Resumen de Conflictos cognitivos en la depresión: de la construcción del síntoma a la reconstrucción de la identidad / cognitive conflicts in depression: from symptom construction to identity reconstruction
The concept of intrapsychic conflict has been present in psychology and psychotherapy since more than a century. The empirical research about inner conflicts, however, is still lacking in many aspects. In the field of clinical and health psychology is crucial to elucidate which is the role of conflicts in the onset and the maintenance of psychological disorders as well as their influence in the process of change. These two questions are especially pertinent to depressive disorders due to the startlingly high rates of relapse and recurrence.
The main goal of the present dissertation resides in improving the understanding and the treatment of depression by investigating the role of cognitive conflicts. Specifically, in our work we have explored the role of a particular conflict: the Implicative Dilemma (ID). The notion of ID refers to the clash between two opposing forces: the need for change and the need for personal coherence. The interference between both occurs whenever, within the context of a person cognitive system, the symptom is associated with any core aspect of his or her identity. Previous research highlighted the relevance of this type of conflict in various clinical samples but not in unipolar depression.
This thesis contains six empirical papers exploring three major issues: (a) the prevalence of IDs in different diagnostic subgroups and their relationship with clinically significant variables; (b) the specific content of the IDs and; (c) the implications of these conflicts for therapeutic change. Our main results indicate that there is not only a greater proportion of depressed subjects presenting with conflicts but they also show a significant higher level of conflict than controls. The clinical value of IDs is reinforced by the fact that both, the presence and the number of conflicts, are associated with the level of symptoms, the level of global functioning, and with other variables of clinical interest such as suicidal attempts. Moreover, IDs are better predictors of the disorder and the severity of symptoms than the mere presence of negative self-constructions.
The content analysis of our studies reveal that, in the depressed participants¿ conflicts, the emotional discomfort is linked to moral personal values such as being good person, altruist or responsible. In the last of our studies, we inspected the way in which such conflicts are resolved after a dilemma-focused intervention for depression. The results show that clinically significant change is associated with the resolution of conflicts, and that this is often based in the dissolution of the association between the symptom and the core personal value. This process involves certain level of reconceptualization of the self, which, eventually, facilitates the narrative reconstruction of the identity.
Taken together, these results seem to confirm the hypothesis that, in most depressive patients, the construction of symptoms implies a conflictive relationship with core values linked to the identity of the person. Thus, the treatment could benefit if clinicians pay attention to the existence of conflicts in the clients¿ cognitive systems. Nevertheless, the studies of the present dissertation are cross-sectional and correlational in nature which precluded casual analysis of reported associations and, therefore, results should be interpreted cautiously. Future longitudinal research might determine the predictive value of IDs in the course of the disorder and their usefulness for case formulation and for improving current treatments of depression.
