Abstract: Primary alexithymia is a personality trait associated with increased levels of depression, anxiety, and physical symptoms. The study tested a model in which Avoidance coping mediates the effects of alexithymia on negative emotional outcomes. The study also assessed the utility of the Emotional Approach coping scale (Stanton, Kirk, Cameron, & Danoff-Burg, 2000) in alexithymia research. Two hundred and sixty-seven undergraduates participated in a one-time group session during which they completed a series of questionnaires measuring baseline levels of alexithymia, depression, anxiety, physical symptoms, perceived stress, perceived social support, positive affect (PA) and negative affect. To improve recall of specific coping strategies, participants completed a written description of a recent stressful event. Students then completed a modified, situational version of a coping questionnaire containing recently developed Emotional Approach items. Factor analysis reproduced the Emotional Approach coping scale accounting for 17.84% of the total variance and demonstrating high interitem reliability ( =.90). Multivariate analyses of variance (MANOVAs) between-subject effects found women more likely than men to use Emotional Approach coping (p <.05) and Seeking Social Support coping (p <.001). A series of regression analyses produced a model in which Avoidant coping mediated the effects of alexithymia on depression (p <.001), anxiety (p <.01), and physical symptoms (p <.05). A further analysis found that lower perceived social support independently mediated the effects of alexithymia on depression (p <.01). Importantly, post hoc regression analysis on the 4th quartile, high alexithymia group (n = 68) found that Emotional Approach coping and less Avoidant coping contributed to higher levels of positive affect. Results support psychotherapeutic interventions that incorporate strategies that increase the use of Emotional Approach coping, reduce the use of Avoidance coping, and increase social/interpersonal skills and perceived social support. Future alexithymia treatment outcome research should include the measurement of perceived social support, positive affect, and coping strategies, particularly Emotional Approach and Avoidance coping.