Avoidant Personality Traits and Avoidant Coping in Cognitive–Behavioral Therapy vs. Short‐Term Psychodynamic Psychotherapy for Adult Depression

Research on the significance of comorbid personality disorders (PD) on the outcome of depression treatment has shown inconsistent findings. In addition, it is still unclear whether treatment choice based on personality traits and coping can enhance the efficacy of depression treatment. Aiming to deliver clinically representative results, we use dimensional measures to examine avoidant personality and coping as moderators for the efficacy of cognitive-behavioral therapy (CBT) versus short-term psychodynamic psychotherapy (STPP) for depression. Furthermore, we explored whether these depression treatments reduced avoidant personality traits and coping. Included were 265 patients with major depressive disorder who received 16-week CBT or STPP in a randomized clinical trial. Depression, avoidant personality traits, and avoidant coping were measured with, respectively, the Hamilton Depression Rating Scale, NEO Five Factor Inventory (extraversion and neuroticism subscales), and Utrecht Coping List (avoidance subscale). Multilevel regression analyses estimated the moderating effects of avoidant personality traits and avoidant coping on the relationship between treatment type and depressive symptom change, as well as changes in avoidant personality traits and avoidant coping in CBT and STPP. Avoidant personality traits and avoidant coping did not moderate the efficacy of CBT and STPP. Both treatments resulted in significant reductions in avoidant personality traits, but not in coping. Both CBT and STPP can be offered to patients with avoidant personality traits and avoidant coping and can reduce avoidant personality traits. Trial Registration: ISRCTN31263312 (http://www.controlled-trials.com).