Cognitive conflicts and symptom severity in dysthymia: "I'd rather be good than happy" / Conflictos cognitivos y gravedad de los síntomas en la distimia: "Prefiero ser bueno que feliz"

A method for studying cognitive conflicts using the repertory grid technique is presented. By means of this technique, implicative dilemmas can be identified, cognitive structures in which a personal construct for which change is wished for implies undesirable change on another construct. We assessed the presence of dilemmas and the severity of symptoms in 46 participants who met criteria for dysthymia and compared then to a non-clinical group composed of 496 participants. Finally, an analysis of the specific content of the personal constructs forming such dilemmas was also performed. Implicative dilemmas were found in almost 70% of the dysthymic participants in contrast to 39% of controls and in greater quantity. In addition, participants in both groups with this type of conflict showed more depressive symptoms and general distress than those without dilemmas. Furthermore, a greater number of implicative dilemmas was associated with higher levels of symptom severity. Finally, content analysis results showed that implicative dilemmas are frequently composed of a constellation of moral values and emotion, indicating that symptoms are often related to moral aspects of the self and so change processes may be hindered. Clinical implications of targeting implicative dilemmas in the therapy context are discussed.

En este estudio se presenta un método para el estudio de los conflictos cognitivos utilizando la técnica de rejilla. Por medio de ella, se identificaron los dilemas implicativos, una estructura cognitiva en la que un constructo personal en el que se desea un cambio se asocia con otro constructo en el que el cambio no es deseable. Se evaluó la presencia de dilemas y la gravedad sintomatológica en una muestra de 46 participantes que cumplían criterios diagnósticos para la distimia y se comparó con un grupo control compuesto por 496 participantes. Por último, se llevó a cabo un análisis del contenido de los constructos personales que forman los dilemas. Se encontraron dilemas en casi 70% de la muestra clínica frente a 39% de la muestra control y en mayor cantidad. Por otro lado, los participantes de ambos grupos con este tipo de conflicto mostraron un nivel mayor de sintomatología depresiva y malestar general que aquellos sin dilemas. Además, se encontró una alta correlación entre el número de dilemas implicativos y la gravedad de los síntomas. Los resultados del análisis de contenido mostraron que los dilemas estaban frecuentemente formados por una constelación de valores morales y constructos emocionales indicando que a menudo los síntomas están asociados a aspectos positivos del sí mismo, por lo que el proceso de cambio puede verse bloqueado. Se discuten las implicaciones clínicas de abordar los dilemas en el contexto terapéutico.

Análisis de contenido de constructos personales en la depresión / Content analysis of personal constructs in depression

Kelly's Personal Construct Psychology (PCP) proposes that attributing meaning to experience is the most fundamental process of human psychological functioning. He describes psychological activity as a continuous process of creating, testing and revising personal theories (usually implicit) that allow people to understand and anticipate events. Personal constructs are the basic units of these personal theories. Constructs are bipolar contrasts of meaning that form an evolving network through which psychological processes are canalized. This system provides with a limited number of alternative views for explaining, anticipating and participating in life. One of the most significant contributions to psychological research made by PCP concerns the possibility to develop tools for the study of subjective construing. The Role Construct Repertory Grid (RepGrid) has been extensively used to explore the view subjects have of themselves, others and their problems. This technique elicits a sample of verbal descriptions of contrasting alternatives, his or her personal constructs; and provides several measures of self construing (e.g., self-esteem) and systems organization (e.g., complexity). Several authors point out the utility and pertinence of exploring the construct system in the evaluation of depressive disorders. They show the interest of studying the construct systems of depressive patients in order to measure some aspects that symptom and standard cognitive measures of cognitive distortions do not take into account. Depressive mood is highly influenced by the subject's view of him or herself and others, and by the organization of his or her constructs. However, the content of these personal constructs has received far less attention from researchers. The main goal of this article is to complement the PCP model of depression through the content analysis of personal constructs. In contrast with traditional content analysis, we do not evaluate the valency of the content but the principal meaning dimensions through which depressive people describe their interpersonal experience. According to PCP and other cognitive approaches, we hypothesize that the contents of the construct systems in the depressive sample are different from those of the control group. Specifically, we believe that the depressive group will show a higher number of constructs related to emotions and morality. The present study was carried out with 53 patients seeking psychological treatment in various private clinics in Barcelona who met DSM-IV criteria for depressive unipolar disorders. The non-clinical comparison group (n= 53), paired by sex and age with the clinical one, included volunteers recruited by graduate and undergraduate students from the University of Barcelona as part of their practical experience with the RepGrid, after receiving specific training in its administration. To compare the pattern of the construct system of both groups, we categorized the content of the personal constructs elicited with the RepGrid using the Classification System for Personal Constructs (SCCP) developed by Feixas et al. The SCCP is composed of six thematic areas (moral, emotional, relational, personal, intellectual, and values/interests) broken down into 45 different categories. Inter-rater agreement was used to determine the reliability of the SCCP. The results were very satisfactory regarding the percentage of agreement between judges. Cohen's Kappa coefficient confirmed the high level of reliability of the SCCP, which was higher than that obtained in previous studies. Data provides evidence of the differences in content frequency distributions between the clinical and non-clinical groups. People from the depressive sample tend to use more constructs related to emotions and less to intellectual issues. The depressive group showed more constructs within certain specific categories such as <>, <> and <>, and less constructs referring to sexuality. The results indicate that content patterns of depressed people show various specific thematic emphases. Indeed, from the wide range of stimuli coming from interpersonal experience, the emotional aspects acquire a special saliency. Although the exploratory nature of the present study does not allow us to establish causal inference, it seems evident that the tendency of depressive people to focus on the emotional dimension could play an important role in the maintenance of the depressive symptoms. Likewise, the lack of constructs concerning intellectual and personal issues reinforces the idea that depressed people tend to focus on the emotional aspects of the interpersonal experience. The results from the content analysis of specific categories show some contrasting features in the construing systems of both groups. The low self-esteem frequently reported for depressive subjects, a self-demanding attitude, and a negative image of the self are aspects potentially related to the <> dimension of meaning, which emerged as the most diverging dimension among the 45 categories within the six areas. On the other hand, constructs within the category <> allude to the focus on certain specific interpersonal aspects of experience. The concern about respect and power in relationships turns out to be an important meaning dimension, which is in line with the special interpersonal sensitivity displayed by depressive people when facing judgement and disapproval on the part of significant others. When we hypothesized that depressive people would present a greater number of moral constructs, we were considering that this higher frequency would be reflecting symptomatic aspects about perfectionism and self-demands. The explorative content analysis of this study has not shown enough sensitivity to this important feature of depressive people. Doubtlessly, a more refined research strategy is necessary in order to achieve a better understanding of the role played by morality in the construing systems. Finally, from the limitations of the present study, some issues are proposed for future lines of research. The combination of content and structural aspects, such as implicative dilemmas, seems to be the best alternative for the evaluation of the construct systems of depressive people. Thus, the advantages of studying the organization and the thematic emphases of individual systems of meaning can be combined. In any case, these results provide evidence for the clinical and theoretical advantages of the SCCP in studying the content of personal meaning systems. Therefore, it seems to be a fruitful and useful assessment instrument which allows the clinician to understand the patient's problem in his or her own way of construing.

Desde el marco de la Psicología de los Constructos Personales (PCP) de Kelly, es posible estudiar de forma sistemática la construcción subjetiva que las personas hacen de sí mismas y de sus problemas. Feixas et al., destacan la pertinencia del estudio de los sistemas de construcción en la evaluación del trastorno depresivo puesto que miden aspectos que no son suficientemente valorados por las medidas cognitivas estándar sobre los síntomas y las distorsiones cognitivas. La mayoría de los trabajos sobre la depresión basados en la PCP se han centrado en las características estructurales, en cambio los aspectos del contenido han recibido menor interés. El propósito de este estudio es realizar un análisis de contenido de los constructos personales en la depresión. Actualmente no existe ningún estudio que haya explorado de forma sistemática las dimensiones de contenido más significativas para esta población. En concordancia con la PCP y otros enfoques cognitivos, hipotetizamos que el contenido de los sistemas de construcción de la muestra depresiva es distinto al de la población normal. En concreto, creemos que la población clínica presenta mayor frecuencia de constructos de tipo moral y emocional en comparación con la muestra no clínica. Para poder poner a prueba estas hipótesis se analizaron los constructos de 106 sujetos, con edades comprendidas entre los 19 y los 57 años, divididos en dos grupos, un grupo clínico (n = 53) de personas diagnosticadas con alguna modalidad depresiva unipolar y otro grupo no clínico (n = 53). Categorizamos el contenido de los constructos elicitados con la técnica de rejilla por medio del Sistema de Categorías de Constructos Personales (SCCP) desarrollado por Feixas et al. El SCCP es un sistema de clasificación compuesto por un total de seis áreas temáticas (moral, emocional, relacional, personal, intelectual y valores e intereses) que se desglosan en 45 categorías para codificar el contenido de los constructos personales. Los principales resultados muestran que existen diferencias significativas entre las distribuciones de frecuencias del contenido de ambas poblaciones. Las personas con depresión (PD) utilizan significativamente más constructos de tipo emocional, y menos de tipo intelectual. Además, en comparación a la muestra normal, los depresivos muestran mayor número de constructos en las categorías <>, <> y, de forma más destacada, en la dimensión <>. Los resultados indican que el patrón prototípico del contenido de los sistemas de constructos de las PD difiere en el énfasis temático predominante. En efecto, de la variedad de acontecimientos de la experiencia, los aspectos conativos resultan especialmente notorios para las personas con depresión. Por otro lado, la carencia de constructos intelectuales y personales refuerza la idea de que las personas con depresión emplean gran parte de su actividad mental en el procesamiento de los aspectos emocionales de la experiencia. Aunque la naturaleza exploratoria de este estudio no permite establecer líneas causales, parece evidente que la focalización de la actividad psicológica de las PD en la dimensión afectiva de la experiencia puede estar desempeñando un papel importante en el mantenimiento de la problemática depresiva. Por último, a partir de las limitaciones de este estudio se proponen algunos diseños para la investigación futura acerca de la relación entre el contenido y la estructura de los sistemas de construcción de las personas con depresión.