Coping Strategies in Major Depression and over the Course of Cognitive Therapy for Depression/Les Stratégies D'adaptation Associées À la Dépression et Leur éVolution Au Cours D'un Traitement Cognitif

Major depression is predicted to become the primary contributor to disease burden in high-income countries such as Canada by 2030 (Mathers & Loncar, 2006). While the disorder's worldwide lifetime prevalence is estimated to be in the 8-12% range, these rates are slightly higher in Canada, with a 24% lifetime prevalence among women and a 15% lifetime prevalence among men (Andrade et al., 2006; Hirschfeld et al., 1997). Beyond the individual suffering that major depression is associated with, which limits activities of daily living at home, work, and school, depression also poses a serious economic problem to society. In Canada alone, overall economic losses have been estimated at $4.5 billion annually, making depression one of the costliest health problems in Canada (Stephens & Joubert, 2001). It is no surprise, then, that a considerable amount of attention has been given to developing effective treatments for depression.Cognitive therapy (CT) is one such treatment; it has been shown to be both efficacious and effective in treating major depression, and is now recommended in most reputable practice guidelines (e.g., National Institute for Health and Care Excellence, 2009; Parikh et al., 2009). However, a successful treatment should not only alleviate symptoms but also alter the underlying factors theoretically linked to the onset and maintenance of a clinical condition. Hence, as support for the efficacy of CT for treating depression increased, the focus in research also shifted toward the mechanisms through which CT achieves its results (Ekers, Richards, & Gilbody, 2008; Kazdin, 2007). For example, because mood disorders are believed to be related to a person's negatively biased information-processing and to dysfunctional beliefs that influence motivation, behaviour, and affect (e.g., Beck, Rush, Shaw, & Emery, 1979), a plethora of studies have examined how core cognitive processes such as cognitive errors, dysfunctional attitudes, and negative automatic thoughts, amongst others, are related to depression (e.g., Blake, Dobson, Sheptycki, & Drapeau, 2016; Clark, Beck, & Alford, 1999; Marton, Connolly, Kutcher, & Korenblum, 1993; Pothier, Dobson, & Drapeau, 2012; Schwartzman, Stamoulos, et al., 2012).Other studies have focused on another construct that is central to cognitive behavioural theories of depression: coping (see Beck, 1976), which refers to strategies that are used to respond to and produce an acceptable adaptation to stressors and situations (Perry, Drapeau, & Dunkley, 2007). Indeed, developing appropriate and adaptive coping strategies and eliminating maladaptive coping strategies are two of the aims of therapy (e.g., David, 2006; Wenzel, 2013). Over the last few decades, it has been shown that depression is related to such maladaptive coping strategies as helplessness (e.g., Pryce et al., 2011), rumination (e.g., Hong, 2007), wishful thinking and avoidance (e.g., Trew, 2011), escape (e.g., Ottenbreit & Dobson, 2004), social isolation (e.g., Hawton et al., 2011), and other types of maladaptive coping strategies (e.g., Mahmoud, Staten, Hall, & Lennie, 2012; Morris, Kouros, Fox, Rao, & Garber, 2014). It has also been found that depressed individuals use fewer adaptive coping strategies (including problem-solving strategies) and less positive reappraisal and negotiation strategies than non- or less-depressed individuals (Garnefski, Legerstee, Kraaij, van den Kommer, & Teerds, 2002; Gloria & Steinhardt, 2014; Sinclair, Wallston, & Strachan, 2016).However, a subset of early studies concluded that use of coping strategies that focus on problem solving are not different in individuals suffering from depression compared to nondepressed individuals (e.g., Coyne, Aldwin, & Lazarus, 1981), while others suggested that there may even be increased levels of coping involving self-reliance among participants with higher levels of depressive symptoms (see Folkman & Lazarus, 1986). …

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