.

      Dahlem, N., Zimet, G., & Walker, R. (1991). The Multidimensional Scale of Perceived Social Support: A confirmation Study. Journal of Clinical Psychology, 47, 756-761.

      Ellison, C. & George, L. (1994). Religious Involvement, Social Ties, and Social Support in a Southeastern Community. Journal for the Scientific Study of Religion, 33, 46-61.

      Kass, J., Friedman, R., Lesserman, J., Zuttermeister, P., & Benson, H. (1991). Health Outcomes and a New Index of Spiritual Experience. Journal for the Scientific Study of Religion, 30, 203-211.

      Maton, K. (1989). The Stress-Buffering Role of Spiritual Support: Cross-Sectional and Prospective Investigations. Journal for the Scientific Study of Religion, 28, 310-323.

      Pretorius, T. (1993). Willingness to use Social Support: Use of the Network Orientation Scale with Black South African Students. Psychological Reports, 73, 1011-1017.

      Ross, C. (1990). Religion and Psychological Distress. Journal for the Scientific Study of Religion, 29, 236-245.

     Sarafino, E. (1994). Health Psychology (2nd ed.). New York: John Wiley & Sons, Inc.

     Sarason, I., Levine, H., Basham, R., & Sarason, B. (1983). Assessing Social support: The Social Support Questionnaire. Journal of Personality and Social Psychology, 44, 127-139.

      Shortz, J., & Worthington, E. (1994). Young Adults Recall of Religiosity, Attributions, and Coping in Parental Divorce. Journal for the Scientific Study of Religion, 33, 172-179.

      Winemiller, D., Mitchell, E., Sutliff, J., & Cline, D. (1993). Measurement Strategies in Social Support: A Descriptive Review of the   Literature. Journal of Clinical Psychology, 49, 638-646.