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.

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This article analyses the autobiography of Rudolf Hoess, commandant of Auschwitz. Textual grid, ABC and self-characterisation analyses of the autobiography are used to construe Hoess's writing. The textual grid analysis suggests that Hoess saw his adult self as being different from others but his young self as similar to Jews. Conflicts in self-construing are identified. The ABC analysis indicates that, from his perspective, it made sense for Hoess to choose not to leave the concentration camp service. The self-characterisation analysis focuses on whether Hoess experienced Kellyan guilt and it suggests that he did, but in unexpected contexts.

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El presente artículo se inicia con una presentación de la Técnica de Rejilla (TR), enmarcada en el contexto de la Teoría de los Constructos Personales (TCP). A continuación, se expone la aplicación de la TR al caso de Ana diagnosticada por trastorno depresivo mayor, bulimia nerviosa y trastorno de personalidad por evitación, además de presentar otros síntomas variados. Se eligió este caso por su complejidad clínica y por la manera en que se ven reflejados los síntomas de la paciente en su estructura cognitiva, puesta de maniñesto por la TR. A pesar de que Ana pidió ayuda por iniciativa propia, en las sesiones se muestra reticente a hablar de sí misma, por lo que la TR resultó ser un buen medio de aproximación a la visión del mundo de la cliente, y un instrumento útil para formular hipótesis clínicas.Palabras clave: Técnica de la Rejilla, trastorno depresivo mayor, bulimia, trastorno de personalidad por evitación. Repertoiy Grid Tecbnique as an assessment instrument for case formulationThis paper begins with a presentation of the Repertory Grid Technique (RGT) within the framework of Personal Construct Theory. It follows with the description of the administration of a grid to Ana, a client diagnosed with major depressive disorder, bulimia nervosa, and avoidant personality disorder, as well as of other symptoms. This case is selected to illustrate the use of the RGT because of both its clinical complexity and the way in which her cognitive structure(as depicted by the RGT) is reflected in the presenting symptoms. Despite the fact that Ana eagerly requested help, during the therapy sessions she seems to be reluctant to talk about herself. The RGT proved to be a useful way of approaching her world view, and also a powerful instrument for case formulation.