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Aguilera M, Paz C, Salla M, Compañ V, Medina JC, Medeiros-Ferreira L, Feixas G. Cognitive-Behavioral and Personal Construct Therapies for Depression in Women with Fibromyalgia: A Randomized Controlled Trial. Int J Clin Health Psychol 2022; 22:100296. [PMID: 35281770 PMCID: PMC8873601 DOI: 10.1016/j.ijchp.2022.100296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background/Objective Method Results Conclusions
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Montesano A, Medina JC, Paz C, García-Mieres H, Niño-Robles N, García-Grau E, Crespillo JC, García-Gutiérrez A, Alabèrnia-Segura M, Feixas G. Does virtual reality increase the efficacy of psychotherapy for young adults with mild-to-moderate depression? A study protocol for a multicenter randomized clinical trial. Trials 2021; 22:916. [PMID: 34903251 PMCID: PMC8666832 DOI: 10.1186/s13063-021-05809-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 11/08/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The improvement of psychological treatments for depression in young adults is a pressing issue highlighted in the literature. Its relevance is determined not only because young adults are underrepresented in research, but also to prevent chronic severe mental health disorders later in life. Engagement is considered a key factor for a good therapeutic outcome, especially among young patients. In this sense, virtual reality could be particularly suited to engage young adults in the therapy process. This project aims to improve the psychological treatment of mild-to-moderate depression in young adults by testing out the efficacy of virtual reality-enhanced personal construct therapy (PCT-VR), as compared to personal construct therapy alone (PCT) and to the reference standard cognitive behavioral therapy (CBT). In contrast to CBT, PCT neither educates patients about depression nor gives them directions on the changes to be made in their dysfunctional behaviors or cognitions. Rather, PCT explores the coherence (or conflicts) of thoughts and behaviors with respect to the person's sense of identity and focuses on meaning-making processes. METHODS The efficacy of this innovative intervention (PCT-VR) will be compared to PCT and to CBT in a randomized clinical trial. The study includes an appraisal of therapists' adherence and independent assessments to preserve internal validity. The Beck Depression Inventory-II is the primary outcome measure for calculating both statistical and clinical significance, but other outcomes will also be assessed (e.g., functioning, well-being, anxiety, stress) at pre- and post-therapy and at 6-month follow-up. The trial will be conducted in a naturalistic context, mostly at the usual health care center of each patient. A sample of 225 participants is targeted to reach enough statistical power to accomplish the goals of the study. DISCUSSION We expect that providing evidence for PCT-VR will widen the repertoire of evidence-based technology-based psychotherapeutic interventions for young adults and contribute to the prevention of deteriorating courses of the disorder. TRIAL REGISTRATION ClinicalTrials.gov NCT04321525 . Registered on 18 February 2020.
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Affiliation(s)
- Adrián Montesano
- School of Psychology and Educational Sciences, Open University of Catalonia, Barcelona, Spain
| | - Joan C. Medina
- School of Psychology and Educational Sciences, Open University of Catalonia, Barcelona, Spain
| | - Clara Paz
- School of Psychology and Education, Universidad de Las Américas, Quito, Ecuador
| | - Helena García-Mieres
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Noelia Niño-Robles
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
| | - Eugeni García-Grau
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
| | - Josep Cañete Crespillo
- Department of Mental Health, Consorci Sanitari del Maresme, Hospital de Mataró, Mataró, Spain
| | | | - Miquel Alabèrnia-Segura
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
| | - Guillem Feixas
- Department of Clinical Psychology and Psychobiology, The Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain
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Suarez V, Feixas G. Cognitive Conflict in Borderline Personality Disorder: A Study Protocol. Behav Sci (Basel) 2020; 10:bs10120180. [PMID: 33256053 PMCID: PMC7761325 DOI: 10.3390/bs10120180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022] Open
Abstract
Borderline personality disorder (BPD) represents a severe mental condition that is usually characterized by distressing identity disturbances. Although most prevailing explanatory models and psychotherapy approaches consider and intervene on self-concept, they seem not to recognize or explore idiosyncratic cognitive conflicts that patients may experience. These conflicts, which have been conceptualized as “implicative dilemmas” and “dilemmatic constructs” by personal construct theorists, could be considered as key elements of the explanatory model for BPD to provide a better understanding of this disorder and possibly enhance the effectiveness of contemporary psychotherapeutic approaches. The current study (Identifier: NCT04498104) aims to examine the characteristics of the interpersonal cognitive system of a group of patients diagnosed with BPD, using the repertory grid technique, and to compare them with those of a community sample. We will test if BPD participants are more affected by cognitive conflicts than controls. Additionally, we will gauge the association between cognitive conflicts and symptom severity as well as their predictive capacity of treatment outcome. The obtained results will be a necessary step to determine if cognitive conflicts have a substantial role on the explanation of BPD. It could also help to consider the development of a conflict resolution intervention module for this disorder.
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Winter DA, Bell RC. A Method for Measuring Conflict in Repertory Grid Data: A Review of Research. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2020. [DOI: 10.1080/10720537.2020.1805073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- David A. Winter
- Department of Psychology, Sport and Geography, University of Hertfordshire, Hatfield, UK
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Paz C, Aguilera M, Salla M, Compañ V, Medina JC, Bados A, García-Grau E, Castel A, Cañete Crespillo J, Montesano A, Medeiros-Ferreira L, Feixas G. Personal Construct Therapy vs Cognitive Behavioral Therapy in the Treatment of Depression in Women with Fibromyalgia: Study Protocol for a Multicenter Randomized Controlled Trial. Neuropsychiatr Dis Treat 2020; 16:301-311. [PMID: 32021219 PMCID: PMC6987966 DOI: 10.2147/ndt.s235161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Fibromyalgia (FM) is a debilitating syndrome, more prevalent in women, which is aggravated by the presence of depressive symptoms. In the last decade, cognitive behavioral therapy (CBT) has demonstrated to reduce such depressive symptoms and pain in these patients, but there are still a considerable number of them who do not respond to interventions. The complexity of the disorder requires the consideration of the unique psychological characteristics of each patient to attain good outcomes. One approach that could accomplish this goal might be personal construct therapy (PCT), an idiographic approach that considers identity features and interpersonal meanings as their main target of intervention. Then, the aim of the study is to test the efficacy of PCT as compared to a well-established treatment in the reduction of depressive symptoms in women with fibromyalgia. METHODS AND ANALYSIS This is a multicenter randomized controlled trial. In each condition participants will attend up to eighteen 1-hr weekly therapy sessions and up to three 1-hr booster sessions during the following 3-5 months after the end of treatment. The depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) will be the primary outcome measure and it will be assessed at baseline, at the end of therapy, and at 6-month follow-up. Other secondary measures will be applied following the same schedule. Participants will be 18- to 70-years-old women with a diagnosis of FM, presenting depressive symptoms evinced by scores above seven in depression items of the HADS-D. Intention-to-treat and complete case analyses will be performed for the main statistical tests. Linear mixed models will be used to analyze and to compare the treatment effects of both conditions. TRIAL REGISTRATION ClinicalTrials.gov: NCT02711020.
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Affiliation(s)
- Clara Paz
- School of Psychology, Universidad de Las Américas, Quito, Ecuador
| | - Mari Aguilera
- Department of Cognition, Development and Educational Psychology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Marta Salla
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Victoria Compañ
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Joan C Medina
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain
- The Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain
| | - Arturo Bados
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Eugeni García-Grau
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Antoni Castel
- Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | | | - Adrián Montesano
- Faculty of Psychology and Educational Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | | | - Guillem Feixas
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain
- The Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain
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Cognitive rigidity in patients with depression and fibromyalgia. Int J Clin Health Psychol 2019; 19:160-164. [PMID: 31193143 PMCID: PMC6517680 DOI: 10.1016/j.ijchp.2019.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/07/2019] [Indexed: 01/31/2023] Open
Abstract
Background/Objective The comorbidity of depression and fibromyalgia chronic syndrome has been well documented in the literature; however, the cognitive structure of these patients has not been assessed. Previous results reported variability in cognitive rigidity in depressive patients, the key for this might be the presence of chronic physical pain such as fibromyalgia. The present study explores and compares the cognitive rigidity and differentiation, between patients with depression with and without fibromyalgia syndrome. Method Thirty one patients with depression and fibromyalgia were matched, considering age, sex and number of depressive episodes, with 31 patients with depression but without fibromyalgia diagnosis. Cognitive rigidity and differentiation were measured with the repertory grid technique. Results The results indicated that depressed patients with fibromyalgia presented higher levels of depressive symptoms, greater cognitive rigidity and lower cognitive differentiation than those without fibromyalgia. Conclusions The results might inform future treatments to address the cognitive structure of these patients.
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Feixas G, Paz C, García-Grau E, Montesano A, Medina JC, Bados A, Trujillo A, Ortíz E, Compañ V, Salla M, Aguilera M, Guasch V, Codina J, Winter DA. One-year follow-up of a randomized trial with a dilemma-focused intervention for depression: Exploring an alternative to problem-oriented strategies. PLoS One 2018; 13:e0208245. [PMID: 30543642 PMCID: PMC6292643 DOI: 10.1371/journal.pone.0208245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 11/13/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is aimed to counteract cognitions and behaviours that are considered as dysfunctional. The aim of the study is to test whether the inclusion of a non-counteractive approach (dilemma-focused intervention, DFI) in combination with CBT group therapy will yield better short- and long-term outcomes than an intervention conducted entirely using CBT. METHOD A total of 128 patients with depression and at least one cognitive conflict, of six health community centres in Barcelona, participated from November of 2011 to December of 2014 in seven weekly group CBT sessions and were then randomly allocated to either DFI or CBT (eight individual sessions each) by an independent researcher. Depressive symptoms were assessed with the Beck Depression Inventory-II at baseline, at the end of therapy and three- and twelve-month follow-ups. Therapists did not participate in any of the assessments nor in the randomisation of patients and evaluators were masked to group assignment. Both intention to treat and complete case analyses were performed using linear mixed models with random effects. FINDINGS According to intention-to-treat analysis (F2, 179 = 0.69) and complete case analysis (F2, 146 = 0.88), both conditions similarly reduced the severity of symptoms across posttreatment assessments. For the 77 participants (CBTgroup +CBTindividual = 40; CBTgroup+DFIindividual = 37) that completed allocated treatment and one-year follow-up assessment, response and remission rates were relative higher for the DFI condition, however no significant differences were found between treatment conditions. The relapse rates were similar between treatment conditions (CBTgroup +CBTindividual = 7/20; CBTgroup+DFIindividual = 8/22). INTERPRETATION Although using a counteractive approach across all the treatment sessions is quite effective, it does not seem to be necessary to produce significant improvement. DFI may be considered as an alternative, which could be included in a wider treatment for depression. TRIAL REGISTRATION ClinicalTrials.gov; ID: NCT01542957.
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Affiliation(s)
- Guillem Feixas
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- The Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Clara Paz
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- School of Psychology, Universidad de Las Américas, Quito, Ecuador
| | - Eugeni García-Grau
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Adrián Montesano
- Department of Psychology and Educational Sciences, Open University of Catalonia, Barcelona, Spain
| | - Joan C. Medina
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- The Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Arturo Bados
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Adriana Trujillo
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Faculty of Psychology, El Bosque University, Bogotá, Colombia
| | - Eliana Ortíz
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Faculty of Psychology, Universidad Católica de Colombia, Bogotá, Colombia
| | - Victoria Compañ
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Marta Salla
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Mari Aguilera
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Víctor Guasch
- Mental Health Services, Fundació Sanitària Sant Pere Claver, Barcelona, Spain
| | - Jordi Codina
- Mental Health Services, Fundació Sanitària Sant Pere Claver, Barcelona, Spain
| | - David A. Winter
- Department of Psychology and Sport Sciences, University of Hertfordshire, Hatfield, United Kingdom
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Escandón-Nagel N, Peró M, Grau A, Soriano J, Feixas G. Emotional eating and cognitive conflicts as predictors of binge eating disorder in patients with obesity. Int J Clin Health Psychol 2018; 18:52-59. [PMID: 30487910 PMCID: PMC6220906 DOI: 10.1016/j.ijchp.2017.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/18/2017] [Indexed: 12/24/2022] Open
Abstract
Background/Objectives: Binge Eating Disorder (BED) is often associated with obesity. In order to identify the variables that allow to better detect the presence of BED, people with overnutrition were compared with and without BED in the presence of cognitive conflicts, eating symptoms and anxious-depressive symptoms. The inclusion of cognitive conflicts had been relevant in bulimia studies but had not been investigated with respect to BED. Method: Two groups with obesity were evaluated, one without BED (OB, n = 54) and the other with BED (OB-BED, n = 48), using a social-demographic questionnaire as well as a semi-structured interview to assess BED, questionnaires (DASS-21, EDE-Q, EEQ) and the Repertory Grid Technique. Results: Overall, the OB-BED group presented more conflicts and more symptoms. The model that best differentiated between the groups included emotional eating and level of cognitive conflicts, correctly classifying 91.4% of the sample. Conclusion: These results highlight the role played by cognitive conflicts and emotional eating as differentiating elements between OB and OB-BED, with a high level of predictive accuracy.
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Affiliation(s)
| | - Maribel Peró
- Universitat de Barcelona, Spain
- Institut de Neurociències, Universitat de Barcelona, Spain
| | | | | | - Guillem Feixas
- Universitat de Barcelona, Spain
- Institut de Neurociències, Universitat de Barcelona, Spain
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Paz C, Montesano A, Winter D, Feixas G. Cognitive conflict resolution during psychotherapy: Its impact on depressive symptoms and psychological distress. Psychother Res 2017; 29:45-57. [PMID: 29173128 DOI: 10.1080/10503307.2017.1405172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the resolution of cognitive conflicts (CCs) within a randomized controlled trial testing the differential efficacy of group cognitive behavioral therapy (CBT) plus an individually tailored intervention module focused on CCs vs. group plus individual CBT, and to determine whether CC resolution was related to improvement in symptoms and psychological distress. METHODS The data come from 104 adults meeting criteria for major depressive disorder and/or dysthymia. Change in scores on the Beck Depression Inventory-II and Clinical Outcomes in Routine Evaluation-Outcome Measure was assessed at the end of treatment and at three-month follow-up. Outcomes were compared between those participants who resolved their CCs and those who maintained them using three-level multilevel growth models. RESULTS CC resolution did not depend on treatment allocation. Participants who resolved their CCs acquired greater benefits with regards to reduction of depressive symptoms and psychological distress than those who maintained their conflicts. CONCLUSIONS CC seems to be a relevant notion to take into consideration to understand symptom improvement. Further research on CC might lead to the advancement of treatments which involve conflict resolution as a change mechanism.
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Affiliation(s)
- Clara Paz
- a School of Psychology , Universidad de Las Américas , Quito , Ecuador.,b Department of Clinical Psychology and Psychobiology , University of Barcelona , Barcelona , Spain
| | - Adrián Montesano
- c Department of Personality, Assessment and Psychological Treatments , Open University of Catalonia , Barcelona , Spain
| | - David Winter
- d Department of Psychology and Sports Sciences , University of Hertfordshire , Hatfield , UK
| | - Guillem Feixas
- b Department of Clinical Psychology and Psychobiology , University of Barcelona , Barcelona , Spain.,e The Institute of Neurosciences , University of Barcelona , Barcelona , Spain
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