Implicative Dilemmas and Symptom Severity in Depression: A Preliminary and Content Analysis Study

Feixas, Guillem; Montesano, Adrián; Erazo-Caicedo, María Isabel; Compañ, Victoria; Pucurull, Olga

doi:10.1080/10720537.2014.850369

Cited by 24 publications

(19 citation statements)

References 15 publications

(11 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The existence of conflicts or dilemmas in the cognitive structure is more prevalent in depression, and could explain the blockage and relapses that characterize these patients, especially the more severe and/or chronic. Our hypothesis is not that these cognitive conflicts are the cause or the main factor maintaining the depression, but rather we believe the dilemmas commonly found in depressive patients [38,39] might reveal that their discomfort is congruent with a part of their cognitive system (while for another part the change is desirable). If these dilemmas are identified they should become a focus of the psychological intervention so as to not hinder the process of change.…”

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

Efficacy of a dilemma-focused intervention for unipolar depression: study protocol for a multicenter randomized controlled trial

Feixas

Bados

García-Grau

et al. 2013

Trials

Self Cite

View full text Add to dashboard Cite

BackgroundDepression is one of the more severe and serious health problems because of its morbidity, disabling effects and for its societal and economic burden. Despite the variety of existing pharmacological and psychological treatments, most of the cases evolve with only partial remission, relapse and recurrence.Cognitive models have contributed significantly to the understanding of unipolar depression and its psychological treatment. However, success is only partial and many authors affirm the need to improve those models and also the treatment programs derived from them. One of the issues that requires further elaboration is the difficulty these patients experience in responding to treatment and in maintaining therapeutic gains across time without relapse or recurrence. Our research group has been working on the notion of cognitive conflict viewed as personal dilemmas according to personal construct theory. We use a novel method for identifying those conflicts using the repertory grid technique (RGT). Preliminary results with depressive patients show that about 90% of them have one or more of those conflicts. This fact might explain the blockage and the difficult progress of these patients, especially the more severe and/or chronic. These results justify the need for specific interventions focused on the resolution of these internal conflicts. This study aims to empirically test the hypothesis that an intervention focused on the dilemma(s) specifically detected for each patient will enhance the efficacy of cognitive behavioral therapy (CBT) for depression.DesignA therapy manual for a dilemma-focused intervention will be tested using a randomized clinical trial by comparing the outcome of two treatment conditions: combined group CBT (eight, 2-hour weekly sessions) plus individual dilemma-focused therapy (eight, 1-hour weekly sessions) and CBT alone (eight, 2-hour group weekly sessions plus eight, 1-hour individual weekly sessions).MethodParticipants are patients aged over 18 years meeting diagnostic criteria for major depressive disorder or dysthymic disorder, with a score of 19 or above on the Beck depression inventory, second edition (BDI-II) and presenting at least one cognitive conflict (implicative dilemma or dilemmatic construct) as assessed using the RGT. The BDI-II is the primary outcome measure, collected at baseline, at the end of therapy, and at 3- and 12-month follow-up; other secondary measures are also used.DiscussionWe expect that adding a dilemma-focused intervention to CBT will increase the efficacy of one of the more prestigious therapies for depression, thus resulting in a significant contribution to the psychological treatment of depression.Trial registrationISRCTN92443999; ClinicalTrials.gov Identifier: NCT01542957.

show abstract

Section: Discussionmentioning

confidence: 95%

“…In addition, participants with IDs had a higher level of symptom severity. Feixas and colleagues [38], in a pilot study, found a higher proportion (59.60%) of depressed patients with at least one ID (versus 40.40% of the control group). Also in this study, symptom levels were associated with the number of these dilemmas.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of a dilemma-focused intervention for unipolar depression: study protocol for a multicenter randomized controlled trial

Feixas

Bados

García-Grau

et al. 2013

Trials

Self Cite

View full text Add to dashboard Cite

show abstract

“…Results from this study not only confirm those of a preliminary study of Feixas et al . () with depressive patients but they are also consistent with previous findings pointing out that IDs are more frequent in a variety of clinical samples (e.g., Compañ et al ., ; Dada, Feixas, Compañ, & Montesano, ; Melis et al ., ) including dysthymia (Montesano et al ., ). Arguably, this type of cognitive conflict is not specific to depression but might cut across several diagnoses.…”

Section: Discussionmentioning

confidence: 99%

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

Feixas

Montesano

Compañ

et al. 2014

British J Clinic Psychol

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…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.…”

Section: Introductionmentioning

confidence: 99%

“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Montesano¹,

Feixas²,

Caspar³

et al. 2017

Front. Psychol.

Self Cite

View full text Add to dashboard Cite

Negative self-views have proved to be a consistent marker of vulnerability for depression. However, recent research has shown that a particular kind of cognitive conflict, implicative dilemma, is highly prevalent in depression. In this study, the relevance of these conflicts is assessed as compared to the cognitive model of depression of a negative view of the self. In so doing, 161 patients with major depression and 110 controls were assessed to explore negative self-construing (self-ideal discrepancy) and conflicts (implicative dilemmas), as well as severity of symptoms. Results showed specificity for the clinical group indicating a pattern of mixed positive and negative self-descriptions with a high rate of conflict. Regression analysis lent support to the conflict hypothesis in relation to clinically relevant indicators such as symptom severity, global functioning. However, self-ideal discrepancy was a stronger predictor of group membership. The findings showed the relevance of cognitive conflicts to compliment the well-consolidated theory of negative self-views. Clinical implications for designing interventions are discussed.

show abstract

Implicative Dilemmas and Symptom Severity in Depression: A Preliminary and Content Analysis Study

Cited by 24 publications

References 15 publications

Efficacy of a dilemma-focused intervention for unipolar depression: study protocol for a multicenter randomized controlled trial

Efficacy of a dilemma-focused intervention for unipolar depression: study protocol for a multicenter randomized controlled trial

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

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

Contact Info

Product

Resources

About