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Clara Paz,1 Mari Aguilera,2 Marta Salla,3 Victoria Compañ,3 Joan C Medina,3,4 Arturo Bados,3 Eugeni García-Grau,3 Antoni Castel,5 José Cañete Crespillo,6 Adrián Montesano,7 Leticia Medeiros-Ferreira,8 Guillem Feixas3,4 1School of Psychology, Universidad de Las Américas, Quito, Ecuador; 2Department of Cognition, Development and Educational Psychology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain; 3Department of Clinical Psychology and Psychobiology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain; 4The Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain; 5Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain; 6Department of Psychiatry, Hospital de Mataró, Mataró, Spain; 7Faculty of Psychology and Educational Sciences, Universitat Oberta de Catalunya, Barcelona, Spain; 8Nou Barris Nord Adult Mental Health Centre, Barcelona, SpainCorrespondence: Clara Paz Jose Queri y Av, De Los Granados, Quito EC170125, EcuadorTel +593 2 3981000 ext. 2518Email clara.paz@udla.edu.ecBackground: 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.Trial Registration: ClinicalTrials.gov: NCT02711020.Keywords: psychotherapy, pain, repertory grid technique, study protocol, CBT, personal construct therapy

Antoni Grau,1,2 Ernesto Magallón-Neri,3,4 Gustavo Faus,1,2 Guillem Feixas3,41ITA Mental Health Specialist, Madrid, Spain; 2ITA Foundation, Barcelona, Spain; 3Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain; 4Institute of Neurosciences, University of Barcelona, Barcelona, SpainIntroduction: Several studies have noted the potentially negative effect of eating disorders (ED) on cognitive performance.Objective: To compare the impact of the duration of abnormal eating behaviors on cognitive performance in a sample of people with short- and long-term eating disorders and in two control groups matched for age.Method: The neuropsychological performance of 82 women diagnosed with an eating disorder were compared with two control groups from the community of 66 healthy women. Time of duration of the disorder was less than two years in half of the clinical sample, and more than 10 years in the other half. The following instruments were used to measure neuropsychological performance: the Matrix Test, the Stroop task, the Trail-Making Test, the Tower of London Test, the Posner Spatial Task, the Rey’s Complex Figure, the Wechsler Vocabulary Test, and the Hayling Completion Test.Results: It showed that persons with long-term ED presented more impaired neuropsychological profiles, but not in all areas. In contrast, the short-term ED group presented similar profiles to the control groups.Discussion: This study highlights the positive association between cognitive impairment and time of evolution of ED, above all in perceptual measures and non-verbal memory. Considering the effect of the evolution of ED cognitive performance (especially in long-term patients) may further our understanding of the development of the disorder and the factors that may favor its persistence.Keywords: eating disorder, cognitive impairment, long-duration ED

Adrián Montesano,1 María Angeles López-González,2 Luis Angel Saúl,2 Guillem Feixas1 1Department of Personality, Assessment and Psychological Treatments, University of Barcelona, Barcelona, 2Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, National Distance Education University, Madrid, Spain Abstract: Recent research has highlighted the role of implicative dilemmas in a variety of clinical conditions. These dilemmas are a type of cognitive conflict, in which different aspects of the self are countered in such a way that a desired change in a personal dimension (eg, symptom improvement) may be hindered by the need of personal coherence in another dimension. The aim of this study was to summarize, using a meta-analytical approach, the evidence relating to the presence and the level of this conflict, as well as its relationship with well-being, in various clinical samples. A systematic review using multiple electronic databases found that out of 37 articles assessed for eligibility, nine fulfilled the inclusion criteria for meta-analysis. Random effects model was applied when computing mean effect sizes and testing for heterogeneity level. Statistically significant associations were observed between the clinical status and the presence of dilemmas, as well as level of conflict across several clinical conditions. Likewise, the level of conflict was associated with symptom severity. Results highlighted the clinical relevance and the transdiagnostic nature of implicative dilemmas. Keywords: implicative dilemmas, cognitive conflicts, intrapersonal conflicts, meta-analysis

Introduction: A constructivist view of the cognitive system contemplates the possibility of meaning conflicts or dilemmas involving self-identity. Patients' contradictions between verbal discourse and actual behaviors (e.g., agreeing with the therapist to carry on an action and then not doing it), or between behaviors (e.g., to dismiss a romantic partner and then initiating sex with her or him) are seen as manifestations of an internal conflict or dilemma. These internal conflicts, which can be detected using the Repertory Grid technique, are found to be common in patients of different conditions but especially for those with a diagnosis of depression (67% of the cases; Feixas et al, 2014). Objectives: To study the efficacy of a dilemma-focused intervention (DFI; Feixas & Compañ, 2016) tackle these conflicts in the therapy process rather than counteracting negative thoughts, as in cognitive-behavioural therapy (CBT). Methods: An RCT was conducted combining group and individual therapy formats. 128 patients participated in eight sessions of group CBT and were then randomised to eight sessions of either individual CBT or DFT. Results: No differences were found between treatment conditions neither at the end of therapy or at follow up (Feixas et al, 2016; 2018). Depressive symptoms decreased in a significant way and with a big effect size (d = 1.37 for the 106 completers). Conclusions: Psychotherapy can have a significant impact on depressive symptoms no matter whether using traditional CBT techniques or assisting patients in identifying their internal conflicts and finding a way to resolve them (DFI). [ABSTRACT FROM AUTHOR]

Introduction: A negative self-concept has been established as one of the key psychological features of depression. However, several studies have shown that a particular kind of cognitive conflict, implicative dilemma, is highly prevalent in depression. Objectives: This study aimed to gauge the relative significance of both aspects, self-negativity and cognitive conflict, for depression. Methods: A cross-sectional study compared 161 patients with major depression with 110 controls. They were assessed to measure negative self-construing (self-ideal discrepancy) and conflicts (implicative dilemmas) with the repertory grid technique, and also symptom severity. Results: At least one implicative dilemma was found for 68.3% of patients with depression, compared to 34.5% of controls (p < .01; phi = .33). As expected, the self-ideal distance was also much higher for the group with depression (M = .47; SD = .15) than for controls (M = .25; SD = .10; d = 1.8). Both cognitive conflict and self-ideal discrepancy entered in the regressionmodel created to predict depressive symptoms. 99%of participants of the clinical group had at least a positive view (coincidence between "self now" and "ideal self"). Conclusions: Negative self-views proved to be a characteristic of people with depression. However, our results show that depression is better characterized by a pattern of mixed positive and negative self-descriptions with a high rate of conflict between them. Therefore, in addition to self-negativity, we need to consider internal conflict (e.g., implicative dilemmas) as a factor to complement our understanding and treatment strategy for depression. [ABSTRACT FROM AUTHOR]

Introduction: Substance abuse among medical professionals is common and can lead to malpractice. The study of identity conflicts developed by the Psychology of Personal Constructs could explain part of this problem. Objectives: This study aims to describe the medical professionals who abuse substances in terms of their personal construing process and other associated psychological measures. Methods: Thirty medical professionals suffering from a substance use disorder hospitalized in a clinic specialized in their treatment were recruited for this study. The Repertory Grid, Beck's Depression Inventory, State-Trait Anxiety Inventory, and Maslach Burnout Inventory were used for assessment. Results: More than half of the participants presented cognitive conflicts (implicative dilemmas) and this group scored higher on trait anxiety and burnout than medical professionals without such conflicts. No statistically significant differences were found between those with implicative dilemmas and those without in terms of depression symptoms or state of anxiety. Logistic regression analysis showed that the presence of cognitive conflicts was best predicted by burnout. Distance between the "ideal self" and "actual self" elements, and cognitive complexity were the best predictors of belonging to the clinical sample or to a randomly matched community sample. Content analysis of the constructs revealed an overrepresentation of constructs referring to values and interests in the clinical sample. Conclusions: Overall, our findings support previous research with regards to psychological factors associated with the development of substance abuse and identity problems among medical professionals. The presence of implicative dilemmas and self-esteem problems can help us better understand these problems. [ABSTRACT FROM AUTHOR]

Introduction: Eating Disorders (ED) are complex and costly for patients, families, and society. Treatments of different types have shown some effectiveness for many sufferers with ED but are still far from satisfactory. Controlled efficacy studies provide evidence with internal validity but the external validity of complex treatment services is compromised. The ITA Model of Integrated Treatment of Eating Disorders (ITAMITED) combines outpatient, inpatient and day hospital adapted to every patient's needs. Objectives: To evaluate the changes occurred in patients with EDs after the ITAMITED service on the bases of a recently implemented routine outcome assessment system. Methods: A cohort of 324 ED patients who entered the ITAMITED service between November of 2017 and October of 2018 was routinely assessed with the Clinical Outcomes in Routine Evaluation (CORE) system and measures specific for EDs (e.g., EAT). Data analysis included details from the patients' health records such as diagnosis, BMI, previous treatments, and chronicity. Results: Changes in CORE yielded large effect sizes for both inpatient and outpatient treatment modalities, and moderate for day hospital care (figure 1). Effect sizes for EAT (figure 2) were big for inpatient treatment and day hospital and moderate for outpatient treatment. Conclusions: Overall, ITAMITED succeeded in improving EDs patients, especially in the inpatient facility. Day hospital care proved more effective for specific ED symptoms than for general functioning and well-being, while the inverse pattern was found for those in outpatient treatment. The effects of many more variables need to be brought into the equation to explain more detailed outcomes. [ABSTRACT FROM AUTHOR]

Research on cognitive variables such as cognitive distortions, misattributions, memory and attention processes has grown substantially in the last 30 years. However, little attention has been paid to the conflictive nature of schemas involved in construing self and others which might help to explain the ambivalence some people experience when facing change. Personal Construct Theory (a predecessor of many cognitive theories) has proved useful in understanding internal conflicts and fragmentation in the meaning systems with which people try to make sense of events. Our group has found a way to identify two types of conflicts or dilemmas from data collected using the Repertory Grid technique. Results suggest that those conflicts are more common in clinical samples than in control groups. Data from different studies will be presented. It supports the idea that cognitive conflicts might play a role in various clinical conditions, and especially in blocking the process of change. [ABSTRACT FROM AUTHOR]