The objective of the study was to examine changes in coping and their predictors in patients in the chronic phase after an acquired brain injury with prominent neuropsychiatric symptoms. Patients with brain injury were recruited from consecutive admissions to the outpatient clinics of four mental health centers in the Netherlands. Patients received psychoeducation and/or one or more individual treatment sessions that were not targeting coping styles. Forty-two patients and thirty-two significant others participated. Patients reported a significantly greater use of passive and avoidance coping than both the general population and patients with brain injury without neuropsychiatric symptoms. There were statistically significant increases in avoidance coping between T1 and T2 (t = 2.0; p < 0.05). Less neuropsychiatric symptoms at T1 were associated with increases in avoidance coping, and more neuropsychiatric symptoms were associated with decreases in avoidance coping (β = -3.3; p < 0.001). Patients' underestimation of their deficits at T1 was associated with greater increases in active coping (β = -2.33; p < 0.05) than were patients' accurate estimation and overestimation of deficits at T1. Self-reported executive functioning at T1 was not associated with changes in coping. In conclusion, avoidance coping increased in the chronic phase after brain injury. The changes in coping could partially be explained by the level of neuropsychiatric symptoms and the level of self-awareness but not by self-reported executive functioning, which should be considered in treatment programs.