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. .