Coping strategy preferences, changes in those preferences and their associations with different patterns of psychological reaction were investigated in three studies of chronically ill patients. A simple self-appraisal device, consisting of the ranking of six clusters of strategies, was used to assess patients coping preferences. In Study 1 patients were found to prefer optimism, and probably fatalism, more than non-patients, while non-patients preferred action strategies and, to some extent, interpersonal coping. In Study 2 coronary patients were bound to prefer more optimism strategies but fewer escape strategies than other chronically ill patients. All patients also changed some of their coping preferences over time, preferring optimism in hospital and fatalism at home. Study 3 showed preferences for action strategies to be associated with desirable psychological reaction patterns such as relatively little uncertainty and helplessness. Preferences for escape strategies were linked with patterns which may be less desirable, such as much anxiety and indirectly expressed anger. Optimism and fatalism, although preferred by many patients, were associated with patterns of psychological reaction in which desirable and undesirable elements were mixed. Preferences for control strategies proved to be linked with reactions of patients when in hospital only, while those for interpersonal coping proved to be reaction-linked only when patients were at home.