Coping effectiveness training reduces depression and anxiety following traumatic spinal cord injuries

Objective. To extend the findings of a pilot study that evaluated a brief group-based psychological intervention aimed at improving psychological adjustment, self-perception and enhancing adaptive coping following spinal cord injury. The theoretical underpinnings of the Coping Effectiveness Training (CET) Programme are Lazarus and Folkman's (1984) cognitive theory of stress and coping, and cognitive behavioural therapy techniques. Design. A controlled trial comparing patients that received the CET intervention with matched controls on measures of psychological adjustment and coping. Method. A total of 45 intervention group participants and 40 matched controls were selected from inpatients at a hospital-based spinal cord injury centre. Outcome measures of anxiety and depression, self-perception and coping were collected before, immediately after and 6 weeks following the intervention. Results. Intervention group participants showed a significant reduction in depression and anxiety, compared to the matched controls following the intervention. There was no evidence of a significant change in the pattern of coping strategies used by the intervention group compared to controls. The intervention group alone completed measures of self-perception. There was a significant decrease in the discrepancy between participants' 'ideal' self and 'as I am', and between 'as I would be without the injury' and 'as I am' following the intervention and at follow-up. Significant correlations were also found between self-perception, and anxiety and depression over time. Conclusions. These results confirm the findings of the pilot study, that the CET intervention facilitated a significant improvement in psychological adjustment to spinal cord injury. It is proposed that this improvement may be understood in terms of changing participants' negative appraisals of the implications of spinal cord injury with the result of increasing the perceived manageability of its consequences. Such decatastrophizing alters appraisals which are associated with current mood. Participants found shared discussion and problem-solving to be particularly helpful. Avenues for further research are discussed.