Depression and identity : Are self-constructions negative or conflictual?

Negative self-views have proved to be a consistent marker of vulnerability for depression. However, recent research has shown that a particular kind of cognitive conflict, implicative dilemma, is highly prevalent in depression. In this study, the relevance of these conflicts is assessed as compared to the cognitive model of depression of a negative view of the self. In so doing, 161 patients with major depression and 110 controls were assessed to explore negative self-construing (self-ideal discrepancy) and conflicts (implicative dilemmas), as well as severity of symptoms. Results showed specificity for the clinical group indicating a pattern of mixed positive and negative self-descriptions with a high rate of conflict. Regression analysis lent support to the conflict hypothesis in relation to clinically relevant indicators such as symptom severity, global functioning. However, self-ideal discrepancy was a stronger predictor of group membership. The findings showed the relevance of cognitive conflicts to compliment the well-consolidated theory of negative self-views. Clinical implications for designing interventions are discussed.Peer reviewedFinal Published versio

La perspectiva narrativa en terapia familiar sistémica

In this article we review the main interventions based on the narrative paradigm in the context of the systemic model. Firstly, we briefly recapitulate, at the risk of being overly simplistic, the evolution of family therapy describing how this process accompanies the development of narrative practice. Second, we focus on the description of Michael White’s narrative therapy and his externalization procedure detailing every stage of the therapeutic process with clinical examples in order to give the reader a detailed view of common narrative interventions. A final section is allocated to describe the affinity between personal construct theory and narrative therapy highlighting its fruitfulness for the evolution of the systemic model.En el presente texto se revisan las principales intervenciones basadas en el paradigma narrativo en el contexto del modelo sistémico. En primer lugar recapitulamos de forma somera, aún a riesgo de resultar excesivamente simplistas, la evolución del modelo sistémico para describir la manera en que este proceso acompaña el desarrollo de la óptica narrativa. En segundo lugar, nos centramos en la descripción del modelo de terapia narrativa de Michael White y el procedimiento de externalización, deteniéndonos en los principales pasos del proceso terapéutico e ilustrando cada fase con ejemplos clínicos con el objeto de dar al lector una visión detallada de las intervenciones narrativas al uso. Un último apartado está dedicado a reseñar la afinidad entre la teoría de constructos personales y las intervenciones narrativas destacando su relevancia para el futuro desarrollo del modelo sistémico

El modelo sistémico en la intervención familiar

Darrera actualització, gener de 2016Text docent d'introducció dels conceptes bàsics del model sistèmic orientat a la intervenció amb famílie

La evaluación en terapia familiar

El documento recoge los principales aspectos a tener en considerar para la evaluación de la familia desde el modelo sistémico

El equipo como instrumento de intervención

Navarro (1992) desglosa las diferentes funciones que puede cumplir el equipo terapéutico en terapia familiar sistémica: El equipo actúa como un grupo observador en las tareas de evaluación familiar, ofrece ayuda al terapeuta en la toma de decisiones o en situaciones comprometidas dentro de la sesión (p. ej., cuando el terapeuta se enfrasca en una discusión no productiva con la familia) y, por último, puede actuar en sí mismo como un instrumento de intervención..

Conflictos cognitivos (dilemas) en pacientes diagnosticados con Trastornos de Ansiedad

El siguiente estudio tiene por objetivo identificar un tipo de conflicto cognitivo, los dilemas implicativos (DI), en pacientes con Trastorno de Ansiedad (TA). El concepto de DI se refiere a las implicaciones positivas y negativas que tiene el síntoma para la persona que lo sufre. La alternativa deseada, es decir, la dirección en la que el cliente quiere ir, tiene implicaciones negativas, por lo cual se resiste al cambio; pudiendo acarrear consecuencias negativas para su sentido de identidad. Desde un enfoque constructivista y mediante la Técnica de la Rejilla de Kelly, se pretende comparar la presencia y número de dilemas en una muestra de 45 pacientes y un grupo de 39 controles. Los resultados evidencian una diferencia significativa entre la presencia de dilemas en los pacientes ansiosos (49%) y el grupo control (25%). Si los DI implican conflicto psicológico y sufrimiento, la ansiedad podría ser una expresión sintomática del conflicto y de su intensidad. Ello plantea la necesidad de tratar a los pacientes con TA tanto sintomáticamente como en sus conflictos cognitivos. Estos resultados son particularmente relevantes al planificar y desarrollaruna intervención terapéutica que debería ser focalizada, eficiente y adecuada a las necesidades del paciente y a sus estructuras cognitivas

The Grief Response Scale (GRS): Development and initial validation of a new instrument based on the integrative-relational model in a sample of bereaved people

Introduction: The experience of grief and loss involves a variety of trajectories and responses, including feelings of shock or disbelief, somatic symptoms, longing for the loved one and avoidance behaviours, as well as positive reactions such as post-traumatic growth or meaning-making. Despite the large number of psychometric instruments available for assessing the pathological dimensions of grief, few tools address the different responses to bereavement. Objective: The aim of this research was to develop and test the psychometric properties (factorial structure, reliability and validity) of an instrument based on the Integrative-Relational Model of grief and designed to address the grief responses (the Grief Response Scale (GRS)) in a clinical sample of participants who had experienced bereavement. Method: In total, 379 participants were recruited from different clinics in Spain. Each participant completed a self-report questionnaire including the GRS and measures of complicated grief, post-traumatic stress disorder, depression, anxiety and post-traumatic growth. Twenty-eight clinical psychologists contacted each of the participants individually in order to carry out the assessment. Results: Exploratory factor and item analysis yielded a six-factor solution for the GRS, including symptomatological distress, avoidance orientation, loss orientation, positive changes, loss integration and social support. Reliability values ranged from ω =0.88 for the symptomatological distress subscale to ω= 0.65 for the loss orientation subscale. We assessed validity evidence using Pearson's correlations, which showed significant positive and negative associations depending on the subscale. we also found statistically significant differences between participants who met the criteria for complicated grief (ICG≥30) and those who did not. Discussion: The GRS appears to be a suitable tool for assessing the range of grief responses in a clinical population. It can measure both complicated and pathological reactions to grief, as well as positive outcomes. The GRS may also be useful for clinicians working with bereavement and end-of-life situations.This work has received a grant from the University Teaching Research Networks Program of the Institute of Educational Sciences of the University of Alicante (2021–22 call). Ref: 5537

Personal Construct Therapy vs Cognitive Behavioral Therapy in the Treatment of Depression in Women with Fibromyalgia: Study Protocol for a Multicenter Randomized Controlled Trial

Background: Fibromyalgia (FM) is a debilitating syndrome, more prevalent in women, which is aggravated by the presence of depressive symptoms. In the last decade, cognitive behavioral therapy (CBT) has demonstrated to reduce such depressive symptoms and pain in these patients, but there are still a considerable number of them who do not respond to interventions. The complexity of the disorder requires the consideration of the unique psychological characteristics of each patient to attain good outcomes. One approach that could accomplish this goal might be personal construct therapy (PCT), an idiographic approach that considers identity features and interpersonal meanings as their main target of intervention. Then, the aim of the study is to test the efficacy of PCT as compared to a well-established treatment in the reduction of depressive symptoms in women with fibromyalgia. Methods and Analysis: This is a multicenter randomized controlled trial. In each condition participants will attend up to eighteen 1-hr weekly therapy sessions and up to three 1-hr booster sessions during the following 3- 5 months after the end of treatment. The depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) will be the primary outcome measure and it will be assessed at baseline, at the end of therapy, and at 6-month follow-up. Other secondary measures will be applied following the same schedule. Participants will be 18- to 70-years-old women with a diagnosis of FM, presenting depressive symptoms evinced by scores above seven in depression items of the HADS-D. Intention-to-treat and complete case analyses will be performed for the main statistical tests. Linear mixed models will be used to analyze and to compare the treatment effects of both conditions