Guillem Feixas

The role of homework and skill acquisition in the outcome of group cognitive therapy for depression

Despite the crucial role typically accorded to between-session self-help assignments in cognitive therapy of depression, the actual impact of homework assignment on therapy outcome has received little empirical attention. The present study evaluated the effect of homework by assigning 63 carefully diagnosed unipolar depressives to one of two otherwise identical 10-week cognitive therapy conditions, only one of which utilized weekly homework assignments. As predicted, assignment to the homework condition predicted more substantial improvement in symptomatic features of depression as rated by an independent clinician at therapy termination, although this effect was not maintained at six month follow-up. However, a post-therapy assessment of skill acquisition in completing the core cognitive restructuring technique did predict self-rated maintenance of treatment gains six months later, irrespective of the treatment condition to which the subject had been assigned. Taken together, these findings reinforce the value of homework in improving treatment response during the active treatment phase of cognitive therapy for depression, and the importance of skill acquisition in promoting maintenance of treatment gains once therapy has ended.

CONTENT ANALYSIS OF PERSONAL CONSTRUCTS

In this article we present a system of 45 content categories for analyzing personal constructs elicited in the context of a repertory grid administration. These categories are divided into six basic areas: moral, emotional, relational, personal, intellectual/operational, and values/interests, as well as two possible supplemental areas: existential and concrete descriptors. We study the reliability of this classification system using a sample of 843 constructs extracted from the grids of 57 subjects and coded by two independent judges. The degree of consensus achieved is very satisfactory.

The stability of structural measures derived from repertory grids

Abstract Although the use of repertory grids in psychological research has proliferated, studies of their psychometric properties are relatively rare. For this reason, we studied the reliability and convergence of several measures of cognitive structure derived from grids, including intensity, percentage of variance accounted for by the first component, cognitive complexity, ordination, extremity of ratings, self-ideal discrepancy, and self-other discrepancy, as well two measures of rating stability, construct consistency and factor loading consistency. Eighty-two Spanish (Catalan) and American participants completed small and large grids on each of four occasions, which enabled exploratory analyses of the impact of grid size and subject characteristics on the structural scores obtained. Results indicated that the majority of scores showed impressive test-relest reliability (modal r = .85 for periods up to 1 month), but also suggested a gradual tightening effect across subsequent administrations. In gener...

Viewing Cognitive Conflicts as Dilemmas: Implications for Mental Health

The idea that internal conflicts play a significant role in mental health has been extensively addressed in various psychological traditions, including personal construct theory. In the context of the latter, several measures of conflict have been operationalized using the Repertory Grid Technique (RGT). All of them capture the notion that change, although desirable from the viewpoint of a given set of constructs, becomes undesirable from the perspective of other constructs. The goal of this study is to explore the presence of cognitive conflicts in a clinical sample (n = 284) and compare it to a control sample (n = 322). It is also meant to clarify which among the different types of conflict studied provides a greater clinical value and to investigate its relationship to symptom severity (SCL-90-R). Of the types of cognitive conflict studied, implicative dilemmas were the only ones to discriminate between clinical and nonclinical samples. These dilemmas were found in 34% of the nonclinical sample and in 53% of the clinical sample. Participants with implicative dilemmas showed higher symptom severity, and those from the clinical sample displayed a higher frequency of dilemmas than those from the nonclinical sample.

COGNITIVE FACTORS IN FIBROMYALGIA: THE ROLE OF SELF-CONCEPT AND IDENTITY RELATED CONFLICTS

Fibromyalgia is a syndrome characterized by the presence of diffuse and chronic musculoskeletal pain of unknown etiology. Clinical diagnosis and the merely palliative treatments considerably affect the patients experience and the chronic course of the disease. Therefore, several authors have emphasized the need to explore issues related to self in these patients. The repertory grid technique (RGT), derived from personal construct theory, is a method designed to assess the patients construction of self and others. A group of women with fibromyalgia (n = 30) and a control group (n = 30) were assessed using RGT. Women with fibromyalgia also completed the Fibromyalgia Impact Questionnaire and a visual-analogue scale for pain, and painful tender points were explored. Results suggest that these women had a higher present self–ideal self discrepancy and a lower perceived adequacy of others, and it was more likely to find implicative dilemmas among them compared to controls. These dilemmas are a type of cognitive conflict in which the symptom is construed as “enmeshed” with positive characteristics of the self. Finally, implications of these results for the psychological treatment of fibromyalgia are suggested to give a more central role to self-identity issues and to the related cognitive conflicts.

The Autobiographical Group: A Tool for the Reconstruction of Past Life Experience with the Aged.

From a personal construct point of view, writing autobiographical texts becomes a relevant therapeutic ingredient for elderly individuals. If conducted in a context of a group, as Birren proposes [1, 2]; it promotes self-awareness, self-disclosure, and the capacity of generating alternative views of lifes experiences. In a group of elderly volunteers from a recreational society of Barcelona (Spain), the guided autobiography method was used to foster the reconstruction of the participants past life experiences. The degree of reconstruction was assessed through a design that included the administration of a repertory grid at the initial and tenth (last) session. A parallel assessment was applied to a control group of participants with similar demographic characteristics. An adaptation of the method proposed by Feixas for the analysis of autobiographical texts was used to assess the assigned writings of the participants for each session [3]. Results show a significant and gradual change in the construing system of those participants in the autobiographical group. Thus, the distance of the elements self-ideal/self and self-ideal/others significantly decreased in comparison to the control group. It is suggested that the guided autobiography is an adequate therapeutic tool to promote the reconstruction of experience in aged individuals.

Personal construct analysis of autobiographical texts: A method presentation and case illustration

Abstract This article develops a method for textual analysis on the basis of an authors construction of experience as expressed in self-descriptive texts. The method follows a multiple-step design, which (a) provides procedures for the selection and elicitation of both constructs and elements; (b) transforms constructs and elements into a binary data matrix that is subjected to a two-way cluster analysis; and (c) provides guidelines for psychological interpretation of the raw and computed data in terms of measures of construing, delimitation of the hierarchical level of the constructs, analysis of interpersonal dyads, and qualitative analysis. The method is illustrated through the analysis of jennys letters–a case study presented by Allport (e.g., 1942), who urged psychologists to develop methods for the analysis of personal documents. As an aid to interpretation, the textual grid provides a plot of jennys main axes of meaning and several systematic guidelines for a heuristic inquiry into her world.

Cognitive conflicts in major depression: Between desired change and personal coherence

Objectives The notion of intrapsychic conflict has been present in psychopathology for more than a century within different theoretical orientations. However, internal conflicts have not received enough empirical attention, nor has their importance in depression been fully elaborated. This study is based on the notion of cognitive conflict, understood as implicative dilemma (ID), and on a new way of identifying these conflicts by means of the Repertory Grid Technique. Our aim was to explore the relevance of cognitive conflicts among depressive patients. Design Comparison between persons with a diagnosis of major depressive disorder and community controls. Methods A total of 161 patients with major depression and 110 non-depressed participants were assessed for presence of IDs and level of symptom severity. The content of these cognitive conflicts was also analysed. Results Repertory grid analysis indicated conflict (presence of ID/s) in a greater proportion of depressive patients than in controls. Taking only those grids with conflict, the average number of IDs per person was higher in the depression group. In addition, participants with cognitive conflicts displayed higher symptom severity. Within the clinical sample, patients with IDs presented lower levels of global functioning and a more frequent history of suicide attempts. Conclusions Cognitive conflicts were more prevalent in depressive patients and were associated with clinical severity. Conflict assessment at pre-therapy could aid in treatment planning to fit patient characteristics. Practitioner points Internal conflicts have been postulated in clinical psychology for a long time but there is little evidence about its relevance due to the lack of methods to measure them. We developed a method for identifying conflicts using the Repertory Grid Technique. Depressive patients have higher presence and number of conflicts than controls. Conflicts (implicative dilemmas) can be a new target for intervention in depression. Cautions/Limitations A cross-sectional design precluded causal conclusions. The role of implicative dilemmas in the causation or maintenance of depression cannot be ascertained from this study.

Bibliometric Review of the Repertory Grid Technique: 1998–2007

This bibliometric review covers the scientific production with or about the repertory grid technique (RGT; Kelly, 1955/1991) between 1998 and 2007. An analysis of previous reviews suggests the need for a more careful and broad process of bibliographic research. With this aim, 24 bibliographic sources were used to cover a wide range of specialties. We began by drawing up an explicit protocol in which the research terms were detailed. Then we consulted the bibliographic sources, taking into account a specification of inclusion and exclusion criteria. As a result of this process, 973 references were obtained: 468 journal papers, 335 book chapters, 108 doctoral theses, and 62 books. The review also evaluates the types of documents found, the evolution of the number of works published, the repertory grids fields of application, and the degree of openness to other disciplines. The most relevant authors, their affiliations, countries, and the publication language are also revealed in this article, as well as the major journals contributing to dissemination of the work done with this technique.

Implicative Dilemmas and Symptom Severity in Depression: A Preliminary and Content Analysis Study

An implicative dilemma, a type of cognitive conflict, is found in a subjects repertory grid whenever a personal construct on which change is desired is associated with another construct on which change is undesirable. We studied dilemmas in 57 participants who met criteria for depressive spectrum disorders and compared them to 496 nonclinical controls. Almost 60% of the clinical sample presented with at least one implicative dilemma in their grids, as compared to 39% of controls. Participants with dilemma(s) showed higher levels of depressive symptoms and general distress (SCL-90-R) than those without any implicative dilemma in their grids. Also, the number of implicative dilemmas was associated with symptom severity. An analysis of the specific content of the personal constructs forming such dilemmas revealed that congruent constructs were mostly of moral nature, whereas discrepant constructs were related to emotional balance. Further studies may investigate whether an intervention targeted to the resolution of such dilemmas could be incorporated into existing treatments for depression to enhance their efficacy.