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Yılmaz M, Taş B, Çelik D, Perry JC, Tanzilli A, Di Giuseppe M, Lingiardi V. Initial validation of the Turkish version of the defense mechanisms rating scales-self-report-30. Front Psychol 2024; 15:1432170. [PMID: 38988381 PMCID: PMC11233775 DOI: 10.3389/fpsyg.2024.1432170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/30/2024] [Indexed: 07/12/2024] Open
Abstract
The Defense Mechanisms Rating Scales-Self Report-30 (DMRS-SR-30) was recently developed to add a self-report alternative to the assessment of defenses, reflecting their generally accepted hierarchical organization. In this study, we aimed to examine psychometric properties and factor structure of the Turkish language version of the DMRS-SR-30. The sample consisted of 1.002 participants who filled out a survey comprising the DMRS-SR-30, the Brief Symptom Inventory, and the Inventory of Personality Organization through Qualtrics. Confirmatory Factor Analysis indicated a three-factor structure (CFI = 0.89, RMSEA = 0.05) that confirms the DMRS theoretical frame with a relatively acceptable fit. Defensive categories and total scale scores showed good to excellent reliability (α values ranging from 0.64 to 0.89). Correlations between defenses, symptoms, and personality functioning demonstrated good convergent and discriminant validity. The individuals with clinically significant BSI scores (T-score ≥ 63) differed on the DMRS-SR-30 scores from the individuals in the non-clinical range. The Turkish version of the DMRS-SR-30 is a reliable and valid instrument to self-assess the hierarchy of defense mechanisms and overall defensive functioning. Moreover, the current study supports the validity of the tripartite model of defenses in a language and culture different from the origins of the DMRS and DMRS-SR-30.
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Affiliation(s)
- Meltem Yılmaz
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Berke Taş
- Department of Psychology, TED University, Ankara, Türkiye
| | - Deniz Çelik
- Department of Psychology, Çankaya University, Ankara, Türkiye
| | - J. Christopher Perry
- Department of Psychiatry, McGill University and Institute of Community and Family Psychiatry at Jewish General Hospital, Montreal, QC, Canada
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | | | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
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Approximating defense mechanisms in a national study of adults: prevalence and correlates with functioning. Transl Psychiatry 2023; 13:21. [PMID: 36690611 PMCID: PMC9870881 DOI: 10.1038/s41398-022-02303-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/30/2022] [Accepted: 12/30/2022] [Indexed: 01/25/2023] Open
Abstract
Despite the clinical relevance of defense mechanisms, there are no published studies in nationally representative samples of their prevalence, correlates, and association with psychosocial functioning. We sought to estimate the prevalence and correlates of 12 defense mechanisms in the general adult population by approximating from items used to assess personality traits in the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), a representative sample of US adults (N = 36,653). We examined the associations between sociodemographic characteristics and prevalence of 3 types of defenses mechanisms (pathological, immature, and neurotic). For each defense mechanism, we used the Short-Form 12 to compare psychosocial functioning among 3 groups: those who (1) endorsed the mechanism with self-recognized impairment, (2) endorsed the mechanism without self-recognized impairment, and (3) did not endorse the defense mechanism. The prevalence of defense mechanisms ranged from 13.2% (splitting) to 44.5% (obsessive/controlling behavior). Pathological defenses were more strongly associated with immature defenses (OR = 5.4, 95% CI = 5.2-5.6) than with neurotic defenses (OR = 2.0, 95% CI = 1.9-2.0), whereas the association between immature and neurotic defenses had an intermediate value between the other two (OR = 2.2, 95% CI = 2.1-2.2). Pathological and immature defenses were associated with younger age, having been never married, lower educational attainment, and lower income. After adjusting the crude results for age and sex, individuals who did not endorse a given defense generally had higher scores on the mental health component of the SF-12 than those who endorsed the defense without self-recognized impairment who, in turn, had on average higher scores than those with self-recognized impairment. These results suggest that neurotic, immature, and pathological defense mechanisms are prevalent in the general population and associated with psychosocial impairment. Recognizing defense mechanisms may be important in clinical practice regardless of treatment modality.
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Altwaijri N, Abualait T, Aljumaan M, Albaradie R, Arain Z, Bashir S. Defense mechanism responses to COVID-19. PeerJ 2022; 10:e12811. [PMID: 35186458 PMCID: PMC8842651 DOI: 10.7717/peerj.12811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/28/2021] [Indexed: 01/10/2023] Open
Abstract
The COVID-19 pandemic has had a wide range of negative physical and mental impacts. This review begins with a theoretical explanation of the psychological defense mechanisms used to deal with the pandemic. It then discusses different categories of defense mechanisms and their roles in managing the impacts of psychological distress. The aim of this review is to highlight the various psychological defense mechanisms individuals use to deal with the pandemic and to discuss how adjustment mechanisms can protect individuals from internal and external threats by shielding the integrity of the ego (the mind) and helping individuals maintain their self-schema.
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Affiliation(s)
| | - Turki Abualait
- College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed Aljumaan
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Raidah Albaradie
- Neuroscience Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Zahid Arain
- Liver Transplant Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Shahid Bashir
- Neuroscience Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Di Giuseppe M, Prout TA, Ammar L, Kui T, Conversano C. Assessing children's defense mechanisms with the Defense Mechanisms Rating Scales Q-sort for Children. RESEARCH IN PSYCHOTHERAPY (MILANO) 2021; 24:590. [PMID: 35047431 PMCID: PMC8715263 DOI: 10.4081/ripppo.2021.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022]
Abstract
Defense mechanisms are unconscious and automatic psychological processes that serve to protect the individual from painful emotions and thoughts. There is ample evidence from the adult psychotherapy and mental health literature suggesting the salience of defenses in the maintenance and amelioration of psychological distress. Although several tools for the assessment of children's defenses exist, most rely on projective and self-report tools, and none are based on the empirically derived hierarchy of defenses. This paper outlines the development of the defense mechanisms rating scale Q-sort for children (DMRS-Q-C), a 60-item, observer-rated tool for coding the use of defenses in child psychotherapy sessions. Modifications to the Defense Mechanisms Rating Scale Q-Sort for adults to create a developmentally relevant measure and the process by which expert child psychotherapists collaborated to develop the DMRS-Q-C are discussed. A clinical vignette describing the child's defensive functioning as assessed by the innovative DMRS-Q-C method is also reported. Finally, we provide an overview of forthcoming research evaluating the validity of the DMRS-Q-C.
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Affiliation(s)
- Mariagrazia Di Giuseppe
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Tracy A. Prout
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Lauren Ammar
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Thomas Kui
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
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Di Giuseppe M, Perry JC. The Hierarchy of Defense Mechanisms: Assessing Defensive Functioning With the Defense Mechanisms Rating Scales Q-Sort. Front Psychol 2021; 12:718440. [PMID: 34721167 PMCID: PMC8555762 DOI: 10.3389/fpsyg.2021.718440] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/24/2021] [Indexed: 11/13/2022] Open
Abstract
The psychodynamic concept of defense mechanisms is nowadays considered by professionals with various theoretical orientations of great importance in the understanding of human development and psychological functioning. More than half century of empirical research has demonstrated the impact of defensive functioning in psychological well-being, personality organization and treatment process-outcome. Despite the availability of a large number of measures for their evaluation, only a few instruments assess the whole hierarchy of defenses, based on the Defense Mechanisms Rating Scales (DMRS), which arguably offers an observer-rated gold standard of assessment. The present article illustrates the theoretical and methodological background of the DMRS-Q, the Q-sort version of the DMRS for clinical use. Starting from the definition and function of the 30 defense mechanisms included in the hierarchy, we extracted 150 items that captured a full range of defensive manifestations according to the DMRS theory. The DMRS-Q set is described in this paper with reference to the DMRS manual. Directions are also provided for using the DMRS-Q online software for the free and unlimited coding of defense mechanisms. After each coding, the DMRS-Q software provides a report including qualitative and quantitative scores reflecting the individual’s defensive functioning. Qualitative scores are displayed as the Defensive Profile Narratives (DPN), while quantitative scores are reported as Overall Defensive Functioning (ODF), defensive categories, defense levels, and individual defense mechanisms. Syntax for the scoring is displayed in the results and a clinical vignette of a psychotherapy session coded with the DMRS-Q is provided. The DMRS-Q is an easy-to-use, free, computerized measure that can help clinicians in monitoring changes in defense mechanisms, addressing therapeutic intervention, fostering symptoms decreasing and therapeutic alliance. Moreover, the DMRS-Q might be a valid tool for teaching the hierarchy of defense mechanisms and increase the observer-rated assessment of this construct in several research fields.
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Affiliation(s)
- Mariagrazia Di Giuseppe
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - J Christopher Perry
- McGill University Department of Psychiatry at the Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, QC, Canada
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Békés V, Aafjes-van Doorn K, Spina D, Talia A, Starrs CJ, Perry JC. The Relationship Between Defense Mechanisms and Attachment as Measured by Observer-Rated Methods in a Sample of Depressed Patients: A Pilot Study. Front Psychol 2021; 12:648503. [PMID: 34646189 PMCID: PMC8503562 DOI: 10.3389/fpsyg.2021.648503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 08/26/2021] [Indexed: 11/13/2022] Open
Abstract
Despite many theoretical and clinical writings, the theorized connection between defense mechanisms and adult attachment in depressed patients has received little empirical attention. This is the first study to examine patients’ defense mechanisms in relation to their attachment in a clinical sample of depressed patients and also the first to use observer-rated measures for assessing both defense mechanisms and attachment. In this pilot study, we aimed to investigate the relationship between patients’ attachment and their use of defense mechanisms in psychotherapy sessions, as well as patterns of change over treatment. We conducted a secondary analysis of data from a randomized controlled trial of 30 patients receiving psychotherapy for major depression. Session transcripts were previously coded for defense mechanisms using the Defense Mechanisms Rating Scales, and depression severity data were collected by the clinician-rated HRSD-17 and the self-report BDI-II. Patients’ attachment was assessed in two transcripts, one in an early session and a second in a late session, using the novel observer-rated Patient Attachment Coding System. In contrast with expectations, in the early phase of therapy, preoccupied attachment-related characteristics were significantly positively related to overall defensive functioning and negatively related to Depressive immature defenses. In the late phase of treatment, preoccupied attachment-related characteristics were negatively correlated with Non-depressive immature defenses. Moreover, as expected, early-phase defense use was related to late phase attachment; specifically, early neurotic and immature Depressive and Non-depressive defenses predicted an increase in avoidant, whereas immature Non-depressive defenses predicted a decrease in preoccupied attachment-related characteristics over the course of treatment, after controlling for early attachment effects. The results imply a longitudinal relationship between defenses and change in attachment-related characteristics over the course of treatment in a depressed sample and warrant further research about the relationship between defenses and attachment during psychotherapy.
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Affiliation(s)
- Vera Békés
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, United States
| | | | - Daniel Spina
- Department of Clinical Psychology, Pennsylvania State University, University Park, PA, United States
| | - Alessandro Talia
- Institute for Psychosocial Prevention, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Claire J Starrs
- Department of Psychology, SUNY Potsdam, Potsdam, NY, United States
| | - J Christopher Perry
- Department of Psychiatry, Canada Institute of Community and Family Psychiatry, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Herrera F, Reith B, Despland JN, Ambresin G. State of the psychoanalytic nation: Switzerland. PSYCHOANALYTIC PSYCHOTHERAPY 2021. [DOI: 10.1080/02668734.2021.1935307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Fabrice Herrera
- Service of General Psychiatry and University Institute of Psychotherapy, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
- University Institute of Psychotherapy, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
- Swiss Society of Psychoanalysis, Bern, Switzerland
| | | | - Jean-Nicolas Despland
- Service of General Psychiatry and University Institute of Psychotherapy, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
- University Institute of Psychotherapy, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
- Swiss Society of Psychoanalysis, Bern, Switzerland
| | - Gilles Ambresin
- Service of General Psychiatry and University Institute of Psychotherapy, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
- University Institute of Psychotherapy, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
- Swiss Society of Psychoanalysis, Bern, Switzerland
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Merlo EM, Stoian AP, Motofei IG, Settineri S. The Role of Suppression and the Maintenance of Euthymia in Clinical Settings. Front Psychol 2021; 12:677811. [PMID: 34093372 PMCID: PMC8173068 DOI: 10.3389/fpsyg.2021.677811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/08/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Defense mechanisms serve as mediators referred to the subjects' attempt to manage stressors capable of threatening their integrity. Mature defense mechanisms represent the high adaptive group, including suppression, which allows the subject to distance disturbing contents from consciousness. In line with general defensive intents, suppression would preserve stable mood states, as in the case of euthymia. Clinical issues usually disturb homeorhesis, so that the study of subjects' suppressive tendencies would suggest possible existing relations among defense mechanisms, mood states, and clinical issues. The study highlighted the significant existing relations among factors such as suppression, euthymia, mood states, and clinical psychological phenomena. Methods: The observation group was composed of 150 participants, 51 males (34%) and 99 females (66%), aged from 25 to 30 years old, with a mean age of 26.63 years old (SD = 1.51). The study was conducted through the use of measures related to subjects' characteristics, euthymia, psychological flexibility and psychological well-being (Euthymia Scale), suppression (Suppression Mental Questionnaire), well-being (Who-5), and compassion (ProQol-5). Results: The performed analyses consisted of descriptive statistics, correlations, differences, and regressions among the considered variables. Starting from the first hypothesis, SMQ factors appeared to be significantly and positively correlated with Euthymia factors, rather than Regression in the Ego service (-). In line with the previous result, significant and positive correlations emerged among SMQ and Well-being (WHO-5) variables, maintaining an inverse relation with Regression in the Ego service. Significant differences emerged between male and female groups concerning SMQ total score and rationalization, with higher male group scores. Finally, significant dependencies emerged among the selected predictors (SMQ variables) and Compassion satisfaction. Conclusion: The emerged results highlighted significant relations among the considered variables so that it was possible to highlight the common directions assumed by suppression variables, well-being, and euthymia. Moreover, suppression appeared as a significant predictor with a causal role in clinical satisfaction. The results that have emerged allow us to consider defenses through an empirical perspective, useful to suggest an extension to other groups, phenomena, and conditions.
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Affiliation(s)
- Emanuele Maria Merlo
- Department of Adult and Childhood Human Pathology “Gaetano Barresi,” University of Messina, Messina, Italy
| | - Anca Pantea Stoian
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- National Institute of Diabetes, Nutrition and Metabolic Diseases “N. C. Paulescu,”Bucharest, Romania
| | - Ion G. Motofei
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Salvatore Settineri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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de Roten Y, Djillali S, Crettaz von Roten F, Despland JN, Ambresin G. Defense Mechanisms and Treatment Response in Depressed Inpatients. Front Psychol 2021; 12:633939. [PMID: 33815219 PMCID: PMC8012720 DOI: 10.3389/fpsyg.2021.633939] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/22/2021] [Indexed: 12/13/2022] Open
Abstract
The study investigated the extent to which defensive functioning and defense mechanisms predict clinically meaningful symptomatic improvement within brief psychodynamic psychotherapy for recurrent and chronic depression in an inpatient setting. Treatment response was defined as a reduction in symptom severity of 46% or higher from the baseline score on the Montgomery-Asberg Depression Rating Scale (MADRS). A subsample of 41 patients (19 responders and 22 non-responders) from an RCT was included. For each case, two sessions (the second and the penultimate) of brief inpatient psychodynamic psychotherapy (a manualized 12-session therapy program developed in Lausanne) were transcribed and then coded using the Defense Mechanism Rating Scales (DMRS) and the Psychotic Defense Mechanism Rating Scales (P-DMRS), an additional scale developed to study psychotic defenses. Results showed that defensive functioning and mature and immature defense changed during psychotherapy and predicted treatment response. Patient's defenses observed throughout therapy also predicted treatment response at 12-month follow-up. The addition of psychotic defenses allows a better prediction of the treatment response. Overall, these results are in line with previous research and provide further validation of defensive functioning as a predictor of outcomes and a mechanism of change in psychotherapy.
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Affiliation(s)
- Yves de Roten
- Institute of Psychotherapy, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Slimane Djillali
- Institute of Psychotherapy, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | | | - Jean-Nicolas Despland
- Institute of Psychotherapy, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Gilles Ambresin
- Institute of Psychotherapy, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
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Di Giuseppe M, Perry JC, Lucchesi M, Michelini M, Vitiello S, Piantanida A, Fabiani M, Maffei S, Conversano C. Preliminary Reliability and Validity of the DMRS-SR-30, a Novel Self-Report Measure Based on the Defense Mechanisms Rating Scales. Front Psychiatry 2020; 11:870. [PMID: 33005160 PMCID: PMC7479239 DOI: 10.3389/fpsyt.2020.00870] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/10/2020] [Indexed: 12/26/2022] Open
Abstract
Defense mechanisms are psychological factors that influence emotional distress and quality of life. There are a number of measures assessing the construct of defense mechanisms, but only few available instruments reflect the gold-standard theoretical hierarchical organization of defenses. We report on the development of a novel 30 item self-report questionnaire, the DMRS-SR-30, based on the parent instrument, the Defense Mechanism Rating Scales (DMRS). This study tested preliminary reliability and validity of the Italian version of the DMRS-SR-30. We first extracted 30 items from the DMRS Q-sort version (DMRS-Q) and adapted them for a self-reported format. We then applied the DMRS quantitative scoring algorithms to provide proportional scores for the 28 individual defenses and summary scores for seven defense levels and overall defensive functioning (ODF) scores. A dynamic interview was used for assessing participant's defense mechanisms with the observer-rated DMRS and DMRS-Q. We examined internal consistency of the scales along with criterion, concurrent, convergent and discriminant validity among participants (N = 94) who completed the DMRS-SR-30, SCL-90, BDI, and IES-R. Results showed very good internal consistency for ODF (Cronbach's alpha = .890) and the high adaptive defense level, whereas some subscales with few items had lower values. Correlation analyses between DMRS-SR-30 and the two DMRS-based observer-rated measures showed very good criterion and concurrent validity for ODF and moderate to high for defense levels subscales. Correlations between the DMRS-SR-30 ODF and SCL-90 GSI, BDI and IES=R (r = -.456, r= -.540, r = -.402, respectively, all p <.001), indicated good convergent validity. Despite the well-known limitations of self-report methods of psychodynamic phenomena, self-report measures are highly practicable for assessing large samples. The DMRS-SR-30 is the first self-assessed measure describing the whole hierarchy of 28 defense mechanisms and providing scores for ODF, defensive categories, defense levels, and individual defenses. Preliminary examination of the Italian version of the DMRS-SR-30 showed promising results of internal consistency, criterion and concurrent validity, and convergent validity and of the measure. Further validation is needed to confirm these findings and explore other aspects of validity and reliability.
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Affiliation(s)
- Mariagrazia Di Giuseppe
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - John Christopher Perry
- Department of Psychiatry, Institute of Community and Family Psychiatry, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Matilde Lucchesi
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Monica Michelini
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Sara Vitiello
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Aurora Piantanida
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Matilde Fabiani
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Sara Maffei
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
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Ciocca G, Rossi R, Collazzoni A, Gorea F, Vallaj B, Stratta P, Longo L, Limoncin E, Mollaioli D, Gibertoni D, Santarnecchi E, Pacitti F, Niolu C, Siracusano A, Jannini EA, Di Lorenzo G. The impact of attachment styles and defense mechanisms on psychological distress in a non-clinical young adult sample: A path analysis. J Affect Disord 2020; 273:384-390. [PMID: 32560933 DOI: 10.1016/j.jad.2020.05.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 04/21/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Insecure attachment styles and immature or neurotic defense mechanisms are related to psychological distress. However, their mutual interaction in influencing psychological distress deserves further investigation. METHODS One-thousand-one-hundred-twenty-nine University students were evaluated using the Global Severity Index of Symptoms Check List 90-Revised for psychological distress, Relationship Questionnaire for attachment styles and Defense Style Questionnaire for defense mechanisms. Following exploratory analyses, a Path Analysis was performed with psychological distress as outcome. RESULTS Fearful and preoccupied attachment styles had a substantial impact on psychological distress. About 30% of their effect was mediated by Immature and Neurotic defenses, with the former having the major effect. Dismissing attachment showed no substantial effect on psychological distress. Secure Attachment and Mature Defenses had a small protective effect on psychological distress, but their inclusion in the path model did not improve overall goodness-of-fit. Attachment style and defense mechanisms accounted for nearly 25% of the variance in psychological distress. CONCLUSIONS The results showed that attachment styles and defense mechanisms have a substantial impact on psychological distress. The effect of attachment style is mediated by defense mechanisms. Individual differences in attachment style and defense mechanisms represent risk factors for psychological distress in young adults.
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Affiliation(s)
- Giacomo Ciocca
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Alberto Collazzoni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy
| | - Fiorela Gorea
- Catholic University of "Our Lady of Good Council", Tirana, Albania
| | - Blerina Vallaj
- Catholic University of "Our Lady of Good Council", Tirana, Albania
| | - Paolo Stratta
- Department of Mental Health, ASL 01 Avezzano-Sulmona-L'Aquila, Italy
| | - Lucia Longo
- Department of Systems Medicine, University of Rome Tor Vergata, Italy; Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Erika Limoncin
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Daniele Mollaioli
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Dino Gibertoni
- DIBINEM Department of Biomedical And Neuromotor Sciences, Unit of Hygiene, Public Health And Biostatistics, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Emiliano Santarnecchi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Italy; Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Francesca Pacitti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy; Catholic University of "Our Lady of Good Council", Tirana, Albania
| | - Cinzia Niolu
- Department of Systems Medicine, University of Rome Tor Vergata, Italy; Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Italy; Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Italy; Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy.
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Boldrini T, Lo Buglio G, Giovanardi G, Lingiardi V, Salcuni S. Defense mechanisms in adolescents at high risk of developing psychosis: an empirical investigation. RESEARCH IN PSYCHOTHERAPY (MILANO) 2020; 23:456. [PMID: 32913831 PMCID: PMC7451313 DOI: 10.4081/ripppo.2020.456] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/02/2020] [Indexed: 12/23/2022]
Abstract
Research within psychotherapy and psychopathology frameworks has been inspired by the central concept of defense mechanisms, which play a pivotal role in psychoanalysis. Defense specificities have only recently been studied systematically in the context of several clinical diagnoses. The present study aimed to explore the specificities of defense mechanisms in adolescents at ultra-high risk of developing psychosis and test the relationship between defensive functioning and attenuated psychotic symptoms. Twenty-six adolescent inpatients at ultra-high risk of developing psychosis and a matched clinical control group of inpatients not at risk of psychosis were interviewed. Two observer-rater methods, the Defense Mechanism Rating Scales and the Psychotic-Defense Mechanism Rating Scales were applied to interview transcripts to assess the individual use of defenses. Ultra-high-risk patients demonstrated lower defense mechanisms (i.e., total instances of defense mechanisms observed) and lower overall adaptiveness of the defenses presented. When specific differences between groups were observed, psychotic defenses were the sole defenses that could partially discriminate between ultra-high-risk and not at-risk patients. Regarding the relationship between defense mechanisms and subthreshold psychotic symptoms, psychotic defenses were associated with negative and disorganization symptoms, rather than with positive symptoms. The psychological vulnerability of ultra-high-risk patients is discussed and treatment implications for psychotherapy with such challenging patients are addressed.
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Affiliation(s)
- Tommaso Boldrini
- Department of Developmental and Socialization Psychology, University of Padova, Padova
| | - Gabriele Lo Buglio
- Department of Developmental and Socialization Psychology, University of Padova, Padova
| | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome
- Department of Psychology, University of Campania “Luigi Vanvitelli,”Caserta, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome
| | - Silvia Salcuni
- Department of Developmental and Socialization Psychology, University of Padova, Padova
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Settineri S, Frisone F, Alibrandi A, Merlo EM. Emotional Suppression and Oneiric Expression in Psychosomatic Disorders: Early Manifestations in Emerging Adulthood and Young Patients. Front Psychol 2019; 10:1897. [PMID: 31481915 PMCID: PMC6710394 DOI: 10.3389/fpsyg.2019.01897] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 08/01/2019] [Indexed: 01/08/2023] Open
Abstract
Background The function of emotions, beginning from the proto-emotions, is the adaptation to the environment. This is based on the Homeorhesis, the equilibrium due to the adaptive operation of excitement and the dissipation of emotions. The object relations of the participants foresee the practice of defense mechanisms in a continuum that goes from the consciousness to the oneiric activities. The predominant and maladaptive use of defense mechanisms in the psychosomatic phenomenology, can be identified with deficits in emotional awareness, with the impossibility to manage excitement and dissipation of emotions foreseen by the oneiric phenomena. Methods The observation group is composed by 140 participants, 56 males (43%) and 84 females (57%),with pathological-functional disorders of psychosomatic domain. The study had been conducted with the use of measures related to the conscious defense of suppression (Suppression Mental Questionnaire), to the emotional awareness linked to the psychosomatic phenomena (Diagnostic Criteria for Psychosomatic Research Structured Interview-DCPR-SI) and to the states of perturbation and conservation of oneiric activities (The Manheim Dream Questionnaire-MADRE). Results Significant inverse correlations emerged among rationalization, repressive function and illness Denial, as for the suppression mental questionnaire factors and irritable mood, but for Regression in the service of the Ego; inverse and significant correlations emerged among suppression, repressive function, rationalization and gastrointestinal psychosomatic outcomes and among suppression, repression and cardiological psychosomatic outcomes. Regarding alexithymia, a positive correlation emerged with rationalization and inverse with Regression in the service of the Ego. Positive correlations emerged between illness denial and overall emotional tone, for disease phobia and meaningfulness and for cardiological psychosomatic outcomes and nightmare distress and recurring nightmares. Conclusion The study of such outcomes due to a prevalent defensive style based on suppression, suggest the identification of a key phenomenon, which translates into maladjustment that goes from functional disorders to parasomnia. The bridge established by the obfuscation of conscious contents until the manifestations of disturbance of ancient activities such as oneiric ones, expresses the need to transform an emotional maladaptive style, in line with classic literature and the current state of art.
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Affiliation(s)
- Salvatore Settineri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Fabio Frisone
- Department of Cognitive Sciences, Psychology, Educational and Cultural Studies (COSPECS), University of Messina, Messina, Italy.,CRISCAT (International Research Center for Theoretical and Applied Cognitive Sciences) University of Messina and Universitary Consortium of Eastern Mediterranean, Noto (CUMO), University of Messina, Messina, Italy
| | - Angela Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Sciences, University of Messina, Messina, Italy
| | - Emanuele Maria Merlo
- Department of Cognitive Sciences, Psychology, Educational and Cultural Studies (COSPECS), University of Messina, Messina, Italy.,CRISCAT (International Research Center for Theoretical and Applied Cognitive Sciences) University of Messina and Universitary Consortium of Eastern Mediterranean, Noto (CUMO), University of Messina, Messina, Italy
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14
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Di Giuseppe M, Ciacchini R, Micheloni T, Bertolucci I, Marchi L, Conversano C. Defense mechanisms in cancer patients: a systematic review. J Psychosom Res 2018; 115:76-86. [PMID: 30470322 DOI: 10.1016/j.jpsychores.2018.10.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/26/2018] [Accepted: 10/27/2018] [Indexed: 10/28/2022]
Abstract
The importance of defense mechanisms in cancer progression and adaptation have been largely observed. However, few studies referred to the generally accepted hierarchical organization of defenses and used validated measurements for defensive assessment. In this systematic review, we investigated the whole hierarchy of defense mechanisms and how they associate with various psychological aspects in cancer patients. A literature search was conducted using electronic databases. Among 1570 records published from 1990 to date, only 15 articles met inclusion criteria. Findings related to cancer patients' defensive functioning and its relations with other physical and psychological variables were extracted. A general consistency emerges on the role of defense mechanisms in cancer progression and recovery. Following the hierarchical organization of defenses, higher physical and emotional functioning emerged as being associated with High-adaptive defenses, while Mental Inhibition defenses, in particular repression, promote psychosomatic symptoms, passive decisional preferences and worse physical and emotional health. Disavowal defenses foster lower anxiety and higher emotional functioning by denying anxiety about death. Image distortion defenses, including both Minor and Major image-distorting defenses, were more frequent in cancer patients than in control groups and finally, Action defenses predicted sleep disturbance and lower survival probability. The early detection of maladaptive defensive functioning may foster appropriate psychotherapeutic intervention and prevent worsening of the illness. Further investigations are required to replicate these findings and highlight associations between defense mechanisms and various aspects of mental functioning in cancer patients.
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Affiliation(s)
- Mariagrazia Di Giuseppe
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy.
| | - Rebecca Ciacchini
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Tommaso Micheloni
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Ilaria Bertolucci
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Laura Marchi
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
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May K. Collaborating With the Fortress Around Early Childhood Trauma: A Depth Psychotherapy Process. Perspect Psychiatr Care 2018; 54:39-45. [PMID: 27861977 DOI: 10.1111/ppc.12198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/02/2016] [Accepted: 10/12/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE A depth psychotherapy process is a deepening of experience facilitating access into a fortress of body and mind defenses that aims to protect although may imprison the adult survivor of early childhood trauma. CONCLUSIONS When psychotherapy moves beyond managing manifest symptoms and behavior, individuals have an opportunity to connect with their authentic self and experience wholeness in their personality and relationships. PRACTICE IMPLICATIONS A theoretical and practical approach including the therapeutic frame, therapeutic alliance, and body psychotherapy attempts to collaborate with a fortress to encourage its cooperation in the release of its captive.
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Affiliation(s)
- Katherine May
- Katherine May, PMHCNS-BC, is a Depth Psychotherapist, The Center for Depth Psychotherapy, PLC USA, Winchester, Virginia, USA.,Adjunct Clinical Instructor, Psychiatric and Mental Health Nurse Practitioner Program, Shenandoah University, Winchester, Virginia, USA
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Abstract
Understanding defense mechanisms is an important part of psychotherapy. In this article, we trace the history of the concept of defense, from its origin with Freud to current views. The issue of defense as an unconscious mechanism is examined. The question of whether defenses are pathological, as well as their relation to pathology, is discussed. The effect of psychotherapy on the use of defenses, and their relation to a therapeutic alliance is explored. A series of empirical research studies that demonstrate the functioning of defense mechanisms and that support the theory is presented. Research also shows that as part of normal development, different defenses emerge at different developmental periods, and that gender differences in defense use occur.
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Identifying indicators of defensive activity in narration about important interpersonal relations. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2014. [DOI: 10.5114/cipp.2014.46231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
<b>Background</b><br />
One of the main components of psychological conversation that influence communication is psychological defensiveness.
In the paper I propose processual – situational understanding of defensiveness, and its measurement based on coding system. Preliminary results on link between personality traits and defensiveness in people’s narratives are presented as well.<br />
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<b>Participants and procedure</b><br />
To test proposed coding system, study was conducted with participants presenting different levels of personality organization’s (borderline: n = 35, 20 women, M = 26.09, SD = 4.82, neurotic: n = 29, 24 women, M = 25.90, SD = 5.25, integrated: n = 31, 26 women, M = 21.94, SD = 1.69). Correlation method was applied (Borderline Personality Inventory, Neuroticism Scale, Emotion Control Inventory), as well as narrative’s interviews. Participants’ statements were coded by competent judges (defensiveness and coherence of narratives), and by automatic lexical analyses (descriptive indicators).<br />
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<b>Results</b><br />
Results indicate that proposed defensiveness coding system is a set of heterogeneous indicators, and four groups of indicators could be extracted. Correlations between those indicators and expression control (positive relation), and coherence of narratives (negative relation). Moreover, differences between borderline participants and neurotic ones emerged.<br />
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<b>Conclusions</b><br />
Proposed coding system seems to be a heterogeneous but useful tool for assessing defensiveness during psychological interviews. It could be applied as an element of a procedural control measures, directed to test the reliability of psychological conversation.
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Perry JC. Anomalies and specific functions in the clinical identification of defense mechanisms. J Clin Psychol 2014; 70:406-18. [PMID: 24677150 DOI: 10.1002/jclp.22085] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Standard teaching about defense mechanisms generally focuses on definitions, which do not readily aid the clinician in identifying defenses whenever individuals use them. This report demonstrates a process by which the clinician can identify when a defense is used, which ones are likely being used, and with what aim. Clinicians first notice that a defense may be operating whenever the other individual presents with anomalies in the expression of affect, behavior, speech, or its content. Some of these anomalies are described. Next, to identify the specific defense or general level of defensive functioning used, the clinician must identify the specific function of the defense in context using a process of guided clinical inference. This report examines 2 verbatim examples from recorded interviews of one case to demonstrate this process. The examples present a microcosm of clinical concerns that have a surprising relationship to the individual's course and prognosis.
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