Duchnick et al. 2009
PEDro=4
RCT
N=41
N(CET)=21; C(SGT)=20

Population: CET: Mean age=50.8yrs; Gender: males=95%; Level of injury: tetraplegia=40%; Severity of injury: AIS A=30%; B=30%; C=5%; D=35%; SGT: Mean age=54.6yrs; Gender: males=100%; Level of injury: tetraplegia=70%; Severity of injury: AIS A=20%, B=20%, C=20%, D=40%. Depression status=mild (no severe psychiatric condition score based on Mini-Mental State Examination).
Treatment: Participants were randomly allocated into either the CET (Coping effectiveness training) group or the SGT (Supportive group therapy) group. Each inpatient group met once weekly for 60 minutes.  The CET group focused on: stress and appraisal, problem solving, communication skills, behavioral strategies, cognitive strategies and social support/assertiveness. SGT group emphasized the sharing of experiences and information related to SCI, emotional and cognitive reactions, and support and education from peers and psychologist.
Outcome Measures: CESD, SAI

1. No baseline differences were found.
2. Mood change was not affected by treatment condition.
3. Significant decrease in anxiety (measured with SAI) and depression (CESD) was seen at discharge (p<0.05). However, both anxiety (p<0.001) and depression (p<0.05) increased significantly between discharge and follow-up (3 months)

Craig et al. 1997 Australia
Downs & Black score=22
Prospective Controlled Trial
N=69

Population: SCI: Age = 16-73 yrs; Gender: males = 57, females = 12; Severity of injury: complete = 68%-71%; Chronicity = acute. Depression status=mixed group
Treatment: 10 week program. Small groups (4-5 per group), for 1.5 hours per week Provided cognitive and behavioural skills to cope with the psychological and social difficulties encountered upon entering the community. Cognitive behavioural therapy included muscle relaxation, visualization techniques, self-hypnosis and cognitive restructuring, social skills and assertiveness training, and sexuality sessions.
Outcome Measures: STAI; BDI, Rosenberg Self-Esteem scale.

1. Significantly greater self-esteem for treatment group (p<0.01).  Taking this into account, no significant differences between the groups were found immediately after injury or 1 year later.
2. No significant initial differences were found between the groups on anxiety and depression when comparing pre, post and 1-year scores.
3. BDI scores were significantly lower for both conditions one year after injury (p=0.014).
4. Neither anxiety nor self-esteem scores improved significantly over the year.
5. Those who scored higher than 14 on the depressive mood scale were analyzed using repeated measures ANOVA.  22 persons (from both groups) were looked at.  Significant differences were noted between the groups (p<0.01). 
6. Significant differences were also noted across time for the BDI scores (p<0.01).  Post hoc tests showed that the treatment group had significantly greater levels of improvement across time (p<0.05).

Craig et al. 1998a
Australia
Downs & Black score=21
Cohort
Initial N=69; Final N=58
N(Treatment)=27; N(Control)=31

Population: Treatment: Mean age=31yrs; Gender: males=23; females=5; Depression status=mixed group
Treatment: 10 week inpatient program. Small groups (4-5 per group), for 1.5 hours per week. Major aim was to provide cognitive and behavioural skills to cope with the psychological and social difficulties encountered upon entering the community. Cognitive behavioural therapy included muscle relaxation, visualization techniques, self-hypnosis and cognitive restructuring, social skills and assertiveness training, and sexuality sessions.
Outcome Measures: STAI; BDI.

1. No significant differences were noted across time for anxiety but there were significant differences noted for depression overall, (p<0.05).
2. Both the treatment and the control groups appeared to be less depressed 1 and 2 yrs after injury. 
3. For individuals who scored high on the depression scale before therapy, (9 from each group) there were significant differences after treatment.  (p<.01) with the control group reporting higher levels of depressive mood.
4. Depressive mood scores showed significant differences across time (p<0.01) with scores 1 and 2 years post injury significantly lower than pretreatment scores (p<0.01).
5. Those that scored high on the anxiety scale (n=19 in total), there were significant differences in scores overall across time (p<0.1) with anxiety scores decreasing over time.

King & Kennedy 1999
UK
Downs & Black score=20
Prospective controlled trial
Initial N=38; Final N=38

Population: Ages = 16–65 yrs; Chronicity = acute. Depression status=mild
Treatment: Consisted of 60-75 minute sessions run twice a week in small groups of 6 to 9 people. Sessions included a mixture of didactic presentations, practical exercises and time allocated for open group discussions. Following components made up the program: appraisal training, cognitive behavioural coping skills training, and strategies for choosing an adaptive match between appraisals and coping skills, and obtaining and maintaining social support.
Outcome Measures: FIM, SSQ, BDI, STAI. COPE.

Pre-intervention comparisons of groups:

1. The intervention group used religion significantly more and humour significantly less as coping strategies (p<0.05) than did controls.
2. There were no pre-intervention differences between the groups on range of injury, social support, FIM scores, other coping strategies, depression or anxiety.

Post-intervention comparison of groups:

1. Depression and Anxiety: Across time there were significant decrease in the depression scores (p<0.05) but not for anxiety (p=ns).
2. Coping: No significant differences between the groups or across time.

Norrbrink Budh et al. 2006
Downs & Black score=19
Prospective controlled trial
N=38
N(control)=11; N(treatment)=27

Population: Treatment: Mean age=53.2yrs; Gender: males=9, females=18; Level of injury: C=15, Th=6, L/S=6; Severity of injury: AIS: A=4, C=3, D=19, E=1; Controls: Mean age=49.9yrs; Gender: males=5, females=6; Level of injury: C=4, Th=7; Severity of injury: AIS: A=6, D=5; Depression status=mixed
Treatment: The intervention group received education, CBT, relaxation and body awareness training totaling five hours weekly over a 10 week period while matched controls received no treatment for neuropathic pain. Depression was assessed as a secondary outcome.
Outcome Measures: HADS

1. At 1 year follow up, the sign test showed no significant change in depression and anxiety levels HADS in the treatment group from baseline.
2. However, the treatment group showed systematic decrease in anxiety and depression as measured by relative change in position (95% confidence interval) at one year follow up.
3. Depression also decreased systematically in the treatment group compared to the control group at 1 year follow up; however, the sign test showed no significant change

Dorstyn et al. 2010
Downs & Black score=19
Prospective controlled trial
N=24
N(control)=13; N(treatment)=11

Population: Treatment: Mean age=53.2yrs; Gender: males=9, females=2; Level of injury: paraplegia=6, quadriplegia=5; Severity of injury: complete =8, incomplete=3; Control: Mean age=44.5yrs; Gender: males=11, females=2; Level of injury: paraplegia=8, quadriplegia=5; Severity of injury: complete =11, incomplete=2;
Treatment: Patients were assessed using the DASS-21. Those with subclinical DASS-21 scores were placed in the control group. Those with moderate to severe scores were offered individual CBT treatment for a range of 7 to 22 sessions for 30-60mins each. These patients were also prescribed low dose amitriptyline as well as 5 control participants for neuropathic pain.
Outcome Measures: DASS-21

1. Mood had no effect on functional independence measure outcomes at admission or discharge.
2. Total DASS-21 scores did not change significantly over time in the treatment group however, depression subscores varied significantly.
3. Mean depression subscores decreased significantly post interventions; however increased significantly at 3 month follow-up.
4. Similarly, DASS-21 total scores, anxiety subscores and stress subscores decreased post interventions and increased at 3 month follow-up.
5. DASS-21 scores for the control group did not change significantly over time.
6. At 3 month follow-up, 78% of individuals in the treatment group met clinical levels of caseness on the DASS-21; only 1 individual in the control group met these criteria.
7. These individuals lacked continued psychological support.

Kennedy et al. 2003
UK
Downs & Black score=19
Cohort
Initial N=85; Final N=85

Population: SCI: Age = 16-65 yrs; Cause of injury: trauma; Chronicity = acute. Depression status=mild (BDI=15)
Treatment: Consisted of 7, 60-75 minutes sessions that ran twice a week in small groups of 6-9 participants. Session topics were: normalizing stress, appraisal skills, problem solving, examination of thoughts feeling and behavior, awareness of negative assumptions, and choosing appropriate ways both to cope and to increase social supports.
Outcome Measures: BDI, STAI, CSS, SPS, and FIM. Measures were taken before and immediately after the intervention, and at a 6wk follow-up with the intervention group, and every 6 weeks with the historic control group.

Pre-intervention comparisons of groups:

1. Intervention group was older more likely to have a complete injury and to have been injured longer than the control group (p<0.01).
2. Intervention group tended to use active and religious coping strategies (p<0.05).
3. Intervention group tended to use drugs/alcohol less frequently (adjusted for unequal variance p<0.05).

Post-intervention comparison of groups:

1. Overall the intervention was successful in decreasing both depression and anxiety.
2. Mood: Depression scores decreased for the intervention group following the intervention (p=0.001).
3. Anxiety: Decreased for the intervention group following the intervention (p=0.001).
4. Coping: Alcohol use was significantly lower for the intervention group, (p=0.003).
5. Self Perception Scale: Intervention group only-ideal self scores had significantly greater scores than either how they would see themselves without injury (p<0.05) or “as I am” on all items (p<0.001).

Craig et al. 1999 Australia
Downs & Black score=18
Case Control
Initial N=58; Final N=58

Population: SCI: Age = 16-73 yrs; Gender: males = 57, females = 12; Severity of injury: complete = 68%-71%; Chronicity = acute. Depression status=mixed group
Treatment: 10 weeks in small groups.  Each session lasted from 1.5 to 2 hours replacing normal rehab therapy.  Patients underwent cognitive behaviour therapy (CBT) attempts to change behaviour and feeling associated with the problem and considered maladaptive.  Main aim of the program was to provide cognitive and behavioural skills to cope with the psychological and social difficulties encountered upon entering the community (as described above).
Outcome Measures: Re-admissions, drug usage, relationships, social discrimination, self-reports of adjustment

Percentages are reported for each area measured.

1. Re-admission: More control were readmitted following discharge (p<0.05).
2. Drug usage: Controls were found to have higher self-reported drug usage than the treatment group (cases) (p<0.05).
3. Relationships and Social discrimination: No significant differences were noted between the two groups in relation to the types of relationship each person developed.
4. Self-reports of adjustment: Treatment groups said they had a higher number of persons who felt they had adjusted well compared to the controls (p<0.01).

Craig et al. 1998b
Australia
Downs & Black score=17
Prospective Controlled Trial (longitudinal)
(Continuation of
Craig et al. 1997)
Initial N=69; Final N=58

Population: SCI: Age = 16-73 yrs; Gender: males = 57, females = 12; Severity of injury: complete = 68%-71%. Chronicity = acute. Depression status=mixed
Treatment: 10 week program.
Small groups (4-5 per group), for 1.5 hours per week. Major aim was to provide cognitive and behavioural skills to cope with the psychological and social difficulties encountered upon entering the community. Cognitive behavioural therapy included muscle relaxation, visualization techniques, self-hypnosis and cognitive restructuring, social skills and assertiveness training, and sexuality sessions.
Outcome Measures: LCB, BDI.

1. No pre-treatment differences between the treatment and the control groups on LCB.
2. No significant differences were found between groups overall for locus of control as a result of treatment.
3. No significant differences occurred across time for LCB.
4. No significant interactions present between group and time.
5. A repeated measure MANOVA was completed on participants (n=26) who scored higher than 33 on the LCB.
6. Significant differences were noted between the two groups (p<0.05).  
7. Across time there was a significant reduction in LCB scores across time.  (p<0.05).
8. Post hoc Scheffe tests indicated post-treatment scores to be lower than pre-treatment scores (p<0.01).
9. A significant association was found between depressive mood and locus of control post-therapy, 1 year later and 2 years later.
10. For the control group locus of control was mildly associated with depressive mood and for the treatment group’s locus of control was not significantly associated with depressive mood at anytime.