Abstract
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.
Highlights
Depression is one of the more severe and serious health problems because of its morbidity, disabling effects and for its societal and economic burden
The present study aims to adapt dilemma-focused therapy (DFT) to a specific individual intervention for unipolar depression combined with cognitive behavioral therapy (CBT) in a group format, the effectiveness of the latter having been already demonstrated [45]
Because DFT is not conceived as a whole treatment for depression, but rather as an ingredient which can be added to other therapies, the study is designed to test the efficacy of a combined package which includes DFT as a substantial component
Summary
Depression is one of the more severe and serious health problems because of its morbidity, disabling effects and for its societal and economic burden. 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. Cognitive behavioral therapy (CBT) has acquired more prestige and is backed by more research in efficacy [7,8], without this resulting in a fully satisfactory solution for the treatment of depression. Another issue raised by Haby and colleagues [9] is that the said efficacy cannot be asserted on the basis of existing research in languages other than English. Efficacy studies in Spanish are scarce and have very small samples
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