Cognitive Therapy for Unipolar Depression: Efficacy of a Dilemma-Focused Intervention
Cognitive Therapy for Unipolar Depression: Efficacy of a Dilemma-Focused Intervention
The purpose of this study is to determine the efficacy of a brief psychological intervention
 focused on the personal dilemmas identified for each depressive patient. For that, this
 intervention is combined to group cognitive therapy (an already proven efficacious format)
 and compared to cognitive individual therapy.
Depression 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 made a significant contribution in the understanding of unipolar depression
 and its psychological treatment. Even though, 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 in the notion of cognitive conflict viewed as personal
 dilemma according to personal construct theory. The investigators use a novel method for
 identifying those conflicts using the repertory grid technique. Preliminary results with
 depressive patients show that more than 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
 in 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 contribute to enhance the efficacy of
 Cognitive-Behavioral Therapy for depression. A therapy manual for this approach will be
 tested using a randomized clinical trial by comparing the outcome of two treatment
 conditions: a CBT treatment package and another package combining cognitive-behavioral and
 dilemma-focused interventions. The investigators expect that this combined package will
 increase the efficacy of CBT, one of the more prestigious therapies for depression, this
 resulting in a significant contribution for its treatment.
Inclusion Criteria:

 -  Meeting diagnostic criteria for Major Depressive Disorder (MDD) or Dysthymic Disorder
 (DD) according to the DSM-IV-TR (APA, 2002) criteria a assessed using SCID-I

 -  A score above 19 on the BDI-II Questionnaire

 -  Presenting at leat one cognitive conflict (implicative dilemma or dilemmatic
 construct) as assessed using the Repertory Grid Technique

 -  Enough level of competence to communicate in Spanish or Catalan

 Exclusion Criteria:

 -  Bipolar disorders

 -  Psychotic symptoms

 -  Substance abuse

 -  Organic brain dysfunction

 -  Mental retardation

 -  Serious suicidal ideation

 -  Receiving psychological treatment (unless it is suspended at the time of inclusion in
 the study itself, in agreement with the patient and the practitioner applying it)

 -  Substantial visual, hearing or cognitive deficits