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Based on the repertory grid technique, we developed Explore Your Meanings (EYME), a digital platform that helps patients explore identity values and internal conflicts using virtual reality (VR). EYME was part of a research project treating depression in young adults, including 10 weekly, 1-h sessions aimed at changing personal constructs-cognitive schemas that shape how individuals interpret reality. We present the case of Mary, a 21-year-old woman diagnosed with persistent major depressive disorder and social phobia. Early sessions with EYME revealed key implicit dilemmas in Mary's worldview, such as feeling that she had to be selfish (an undesired personal characteristic) to become smarter and more self-confident (desired pole). As Mary visualized these constructs in VR, she began to recognize her identity conflicts and strengths, ultimately helping her to improve her negative self-image. Interventions focused on reframing these constructs, particularly around "intelligence" and introducing "emotional intelligence," which helped Mary adopt a more nuanced view of herself. A key session involved a two-chair dialog between her "critical" and "emotional" selves, facilitating the integration of polarized aspects of her personality. In subsequent sessions, EYME reinforced these changes, with Mary reinterpreting behaviors like being "selective" as protective rather than negative. By the end of therapy, she no longer met the criteria for depression or social phobia, and her psychological distress had normalized., (© 2025 Wiley Periodicals LLC.)

Background: Since long ago it has been asserted that internal conflicts are relevant to the understanding and treatment of mental disorders, but little research has been conducted to support the claim. The aim of this study was to test the differential efficacy of group cognitive behavioral therapy (CBT) plus an intervention focused on the dilemma(s) detected for each patient versus group individual CBT plus individual CBT for treating depression. A comparative controlled trial with a 3-month follow-up was conducted., Methods: One hundred twenty-eight adults meeting criteria for MDD and/or dysthymia, presenting at least one cognitive conflict (implicative dilemma or dilemmatic construct, assessed by the repertory grid technique) and who had completed seven sessions of group CBT were randomly assigned to eight sessions of individual manualized CBT or dilemma-focused therapy (DFT). The Beck Depression Inventory-II was administered at baseline, at the end of therapy and after 3 months' follow-up., Results: Multilevel mixed effects modeling yielded no significant differences between CBT and DFT with the intention-to-treat sample. Equivalent effect sizes, remission, and response rates were found with completers as well. In combination with group CBT, both individual CBT and DFT significantly reduced depressive symptoms., Conclusions: Both conditions obtained comparable results to those in the literature. Thus, the superiority of the adjunctive DFT was not demonstrated. Working with dilemmas can be seen as a promising additional target in the psychotherapy of depression, but further research is still required., (© 2016 The Authors. Depression and Anxiety published by Wiley Periodicals, Inc.)