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Fiorentino F, Lo Buglio G, Morelli M, Chirumbolo A, Di Giuseppe M, Lingiardi V, Tanzilli A. Defensive functioning in individuals with depressive disorders: A systematic review and meta-analysis. J Affect Disord 2024; 357:42-50. [PMID: 38663554 DOI: 10.1016/j.jad.2024.04.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to address the limited generalizability of studies on defense mechanisms in depression by comparing depressive individuals with non-clinical controls (aim a) and examining changes throughout psychological interventions (aim b) (PROSPERO CRD42023442620). METHODS We followed PRISMA 2020 guidelines, searching PubMed/Web of Science/(EBSCO)PsycINFO until 13/04/2023 for studies evaluating defense mechanisms with measures based on the hierarchical model in depressive patients versus non-clinical controls or throughout psychological intervention. We conducted random-effect meta-analyses for mature defenses/non-mature (neurotic/immature) defenses/overall defensive functioning (ODF), with standardized mean difference (SMD) as outcome measure metric. Meta-regression/sub-group/sensitivity analyses were conducted. Study quality was appraised using the Newcastle-Ottawa Scale (NOS), and certainty of evidence for aim b outcomes was evaluated using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). RESULTS 18 studies were included (mean NOS score = 5.56). Depressive patients used significantly more non-mature defenses than non-clinical controls (SMD = 0.74; k = 13). Non-clinical controls did not significantly differ in use of mature defenses compared to depressive patients (SMD = 0.33; k = 14). Significant moderators were publication year/NOS score/geographical distribution/mean age for non-mature defenses and NOS score/geographical distribution for mature defenses. Throughout psychological interventions, only ODF significantly increased (SMD = 0.55; k = 2) (GRADE = very low). LIMITATIONS Quality of many studies was medium/sub-optimal, and longitudinal studies were scarce. CONCLUSION Individuals with depressive disorders show a high use of non-mature defenses that could be assessed and targeted in psychological interventions, especially in younger patients.
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Affiliation(s)
- Flavia Fiorentino
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
| | - Gabriele Lo Buglio
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Mara Morelli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | | | | | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
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Vierl L, Hörz-Sagstetter S, Benecke C, Spitzer C, Juen F. All the Same? Different Measures of Personality Functioning Are Similar but Distinct. A Comparative Study from a Psychodynamic Perspective Using Exploratory Graph Analysis. J Pers Assess 2024; 106:314-327. [PMID: 37647512 DOI: 10.1080/00223891.2023.2251150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023]
Abstract
Personality functioning (PF) is a central construct in many theories of personality pathology. Based on psychodynamic theories, two screening questionnaires to assess PF are widely used: The Inventory of Personality Organization-16 item version and the Operationalized Psychodynamic Diagnosis-Structure Questionnaire Short Form. This study aimed to explore the similarities and differences of the two questionnaires in a large clinical sample of N = 1636 psychotherapeutic inpatients. Correlation analyses were conducted to examine the associations between the global scores and between the subscales. The study further used Exploratory Graph Analysis (EGA) to explore the dimensionality of the items. The stability of estimates was evaluated using a bootstrap version of EGA (bootEGA). The results indicated that the two questionnaires are highly correlated, yet not multicollinear, and moderate to large correlations were found between their subscales. EGA revealed six dimensions that fairly represented the original subscales. BootEGA showed that the dimensions and items were stable, except for one item that did not load sufficiently on any dimension. The findings suggest that although the questionnaires are highly correlated, their subscales tap into distinct domains of PF. We discuss implications stemming from these findings for clinical and scientific practice.
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Affiliation(s)
- Larissa Vierl
- Akademie für Psychoanalyse und Psychotherapie München e.V, Munich, Germany
- Department of Psychology, University of Kassel, Germany
| | - Susanne Hörz-Sagstetter
- Akademie für Psychoanalyse und Psychotherapie München e.V, Munich, Germany
- Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Germany
| | - Cord Benecke
- Department of Psychology, University of Kassel, Germany
| | - Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Germany
| | - Florian Juen
- Akademie für Psychoanalyse und Psychotherapie München e.V, Munich, Germany
- Department of Psychology, Universität der Bundeswehr, Munich, Germany
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Broc G, Brunel L, Lareyre O. Dynamic Ecosystem Adaptation through Allostasis (DEA-A) Model: Conceptual Presentation of an Integrative Theoretical Framework for Global Health Change. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:432. [PMID: 38673343 PMCID: PMC11050241 DOI: 10.3390/ijerph21040432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/27/2024] [Accepted: 03/31/2024] [Indexed: 04/28/2024]
Abstract
Achieving ambitious goals in Global Health first requires an integrative understanding of how individuals and organizations adapt in a living ecosystem. The absence of a unified framework limits the consideration of the issues in their complexity, which further complicates the planning of Global Health programs aimed at articulating population-based prevention and individual-level (clinical) interventions. The aim of the conceptual contribution is to propose such a model. It introduces the Dynamic Ecosystem of Adaptation through Allostasis (DEA-A) theoretical framework, emphasizing the functional adaptation of individuals and organizations in symbiosis with their living ecosystem. The DEA-A framework articulates two central components to grasp the complexity of adaptation: the internal dynamics (intrasystem level) and the environmental dynamics (ecosystem level). It bridges diverse conceptual approaches, including stress and adaptation models, behavior-change models, and ecosystem-based perspectives. Epistemological considerations raised in the conceptual article prompt a reconsideration of methods and tools for the planning of intervention. Further contributions will present a suitable methodology for the application of the DEA-A framework along with practical recommendations.
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Affiliation(s)
- Guillaume Broc
- EPSYLON EA 4556, Paul Valéry Montpellier 3, University of Montpellier, 34090 Montpellier, France; (L.B.); (O.L.)
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Cieślak I, Jaworski M, Panczyk M, Barzykowski K, Majda A, Theofanidis D, Gotlib-Małkowska J. Multicultural personality profiles and nursing student attitudes towards refugee healthcare workers: A national, multi-institutional cross-sectional study. NURSE EDUCATION TODAY 2024; 134:106094. [PMID: 38277758 DOI: 10.1016/j.nedt.2024.106094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/19/2023] [Accepted: 01/12/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Multicultural organizations in the era of globalization require intercultural leadership skills. Healthcare, as a sector serving diverse populations, necessitates culturally sensitive staff. Intercultural nurse education should start in undergraduate education. A tailored approach is needed, especially in the context of Poland's refugee crisis. OBJECTIVE To investigate how a multicultural personality profile and specific intercultural perspectives affect the attitudes of nursing students towards Ukrainian refugee background healthcare professionals. DESIGN A nationwide cross-sectional multicentre online survey study was conducted. The questionnaire was distributed with the aid of the Lime Survey web platform. METHODS The study utilized a Polish version of the Multicultural Personality Questionnaire. The questionnaire also included demographics and questions assessing intercultural competence and attitudes towards refugee medical professionals. K-Means Cluster Analysis was used to classify different patterns of multicultural personality. P-value <0.05 was deemed to be statistically significant. PARTICIPANTS The study sample consisted of 1325 undergraduate nursing students from 39 nursing schools in Poland: 54.0% in first year, 28.7% in second year, and 17.3% in third year. Most respondents were female (N = 1229, 90%). RESULTS Using cluster analysis respondents were categorized into four groups based on their level of three analyzed multicultural personality traits: cultural empathy, social initiative, and open-mindedness (high, low, average or mixed level). Statistical analysis demonstrated that personality profiles significantly affected nursing students' attitudes towards refugee health professionals (p = 0.003). Additionally, students' willingness to engage in intercultural communication classes and their belief in the learnability of intercultural competence also impacted their attitudes (p < 0.001 for both). Further analysis revealed correlations between personality profiles, belief in competency acquisition, and willingness to enhance competencies. CONCLUSION The design of intercultural competence education for undergraduate nursing students should be preceded by a mapping of the students' personality profile and a needs analysis in this regard, which may contribute to long-term effectiveness of such initiatives.
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Affiliation(s)
- Ilona Cieślak
- Department of Education and Research in Health Sciences, Medical University of Warsaw, Litewska 14/16 street, Warsaw 00-581, Poland.
| | - Mariusz Jaworski
- Department of Education and Research in Health Sciences, Medical University of Warsaw, Litewska 14/16 street, Warsaw 00-581, Poland
| | - Mariusz Panczyk
- Department of Education and Research in Health Sciences, Medical University of Warsaw, Litewska 14/16 street, Warsaw 00-581, Poland
| | - Krystian Barzykowski
- Institute of Psychology, Faculty of Philosophy, Jagiellonian University, Ingardena 6 street, 30-060 Kraków, Poland
| | - Anna Majda
- Laboratory of Theory and Fundamentals of Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, Kopernika 25 street, 31-501 Kraków, Poland
| | - Dimitros Theofanidis
- Department of Nursing, International Hellenic University, PO. Box 141, Sindos, 57400 Thessaloniki, Greece
| | - Joanna Gotlib-Małkowska
- Department of Education and Research in Health Sciences, Medical University of Warsaw, Litewska 14/16 street, Warsaw 00-581, Poland
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Marchetti I, Micheli I, Grassi M. Defense styles, well-being, and functional disability in the African context: A structured interview-based study. J Pers 2023. [PMID: 38014707 DOI: 10.1111/jopy.12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/02/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE We investigated the defense styles in the African context by exploring their internal structure in Burkinabé individuals. Moreover, we explored how defense styles were related to sociocultural variables. Finally, we tested whether defense styles could mediate the relationship between sociocultural variables and mental well-being as well as functional disability. METHOD The study recruited 998 individuals (66.9% male; age = 25.50 ± 7.8 years) living in Burkina Faso. Standard measures for defense mechanisms, mental well-being, and functional disability were administered as a structured interview in the local vehicular language, that is, Dyula. RESULTS Principal component analysis identified three major defense styles-mature, neurotic, and immature. Gender, formal education, living area, and believing in traditional practices were associated with any of the three defense styles. Moreover, the immature style mediated the impact of sociocultural variables on specific outcomes, such as higher functional disability and lower mental well-being. The neurotic style was associated with lower functional disability, while the mature style was not associated with any of the outcome variables. CONCLUSION Our study provided preliminary support to the notion that defense styles may function similarly across cultures and they are likely reactive to the sociocultural context.
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Affiliation(s)
- Igor Marchetti
- Department of Life Sciences, Psychology Unit, University of Trieste, Trieste, Italy
| | - Ilaria Micheli
- Department of Legal, Language, Interpreting and Translation Studies, University of Trieste, Trieste, Italy
| | - Michele Grassi
- Department of Life Sciences, Psychology Unit, University of Trieste, Trieste, Italy
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Carone N, Benzi IMA, Muzi L, Parolin LAL, Fontana A. Problematic internet use in emerging adulthood to escape from maternal helicopter parenting: defensive functioning as a mediating mechanism. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26. [PMID: 37946531 DOI: 10.4081/ripppo.2023.693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/29/2023] [Indexed: 11/12/2023]
Abstract
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.
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Affiliation(s)
- Nicola Carone
- Department of Brain and Behavioral Sciences, University of Pavia.
| | | | - Laura Muzi
- Department of Philosophy, Social Sciences, Humanities and Education, University of Perugia.
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Martino G, Bellone F, Vicario CM, Gaudio A, Corica F, Squadrito G, Lund-Jacobsen T, Schwarz P, Lo Coco G, Morabito N, Catalano A. Interrelations between clinical-psychological features and bone mineral density changes in post-menopausal women undergoing anti-osteoporotic treatment: a two-year follow-up. Front Endocrinol (Lausanne) 2023; 14:1151199. [PMID: 37229451 PMCID: PMC10203700 DOI: 10.3389/fendo.2023.1151199] [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: 01/25/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction Psychological features have been bidirectionally associated with osteoporosis, but it is still unclear whether patient's anxiety fluctuations during the anti-osteoporotic treatment can have an impact on bone mineral density (BMD) variation. The aim of this study was to investigate the interrelations between psychological distress features, such as anxiety, depression, health-related QoL (HRQoL) and bone health in women receiving anti-osteoporotic treatment. Methods 192 post-menopausal osteoporotic women were treated with alendronate or risedronate according to the standard procedure. The levels of anxiety, depression, and perceived HRQoL, along with BMD, were assessed at baseline and at a 2-year follow-up. Results At the end of the study, the patients showed a statistically significant increase of both psychic and somatic anxiety (p<0.0001) and exhibited a worsening of depressive symptoms (p<0.0001), whereas HRQoL showed no change. BMD improved and no incident fractures occurred. BMD variation (ΔBMD) at lumbar spine was significantly associated with anxiety levels (r=0.23, p=0.021). Multiple regression analysis showed that both patients' worsening anxiety levels (β = -0.1283, SE=0.06142, p=0.04) and their treatment adherence (β=0.09, SE=0.02, p=0.0006) were independently associated with ΔBMD. Discussion The findings of the current follow-up study suggest that BMD in post-menopausal women undergoing anti-osteoporotic treatment was predicted by treatment adherence and anxiety change over time.
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Affiliation(s)
- Gabriella Martino
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Federica Bellone
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Carmelo Mario Vicario
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, Messina, Italy
| | - Agostino Gaudio
- Department of Clinical and Experimental Medicine, University Hospital of Catania, Catania, Italy
| | - Francesco Corica
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Giovanni Squadrito
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Trine Lund-Jacobsen
- Department of Endocrinology, Centre for Cancer and Organ Diseases, The Copenhagen University Hospital, Rigshospitalet and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Schwarz
- Department of Endocrinology, Centre for Cancer and Organ Diseases, The Copenhagen University Hospital, Rigshospitalet and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gianluca Lo Coco
- Department of Psychology, Educational Science and Human Movement- University of Palermo, Palermo, Italy
| | - Nunziata Morabito
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Antonino Catalano
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
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da Silva Machado R, Vieira IS, Scaini C, Molina ML, Barbosa LP, da Silva GDG, Ores L, de Mattos Souza LD, Jansen K, da Silva RA. Ego-defense mechanisms and brief psychotherapies for the management of major depressive disorder in adults: A longitudinal and quasi-experimental study. J Affect Disord 2023; 330:291-299. [PMID: 36871912 DOI: 10.1016/j.jad.2023.02.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE To evaluate the effect of psychotherapies on ego defense mechanisms and the reduction of depressive symptoms in a 12-month follow-up period. METHODS This longitudinal and quasi-experimental study nested within a randomized clinical trial included a clinical sample of adults (18-60 years) diagnosed with major depressive disorder using the Mini-International Neuropsychiatric Interview. Two models of psychotherapy were used: Supportive Expressive Dynamic Psychotherapy (SEDP) and Cognitive Behavioral Therapy (CBT). Defense Style Questionnaire 40 was used to analyze defense mechanisms and the Beck Depression Inventory was used to measure the depressive symptoms. RESULTS The total sample comprised 195 patients (113 SEDP and 82 CBT), with the mean age was 35.63 (11.44) years. After adjustments, increased mature defenses was significantly associated with reduced depressive symptoms at all follow-up times (p < 0.001) and the decrease in immature defenses was significantly associated with the reduction of depressive symptoms at all follow-up times (p < 0.001). While neurotic defenses were not associated with a reduction in depressive symptoms at any time of follow-up (p > 0.05). CONCLUSION Both models of psychotherapy were effective in increasing mature defenses and decreasing immature ones, as well as decreasing depressive symptoms at all evaluation times. With this, it is understood that a greater understanding of these interactions will allow a more adequate diagnostic and prognostic evaluation and the design of useful strategies that adapt to the patient's reality.
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Affiliation(s)
- Rosiene da Silva Machado
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | - Igor Soares Vieira
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil; Centro Universitário Estácio de Sergipe, SE, Brazil
| | - Carolina Scaini
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | - Mariane Lopez Molina
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil; Faculdade Anhanguera do Rio Grande, RS, Brazil
| | - Luana Porto Barbosa
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | - Giovana Del Grande da Silva
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | | | - Luciano Dias de Mattos Souza
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | - Karen Jansen
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | - Ricardo Azevedo da Silva
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil.
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Maier L, Blanck J, Singer S. Unipolare Depression – psychodynamische Vielfalt. FORUM DER PSYCHOANALYSE 2023. [DOI: 10.1007/s00451-022-00496-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
ZusammenfassungVersorgungsengpässe in der ambulanten Psychotherapie haben in den letzten Jahren zu diversen Gesetzesinitiativen geführt. Eine davon war die Einführung von diagnosespezifischen Behandlungskontingenten. Ausgehend von diesem gesundheitspolitischen Vorhaben fragten wir uns, inwiefern empirische Daten für oder gegen eine solche Praxis sprechen, das heißt, wie „homogen“ Patient:innen mit derselben ICD-10-Diagnose aus psychodynamischer Sicht sind. Mithilfe der qualitativen Inhaltsanalyse wurden 13 Berichte von Patient:innen mit der Erstdiagnose F33.1 (Rezidivierende depressive Störung, gegenwärtig mittelgradige Episode) ausgewertet, die im Rahmen des Gutachtenverfahrens geprüft wurden. Zusätzlich schätzten wir das generelle Funktionsniveau ein und verglichen die Reife der Abwehr mit dem Vorliegen komorbider psychischer Diagnosen. Es wurden 56 Seiten Textmaterial analysiert. Wir identifizierten 4 Konflikttypen (Selbstwert, Nähe-Distanz, Unterwerfung, Schuld) sowie strukturelle Beeinträchtigungen in 4 Bereichen (Selbst- und Objektwahrnehmung, Selbstregulierung, Bindung und Identität), bei Vorliegen verschiedener Therapieziele und Interaktionsformen. Die Abwehr bewegte sich auf unreifem bis neurotischen Niveau, was nicht im Zusammenhang mit dem Vorliegen komorbider Diagnosen stand. Das Funktionsniveau ließ auf ein breites Spektrum genereller Beeinträchtigung schließen. Unsere Ergebnisse legen nahe, dass Depressionen vielfältige psychodynamische Hintergründe haben. Dies steht im Widerspruch zu der Idee einer Zuordnung von ICD-10-Diagnose und Behandlungskontingent.
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Conversano C, Di Giuseppe M, Lingiardi V. Case report: Changes in defense mechanisms, personality functioning, and body mass index during psychotherapy with patients with anorexia nervosa. Front Psychol 2023; 14:1081467. [PMID: 36895755 PMCID: PMC9989464 DOI: 10.3389/fpsyg.2023.1081467] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/25/2023] [Indexed: 02/23/2023] Open
Abstract
Eating disorders (EDs) are difficult to treat in psychotherapy due to their pervasive symptomatology and frequent and rapid relapses. Restrictive anorexia nervosa (AN) is the most challenging ED, often associated with severe physical and mental conditions. Perceived as an ego-syntonic syndrome that somehow protects the patient from a number of developmental tasks, treating AN requires extensive multidisciplinary long-term intervention. As with other emotion regulation strategies, defense mechanisms mediate an individual's reaction to internal or external stressors, including those related to ED conditions. Improving defensive functioning adaptiveness predicts psychotherapy outcomes and is an essential component of the therapeutic process. In this study, we qualitatively described changes in the use of defense mechanisms, personality functioning (PF), and body mass index (BMI) in two patients with severe AN in treatment with intense dynamic psychotherapy. Changes in personality functioning and defense mechanisms were periodically assessed every 6 months using clinician report measures such as the Shedler-Westen Assessment Procedure-200 (SWAP-200) and the Defense Mechanisms Rating Scales Q-sort (DMRS-Q), respectively. BMI was also monitored throughout the treatment. A qualitative description of the patient's defensive profile and the quantitative score on all ranges of defense mechanisms were used for studying changes in patients' use of defenses during the treatment and relationships between defenses and outcome indexes. Personality and defensive functioning improved after 1 year of intense dynamic psychotherapy, independently from BMI improvement. All outcome indexes dramatically decreased before a scheduled interruption of the treatment, underling that an integrated therapeutic approach is essential for improving and eventually orienting toward complete ED symptoms remission. Long-term dynamic psychotherapy fosters self-awareness of psychological distress and enhances more mature ways of coping. Monitoring changes in personality and defense mechanisms helps in understanding patients' reactions to stressful life events and in developing specific therapeutic interventions.
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Affiliation(s)
- Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | | | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza", University of Rome, Rome, Italy
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Tanzilli A, Boldrini T, Carone N, Gualco I, Lingiardi V, Williams R. Patient personality dimensions, relational patterns and therapeutic alliance in clinical practice: An empirical investigation. Clin Psychol Psychother 2023; 30:97-111. [PMID: 35981709 DOI: 10.1002/cpp.2779] [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: 04/10/2022] [Revised: 07/03/2022] [Accepted: 08/15/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Transference (meant in this context, as the patient relational patterns expressed towards the clinician) and therapeutic alliance play a crucial role in the treatment of personality pathology. To date, no empirical study examined the association between these two dimensions of the clinical relationship and patients' personality maladaptive traits in psychotherapy. METHODS A national sample of therapists (N = 100) of different theoretical orientations assessed dysfunctional personality features of a patient in their care using a comprehensive and empirically grounded dimensional diagnostic approach from the Shedler-Westen Assessment Procedure-200 (SWAP-200). Moreover, they filled in the Psychotherapy Relationship Questionnaire (PRQ) to identify interpersonal patterns expressed early in treatment by the patients and the Working Alliance Inventory (WAI-T) to evaluate quality of therapeutic alliance. RESULTS Overall, the most severe and maladaptive dimensions of patients' personality were associated with more negative clinician-patient dynamics and poorer levels of therapeutic alliance in statistically significant and clinically relevant ways. Notably, the hostile transference was predicted by both SWAP Hostility and Psychopathy, whereas the SWAP Narcissism was the strongest predictor of the special/entitled transference. The latter was also predicted by SWAP Emotional Dysregulation; conversely, the SWAP Dysphoria was the most robust predictor of anxious/preoccupied pattern. The SWAP Schizoid Orientation and Psychopathy predicted avoidant/dismissing attachment pattern; moreover, they were strongly and negatively related to the SWAP Psychological Health that was the best predictor of positive transference and alliance. CONCLUSIONS Findings support that therapists' careful understanding of patients' interpersonal ways during early treatment stages may meaningfully inform diagnostic and therapeutic processes.
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Affiliation(s)
- Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Tommaso Boldrini
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Nicola Carone
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ivan Gualco
- Center for Individual and Couple Therapy, Genoa, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Riccardo Williams
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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12
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Tanzilli A, Cibelli A, Liotti M, Fiorentino F, Williams R, Lingiardi V. Personality, Defenses, Mentalization, and Epistemic Trust Related to Pandemic Containment Strategies and the COVID-19 Vaccine: A Sequential Mediation Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114290. [PMID: 36361183 PMCID: PMC9656964 DOI: 10.3390/ijerph192114290] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/10/2022] [Accepted: 10/27/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND The COVID-19 pandemic has considerably influenced all domains of people's lives worldwide, determining a high increase in overall psychological distress and several clinical conditions. The study attempted to shed light on the relationship between the strategies adopted to manage the pandemic, vaccine hesitancy, and distinct features of personality and mental functioning. METHODS The sample consisted of 367 Italian individuals (68.1% women, 31.9% men; M age = 37, SD = 12.79) who completed an online survey, including an instrument assessing four response styles to the pandemic and lockdown(s), the Personality Inventory for DSM-5-Brief Form, the Defense Mechanisms Rating Scales-Self-Report-30, the Reflective Functioning Questionnaire, and the Epistemic Trust, Mistrust, Credulity Questionnaire. RESULTS Maladaptive response patterns to pandemic restrictions were related to dysfunctional personality traits, immature defense mechanisms, poor mentalization, and epistemic mistrust or credulity. Moreover, more severe levels of personality pathology were predictive of an extraverted-maladaptive response style to health emergency through the full mediation of low overall defensive functioning, poor certainty of others' mental states, and high epistemic credulity. CONCLUSIONS Recognizing and understanding dysfunctional psychological pathways associated with individuals' difficulties in dealing with the pandemic are crucial for developing tailored mental-health interventions and promoting best practices in healthcare services.
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13
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Di Giuseppe M, Orrù G, Gemignani A, Ciacchini R, Miniati M, Conversano C. Mindfulness and Defense Mechanisms as Explicit and Implicit Emotion Regulation Strategies against Psychological Distress during Massive Catastrophic Events. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912690. [PMID: 36231993 PMCID: PMC9566362 DOI: 10.3390/ijerph191912690] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 05/31/2023]
Abstract
Emotion regulation is an important aspect of psychological functioning that influences subjective experience and moderates emotional responses throughout the lifetime. Adaptive responses to stressful life events depend on the positive interaction between explicit and implicit emotion regulation strategies, such as mindfulness and defense mechanisms. This study demonstrates how these emotion regulation strategies predict psychological health during the early phase of the COVID-19 pandemic. A convenience sample of 6385 subjects, recruited via snowball sampling on various social media platforms, responded to an online survey assessing psychological reaction to social restrictions imposed to limit the spread of COVID-19 in Italy. Psychological distress, post-traumatic stress symptoms, mindfulness, and defense mechanisms were assessed using SCL-90, IES-R, MAAS, and DMRS-30-SR, respectively. Higher mindfulness was significantly associated with higher overall defensive maturity and a greater use of high-adaptive defenses (p < 0.0001). Both mindfulness and defense mechanisms acted as good predictors of psychological health (R2 = 0.541) and posttraumatic symptoms (R2 = 0.332), confirming the role of emotion regulation in protecting against maladaptive responses to stressful situations.
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Affiliation(s)
- Mariagrazia Di Giuseppe
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, 56126 Pisa, Italy
- Department of History, Culture and Society, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Graziella Orrù
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Rebecca Ciacchini
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Mario Miniati
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, 56126 Pisa, Italy
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14
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Herdi O. A new defence mechanism in the modern world: Flowing. PSYCHODYNAMIC PRACTICE 2022. [DOI: 10.1080/14753634.2022.2127553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Oğuzhan Herdi
- Department of Clinical Psychology, Antalya Bilim University, Antalya, Turkey
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15
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Carlucci S, Chyurlia L, Presniak M, Mcquaid N, Wiebe S, Hill R, Wiley JC, Garceau C, Baldwin D, Slowikowski C, Ivanova I, Grenon R, Balfour L, Tasca GA. Change in Defensive Functioning Following Group Psychodynamic-Interpersonal Psychotherapy in Women With Binge-Eating Disorder. Int J Group Psychother 2022; 72:143-172. [PMID: 38446586 DOI: 10.1080/00207284.2022.2061980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We examined change in defensive functioning following group psychodynamic-interpersonal psychotherapy (GPIP) for binge-eating disorder (BED) compared to a waitlist control. We hypothesized that defensive functioning will improve to a greater extent at posttreatment for those in GPIP compared with those in a waitlist control condition. Participants were women with BED assigned to GPIP (n = 131) or a waitlist control (n = 44) condition in a quasi-experimental design. Those who received GPIP had significantly greater improvements in defensive functioning from pretreatment to six months posttreatment compared to the control group. GPIP may be effective for improving defensive functioning in individuals with BED. A randomized controlled trial is needed to confirm that GPIP is efficacious for addressing defensive functioning among women with BED.
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16
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Prout TA, Di Giuseppe M, Zilcha-Mano S, Perry JC, Conversano C. Psychometric Properties of the Defense Mechanisms Rating Scales-Self-Report-30 (DMRS-SR-30): Internal Consistency, Validity and Factor Structure. J Pers Assess 2022; 104:833-843. [PMID: 35180013 DOI: 10.1080/00223891.2021.2019053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Assessment of defense mechanisms has a longstanding history within the clinical psychology and psychopathology literature. Despite their centrality to clinical practice, there are few self-report measures that assess defenses and, those that do exist, have limitations in addressing individual defenses and levels of defensive functioning. To address this need, we investigated the psychometric properties of the Defense Mechanisms Rating Scale - Self-Report - 30 item (DMRS-SR-30) with a global, community sample of 1,539 participants who responded to an online survey about distress and coping. Exploratory factor analysis found a three-factor model for the DMRS-SR-30 - mature, mental inhibition and avoidance, and immature-depressive. Internal consistency was high for the Overall Defensive Functioning (ODF) and the three extracted factors with coefficient alphas ranging from .75 to .90. Examination of concurrent validity with a commonly used measure of defensive functioning found significant relationships in the predicted directions. The group of immature defenses had the strongest concurrent validity (r = .50). Finally, correlations with external criteria - including psychological distress and adverse childhood experiences - supported the convergent and discriminant validity of the DMRS-SR-30. The three factor structure of the DMRS-SR-30 has good psychometric properties. Limitations and directions for future research, as well as clinical implications, are described.
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Affiliation(s)
- Tracy A Prout
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | - Mariagrazia Di Giuseppe
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | | | - J Christopher Perry
- Institute of Community and Family Psychiatry, JGH, McGill University, Montreal, Québec, Canada
| | - Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
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17
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Di Giuseppe M, Perry JC, Prout TA, Conversano C. Editorial: Recent Empirical Research and Methodologies in Defense Mechanisms: Defenses as Fundamental Contributors to Adaptation. Front Psychol 2021; 12:802602. [PMID: 34925197 PMCID: PMC8678405 DOI: 10.3389/fpsyg.2021.802602] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mariagrazia Di Giuseppe
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - John Christopher Perry
- McGill University and the Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, QC, Canada
| | - Tracy A Prout
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, United States
| | - Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
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18
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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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