Cognitive conflicts and symptom severity in dysthymia: “I’d rather be good than happy”

Abstract

SUMMARYA method for studying cognitive conflicts using the repertory grid technique is presented. By means of this technique, implicative dilemmas can be identified, cognitive structures in which a personal construct for which change is wished for implies undesirable change on another construct. We assessed the presence of dilemmas and the severity of symptoms in 46 participants who met criteria for dysthymia and compared then to a non-clinical group composed of 496 participants. Finally, an analysis of the specific content of the personal constructs forming such dilemmas was also performed. Implicative dilemmas were found in almost 70% of the dysthymic participants in contrast to 39% of controls and in greater quantity. In addition, participants in both groups with this type of conflict showed more depressive symptoms and general distress than those without dilemmas. Furthermore, a greater number of implicative dilemmas was associated with higher levels of symptom severity. Finally, content analysis results showed that implicative dilemmas are frequently composed of a constellation of moral values and emotion, indicating that symptoms are often related to moral aspects of the self and so change processes may be hindered. Clinical implications of targeting implicative dilemmas in the therapy context are discussed.Key words: Dysthymia, Repertory Grid Technique, cognitive conflicts, implicative dilemmas, content analysis, personal constructs. RESUMENEn este estudio se presenta un método para el estudio de los conflictos cognitivos utilizando la técnica de rejilla. Por medio de ella, se identificaron los dilemas implicativos, una estructura cognitiva en la que un constructo personal en el que se desea un cambio se asocia con otro constructo en el que el cambio no es deseable. Se evaluó la presencia de dilemas y la gravedad sintomatológica en una muestra de 46 participantes que cumplían criterios diagnósticos para la distimia y se comparó con un grupo control compuesto por 496 participantes. Por último, se llevó a cabo un análisis del contenido de los constructos personales que forman los dilemas. Se encontraron dilemas en casi 70% de la muestra clínica frente a 39% de la muestra control y en mayor cantidad. Por otro lado, los participantes de ambos grupos con este tipo de conflicto mostraron un nivel mayor de sintomatología depresiva y malestar general que aquellos sin dilemas. Además, se encontró una alta correlación entre el número de dilemas implicativos y la gravedad de los síntomas. Los resultados del análisis de contenido mostraron que los dilemas estaban frecuentemente formados por una constelación de valores morales y constructos emocionales indicando que a menudo los síntomas están asociados a aspectos positivos del sí mismo, por lo que el proceso de cambio puede verse bloqueado. Se discuten las implicaciones clínicas de abordar los dilemas en el contexto terapéutico.

Depression and Identity: Are Self-Constructions Negative or Conflictual?

“…A series of studies found that IDs are significantly more prevalent in depressive participants than in controls and that they are also associated with the severity of patients’ clinical status (Feixas et al, 2014a,b; Montesano et al, 2014). Based on these results, we sought to improve our understanding of the role of these internal conflicts on the cognitive system of depressed individuals, by testing out their relevance against the classical cognitive formulation of a negative view of the self.…”

“…A growing body of literature about intrapersonal conflict, nonetheless, has yielded promising support for its role in mental health and motivational processes (Lauterbach, 1996; Grawe, 2004; Mansell, 2005; Carey, 2008; Feixas et al, 2014b; Montesano et al, 2014). Distressing effects of inner conflicts have been observed to be influencing the onset and maintenance of a variety of psychological disorders (see Michalak et al, 2011, for a review) as well as to be associated with subjective well being and life satisfaction (Palys and Little, 1983; Little et al, 2007).…”

“…They are constructs in which the self and the ideal self are close to each other, allocated to the same pole of the construct (e.g., good person), and therefore the person perceives congruency between the present self and the ideal self. These are mostly core constructs that are connected to personal values, beliefs, and attitudes that define the central sense of an individual’s identity (Montesano et al, 2009, 2014); therefore, a person would resist changing to avoid self-invalidation. In the example, both the actual self and the ideal self of the participant are regarded as “good person” as opposed to “bad person.”…”

“…Specifically, researchers reported percentages of 68.3% of patients with a diagnosis of major depression (Feixas et al, 2014a) and 69.6% in a sample with dysthymia (Montesano et al, 2014) in contrast to roughly a third of non-clinical individuals. In addition, depressed patients tended to show a much higher number of IDs, to the extent of tripling the number in control groups.…”

“…But in our view, the main problem for changing these negative views is that often they are connected in a conflictual way with other positive views which are more central to the sense of identity in that they involve core self-constructions. In depressive patients, congruent constructs mostly concern self-perceived moral qualities (such as “sensitive,” “cares for others,” “good person”; see Montesano et al, 2014). Therefore, the opposite poles of these core constructs are really undesirable for these patients who try to avoid movement toward those poles (e.g., “insensitive,” “selfish,” “bad person”).…”