Efficacy of a dilemma-focused intervention for unipolar depression: study protocol for a multicenter randomized controlled trial.

BACKGROUND: 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 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. DESIGN: A 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). METHOD: Participants 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. DISCUSSION: We 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 REGISTRATION: ISRCTN92443999; ClinicalTrials.gov Identifier: NCT01542957.

Depressão pós-parto: gravidade dos sintomas e aliança terapêutica / Postpartum depression: symptom severity and therapeutic alliance

O objetivo deste trabalho foi avaliar o impacto da gravidade dos sintomas de mulheres com depressão pós-parto no estabelecimento da Aliança Terapêutica (AT). O estudo fez parte de um ensaio clínico, que avaliou a efetividade de modelos psicoterapêuticos no tratamento da depressão pós-parto. Para avaliar a gravidade dos sintomas depressivos aplicou-se o Inventário Beck de Depressão(BDI). O Working Alliance Inventory (WAI) foi utilizado para a AT, nas versões Paciente (WAI-C) e Terapeuta (WAI-T). Utilizou-se a análise por correlação e qui-quadrado. Houve Associação entre as variáveis na fase intermediária do tratamento, contudo esta foi insuficiente para indicar que a gravidade dos sintomas depressivos influencia na formação de aliança.

The study aims to assess the impact of symptom severity on the development of the allianca in women with postpartum depression. This study is part of a randomised controlled trial that investigated the effectiveness of psychotherapy in the treatment of postpartum depression. To assess depressive symptom severity , the Beck Depression Inventory was employed. The client and therapist forms of the Working Alliance Inventory (WAI) were usede to evaluate the therapeutic alliance. Data was analyzde with correlations and chi-square tests. The association of the investigated variables during the intermediary phase of the treatment was insufficient to indicate that depressive symptom severity had influence on the development of the therapeutic alliance.

Depressão pós-parto: gravidade dos sintomas e aliança terapêutica / Postpartum depression: symptom severity and therapeutic alliance

O objetivo deste trabalho foi avaliar o impacto da gravidade dos sintomas de mulheres com depressão pós-parto no estabelecimento da Aliança Terapêutica (AT). O estudo fez parte de um ensaio clínico, que avaliou a efetividade de modelos psicoterapêuticos no tratamento da depressão pós-parto. Para avaliar a gravidade dos sintomas depressivos aplicou-se o Inventário Beck de Depressão(BDI). O Working Alliance Inventory (WAI) foi utilizado para a AT, nas versões Paciente (WAI-C) e Terapeuta (WAI-T). Utilizou-se a análise por correlação e qui-quadrado. Houve Associação entre as variáveis na fase intermediária do tratamento, contudo esta foi insuficiente para indicar que a gravidade dos sintomas depressivos influencia na formação de aliança.(AU)

The study aims to assess the impact of symptom severity on the development of the allianca in women with postpartum depression. This study is part of a randomised controlled trial that investigated the effectiveness of psychotherapy in the treatment of postpartum depression. To assess depressive symptom severity , the Beck Depression Inventory was employed. The client and therapist forms of the Working Alliance Inventory (WAI) were usede to evaluate the therapeutic alliance. Data was analyzde with correlations and chi-square tests. The association of the investigated variables during the intermediary phase of the treatment was insufficient to indicate that depressive symptom severity had influence on the development of the therapeutic alliance.(AU)