title: Efficacy of a dilemma-focused intervention for unipolar depression: study protocol for a multicenter randomized controlled trial.
abstract: BACKGROUND
  Depression 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.
  
  
  METHODS
  A 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).
  
  
  METHODS
  Participants 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.
  
  
  CONCLUSIONS
  We 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.
  
  
  BACKGROUND
  ISRCTN92443999; ClinicalTrials.gov Identifier: NCT01542957.
authors.affiliation: Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, Universitat de Barcelona, Campus Mundet, Passeig Vall Hebron, 171, Barcelona, Spain. gfeixas@ub.edu
authors.forename: Guillem
authors.initials: G
authors.lastname: Feixas
authors.forename: Arturo
authors.initials: A
authors.lastname: Bados
authors.forename: Eugeni
authors.initials: E
authors.lastname: García-Grau
authors.forename: Adrián
authors.initials: A
authors.lastname: Montesano
authors.forename: Gloria
authors.initials: G
authors.lastname: Dada
authors.forename: Victoria
authors.initials: V
authors.lastname: Compañ
authors.forename: Mari
authors.initials: M
authors.lastname: Aguilera
authors.forename: Marta
authors.initials: M
authors.lastname: Salla
authors.forename: Joan Miquel
authors.initials: JM
authors.lastname: Soldevilla
authors.forename: Adriana
authors.initials: A
authors.lastname: Trujillo
authors.forename: Clara
authors.initials: C
authors.lastname: Paz
authors.forename: Lluís
authors.initials: L
authors.lastname: Botella
authors.forename: Sergi
authors.initials: S
authors.lastname: Corbella
authors.forename: Luis Angel
authors.initials: LA
authors.lastname: Saúl-Gutiérrez
authors.forename: José
authors.initials: J
authors.lastname: Cañete
authors.forename: Miquel
authors.initials: M
authors.lastname: Gasol
authors.forename: Montserrat
authors.initials: M
authors.lastname: Ibarra
authors.forename: Leticia
authors.initials: L
authors.lastname: Medeiros-Ferreira
authors.forename: José
authors.initials: J
authors.lastname: Soriano
authors.forename: Eugénia
authors.initials: E
authors.lastname: Ribeiro
authors.forename: Franz
authors.initials: F
authors.lastname: Caspar
authors.forename: David
authors.initials: D
authors.lastname: Winter
mesh_terms: D002985:Clinical Protocols; D015928:Cognitive Behavioral Therapy; D003220:Conflict, Psychological; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D006801:Humans; D018187:Personal Construct Theory; D011569:Psychiatric Status Rating Scales; D011615:Psychotherapy, Group / Q000379:methods*; D012107:Research Design; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome