Emotion dysregulation and coping motives as mediators of change in cognitive behavioral therapy-based treatments for depression and heavy episodic drinking among college students

Background

Both cognitive behavioral therapy (CBT) alone and combined with brief motivational interviewing (CBT + BMI) are associated with reductions in depression, alcohol-related problems (ARP), and heavy alcohol use among college students with co-occurring depression and heavy episodic drinking (HED). Little is known regarding how these interventions facilitate change and the temporal ordering of reductions. This study examined mediators of CBT alone versus CBT + BMI, including (1) emotion regulation constructs (cognitive reappraisal, expressive suppression, avoidance coping) and (2) drinking to cope motives. The temporal relationships between improvement in depression and reduction of ARP and HED were also examined.

Methods

Data from 94 college students with depression and HED randomized to either eight weeks of CBT alone or CBT + BMI collected during a previous trial were utilized. Multilevel structural equation models were adopted to investigate mediation models. A cross-lagged panel analysis examined temporal relationships between depression, ARP, and HED.

Results

Mediators associated with improvement did not differ between the two interventions. In both, depression amelioration was mediated by increased cognitive reappraisal and reduction of avoidance coping and drinking to cope. Reduction of drinking to cope mediated improvements in ARP.

Limitations

It is uncertain whether observed changes can be solely attributed to CBT, or if other factors may have played a role.

Conclusions

Treatment programs providing emotion regulation skills to cope with aversive affect, as an alternative to alcohol misuse, may lead to depression improvement.