personal dilemmas as cog vulnerability factors in dep_rev

8/6/2019 Personal Dilemmas as Cog Vulnerability Factors in Dep_rev

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Personal dilemmas as cognitivevulnerability factors

42nd. International Meeting of theSociety for Psychotherapy Research

June 29 July 2, 2011

Bern, Switzerland

Guillem Feixas (UB), Victoria Compa (UB),Adrin Montesano (UB), Luis Angel Sal (UNED)

This work has been supported by the Spanish Ministry of Scienceand Innovation, grant ref. PSI2008-00406.


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Cognitive factors affecting depression Early models (Beck et al in the seventies)

negative views of self, the world and the future cognitive errors and other attribution biases

Recent contributions

process ng o se -re eren a s mu memory (both implicit and explicit) biases deficits in the control of attention (rumination) need for assessing self-relevant stimuli and depth of

processing (Wisco, 2009)

no traces of cognitive or internal conflicts.


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The notion of internal conflict

Conflicts and personal dilemmas have been

credited for their importance in psychology Psychoanalysis was founded on the notion of

conflict in terms of the internal d namics of the psyche

Piaget used the term cognitive conflict torefer to contradictions the child encounterswhen trying to explain events

Also in Gestalt Therapy, Bernes Transactional

Analysis, and other approaches.


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In Cognitive Analytic TherapyComing from and object relations and personal

construct background, Ryle (1979) underlinedthe importance of dilemmas. They were one of the seeds for his cognitive analytic approachwhich was developed later: "Dilemmas can be expressed in the form of "either/or"

(false dichotomies that restrict the range of choice),or of "if/then" (false assumptions of association thatsimilarly inhibit change). Two common dilemmascould be expressed as follows: 1) "in relationships Iam either close to someone and feel smothered, or Iam cut off and feel lonely"; () 2) "I feel that if I ammasculine then I have to be insensitive" ( italics in theoriginal).


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Social cognitive theorists (Festinger, Heider)where also focused on conflicts and effortshuman do to balance them

HOWEVER, little has been done in terms of

thus, little research has been done

Even less is known about the role of conflicts forboth physical and psychological health,development, and change (psychotherapy)


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Personal Construct Theory

Kelly (1955) sees the human being verymuch as a scientist who createshypotheses in order to make it easier to

. These hypotheses are personal constructs

which are basically bipolar in nature. Constructs are the grasping of differences,

discriminations we make in ourexperience.


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PCT: core vs. peripheral constructs A person is obviously not guided by one only

construct but by an entire network of meanings. This system consists of hierarchically arranged

personal constructs.

e mos cen ra or core cons ruc s are osethat define the person's identity. In addition, there are more peripheral constructs

that, although subordinate to these coreconstructs, are actively involved in construingevents and further actions.


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PCT: Identity, fragmentation In the core of the construct system lies the sense of

identity, represented by a set of core constructs whoseinvalidation produces great distress, and is stronglyresisted.

This portion of the system is mainly non-verbal orimplicit but governs decisions taken at lower, more

. It also might produce plans and personal goals that in

certain situations become incompatible. IT IS NOT A LOGICAL SYSTEM

The person is not aware of all its components, neitherof the conflicts created by the fragmentation of thesystem.


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Repertory Grid Technique (RGT) The RGT is a structured procedure designed to elicit

a repertoire of constructs and to explore theirstructure and interrelations.

Its aim is to describe the ways in which people give

meaning to their experience in their own terms. It is not so much a test in the conventional sense of

the word as a structured interview designed to

make those constructs with which persons organisetheir world more explicit.


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A Repertory Grid consists of: a series of elements that are

representative of the content area understudy,

a set of personal constructs that thesubject uses to compare and contrastthese elements,

a rating system (e.g., from 1 to 7) thatevaluates the elements based on the

bipolar arrangement of each construct.


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Teresas grid


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Self-congruency andself-discrepancy in the RGT

To study the construction of the self, the RGT

includes these two elements: SELF NOW (How I see myself now?)

IDEAL SELF How I wou i e to eConstructs in which SN and IS are close are

termed congruent and those in which theyare set apart discrepant


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Types of cognitive conflictidentified with the Repertory Grid

Implicative dilemmas

based on the association between acongruent and a discrepant construct

Dilemmatic constructs

based on the central position of the IDEALSELF in a given construct


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ConcernedConcernedaboutabout othersothers

SelfishCongruentConstruct

An example of Implicative Dilemma

Gets depressedeasily Does not getDepressed easily

Discrepant

Construct

r = 0,41


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Cognitive conflict A type of cognitive structure Related to identity (core constructs), implicit or

tacit, resistant to change A particular form of organization that links

. .,overcome my shyness) to core values (e.g., I ammodest) in a conflictive way (e.g., If I become

social I might also end up being arrogant BUT If I want to keep my modesty I have to remaintimid)


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Cognitive conflict: Clinical Implications Leaving the symptom pole of a construct,

while desirable, may carry negativeimplications

traits central to the clients sense of identity

Abandoning the symptom would involve a

major change in the system

being adifferent, undesirable, type of person


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EMPIRICAL STUDY

work in progress,

(data collected until April, 2011)


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MAIN HYPOTHESIS Cognitive conflicts are especially prevalent in

unipolar depression, and may therefore play arole in its etiopathogenesis and/or itsmaintenance. Thus, cognitive conflicts may helpo exp a n e cu y o ese pa en s o

overcome their disphoric mood. The role of these conflicts varies depending on

the type of depression (dysthimic vs. majordepressive disorder)

A higher presence of conflicts is associated withsymptom severity and chronicity.


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Participants: clinical sample Group A : Major Depression (n = 69, 55 women and 14 men).

Inclusion criteria: Meet diagnostic criteria for major depressive

disorder according to DSM-IV-TR (APA, 2002) and a score above 19in the BDI-II questionnaire. Group B : Dysthymia (n = 12, 9 women and 3 men): Criteria for

inclusion: Meet diagnostic criteria for dysthymic disorder according- - - .

Exclusion criteria : are excluded from groups A and B persons havingbipolar disorder, psychotic symptoms, substance abuse, organicbrain dysfunction or mental retardation. The presence of othercomorbidities (anxiety disorders, eating, personality, etc.) will notbe a reason for exclusion but will be evaluated for statistical control.Depending on the number of participants who met criteria for bothdiagnoses (called "double depression") assess its treatment as adistinct group or their exclusion from the study.


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Participants: non-clinical samples 65 psychology students (graduate and

undergraduate):50 women (77%) 15 hombres (23%)

80 participants from a community sample45 women (56%) 35 men (44%)


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Instruments

SCID-I (First, Spitzer, Gibbon and Williams, 1999)for the diagnosis of mental disorders and thecollection of socio-demographic data andconsumption of psychotropic drugs.

-depressive symptoms.

Repertory Grid Technique (Fransella, Bell &Bannister, 2004; Feixas and Cornejo, 1996) for

evaluating the presence, number and intensity of cognitive conflicts, construction of the self andcognitive structure.


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Results: Presence of Implicative Dilemma(s)

60

70

80

Percentage of participants withImplicative Dilemma(s)

50

60

70

80

Percentage of participants withImplicative Dilemma(s)

0

10

20

30

40

MajorDep Dysthimya Students Community

0

10

20

30

40

Depression Control

p = 0.02


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Number of Implicative Dilemmas (I)

2,5

3

3,5

Proportion of Implicative Dilemmas

2,5

3

3,5

Proportion of ImplicativeDilemmas

0

0,5

1

1,5

2

MajorDep Dysthymia Stude nts Community0

0,5

1

1,5

2

Depression Control

p < 0.000 in all comparisons (dysthimia was not compared)


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Number of Implicative Dilemmas (II)Major Depression Dysthymia Students Community

N = 69

X = 3,08(SD = 3,89)

N =12

X = 2,58(SD = 4,43)

N = 65

X = 1,22(SD = 1,95)

N = 80

X = 0,85(SD =1,73)

Comparing with Major Depression p = 0,000 p = 0,000


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Presence of ID(s) and depressive symptoms

15

2025

30

35

40

Absence of IDs

Presence of ID(s)BDI-II

0

5

10

Depression Control

ID(s) Depression group Control group

Absence N = 23; X = 37,13 (DT = 11,40) N = 74; X = 4,43 (DT = 3,88)

Presence N = 58; X = 33,53 (DT = 9,35) N = 71; X = 7,90 (DT = 6,70)

p 0,147 0,000


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Presence of ID(s) and depressive symptoms (II)

ID(s) Major Depression Students CommunityAbasence N = 19

X = 37,47(SD = 11,34)

N = 26X = 4,12

(SD = 3,83)

N = 48X = 4,60

(SD = 3,94)

Presence N = 50X = 34,16

(SD = 9,48)

N = 39X = 8,64

(SD = 7,57)

N = 32X = 7,00

(SD = 5,45)

p 0,224 0,007 0,025


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Presence of ID(s) and cronicity

MDD (single e.)

N = 32

MDD (recurrent)

N = 37

Dysthymia

N = 12

Presence of Implicative 68,8% (22) 75,7% (28) 66,7% (8)Dilemma(s)


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Presence of Dilemmatic Construct(s) (DC)

Major Depression Dysthymia Students Community

Depression Control

60,5% (49) 73,1 % (106)

60,87 % (42) 58,3 % (7) 75,4 % (49) 71,3 % (57)

About 90% of the clinical sample presented either ID(s) or DC(s)


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Conclusions Cognitive conflicts might explain the blockage

and the difficult progress of patients withdepression

resolution of these internal conflicts.


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New project

An intervention focused on the cognitive conflict(s)specifically detected for each patient will

contribute to enhance the efficacy of psychotherapy for depression.A therapy manual is being developed and tested

outcome of two treatment conditions:1. A cognitive-behavioral treatment package (8 group

+ 8 individual sessions)

2. A package combining CBT (8 group sessions) and adilemma-focused intervention (8 individual sessions)We expect that this combined package will increase

the efficacy in the treatment of depression


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Many thanks for your attention!!

[email protected]

http://www.usal.es/tcp

personal dilemmas as cog vulnerability factors in dep_rev

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