This longitudinal study applied a stress and coping model to examine the differential pathways of perceived positive and negative health behavior changes. Participants with congestive heart failure completed self-report measures of psychological resources, coping strategies, and perceived behavior changes and were assessed again 6 months later. Patients with higher positive affect and spiritual well-being reported more positive health behavior changes over time, effects mediated by approach coping. Alternatively, patients with lower psychological resources reported more negative behavior changes over time, effects mediated by avoidance coping. The results suggest that different psychological resources are related to different types of coping which, in turn, are associated with perceived positive or negative changes in health behavior over time.