Coping effectiveness training for people with spinal cord injury

This project describes the development. implementation and evaluation of a new psychological intervention for improving psychological adjustment and enhancing adaptive coping following spinal cord injury. The Coping Effectiveness Training programme developed is a group-based seven session long intervention. It is grounded on the cognitive theory of stress and coping developed by Lazarus and Folkman (1984) and represents an original adaptation of the theory to the needs of this client group. The intervention was successfully implemented as part of the rehabilitation programme of a national spinal injury centre. Proactive strategies were necessary to establish the essential good collaboration with other rehabilitation staff and ensure good patient participation in the groups.A non-randomised controlled trial was used to evaluate the intervention, using nineteen participants from three Coping Effectiveness Training groups and nineteen carefully matched controls selected from the database of a previous study (Kennedy, 1995). Participants who attended the groups showed significantly greater reductions in levels of depression and anxiety compared to matched controls immediately after the intervention and at six weeks follow-up. indicating that the intervention had facilitated a significant improvement in participants' psychological adjustment to spinal cord injury. A trend towards a significant improvement in participants' self-concept was also found over the observation period. However. there was no evidence of significant changes in the coping strategies used by participants who attended the groups compared to matched controls. with the exception of the 'Acceptance' coping strategy. Most participants said the groups had been helpful in making the consequences of the injury more manageable, with the interaction with other group participants being highlighted as the most beneficial aspect of the intervention. It is proposed that the improvements made in psychological adjustment can be understood in terms of changes in participants' beliefs about the implications of spinal cord injury and about the coping skills needed to be able to continue living meaningful and satisfying lives