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 ID s 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 ID s 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.

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.

Virtual reality (VR) applications have shown significant potential in enhancing psychological interventions by evoking vivid emotional reactions and creating immersive environments. This commentary provides an overview of five clinical case reports illustrating the advantages and pitfalls of VR‐enhanced psychotherapy in social anxiety disorder, PTSD due to military trauma, auditory hallucinations, depression, and chronic pain. The case reports are analyzed with a dimensional framework designed to evaluate VR applications to be used in psychotherapy. The framework is based on three key dimensions: Strategy (e.g., Exposure, Training, Exploration), Focus (Symptom, Attitudes, Identity and Flourishing), and Perspective (Self, Other, Witness, Multiperspective). For example, the use of VR‐based body scan exercises in chronic pain management can enable the training of body‐related attentional skills helping individuals to not only focus on pain sensations, while VR exposure therapy helps clients with social anxiety or PTSD to confront feared situations, reprocess traumatic experiences, and develop coping skills. VR Avatar Therapy, on the other hand, enables individuals with auditory hallucinations to actually have a dialogue with the voices they hear since these are embodied in avatars controlled by therapists, promoting symptom externalization and self‐identity exploration. Finally, the Explore Your Meanings tool enables immersive multi‐perspective exploration of self‐identity in 3D immersive spaces where it is easy to visualize the differences between the perceived and ideal self. The cases demonstrate VR's unique ability to provide real‐time, dynamic treatment personalization, aligning with the trend toward individualized care in psychotherapy.

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.