This study examined changes in cognitive complexity and symptomatology in psychotic and non-psychotic patients undergoing psychotherapy. Grid technique was used to measure differentiation and integration, representing cognitive complexity. Two studies found that at therapy end, patients simplified their cognitive systems, with decreases in differentiation and integration. Symptomatology also significantly decreased. For non-psychotic patients, decreases in differentiation correlated with improved symptoms. A psychosocial intervention for psychotic patients similarly found decreases in integration/differentiation and symptoms over two years. The findings suggest psychotherapy helps simplify patients' cognitive systems as symptoms improve.

1. The development of cognitive
complexity during the
psychotherapeutic process:
A comparative study between
psychotic and non-psychotic patients
Gómez, A.M., Pacheco, M., Botella, L.,
Herrero, O. y Corbella, S.
Ramon Llull University

2. Grid Technique (Kelly 1955/1991) is increasingly used as a
psychotherapy research instrument (Winter, 2003). Using Grid
Technique allows the researcher to study cognitive complexity. Both in
Study 1 and 2, and following Adams-Webber (1979) and Botella &
Gallifa (2000) we adopted a conception of cognitive complexity as a
two-dimensional space, made up of a combination of differentiation
and integration. As can be seen in Table 1, we considered different
cognitive profiles as a function of the combination of both axes. The
assessment of cognitive complexity was carried out in both studies by
means of the Structural Quadrants Method (Botella & Gallifa, 2000).
Introduction
HIGH
INTEGRATION
LOW
INTEGRATION
HIGH
DIFFERENTIATI
ON
Complex Fragmented
LOW
DIFFERENTIATI
ON
Monolithic Simple
Table 1.
Cognitive complexity as
a two-dimensional
factor: a proposal of
cognitive profiles.

3. Hypothesis
At the end of effective individual therapy subjects with non-
psychotic psychotherapy complaints tend to simplify their
relational construction system, since differentiation and
integration decrease, and both processes are linked to
symptomatic improvement.
Study 1:
Subjects
After eliminating drop out cases (n = 10) and single session
consultations (n = 8) the final sample was reduced to 34
participants (28 females and 6 males). They were in therapy
for an average of 15 sessions and all of them finished
therapy successfully.

4. Using Grid Technique and CORE Outcome Questionnaire
Social self complexity was assessed by means of the adaptation of
Grid Technique (Kelly, 1955/1991) developed by Butt & Bannister
(1987) and Butt, Burr & Bell (1997). Cognitive complexity indexes were
calculated by means of the Structural Quadrants Method algorithm
Botella & Gallifa (2000).
Symptomatic state was assessed by means of the CORE Outcome
Questionnaire (Core System Group, 1998).
Procedure
1st Phase: Sample selection.
2nd Phase: Assessment. Instruments described in the section Material
were administered.
-Initial administration: during the initial session.
-Intermediate administration: between therapy sessions 8th and 9th.
-Final administration: during the final session or after 9 months since the
beginning of therapy.
3rd Phase: Data analysis, with SPSS 10.0 program and the Structural
Quadrants Method algorithm Botella & Gallifa (2000).

5. Results
Therapy was effective
29.41
4.76
0
61.76
38.09
16.66
8.82
57.14
83.33
0
10
20
30
40
50
60
70
80
90
Initial CORE 8th Ses. CORE Final CORE
Clinic Level of
Symptomatology
Subclinic Level of
Symptomatology
No Clinic Level of
Symptomatology

6. Figure 3. The evolution of
differentiation
FinalDifferent.8th Ses. Different.InitialDifferent.
Mean
,5
,4
,3
,2
FinalIntegration8th.Ses. IntegrationInitialIntegration
Mean
,8
,7
,6
,5
At the end of effective group therapy clients tend to simplify their
relational construction system, and differentiation and integration
decrease.
Figure 2. The evolution of
differentiation

7. As long as Initial and Final Differentiation correlate
significantly with level of symptomatology at the end of
therapy, we can affirm that the decreasing of
differentiation is associated to the decreasing of
symptoms and, consequently, to symptomatic
improvement. Integration does not correlate significantly
with the level of symptomatology at any point during
therapy.

8. Hypothesis
At the end of group therapy subjects diagnosed with
paranoid schizophrenia tend to simplify their relational
construction system, since differentiation and integration
decrease, and both processes are linked to symptomatic
improvement.
Study 2:
Subjects
30 patients who complied with the study’s inclusion criteria
were selected from a mental health center. Among these 30
participants, 15 were selected at random and were assigned
to a treatment group, while the other 15 were assigned to a
control group. These latter ones kept receiving their regular
out-patient treatment.

9. Using de Grid Technique and PANSS
We administrated the Self-Grid (Kelly 1955/1991) and the Positive
and Negative Syndromes Scale (PANSS) (Peralta & Cuesta, 1994).
Procedure
1st Phase: Sample selection.
2nd Phase: Assessment. Instruments described in the section
Material were administered.
-Initial administration: before the psicosocial intervention
beginning.
-Intermediate administration: after 12 months since the
beginning of the psicosocial intervention.
-Final administration: after 24 months since the beginning of
the psicosocial intervention.
3rd Phase: Data analysis, with SPSS 10.0 program and the
Structural Quadrants Method algorithm Botella & Gallifa
(2000).

10. Results
In intergroup results, there were no statistically significant
differences after 2 years group treatment. In the intragroup
results, after 12 months since the beginning of the
intervention, integration (see Figure 5) and symptomatic state
(see Figures 6, 7 and 8) decreased in a statistically significant
way in the treatment group.

11. After 24 months from the treatment group
beginning, integration and differentiation did not show
changes and positive and negative symptoms
decreased in a significantly way once more (see
Figures 5, 6 and 7). Integration and differentiation
decreasing determined that treatment group presented
a self constructive system that evolved from monolithic
to simple.

12. Differentation 3Differentation 2Differentation 1
Mean
,24
,22
,20
,18
,16
,14
,12
Integration 3Integration 2Integration 1
Mean
,6
,5
,4
,3
The evolution of differentiation and of the integration
Figure 4 Figure 5

13. Treatment Group
PANSS-P3PANSS-P2PANSS-P1
Mean
30
28
26
24
22
20
Treatment Group
PANSS-N3PANSS-N2PANSS-N1
Mean
29
28
27
26
25
24
23
22
Treatment Group
PANSS-PG3PANSS-PG2PANSS-PG1
Mean
56
54
52
50
48
46
44
42
Figure 6
Figure 8º
Figure 7

14. Both in Study 1 and 2, symptomatology decreases
significantly. In Study 1, non-clinic level symptomatology
increases up to 83,33% of cases at the end of therapy, the
sub-clinic level decreases until 16’66% and clinic level
decreases until it disappears.
In Study 2, symptomatic state of treatment group participants
was decreasing progressively during the 2 years of
psychosocial intervention, and this proves treatment validity.
As regards PANSS intragroup results, all the scales were
statistically significant, showing a symptomatology decreasing
from the pretreatment administration to the 2 years of group
intervention.
Discussion:

15. As regards cognitive complexity, Study 1 results and the
intragroup ones in Study 2 show that at the end of
intervention subjects tend to simplify their relational
construction system, as differentiation and integration
decrease. In Study 1, differentiation decrease correlates
significantly with symptomatic improvement.

16. Adams-Webber, J.R. (1979). Personal construct theory: Concepts and
applications. New York: Wiley.
Bell, R.C. (1987). G-PACK: A computer program for the elicitation and analysis of
repertory grids. Unpublished document: Department of Psychology, University of
Melbourne.
Butt, T. & Bannister, D. (1987). Better the devil you know. In W. Dryden (Ed.), Key
cases in Psychotherapy. (pp.121-147). London: Croom Helm.
Butt, T., Burr, V. & Bell, R. (1997). Fragmentation and the sense of self.
Constructivism in the Human Sciences. 2 (1), 12-29.
Gallifa, J. & Botella, L. (2000). The structural quadrants method: A new approach to
the assessments of construct system complexity via the Repertory Grid. Journal
of Constructivist Psychology, 13, 1-26.
Kelly, G.A. (1955/1991). The Psychology of Personal Constructs (Vols. 1 y 2).
London: Routledge.
Peralta, V. & Cuesta, M.J. (1994). La validación de la escala de síndromes positivo
y negativo (PANSS). Actas Luso Españolas de Neurología, Psiquiatría y Ciencias
Afines, 22, 171-177.
Winter, D.A. (1992). Personal Construct Psychology in Clinical Practice.
Theory, Research and Applications. London: Routledge.
Winter, D.A. (2003). Repertory Grid Technique as a psychotherapy research
measure. Psychotherapy Research, 13 (1), 25-42.