Are depressed patients’ coping strategies associated with psychotherapy treatment outcomes?

Background

In theory, depression is thought to be associated with deficits in adaptive and excesses in maladaptive coping strategies. This study aimed to investigate associations between coping strategies and depression treatment outcomes.

Method

Participants (N = 126) completed measures of adaptive and maladaptive coping strategies before and after accessing evidence-based psychotherapies for depression. The primary outcome was self-reported depression severity measured with the Patient Health Questionnaire (PHQ-9). Hierarchical regression was used to investigate associations between coping strategies and post-treatment depression symptoms, controlling for therapeutic alliance and relevant demographics.

Results

Lower pre-treatment engagement coping and higher rumination predicted higher post-treatment depression, but both of these effects became non-significant after controlling for baseline depression severity. Similarly, correlations between change in rumination and change in depression were no longer significant after controlling for baseline severity.

Conclusions

Deficits in adaptive (engagement) and excesses in maladaptive (rumination) coping strategies may simply be proxy indicators (epiphenomena) of depression severity.

Practitioner points

- Lower pre-treatment engagement coping predicted higher post-treatment depression

- Higher pre-treatment rumination predicted higher post-treatment depression

- Change in rumination during treatment correlated with change in depression symptoms

- However, none of the above associations remained statistically significant after controlling for baseline depression severity