Depression and anxiety are commonly comorbid among patients with chronic medical conditions. These comorbidities are associated with negative outcomes including poorer quality of life and worse physical functioning. Evidence that traditional cognitive behavioral therapy (CBT) is less effective for these populations has led to the development of brief CBT protocols that incorporate physical health self-management skills and are delivered in primary care. To continue refining treatment packages, it is important to understand how brief CBT works. The present study used the transactional model of stress and coping as a framework for investigating potential mechanisms of action of brief CBT. Veterans with chronic obstructive pulmonary disease and/or heart failure and elevated symptoms of depression and/or anxiety were randomized to receive brief CBT (n =180) or enhanced usual care (EUC; n = 122). At 4-month follow-up, depression and anxiety symptoms were significantly lower in veterans who received brief CBT, compared to EUC. Multiple mediation analyses revealed that brief CBT was associated with higher self-efficacy and less avoidant coping at 4-month follow-up, which were in turn associated with less depression and anxiety symptoms. Illness intrusiveness was also a significant mediator of the relationship between brief CBT and anxiety symptoms, but not depression symptoms. In contrast, increases in active coping attributable to brief CBT were not associated with improvements in depression or anxiety symptoms. These results demonstrate the utility of the transactional model of stress and coping as a framework for understanding mechanisms of action of brief CBT in patients with comorbid physical and psychological conditions.
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Doctor of Philosophy (Ph.D.)
College of Sciences
Psychology; Clinical Psychology
Length of Campus-only Access
Doctoral Dissertation (Open Access)
Deavers, Frances, "How Does Brief Cognitive Behavioral Therapy Work? Potential Mechanisms of Action for Veterans with Physical and Psychological Comorbidities" (2017). Electronic Theses and Dissertations. 5641.