Resilience, Defense Mechanisms, and Implicit Emotion Regulation in Psychodynamic Child Psychotherapy

The association between expressive suppression and anxiety in Chinese left-behind children in middle school: serial mediation roles of psychological resilience and self-esteem

BACKGROUND

Left-behind children (LBC) have become a special population to be concerned due to the negative consequences of parental absence during their physical and psychological development in China. Expressive suppression (ES) is a response-focused emotion regulation and may be frequently used by LBC to suppress their emotions resulting in different forms of internalizing problems. The objective of the present study was to investigate the role of ES as an emotion regulation strategy on anxiety in Chinese left-behind children in middle school (LBC-MS) by considering the mediating role(s) of psychological resilience and self-esteem.

METHODS

820 middle school students aged between 12 and 17 years from a middle school in Xiangtan, Hunan Province, participated in the study. Screen for Child Anxiety Related Emotional Disorders (SCARED), Emotion Regulation Questionnaire (ERQ), Resilience Scale for Chinese Adolescents (RSCA), and Rosenberg Self-Esteem Scale (SES) were administered. Variables measured using the above scales in left-behind children in middle school (LBC-MS) and non-left-behind children in middle school (non-LBC-MS) were compared, and descriptive statistics were used to present the overall characteristics. Then the PROCESS macro of SPSS was used to conduct regression-based statistical mediation for the data of 211 left-behind children.

RESULTS

This study revealed that LBC-MS had higher anxiety and ES scores and lower psychological resilience and self-esteem scores than non-LBC-MS (Ps < 0.01). ES was found positively associated with anxiety in LBC-MS and negatively associated with psychological resilience and self-esteem (Ps < 0.05 - 0.01). Specifically, both psychological resilience and self-esteem significantly mediated the association between ES and anxiety, accounting for 7.50% and 10.68%, respectively, of the total associations. Moreover, psychological resilience and self-esteem had a chain mediating effect between ES and anxiety in LBC-MS.

CONCLUSION

The findings indicated that LBC-MS in China may frequently engage in the use of ES which correlated with higher level of anxiety. Psychological interventions should be dedicated to this underserved group. Intervention approaches that improve emotion regulation strategies (i.e., decrease the use of ES) and increase psychological resilience and self-esteem may help to alleviate anxiety in LBC-MS.

Coping Styles and Defense Mechanisms Mediate Associations Between Exposure to Adverse Childhood Experiences and CPTSD Symptoms in Faroese Adolescents

Background

The experience of several adverse childhood experiences (ACEs) has been shown to be associated with Post-Traumatic Stress Disorder (PTSD) and Disturbances in Self-Organization (DSO) symptoms among adolescents. Defense mechanisms and coping styles are psychological processes involved in the association of ACEs with PTSD and DSO symptoms. However, there is a lack of research on the joint association of these variables among Faroese adolescents.

Aim

The aim of this study was to analyze the effect of exposure to ACEs on PTSD and DSO symptoms trough the indirect effect of defense mechanisms and coping styles in a sample of Faroese adolescents.

Method

Six hundred and eighty-seven Faroese adolescents were recruited from 19 schools. Participants responded to validated self-report questionnaires. A multiple step mediation and a serial mediation methodology were conducted through structural equation modeling.

Results

Exposure to ACEs was linked to PTSD and DSO symptoms through the indirect effect of immature defense mechanisms, emotional coping, and detachment coping. Exposure to ACEs was linked to PTSD symptoms through rational coping.

Conclusions

The results suggest a mutual relationship between defense mechanisms and coping styles in coping with multiple adversity among adolescents.

Polytraumatization, defense mechanisms, PTSD and complex PTSD in Indian adolescents: a mediation model

BACKGROUND

Adolescence is recognized as a particularly susceptible developmental period for experiencing multiple types of Adverse Childhood Experiences (ACE), increasing the vulnerability to higher levels of Post-Traumatic Stress Disorder (PTSD) and Complex PTSD symptoms. Some studies found that defense mechanisms play an important role on the association between ACE and psychological symptoms.

METHODS

We analyzed the associations between direct and indirect exposure to ACE and PTSD and Complex PTSD (affective dysregulation, negative self-concept and disturbances in relationships) through the mediation role of mature defense mechanisms: mature, neurotic, and immature defense mechanisms in Indian adolescents. A sample of 411 Indian adolescents (M = 14.2 years old; S.D. = 0.5) completed validated self-report questionnaires. Serial multiple mediation models were tested by conducting a structural equation modelling employing Preacher and Hayes' procedures (2008).

RESULTS

Immature and neurotic defense mechanisms mediated the association between direct exposure to ACE with PTSD symptoms. Immature defense mechanisms were mediators of the relationship between direct exposure to ACE and Complex PTSD symptoms clusters.

CONCLUSIONS

Maladaptive defense mechanisms can disturb the process of self-regulation and emotion regulation capabilities in coping with traumatic experiences, leading to higher PTSD and Complex PTSD symptoms severity.

Problematic internet use in emerging adulthood to escape from maternal helicopter parenting: defensive functioning as a mediating mechanism

The increasing use of the Internet has raised concerns about its problematic use, particularly among emerging adults who grew up in a highly digitalized world. Helicopter parenting, characterized by excessive involvement, overcontrol, and developmentally inappropriate behavior, has been identified as a potential factor contributing to problematic Internet use (PIU). Under these circumstances, considering that emerging adults navigate their adult lives and strive to reduce their sense of being in-between, implicit emotion regulation strategies, such as defense mechanisms, may help comprehend PIU. The present questionnaire-based study investigated the associations between maternal and paternal helicopter parenting and PIU through defensive functioning among a community sample of 401 cisgender emerging adults (71.82% females; 82.04% heterosexuals; Mage=24.85, SD=2.52) living in Italy. About one-fourth (25.19%) reported PIU. Greater maternal, B=0.904, SE=0.235, p<.001, but not paternal, B=0.343, SE=0.188, p=.068, helicopter parenting was significantly associated with PIU through a less mature defensive functioning. Conversely, neither maternal, B=1.158, SE=0.722, p=.109, nor paternal, B=0.355, SE=0.731, p=.628, helicopter parenting had a direct association with PIU. The results suggest the importance for psychotherapists to incorporate individuals' defense mechanisms and parent-child relationship history when designing tailored interventions for effective treatment of PIU. This emphasis is crucial because, in the context of a developmentally appropriate parenting style, relying on more mature defenses after psychotherapeutic intervention can lead to healthier adjustment among emerging adults.

Mediators of outcome in adolescent psychotherapy and their implications for theories and mechanisms of change: a systematic review

Psychotherapeutic treatment of adolescents requires age-specific approaches and thus plausibly also involves different change mechanisms than adult psychotherapy. To guide further research and improve therapeutic outcomes for adolescents, we reviewed all RCTs investigating mechanisms of change in the psychological treatment of adolescents to identify the most promising age-, disorder- or treatment-specific mediators. Following the preferred reporting items for systematic reviews (PRISMA), 106 studies were included that reported 252 statistical mediation tests assessed with 181 different measures. Most often studied and significant mediators were cognitive, followed by family-related, and behavioral variables. Several mediators were identified to be promising for future investigations: changes in negative thoughts, dysfunctional beliefs and metacognitive skills; family functioning and parenting skills; as well as successful engagement in therapy activities and increased impulse control. Symptom change during therapy was least often a mediator for other therapeutic changes. Relational and emotional mediators were largely understudied, whereas peer-influence appeared a promising mediator for intervention outcomes. Adolescence-specific mediators were most commonly investigated. Majority of studied mediators were not disorder-specific. There was a tendency to mainly test change mechanisms of specific theoretical models without considering other possible change theories. Further, virtually no studies fulfilled all criteria for rigorously investigating mediation and only nine were classified with an overall good study quality. While bearing in mind the current limitations in study designs, methodological rigor and reporting, there appears to be substantial evidence for transdiagnostic age-specific change models in the psychological treatment of adolescents. For future research, need for consensus on a core set of transdiagnostic and transtheoretical mediators and measures is highlighted. These should address likely core mechanisms of change, as well as take into account age-relevant developmental challenges and biological markers.

Assessing children's defense mechanisms with the Defense Mechanisms Rating Scales Q-sort for Children

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.

Randomized controlled trial of Regulation Focused Psychotherapy for children: A manualized psychodynamic treatment for externalizing behaviors

OBJECTIVE

This article examines outcomes of the first randomized controlled trial of Regulation Focused Psychotherapy for Children (RFP-C), a manualized, short-term, psychodynamic intervention for decreasing symptoms of the oppositional defiant disorder (ODD) in school-aged children.

METHOD

Participants (n = 43) were school-aged children who were randomly assigned to RFP-C or a waitlist control group. Symptoms of ODD and explicit emotion regulation capacities were assessed at baseline, end of waitlist, and end of treatment. Multilevel modeling was used to account for patient and therapist factors in outcomes.

RESULTS

At the end of treatment, parents reported significant reductions in children's ODD symptoms on the primary outcome measure. There were no observed changes in explicit emotion regulation. Reliable change index scores indicated that 79.4% of children were recovered or improved after 10 weeks of treatment. There were no identifiable patient or therapist effects. Treatment adherence and completion was high.

CONCLUSION

This study is the first randomized controlled trial of a manualized psychodynamic intervention for children with ODD. Participants demonstrated significant reductions in symptoms of ODD after 10 weeks of treatment. Further investigation is needed to compare RFP-C relative to active treatment, assess changes in implicit emotion, and to determine long-term maintenance of symptom improvement.Clinical trial registration information: Evaluation of Regulation Focused Psychotherapy for Children (RFP-C); https://clinicaltrials.gov/ct2/show/NCT03594253.

Resilience Coping in Preschool Children: The Role of Emotional Ability, Age, and Gender

Background: In the process of children’s physical and mental development, emotional ability is an important part of their cognitive and social ability. Resilience in the face of difficulties or setbacks and other adversity will also produce differences in adaptability, thus affecting physical and mental development. Objectives: This study aimed to measure the effect of children’s emotional ability on resilience and to provide an in-depth analysis based on age and gender differences. Methodology: A total of 300 preschool children aged 3–6 years old in kindergartens of China were randomly selected as the research subjects. Through a combination of experiments and questionnaires, the emotional ability and resilience of children were measured, and differences were analyzed according to the actual situation, using age and gender. Results: Children of different ages have significant differences in the dimensions and total scores of emotional ability and resilience, but only some of the resilience dimensions have significant gender differences. Moreover, the emotional ability has a significant positive effect on resilience. Discussions: The results confirm the influence of children’s emotional ability on resilience, but the research hypothesis has not been fully verified. Limitations: This study has the limitations of a single measurement method and a more effective research tool.

Internet Gaming Disorder, Risky Online Behaviour, and Mental Health in Hong Kong Adolescents: The Beneficial Role of Psychological Resilience

In the present cyber age, Internet gaming disorder (IGD) and risky online behaviour are prevalent, and adolescents are especially vulnerable to such emergent problems. Few studies have explored the protective factors that mitigate harm caused by IGD and various common risky online behaviours. This study examined the prevalence of IGD and risky online behaviour, their hypothesised associations with depressive symptoms, and the beneficial role of psychological resilience as an underlying psychological mechanism. The participants included 1,099 Chinese junior secondary school students (33% boys, mean age = 13.5 years, age range = 10-17 years) who completed a battery of validated self-report questionnaires at their schools. The results revealed that 4% of the participants were at high risk of IGD and 6% were at an overall risk level of IGD. Depressive symptoms were positively associated with IGD and risky online behaviour, and psychological resilience mediated both of these associations. These results imply that clinicians and teachers should incorporate psychological resilience training into intervention approaches to mitigate IGD and risky online behaviour.

We should address residential relocation to improve patient care

Moving, or residential relocation, occurs frequently in childhood and adolescence as well as in adulthood, yet little scientific consensus exists on its impact upon health outcomes. This paper summarises the available literature on this broad topic and explores the currently known factors of importance surrounding residential relocation. There is already evidence to support an increased risk of suicidal ideation, psychiatric disorders including substance use disorders, functional impairments and future general medical health impairments in children, adolescents and adults with histories of residential relocation. Intrapersonal factors, such as personality type and the availability of coping skills, as well as interpersonal factors, such as family composition and system strengths, attenuate risk and are integral to additionally assess. While there is support for the contribution of residential relocation in the onset of youth psychopathology that warrant consideration of residential relocation in the standard assessment of a patient, further studies are needed to better explore this factor in select populations.

Mindfulness, Age and Gender as Protective Factors Against Psychological Distress During COVID-19 Pandemic

OBJECTIVE

Mindfulness disposition is associated with various psychological factors and prevents emotional distress in chronic diseases. In the present study, we analyzed the key role of mindfulness dispositions in protecting the individual against psychological distress consequent to COVID-19 social distancing and quarantining.

METHODS

An online survey was launched on March 13, 2020, with 6,412 responses by April 6, 2020. Socio-demographic information, exposure to the pandemic, and quarantining were assessed together with psychological distress and mindfulness disposition. Multivariate linear regression analysis was performed to study the influence of predictive factors on psychological distress and quality of life in Italian responders during the early days of lockdown. Pearson correlations were calculated to study the relationship between mindfulness and psychiatric symptoms.

RESULTS

Multivariate linear regression run on socio-demographics, COVID-19-related variables, and mindfulness disposition as moderators of overall psychological distress showed that mindfulness was the best predictor of psychological distress (β = -0.504; p < 0.0001). High negative correlations were found between mindfulness disposition and the overall Global Severity Index (r = -0.637; p < 0.0001), while moderate to high associations were found between mindfulness and all SCL-90 sub-scales.

DISCUSSION

Findings showed that high dispositional mindfulness enhances well-being and helps in dealing with stressful situations such as the COVID-19 pandemic. Mindfulness-based mental training could represent an effective intervention to stem post-traumatic psychopathological beginnings and prevent the onset of chronic mental disorders.

Preliminary Reliability and Validity of the DMRS-SR-30, a Novel Self-Report Measure Based on the Defense Mechanisms Rating Scales

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.

Defense mechanisms in adolescents at high risk of developing psychosis: an empirical investigation

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.

Intervening on the Developmental Course of Children With Borderline Intellectual Functioning With a Multimodal Intervention: Results From a Randomized Controlled Trial

An adverse social environment is a major risk factor for borderline intellectual functioning (BIF), a condition characterized by an intelligence quotient (IQ) within the low range of normality (70-85) with difficulties in the academic achievements and adaptive behavior. Children with BIF show impairments in planning, language, movement, emotion regulation, and social abilities. Moreover, the BIF condition exposes children to an increased risk of school failures and the development of mental health problems, and poverty in adulthood. Thus, an early and effective intervention capable of improving the neurodevelopmental trajectory of children with BIF is of great relevance.

AIM

The present work aims to report the results of a randomized controlled trial (RCT) in which an intensive, integrated and innovative intervention, the movement cognition and narration of the emotions (MCNT) was compared to standard speech therapy (SST) for the treatment of children with BIF.

METHODS

This was a multicenter, interventional, single blind RCT with two groups of children with BIF: the experimental treatment (MCNT) and the treatment as usual (SST). A mixed factorial ANOVA was carried out to assess differences in the effectiveness between treatments. Primary outcome measures were: WISC III, Child Behavior Checklist (CBCL), Vineland II, and Movement ABC.

RESULTS

MCNT proved to be more effective than SST in the increment of full-scale IQ (p = 0.0220), performance IQ (p < 0.0150), socialization abilities (p = 0.0220), and behavior (p = 0.0016). No improvement was observed in motor abilities. Both treatments were linked to improvements in verbal memory, selective attention, planning, and language comprehension. Finally, children in the SST group showed a significant worsening in their behavior.

CONCLUSION

Our data show that an intensive and multimodal treatment is more effective than a single domain treatment for improving intellectual, adaptive and behavioral functioning in children with BIF. These improvements are relevant as they might represent protective factors against the risk of school failure, poverty and psychopathology to which children with BIF are exposed in the adult age. Limitations of the study are represented by the small number of subjects and the lack of a no-treatment group.

CLINICAL TRIAL REGISTRATION

ISRCTN Registry (isrctn.com), identifier ISRCTN81710297.

Psychological Resilience, Mental Health, and Inhibitory Control Among Youth and Young Adults Under Stress

Psychological resilience allows one to cope successfully with adversities occurring during stressful periods, which may otherwise trigger mental illness. Recent models suggest that inhibitory control (IC), the executive control function which supports our goal-directed behavior and regulates our emotional response, may underlie resilience. However, the ways in which this is manifested during stressful situations in real life is still unclear. Here, we examined the relationship between IC, psychological resilience, psychological distress, and anxiety among 138 female and male participants in a stressful situation: during their initial combat training in the military. Using a mobile app, we assessed IC using emotional and non-emotional variations of the Go/No-Go task. Psychological resilience, psychological distress, and anxiety were assessed using mobile versions of self-report questionnaires. We found that psychological resilience is significantly correlated with non-emotional IC (r = 0.24, p < 0.005), but not with emotional IC; whereas, psychological distress and anxiety are correlated with emotional IC (r = -0.253, p < 0.005 and r = -0.224, p < 0.01, for psychological distress and anxiety, respectively), but not with non-emotional IC. A regression model predicting emotional IC confirmed non-emotional IC and distress as unique contributors to the variance, but not psychological distress. In addition, associations between psychological distress and emotional IC were found only for female participants. Collectively, the results clarify the link between IC, resilience, and mental health in real-life stressful situations, showing separate mechanisms of IC involved in resilience on the one hand, and mental health on the other hand. These results have implications for building mobile resilience interventions for youth and young adults facing stressful situations.