CC a neglected Indiv Difference_rest of slides.pdf

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A S T U D Y O F I D E N T I T Y R E L A T E D C O N F L I C T S I N M A J O R

D E P R E S S I O N

P a p e r p r e s e n t e d a t t h e 2 0 1 3 m e e t i n g o f t h e I n t e r n a t i o n a l S o c i e t yf o r t h e S t u d y o f I n d i v i d u a l D i f f e r e n c e s , B a r c e l o n a .T O WAT C H F I R S T PA RT ( A U D I O S L I D E S ) :D O I : 1 0 . 1 0 1 6 / J . PA I D . 2 0 1 3 . 0 7 . 0 3 3

Rest of the slides ofCognitive conflicts: A neglected Individual

Difference?

Guillem Feixas Adrián Montesano

Clara Paz

http://www.sciencedirect.com/science/article/pii/S019188691300319X

http://www.sciencedirect.com/science/article/pii/S019188691300319X



Symptom Severity and IDs

BDI-IIModerate positive correlation with number of dilemmas.

rho = .32, n = 240, p < .01

Significant differences in scores for participants with/withoutIDs

t-test

IDs N Mean SD

yes 133 28.3 15.8

no 107 18.2 17.7t (215) = -4.61, p < .01 (two tailed)Eta squared = .08 (medium effect size)



Chronicity and IDs: Single Episode vs. Recurrent

Presence of IDs73.2 % (52) of patients with a diagnosis of recurrentdepression had al least one ID

Non-significant difference with single episode patients

Number of IDs

Diagnosis N Mean Sd

Single 75 2.14 3.61

Recurrent 71 3.16 3.75

U = 2149,5, z = -2.04, p = .04, r = .24 (small effect size)



Global Functioning and IDs

GAF (DSM-IV-R)57 patients were in sick leave:

70.2 % had IDs and 29.8 % did not

Moderate negative correlation of GAF with number of IDs.rho = -.22, n = 145, p = .007

Significant differences in scores for clinical participants with/without IDs.

t-test

IDs N Mean SD

Yes 100 56.4 7.2

No 46 60 7.4 t (144) = 2.33, p = .02 (two tailed)Eta squared = .036 (small effect)



Suicide and IDs

18 depressive patients (12.3 %) had tried to commitsuicide at least once.

Among these: 16 (89 %) presented with at least one ID while 2 did not.The BDI-II mean of participants with IDs was lower than

participants without conflicts.

IDs N Mean SD

Yes 16 36,63 10,92

No 2 45 5,66



Predictive power of Presence of IDs

The strongest predictor of belonging to the clinical sample waspresence of IDs, recording an odds ratio of 5.29. This indicatedthat participants who presented IDs were over 5 times morelikely to belong to the clinical sample, controlling for other

factors in the model.

B E.T. Wald DoF Sig.OddsRatio

I.C. 95% forodds ratio

Low UpPresence of ID(s) 1,66 ,37 19,58 1 ,000 5,29 2,53 11,06

Number of constructs -,07 ,03 5,04 1 ,025 ,92 ,86 ,99

Gender ,81 ,37 4,69 1 ,030 2,26 1,08 4,75

Age ,13 ,01 50,35 1 ,000 1,14 1,1 1,18

X2 (4, N =240) = 123.17, p < .01



0

5

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2025

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45

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Congruent Discrepant

Content analysis of IDs

Percentage of constructs in areas of content

Moral Emotional Relational Personal Intellectual Interests

Congruent 44,4 17,5 19,3 8,2 0,0 10,5

Discrepant 6,4 36,8 21,1 33,9 1,2 0,6Chi-square test

2 = 104.5; p < .01



Discussion



Presence and Number of Dilemmas

We found at least one ID in two thirds of thedepression sample in contrast to one third ofcontrols.

The difference between groups was underlined bythe fact that depressed participants had more IDs.Presence of IDs was the strongest predictor of belonging to the clinical sample.

Promising evidence for the relevanceof IDs in Major Depression.



Distress and Implicative Dilemmas

Symptom severity:Participants with at least one ID displayed higher levels of symptomsas measured by the BDI-II.The number of IDs was also associated to levels of symptoms.Patients with IDs might have a higher risk of committing suicide.

Chronicity:Patients with recurrent depression showed a greater number of IDsthan patients with single episode.

Global functioning: Among depressed participants, those who presented with one ormore IDs tended to display lower levels of global functioning.Moreover, the greater number of dilemmas was associated to lowerscores in the GAF.



Content of Implicative Dilemmas

Congruent constructs were mostly of moralnature and also of emotional warmthexpressing aspects of kindness and concern forothers.Content of discrepant constructs was usually relatedto the degree of emotional (un)balance and otherspecific emotions such as melancholy and sadness.

Implicative Dilemmas in depressed patientsinvolve the association of symptom improvement with undesired qualities such as emotional

coldness and negative moral values.



Key Points

The concept of ID might help explain the difficulties that therapistsfrequently encounter in fully engaging depressed patients intotherapeutic change and in preventing future relapses.

Cognitive conflicts and dilemmas are not specific of depression. Theycould be transversal to diagnostic entities.

IDs could constitute a focus of therapeutic work and allowindividualizing the design of the treatment to fit patient characteristics.

Exploring the patient’s cognitive conflicts right from the beginning oftherapy using the Repertory Grid Technique might help therapists toconsider them as a target of psychological intervention.



V i c to r i a Co mpa ñ , Ma r t a S a l l a , Ad r i á n C ha u ra nd ,

A dr i ana T ru j i l l o , O lga P u cu ru l l , G lo r ia Dada , L u i s Á ng e l S aú l , Ma r Co l à s an d o the r s

MANY THANKS !!!

F O R M O R E I N F O R M AT I O N : W W W. U S A L . E S / T C P

ht tp : / /www.ub .edu/gdne/gfe ixas

g f e i x a s @ u b . e d u

This presentation has been possiblethanks to the work of my

colleagues:

http://www.ub.edu/gdne/gfeixas/

http://www.ub.edu/gdne/gfeixas/

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