The Construction of Happiness in Depression Juan Carlos Medina Alcaraz ADVERTIMENT. La consulta d’aquesta tesi queda condicionada a l’acceptació de les següents condicions d'ús: La difusió d’aquesta tesi per mitjà del servei TDX (www.tdx.cat) i a través del Dipòsit Digital de la UB (diposit.ub.edu) ha estat autoritzada pels titulars dels drets de propietat intel·lectual únicament per a usos privats emmarcats en activitats d’investigació i docència. No s’autoritza la seva reproducció amb finalitats de lucre ni la seva difusió i posada a disposició des d’un lloc aliè al servei TDX ni al Dipòsit Digital de la UB. No s’autoritza la presentació del seu contingut en una finestra o marc aliè a TDX o al Dipòsit Digital de la UB (framing). Aquesta reserva de drets afecta tant al resum de presentació de la tesi com als seus continguts. En la utilització o cita de parts de la tesi és obligat indicar el nom de la persona autora. ADVERTENCIA. 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Department of Clinical Psychology and Psychobiology Faculty of Psychology Doctoral Program in Clinical and Health Psychology 2014-2018 Title of the Doctoral Thesis: The Construction of Happiness in Depression Juan Carlos Medina Alcaraz Supervisor: Guillem Feixas i Viaplana, PhD. Barcelona, September 2018 “Ring the bells that still can ring Forget your perfect offering There is a crack in everything That's how the light gets in.” Leonard Cohen Acknowledgements I would like to show my gratitude, appreciation, and affection to my supervisor, the professor Guillem Feixas, who accepted me within his research team six years ago and has never ceased to be an endless source of knowledge and inspiration. His passionate commitment has nurtured my skills as both a therapist and researcher, and wherever my career path takes me in the future, I will be there thanks to him. I must also value the support of my research team and other colleagues at our department: Adrián, Adriana, Alejandro, Carmen, Clara, Dámaris, Danilo, Eliana, Fran, Helena, Joan Miquel, Mari, Marta, Michał, Miquel, Noelia, Olga, Ricardo, Víctor, Victoria. All of them, beloved inhabitants of the small world the university becomes during the academic year, have contributed to this thesis in many ways. I want to show my thankfulness also to the professors Arturo Bados, Chris Evans, Eugeni García-Grau, Maria José Pubill, and Martin Drapeau, who have kindly and generously shared their expertise all these years, strengthening my scientific and clinical training. Furthermore, it is only fair to acknowledge the willingness of all participants in the studies included in this thesis to collaborate in our research, as well as the hard work of many students in collecting and coding data. It is thanks to them that we have been able to produce the findings presented herein. I would like to share my gratefulness to my family, especially my parents Juan Francisco and Mercedes, and my sister Laura. They also helped me to become a better therapist by showing me what Rogers meant by unconditional positive regard, and they gave me any part of myself I can be proud of today. I want to thank my partner Muriel for her love and support during the last eight years, for being by my side in the good and in the bad times, and for being an example of persistence and hard work. I am also thankful to her family, for making me feel at home from the beginning, and to her father, Sagi Tarbal, for the artwork on the cover. Finally, I want my friends to receive also my appreciation and gratitude for being always there: my lifelong friends from Igualada, those from my first years at the Universitat Autònoma de Barcelona, those I met later in Barcelona, my friends from Granollers, and those in Montreal. The work entailed by this thesis would have never been completed without the contribution of many people, including those mentioned herein, but also many others who have supported me throughout these four years. I apologise for not being able to list every person given the space constraints of this section, but I am thankful to all of them. i Contents List of tables and figures .................................................................................................... iv List of abbreviations .......................................................................................................... vi Abstract ............................................................................................................................. vii Resum ................................................................................................................................. x 1. Introduction ............................................................................................................................ 1 1.1. Depression ....................................................................................................................... 1 1.1.1. Clinical characteristics. ............................................................................................. 1 1.1.2. Epidemiology and burden of depression. .................................................................. 3 1.1.3. Cognitive model of depression. ................................................................................ 6 1.1.4. Depression and fibromyalgia syndrome. .................................................................. 9 1.2. Happiness....................................................................................................................... 11 1.2.1. Positive psychology. ............................................................................................... 11 1.2.2. Approaching the definition of happiness. ............................................................... 13 1.2.3. Measuring happiness. .............................................................................................. 17 1.2.4. The statistics of happiness. ..................................................................................... 19 1.2.5. Factors contributing to happiness. .......................................................................... 22 1.2.6. Happiness in depression. ......................................................................................... 29 1.3. Personal Construct Theory ............................................................................................ 30 1.3.1. Personal construct theory and depression. .............................................................. 36 1.3.2. Personal construct theory and happiness. ............................................................... 42 1.4. Rationale for the Present Research ................................................................................ 46 2. Objectives and Hypotheses .................................................................................................. 49 2.1. Main Objective .............................................................................................................. 49 2.2. Specific Objectives of Study 1 ...................................................................................... 50 2.3. Complementary Objectives of Study 1 .......................................................................... 50 2.4. Specific Objectives of Study 2 ...................................................................................... 50 2.5. Complementary Objective of Study 2 ........................................................................... 51 2.6. Hypotheses of Study 1 ................................................................................................... 51 2.7. Hypotheses of Study 2 ................................................................................................... 52 3. Methods ................................................................................................................................ 53 3.1. Study 1 ..........................................................................................................................