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International Meeting of the Society for Psychotherapy Research June 29 July 2, 2011 Bern, Switzerland
Recent contributions
processing of self-referential stimuli 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)
Social cognitive theorists (Festinger, Heider) where also focused on conflicts and efforts human do to balance them HOWEVER, little has been done in terms of defining conflicts in an operational way, and thus, little research has been done Even less is known about the role of conflicts for both physical and psychological health, development, and change (psychotherapy)
Teresas grid
Congruent Construct
Selfish
r = 0,41
Discrepant Construct
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 specific cognitive contents (e.g., I wish to overcome my shyness) to core values (e.g., I am modest) 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 remain timid)
EMPIRICAL STUDY
work in progress, (data collected until April, 2011)
MAIN HYPOTHESIS
Cognitive conflicts are especially prevalent in unipolar depression, and may therefore play a role in its etiopathogenesis and/or its maintenance. Thus, cognitive conflicts may help to explain the difficulty of these patients to overcome their disphoric mood. The role of these conflicts varies depending on the type of depression (dysthimic vs. major depressive disorder) A higher presence of conflicts is associated with symptom severity and chronicity.
Instruments
SCID-I (First, Spitzer, Gibbon and Williams, 1999) for the diagnosis of mental disorders and the collection of socio-demographic data and consumption of psychotropic drugs. BDI-II (Sanz, shot and Vazquez, 2003) for assessing 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 and cognitive structure.
70 60 50 40 30 20 10 0 Depression Control
MajorDep
Dysthimya
Students
Community
p = 0.02
ID(s) Abasence
Presence
Conclusions
Cognitive conflicts might explain the blockage and the difficult progress of patients with depression Need for specific interventions focused in the resolution of these internal conflicts.
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 using a randomized clinical trial by comparing the 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 a dilemma-focused intervention (8 individual sessions)
We expect that this combined package will increase the efficacy in the treatment of depression