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.

Se presenta la versión en español del Clinical Outcomes in Routine Evaluation- Outcome Measure (CORE-OM), un instrumento creado por el Core System Group para la evaluación del cambio terapéutico. El CORE-OM es un cuestionario que evalúa el malestar psicológico a partir de cuatro dimensiones: Bienestar subjetivo, Problemas/Síntomas, Funcionamiento general y Riesgo. Se describe el cuestionario y se exponen los estudios psicométricos realizados, los cuales indican que el instrumento posee un nivel de validez y fiabilidad adecuadas, así como una excelente aceptación y sensibilidad al cambio terapéutico. Con la supervisión y guía de miembros del equipo creador del CORE-OM, se realizó el proceso de traducción de la versión original en inglés. Colaboraron 12 personas competentes en ambas lenguas de diferentes lugares de España; posteriormente 64 castellano-parlantes de distintas condiciones y orígenes lingüísticos participaron en la revisión del instrumento. Así se obtuvo una versión definitiva en español del CORE-OM, de la que se derivaron las versiones más breves resultantes (CORE-SFA, CORE-SFB, CORE-10 y CORE-5) y todas ellas en versión femenina y masculina. Ahora que el CORE-OM está disponible para todos los psicoterapeutas de habla hispana (www.ub.edu/terdep/core), se hace necesario continuar con el estudio de validación con el objetivo de disponer de las propiedades psicométricas del instrumento en su versión en español.

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Studies on clients' language processes in psychotherapy have focused on specific non-narrative aspects rather than on narrative processes. This study's goal was to test the commonalities and differences between a group of narratives from 15 depressed patients and 14 anxious patients. Patients' narratives were obtained through self-characterizations written by the client and, were analyzed by means of the Narrative Assessment Grid -a combination of narrative analysis dimensions. Results indicated that both groups could be distinguished by six of the 22 dimensions assessed: (a) Variety of characters, (b) Objectifying, (c) Intelligibility/Clarity, (d) Cognitive Subjectifying, (e) Metaphorizing; and (f) Intelligibility/Stability. Clinical implications of our results are discussed.

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