| Despite a substantial battery of effective treatments for adolescent depression, little is known about why these treatments are effective. The current investigation examined treatment process mechanisms, with specific attention paid to the role of coping and involuntary responses to stress. The primary goal was to evaluate change in coping skills as a mediator of outcome in a school-based, open trial of cognitive-behavioral therapy (CBT) for adolescent depression. The CBT was administered to an ethnically diverse, severely depressed sample demonstrating high levels of comorbid disorders. While mediation was not supported, parts of the model were confirmed. In the context of CBT for adolescent depression, coping was demonstrated to change, and these changes prospectively related to reduction of depressive symptoms. Despite targeting cognitive skills, such as cognitive restructuring and positive thinking, the responses that demonstrated the most change were maladaptive coping and stress reactions, including rumination and escape. Various methods of measuring therapy exposure and coping and stress reactions were employed. The current study demonstrated that CBT does alter coping and stress reactions and these changes are associated with treatment response. |
