Cognitive conflicts in major depression: Between desired change and personal coherence

Abstract

ObjectivesThe notion of intrapsychic conflict has been present in psychopathology for more than a century within different theoretical orientations. However, internal conflicts have not received enough empirical attention, nor has their importance in depression been fully elaborated. This study is based on the notion of cognitive conflict, understood as implicative dilemma (ID), and on a new way of identifying these conflicts by means of the Repertory Grid Technique. Our aim was to explore the relevance of cognitive conflicts among depressive patients.DesignComparison between persons with a diagnosis of major depressive disorder and community controls.MethodsA total of 161 patients with major depression and 110 non-depressed participants were assessed for presence of IDs and level of symptom severity. The content of these cognitive conflicts was also analysed.ResultsRepertory grid analysis indicated conflict (presence of ID/s) in a greater proportion of depressive patients than in controls. Taking only those grids with conflict, the average number of IDs per person was higher in the depression group.In addition, participants with cognitive conflicts displayed higher symptom severity. Within the clinical sample, patients with IDs presented lower levels of global functioning and a more frequent history of suicide attempts.ConclusionsCognitive conflicts were more prevalent in depressive patients and were associated with clinical severity. Conflict assessment at pre-therapy could aid in treatment planning to fit patient characteristics.Practitioner points Internal conflicts have been postulated in clinical psychology for a long time but there is little evidence about its relevance due to the lack of methods to measure them. We developed a method for identifying conflicts using the Repertory Grid Technique. Depressive patients have higher presence and number of conflicts than controls. Conflicts (implicative dilemmas) can be a new target for intervention in depression. Cautions/Limitations A cross-sectional design precluded causal conclusions. The role of implicative dilemmas in the causation or maintenance of depression cannot be ascertained from this study.

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.…”

“…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.…”

A Dilemma-Focused Intervention for Depression: A Multicenter, Randomized Controlled Trial With a 3-Month Follow-Up

“…Using the definition of cognitive conflicts as implicative dilemmas, several studies have found this notion clinically relevant to the understanding of psychological distress in a variety of different disorders . Specifically, some authors indicate that the presence of implicative dilemmas was greater in people with depression than in control groups . Moreover, depressed patients with implicative dilemmas presented lower levels of global functioning and more frequent history of suicide attempts .…”

Content Analysis of the Construction of Self and Others in Women with Bulimia Nervosa

“…Previous studies (Feixas et al, 2002; Montesano et al, 2009; Compañ et al, 2011; Feixas et al, 2014) have confirmed a high level of reliability of the CSPC. In effect, inter-rater agreement between judges encoding the same constructs separately and after discussing discrepancies in codings showed indices between 0.90 and 0.95 for both areas and categories.…”

“…The CSPC has been used in previous research to analyze the patterns of construct content related to different clinical samples, such as patients with depression (Montesano et al, 2009; Feixas et al, 2014), women with fibromyalgia (Compañ et al, 2011) and victims of sexual abuse (Harter et al, 2004). To the extent of our knowledge, the content of personal constructs from BN patients has not been studied yet.…”