A review of cognitive conflicts research: a meta-analytic study of prevalence and relation to symptoms

Adrián Montesano, María Angeles López-González, Luis Angel Saúl, Guillem Feixas, Adrián Montesano, María Angeles López-González, Luis Angel Saúl, Guillem Feixas

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: cognitive conflicts; implicative dilemmas; intrapersonal conflicts; meta-analysis.

Figures

Figure 1
Figure 1
Example of an implicative dilemma and its components. Notes: 1, congruent construct; 2, discrepant construct; 3, correlation between constructs.
Figure 2
Figure 2
Flowchart of search and selection of studies. Abbreviations: IDs, implicative dilemmas; ref, reference; WoS, Web of Science.
Figure 3
Figure 3
Forest plot for meta-analysis of the prevalence of subjects presenting with implicative dilemmas.
Figure 4
Figure 4
Forest plot for meta-analysis of the level of conflicts. Abbreviation: Std diff, standard difference.
Figure 5
Figure 5
Forest plot for meta-analysis of the relationship between level of conflicts and symptom severity.

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