Changes in coping behavior in a randomized controlled trial of concurrent treatment for PTSD and alcohol dependence

•We examined how coping changes over treatment among adults meeting diagnoses of comorbid PTSD and alcohol dependence.•Treatment included naltrexone or placebo, with or without PE, and all participants also received supportive counseling.•Avoidance and adaptive coping decreased across all groups.•Participants who received PE showed faster decreases in avoidant coping.•Greater reductions in PTSD symptoms were associated with greater changes in coping style.

ObjectiveThe current study examines changes in coping among 165 adults meeting DSM-IV criteria for co-morbid posttraumatic stress disorder (PTSD) and alcohol dependence (AD).MethodParticipants were randomized to receive naltrexone or placebo, with or without prolonged exposure (PE). All participants received supportive counseling focused on alcohol use (BRENDA). Assessments of coping, PTSD, and AD were conducted at pre-treatment, mid-treatment, post-treatment, 3-month follow-up, and 6-month follow-up.ResultsParticipants exhibited significant decreases in both avoidant coping and adaptive coping from pre-treatment to 6-month follow-up across all groups. Participants who received PE showed faster decreases in avoidant coping during this period than participants who did not receive PE. PTSD symptom reduction was associated with changes in both avoidant and adaptive coping across groups. Improvement in PTSD symptoms was related to a faster rate of reduction in avoidant coping in the PE groups compared to those receiving BRENDA alone.ConclusionsThe current results suggest that concurrent treatment for co-morbid PTSD-AD decreases avoidant and adaptive coping, and participants who show greater reductions in PTSD symptoms also show greater changes in coping style. Consistent with theorized mechanisms of change in PE, the addition of PE to supportive counseling for AD was associated with a greater reduction of avoidant coping than supportive counseling alone.