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Coping after recurrent miscarriage:
uncertainty and bracing for the
worst
Henrietta D L Ockhuijsen,1 Jacky Boivin,2 Agnes van den Hoogen,3
Nickolas S Macklon4

1
PhD Student, Department of ABSTRACT BACKGROUND
Reproductive Medicine and
Background The aim of this study was to More than one in 10 pregnancies will
Gynaecology, University Medical
Centre Utrecht, Utrecht, The understand how women with single or recurrent end in a miscarriage and this risk
Netherlands miscarriages cope during the waiting periods increases with age. Further, between 1%
2
Professor, School of Psychology, after miscarriage – waiting for pregnancy or and 3% of women will suffer recurrent
Cardiff University, Cardiff, UK
3 waiting for pregnancy confirmation – and to miscarriages, with an underlying cause
Nurse Researcher, Department
of Neonatology, Wilhelmina investigate their perception of a ‘positive found in fewer than 50% of such
Children’s Hospital and reappraisal’ coping intervention designed for couples. Miscarriage is a cause of psycho-
University Medical Centre these waiting periods. Positive reappraisal is a social distress, as for many women it
Utrecht, Utrecht, The
Netherlands
cognitive strategy to change the meaning of a means more than the loss of a pregnancy.
4
Professor of Obstetrics and situation, specifically reinterpreting the situation It represents the feeling of a lost baby, a
Gynaecology, Human in a more positive way. lost future child and a lost motherhood.
Development and Health, Methods A qualitative methodology was used. Miscarriages also cause physical trauma,
University of Southampton,
Southampton, UK Data were obtained from two focus groups sudden pain, blood loss and unexpected

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comprising nine women with one or more admission to hospital.1 2 From their prac-
Correspondence to miscarriages. tice, health care workers know that
Ms Henrietta D L Ockhuijsen,
Results Two core categories, ‘uncertainty’ and women who have suffered miscarriages
Department of Reproductive
Medicine and Gynaecology, ‘bracing’, were highlighted during the waiting potentially experience two subsequent
University Medical Centre period for confirmation of an ongoing waiting periods: the period between
Utrecht, PO Box 85500, Utrecht pregnancy. Women who had experienced a renewed attempts to conceive and con-
3508 GA, The Netherlands;h.d.l.
ockhuysen@umcutrecht.nl
single miscarriage appraised this waiting period ception (waiting for conception), and the
as benign and used distraction and coping by period between conception and confirm-
Received 28 February 2012 social support. Women with recurrent ation that the pregnancy is ongoing
Revised 8 October 2012 miscarriages could not confidently appraise the (waiting for ongoing pregnancy). Waiting
Accepted 10 October 2012
Published Online First waiting period as one that would bring hope or is associated with a build-up of anxiety
17 January 2013 joy and used bracing for the worst as their and stress, which starts because of the
coping strategy to manage this ambivalence. uncertainty in timing of the conception
With this strategy, women tried to control their and the ongoing pregnancy, but eventu-
current emotions, and looked into the future to ally also includes anticipatory anxiety
try to minimise their distress if a further about the outcome, either pregnancy loss
miscarriage occurred. Although all women or live birth.3
thought that a ‘positive reappraisal’ coping Women who have experienced miscar-
intervention would be practical and applicable riages may benefit from psychosocial
during waiting periods, only women with support and counselling during these
recurrent miscarriages actually wanted to use waiting periods.1 Several studies have
such an intervention. investigated the influence of psychosocial
Conclusions Coping interventions targeting interventions in women who have experi-
reappraisal of the waiting period stressor enced miscarriage.4–8 Most have focused
situation could help women to cope as they wait on the period immediately following mis-
for a subsequent pregnancy to be confirmed as carriage.5–8 There is less information
To cite: Ockhuijsen HDL,
Boivin J, van den Hoogen A,
ongoing. Coping interventions may need to be relating to support during the first trimes-
et al. J Fam Plann Reprod tailored, but before any strategy is introduced, ter of a subsequent pregnancy.4
Health Care further study is needed to identify the most Interventions such as counselling sessions
2013;39:250–256. appropriate approach. with nurses,7 psychological counselling6

250 Ockhuijsen HDL, et al. J Fam Plann Reprod Health Care 2013;39:250–256. doi:10.1136/jfprhc-2012-100346
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or a weekly ultrasound scan4 have been shown to
reduce anxiety and depressive symptoms. Not all
patients use or have access to these interventions and
many request adjunct interventions that could be used
in addition to such interventions, or as alternatives if
they are not readily available.8
Lancastle and Boivin9 recently developed a short
self-help Positive Reappraisal Coping Intervention
(PRCI) for use during medical waiting periods. It con-
sists of daily reading of 10 positive statements encour-
aging the use of ‘positive reappraisal coping’. This is a
cognitive strategy to change the meaning of a situ-
ation, in particular, reinterpreting the situation as it
stands in a more positive way.9 The PRCI is based on
the stress theory of Lazarus and Folkman.10 According
to this theory, emotional processes are dependent on
actual expectations about the significance and
outcome of a specific situation and how people cope
following these appraisals.10 People use a variety of
coping strategies to manage stressful events.10
Problem-focused coping strategies are aimed at con-
fronting and seeking solutions to a situation, while
emotion-focused coping strategies focus on ameliorat-
ing the associated level of emotional distress.
Meaning-based strategies as used in the PRCI (e.g.
deriving benefit from adversity or focusing on the
positive) are future-orientated strategies that have
been shown to be effective where sustained coping Figure 1 Positive Reappraisal Coping Intervention.9 © 2008

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efforts are required when a stressor situation is uncon- Cardiff University. Figure reproduced with the kind permission
of the authors and Cardiff University.
trollable and its outcome unpredictable.11 12 This is
the case in medical waiting periods such as those after
experiencing miscarriages. Another future-orientated
coping strategy is ‘bracing’. Bracing occurs as an study design involving two focus groups as recom-
attempt to anticipate unpleasant surprises, presumably mended for implementation of interventions in novel
to avoid disappointment.13–16 contexts.17 In the focus groups we aimed to explore
The PRCI was originally developed for the waiting the experience, coping styles and strategies of women
period after embryo transfer in infertility treatment. It during the waiting period for ongoing pregnancy.
consists of a small card (Figure 1) that contains 10
positive reappraisal statements, together with a leaflet METHODS
with detailed information about the coping techni- Participants
ques. Women are asked to read the PRCI at least Women attending an Early Pregnancy Unit and/or
twice a day, in the morning and evening, and at any Recurrent Miscarriage Clinic managed by nurses and
other time that they feel the need to do so. Women doctors at the University Medical Centre Utrecht in The
have to read the statements and think about how each Netherlands were invited to participate in this study.
statement applies to them personally. As conception Twenty-five participants, all Dutch-speaking, were
or confirmation of ongoing pregnancy after a miscar- approached by telephone and 14 agreed to participate.
riage often involve a sustained period of waiting, we The main reason for declining was reluctance to talk
felt that the PRCI could potentially also be a useful about this subject in a group setting. The potential parti-
adjunct intervention for women in this patient group. cipants were assigned to focus groups based on the
To adapt and further develop the PRCI for women number of miscarriages that they had experienced. One
with miscarriages, the UK Medical Research Council focus group comprised women who had experienced a
medical framework for developing complex interven- single miscarriage, were currently more than 12 weeks
tions was used.16 pregnant and were waiting for confirmation of ongoing
This article presents the results of the first phase of pregnancy (SM group). Of the seven women invited to
the study, which was to describe the coping strategies this group, one did not attend and two cancelled due to
of women after miscarriage to determine whether the illness. The final sample size in the SM group was there-
PRCI intervention could also be applied to this popula- fore four women. The second focus group comprised
tion. To model the intervention, we used a qualitative women with recurrent miscarriages of whom two were

Ockhuijsen HDL, et al. J Fam Plann Reprod Health Care 2013;39:250–256. doi:10.1136/jfprhc-2012-100346 251
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over 12 weeks pregnant (RM group). Of the seven Data analysis
women invited to this group, two women did not The interviews were tape-recorded and transcribed in
attend, one because of emotional problems and one for full. The method of grounded theory was used to
practical reasons. The final sample size in the RM group analyse the data of focus groups.18 In this method,
was therefore five women. The focus groups took place three levels of the coding are used: open, axial and
in a meeting room outside the clinic. Demographic char- selective coding.19 The interviews were organised and
acteristics of the 14 women who agreed to participate analysed by thematic analysis assisted by the software
are given in Table 1. programme MAXQDA 10™ (VERBI Software
GmbH, Marburg, Germany). To validate the accuracy
of the findings, virtual repeatability was used.20 This
Data collection
was made possible by transcribing the interviews,
An interviewer, note-taker and the researcher, all
making field notes and using peer review and peer
female, were present during the two focus group ses-
debriefing with two colleagues proficient in qualitative
sions. The interviewer had a degree in health science
research to ensure repeatability of findings. One col-
and was experienced in leading focus groups. Notes
league reanalysed the raw data with subsequent con-
were taken by a psychologist and the researcher was
sensus discussions with the researcher about emerging
present to observe.
categories. Member checking took place during the
Data collection took place by semi-structured inter-
interviews by asking the participants whether the sum-
view to address issues relevant to miscarriages. The
maries were a true reflection of their reality.
interview schedule broadly followed questions about
Illustrative quotations were edited for ease of
experiences and coping strategies around waiting for
reading and relevance using the following notation
conception and waiting for ongoing pregnancy. During
system: ‘…’ refers to omission of some part of the
the focus group session the PRCI was provided and
quotation because it is irrelevant to the argument.
explained, but not used by the women. Questions were
Where necessary for clarity, additional text (indicated
asked about the perceptions of the feasibility and
by square brackets) has been included for ease of
acceptability of the PRCI. The central questions for the
reading and comprehensibility. Each quotation is fol-
focus groups were: “How have women with single or
lowed by a fictitious name (see Table 1), true age and
recurrent miscarriages experienced and coped during
number of miscarriages experienced by the respond-
the waiting periods after miscarriage?” and “What is

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ent. Translation of the quotations for the purposes of
their opinion about the usefulness of the PRCI?” As
this article was by the researcher and a native English
most of the women in the RM group were not yet
speaker carried out back-translations to verify their
pregnant, their experiences about waiting for an
accuracy.
ongoing pregnancy related to past pregnancies that had
miscarried. Prompts were developed to ensure that
women covered specific categories. The session contin- Ethics approval
ued until no new data were gathered, that is, until the Permission to conduct the study was obtained from
data were saturated. The focus groups each lasted 2½ the Ethical Committee of the University of Utrecht,
hours with a break of 15 minutes. Utrecht, The Netherlands.

Table 1 Demographic characteristics of participants in the single miscarriage and recurrent miscarriage focus groups
Name Age (years) Children (n) Miscarriages (n) Pregnant Attendance at focus group
Single miscarriage (SM)
Anna 36 0 1 Yes Did not attend due to illness
Bea 29 0 1 Yes Did not attend due to illness
Cecile 29 0 1 Yes Yes, conception time 3 months, 15 weeks pregnant
Diana 29 0 1 Yes Yes, conception time 12 months, 26 weeks pregnant
Eva 28 4 1 Yes Did not attend, unspecified
Freya 34 0 1 Yes Yes, conception time 2 months, 21 weeks pregnant
Gloria 31 2 1 Yes Yes, conception time 6 months, 26 weeks pregnant
Recurrent miscarriage (RM)
Helen 34 0 3 No Yes, 5 months after last miscarriage
Irene 38 1 3 No Yes, 3 months after last miscarriage
Julia 30 0 3 Yes Did not attend due to emotional problems
Karen 33 1 3 Yes Yes, conception time 2 months, 16 weeks pregnant
Lucy 34 1 4 No Yes, 5 months after last miscarriage
Maria 29 1 3 No Did not attend for practical reasons
Nancy 38 0 6 No Yes, 5 months after miscarriage

252 Ockhuijsen HDL, et al. J Fam Plann Reprod Health Care 2013;39:250–256. doi:10.1136/jfprhc-2012-100346
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RESULTS Waiting period for ongoing pregnancy
The results of open coding are presented, followed by Appraisal of the waiting period for ongoing pregnancy
the axial and selective coding. Women with SM or RM differed in the way they
appraised the waiting period for ongoing pregnancy.
Open-coding categories Women in the SM group were a little uncertain
Open coding produced the following four categories: during the waiting period but they still mainly
experiences, appraisal, coping and PRCI. The categor- appraised the waiting period as benign or a ( positive)
ies and their subcategories as indicated by women in challenge rather than a threat with potential for harm.
the two focus groups are shown in Table 2. “A girlfriend has had four miscarriages. That is a com-
Waiting period for conception pletely different story. Her experiences were quite dif-
ferent. When I compare myself to her, I do not have
Experiences
strong feelings, almost nothing.” [Gloria, 31-1]
Women with the experience of SM or RM reported
that the waiting period for ongoing pregnancy was Women in the RM group did not know or were
not as stressful as the time immediately after the mis- unable to appraise the waiting period: is it benign, a
carriage. All women judged the latter period as the challenge, threat or harm? As a result women in the
worst time. Both groups had feelings of grief because RM group were very uncertain about how they
of the loss of a future baby and felt in need of more should regard or feel about the pregnancy.
support during this period.
“I noticed that two things were present in a subsequent
“What I found the most difficult were the first weeks pregnancy. You are reminded of your loss or more
after the miscarriage. When I look back, this was the losses and that causes extra sadness and I had the
hardest time. You are disappointed and you have phys- feeling that I did not want to lose this child, and on
ical problems. If I have to face that again I will use all the other hand I wanted to love this child. That makes
the help there is.” [Helen, 34-3]. you very insecure and afraid.” [Julia, 34-3]

Women who had experienced one miscarriage had The length of time of the uncertainty depended on
the feeling that their miscarriage was just bad luck. the previous experiences. Some women were uncer-
They still had hope for the future. tain for the first weeks while others were uncertain
for up to 20 weeks.

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“It is a bit of a false start feeling. You are positioned in
the starting blocks and you think … but we can have a “I had an ultrasound at 7 weeks and then I heard the
new opportunity. You have no reason for worrying too heartbeat. Only this does not give certainty because
much.” [Freya, 34-1] the last pregnancy ended at 7 weeks. It [uncertainty]
has actually lasted up to 20 weeks before I thought
Women with RM had fears for the future and some yes, it is now really well.” [Gloria, 31-1]
women were afraid of never having another preg-
nancy or children of their own. Women with RM declared that the uncertainty grew
after every new miscarriage.
“What I find difficult is the thought that I might never
have children and no family but what is very bad is “We were actually still not quite accustomed to the
that what I have now apparently is not enough. I am idea, and then it went wrong. That is an entirely differ-
so busy wondering whether I will ever have children.” ent approach than when one is very focused on the
[Helen, 34-3] pregnancy. The second time that it goes wrong …. that
happens … but after the second time it is becoming
Table 2 Categories and subcategories emerging from open more precarious because then you do not know the
coding in the single miscarriage and recurrent miscarriage focus cause and I would also not know how you might affect
groups it.” [Lucy, 34-4]
Recurrent miscarriage
Category Single miscarriage group group Coping during the waiting period for ongoing pregnancy
Waiting period for conception The coping strategies the two groups used the most
Experiences Time after miscarriage Time after miscarriage were emotion-focused strategies like avoidance,
Hope for the future Fear for the future seeking social support, positive reappraisal and distrac-
Waiting period for ongoing pregnancy tion. The main difference between women with SM or
Appraisal Challenge Uncertainty RM was the reason for using the coping strategies.
Coping Emotion-focused coping Emotion-focused coping Women with SM made a point of trying to cope in
Informing a broader social Controlling a different way than during their first pregnancy. For
network Bracing
Informing a specific social instance, one woman avoided sports during the first
network pregnancy because she was afraid that it was bad for
PRCI Practical and applicable Practical and applicable the baby, however in the second pregnancy she ran a
No need to use it Need to use it marathon. Some women avoided seeking information
PRCI, Positive Reappraisal Coping Intervention. on the internet or avoided thinking too much about

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the baby. Others searched for social support by Both groups suggested that perhaps the card would
informing a broader social network sooner about the be more useful if women additionally kept a diary.
pregnancy to anticipate a need for support in case of
“I don’t think it is difficult to use. But it might help
a possible new miscarriage. more if you write something in the morning about the
“I told family and friends in both pregnancies, but statements and then in the evening you could evalu-
earlier in the second because they already knew of the ate.” [Cecil, 29–1]
previous miscarriage. Yes it helps to talk about it
because when it goes wrong again you can have more Axial and selective coding
support from those people.” [Cecile, 29-1] The two core categories ‘uncertainly’ and ‘bracing’
Women with RM primarily used the coping strategy emerged out of the data from open coding. These
of bracing for the future. These women tried to core categories explained the differences between SM
control their emotions and future emotions as much and RM in coping and have an association with the
as possible to prepare for the worst outcome. They open coding categories found.
anticipated negative feelings that could be caused by a Uncertainty
new miscarriage in the future. For instance, they Waiting for ongoing pregnancy is an event that
avoided thinking and daydreaming about the baby. women with SM experienced and coped with differ-
“You notice the thoughts of no planning ahead, no ently to women with RM. The more miscarriages a
dreaming … I wanted to be happy really … I had woman had experienced, the more difficult it became
every reason to but ever since that [miscarriage] you in a subsequent pregnancy to confidently appraise the
are feeling cautious.” [Lucy, 34-4] waiting period for ongoing pregnancy. Women with
SM still experienced a new pregnancy as benign or a
Women in both groups distracted themselves by
( positive) challenge while women with RM became
going on a holiday or meeting a friend, but it was not
more uncertain in a subsequent pregnancy. This uncer-
always effective. The thought of a possible new mis-
tainty expanded with the increase in the number of
carriage was frequently on their minds.
miscarriages.
“You try distraction but it does not always work. You
Bracing
try it but you always carry it [the miscarriage] with
Both groups used emotion-focused coping strategies

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you, so it is more about killing the time.” [Karen, 33-2]
aimed at regulating emotions they were experiencing,
Women with RM reported trying to control their but women with RM used the coping strategy to
social support as much as possible by informing a control or brace against their current emotions and
smaller group of people in case of a subsequent con- the possible future emotions arising from a negative
ception. They informed only those people who really outcome. SM women just used them to cope in a dif-
could give good support. ferent way than during their first pregnancy.
“The more often I became pregnant the fewer people I Relationship between uncertainty and bracing
told [of the pregnancy]. The first time I told everyone Uncertainty appears when women do not know how
who was willing to hear it. The last time I only told a to appraise the ‘waiting for ongoing pregnancy’
cousin.” [Nancy, 38-6]
period. They do not know if the waiting period will
be a challenge, threat or harm because the outcome
Perceptions of PRCI becomes more unpredictable the greater the number
The SM and RM groups thought that the PRCI could of miscarriages. The more miscarriages women have
be practical and applicable. However, most women experienced the more the uncertainty grows. It grows
with SM did not feel the need to use an intervention because women have less faith that they will ever have
whereas most women with RM did. One woman with an ongoing pregnancy. Women brace as a coping strat-
repeated miscarriage stated: egy to deal with this uncertainty. Bracing is an attempt
to control the emotions and future emotions as much
“Yes, I would use it, you want to do something. There
as possible, and to prepare for the worst outcome.
is nothing else I can do, and now there is something.
I think for that reason it can be very helpful.” [Helen,
34–3] DISCUSSION
This qualitative study was aimed at exploring the
Women with a single miscarriage could imagine that coping strategies in women with single and recurrent
the PRCI would be useful to other women with more miscarriage. We also examined whether a PRCI was
negative miscarriage experiences. perceived as useful for this population. The results
“Yes if you really have all the negative thoughts and show that two core categories, ‘uncertainty’ and
you do not know how to handle it then I think it is an ‘bracing’, differed between women with RM or SM.
excellent tool … you focus on the positive things. But The more miscarriages women had experienced, the
for me personally, I would not use it.” [Bea, 29–1] more likely that bracing was adopted as the core

254 Ockhuijsen HDL, et al. J Fam Plann Reprod Health Care 2013;39:250–256. doi:10.1136/jfprhc-2012-100346
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coping strategy to deal with increasing uncertainty for the future, seeing the first miscarriage as “bad
about a current or eventual pregnancy. Women luck”, and therefore experienced the new pregnancy
thought that coping interventions during the waiting as benign or a challenge.
period could be useful and that these could include In risky situations, two strategies can be used:
positive reappraisal tools such as PRCI or other cogni- defensive pessimism and an optimistic strategy.27
tive or psycho-educational interventions.12 Defensive pessimism is discounting of past successes
All women thought that the PRCI could be practical and the lowering of expectations prior to entering a
and applicable but most women with SM did not want situation. In the optimistic strategy, the expectations
to use this or any other intervention, in contrast with are high at the outset with post hoc restructuring of
women with RM who did. This asymmetry may be the situation when the outcome is known.27 It may be
due to differences between groups in appraisal of the that women with SM were already using the coping
situation. Women with SM felt that the first miscar- style of positive reappraisal to deal with the current
riage was bad luck, and expected the present pregnancy pregnancy. This optimism may explain the lack of
to continue, lessening the need for additional support. bracing. Clearly all these future-oriented approaches
In contrast, women with RM clearly lacked confidence theoretically overlap with bracing (and cushioning).
about future outcomes, with perceptions and coping However, our results and those from other studies
orientated toward potential failure (i.e. bracing for the concur that the particular characteristics of waiting for
worst). Another explanation for the difference can be an ongoing pregnancy provoke specific cognitions and
found in the Common Sense Model.21 This model pro- emotions that women may find difficult to manage
poses that people make mental representations of their because they refer to a future unknown, unpredictable
illness using different sources of information, for and uncontrollable outcome. As such, more research
instance from memory, social environment and somatic attention should be devoted to this topic in relation to
information. Mental representations may change with miscarriage and to whether bracing (and other future-
the increasing number of miscarriages. In this cognitive oriented coping strategies) leads to positive or nega-
context, women with RM may benefit from coping tive emotions in women with SM or RM.
strategies targeting reappraisal, such as PRCI. These The uncertainty for women in the RM group
findings support conclusions from a recent survey on increased with every new miscarriage. The relation-
the modes of support likely to be valued by women ship between the number of miscarriages and the level

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with RM.22 of anxiety in a subsequent pregnancy is unclear. Some
The use of the coping strategy ‘brace for the worst’, studies find a positive relationship2 and others no
by which women try to control their emotions and relationship.28 29
future emotions as much as possible, has not previ- In the present study, women used mainly emotion-
ously been described among women with RM. focused coping styles to handle anxiety, which is con-
However, in qualitative studies, similar behaviour has sistent with the context. Terry and Hynes30 argue that
been reported such as “holding back emotions”23 and in low-control situations the use of emotion-focused
“emotional cushioning”.24 In a longitudinal, qualita- coping is more effective than problem-focused coping.
tive study among 82 pregnant women who had In contrast to our findings, in a longitudinal study of
experienced loss, a number of comparable coping 82 women pregnant after previous miscarriage, the
styles were reported.25 For example, some women dominant form of coping was problem-focused and
were hesitant to express their growing self-assurance women appraised their pregnancies as a moderate
because they were afraid to “jinx” their pregnancy threat.30 These differences may be explained by the
and they delayed the announcement of pregnancy. timing of the assessments. Women entered that study
The women in that study actively pursued many during their 10th to 17th week of pregnancy. Lazarus
avenues to gain control and cope with the difficulties and Folkman10 reported that the longer the waiting
of their pregnancies. Kiwi26 argued that patients with period, the more the period was likely to be appraised
recurrent miscarriages might develop a protective as a threat. While the pregnancy is progressing, the
emotional shield during pregnancy in an attempt to waiting period becomes shorter. Time can be a vari-
reduce the pain of impending loss. Norem and able that changes the coping styles.
Cantor27 described emotional cushioning as a process The main weakness of the present study was the dif-
by which individuals protect themselves against ference between the number of miscarriages and
threats to self-esteem in risky situations. The reason current pregnancy status, since all women in the SM
why women with SM did not use bracing is not clear. group were currently pregnant compared with just
The differences could be caused by the fact that all one in the RM group. All women in the RM group
women in the SM group were pregnant while most had had a miscarriage 3 months or longer ago and
women in the RM group were not. Carroll et al.15 they were all waiting for conception. All women in
proposed that bracing was an attempt to avoid disap- the SM group were at more than 12 weeks of gesta-
pointment and reflected the cognitive strategy of tion. A further weakness was the non-attendance and
defensive pessimism. Women with SM still had hope consequent reduced sample size. It is likely that non-

Ockhuijsen HDL, et al. J Fam Plann Reprod Health Care 2013;39:250–256. doi:10.1136/jfprhc-2012-100346 255
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stress. Social Sci Med 1997;45:1207–1221.
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12 Folkman S, Moskowitz JT. Coping: pitfalls and promise. Annu
et al.32 advise at least two focus groups of each par-
Rev Psychol 2004;55:745–774.
ticipant type and a group size between four and 12 13 Taylor KM, Shepperd JA. Bracing for the worst: severity,
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and the final sample size (four and five) was still bias. Pers Soc Psychol Bull 1998;24:915–926.
within an acceptable range.31 14 Shepperd JA, Findley-Klein C, Kwavnick KD, et al. Bracing for
In conclusion, similarities and differences were loss. J Pers Soc Psychol 2000;78:620–634.
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Despite the limitations of this study, the two core cat- Gen Psychol 2006;10:56–73.
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understand whether modulating these coping strat-
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Funding None.
2003;18:141–184.
Competing interests None.
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Provenance and peer review Not commissioned; externally Supportive care for women with unexplained recurrent
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