A DILEMMA-FOCUSED INTERVENTION FOR DEPRESSION: A MULTICENTER, RANDOMIZED CONTROLLED TRIAL WITH A 3-MONTH FOLLOW-UP.
Since long ago it has been asserted that internal conflicts are relevant to the understanding and treatment of mental disorders, but little research has been conducted to support the claim. The aim of this study was to test the differential efficacy of group cognitive behavioral therapy (CBT) plus an intervention focused on the dilemma(s) detected for each patient versus group individual CBT plus individual CBT for treating depression. A comparative controlled trial with a 3-month follow-up was conducted.



One hundred twenty-eight adults meeting criteria for MDD and/or dysthymia, presenting at least one cognitive conflict (implicative dilemma or dilemmatic construct, assessed by the repertory grid technique) and who had completed seven sessions of group CBT were randomly assigned to eight sessions of individual manualized CBT or dilemma-focused therapy (DFT). The Beck Depression Inventory-II was administered at baseline, at the end of therapy and after 3 months' follow-up.



Multilevel mixed effects modeling yielded no significant differences between CBT and DFT with the intention-to-treat sample. Equivalent effect sizes, remission, and response rates were found with completers as well. In combination with group CBT, both individual CBT and DFT significantly reduced depressive symptoms.



Both conditions obtained comparable results to those in the literature. Thus, the superiority of the adjunctive DFT was not demonstrated. Working with dilemmas can be seen as a promising additional target in the psychotherapy of depression, but further research is still required.
Faculty of Psychology, University of Barcelona, Barcelona, Spain. gfeixas@ub.edu.|Institute for Brain, Cognition and Behavior (IR3C), University of Barcelona, Barcelona, Spain. gfeixas@ub.edu.
Guillem
G
Feixas
Faculty of Psychology, University of Barcelona, Barcelona, Spain.
Arturo
A
Bados
Faculty of Psychology, University of Barcelona, Barcelona, Spain.
Eugeni
E
García-Grau
Faculty of Psychology, University of Barcelona, Barcelona, Spain.|Institute for Brain, Cognition and Behavior (IR3C), University of Barcelona, Barcelona, Spain.
Clara
C
Paz
Faculty of Psychology, University of Barcelona, Barcelona, Spain.|Institute for Brain, Cognition and Behavior (IR3C), University of Barcelona, Barcelona, Spain.
Adrián
A
Montesano
Faculty of Psychology, University of Barcelona, Barcelona, Spain.
Victoria
V
Compañ
Faculty of Psychology, University of Barcelona, Barcelona, Spain.
Marta
M
Salla
Faculty of Psychology, University of Barcelona, Barcelona, Spain.
Mari
M
Aguilera
Faculty of Psychology, University of Barcelona, Barcelona, Spain.|Institute for Brain, Cognition and Behavior (IR3C), University of Barcelona, Barcelona, Spain.
Adriana
A
Trujillo
Hospital of Mataró, Mataró, Spain.
José
J
Cañete
Nou Barris Nord Adult Mental Health Center, Barcelona, Spain.
Leticia
L
Medeiros-Ferreira
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
José
J
Soriano
Parc de Salut Mar, Santa Coloma de Gramenet, Barcelona, Spain.
Montserrat
M
Ibarra
Faculty of Psychology, University of Barcelona, Barcelona, Spain.|Institute for Brain, Cognition and Behavior (IR3C), University of Barcelona, Barcelona, Spain.
Joan C
JC
Medina
Faculty of Psychology, University of Barcelona, Barcelona, Spain.|Institute for Brain, Cognition and Behavior (IR3C), University of Barcelona, Barcelona, Spain.
Eliana
E
Ortíz
Parc de Salut Mar, Santa Coloma de Gramenet, Barcelona, Spain.
Fernando
F
Lana
D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003220:Conflict, Psychological; D003674:Defense Mechanisms; D003865:Major Depressive Disorder / Q000523:psychology* / Q000628:therapy*; D019263:Dysthymic Disorder / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018187:Personal Construct Theory; D011340:Problem Solving; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics / Q000706:statistics & numerical data*; D011613:Psychotherapy / Q000379:methods; D011615:Psychotherapy, Group / Q000379:methods*; D016896:Treatment Outcome
cognitive therapy; conflict; major depressive disorder; personal construct theory; psychotherapy; treatment efficacy