Adaptive Defense Style Research Articles

Cognitive Control Processes and Defense Mechanisms That Influence Aggressive Reactions: Toward an Integration of Socio-Cognitive and Psychodynamic Models of Aggression.

Research on cognitive processes has primarily focused on cognitive control and inhibitory processes to the detriment of other psychological processes, such as defense mechanisms (DMs), which can be used to modify aggressive impulses as well as self/other images during interpersonal conflicts. First, we conducted an in-depth theoretical analysis of three socio-cognitive models and three psychodynamic models and compared main propositions regarding the source of aggression and processes that influence its enactment. Second, 32 participants completed the Hostile Expectancy Violation Paradigm (HEVP) in which scenarios describe a hostile vs. non-hostile social context followed by a character's ambiguous aversive behavior. The N400 effect to critical words that violate expected hostile vs. non-hostile intent of the behavior was analyzed. Prepotent response inhibition was measured using a Stop Signal task (SST) and DMs were assessed with the Defense Style Questionnaire (DSQ-60). Results showed that reactive aggression and HIA were not significantly correlated with response inhibition but were significantly positively and negatively correlated with image distorting defense style and adaptive defense style, respectively. The present article has highlighted the importance of integrating socio-cognitive and psychodynamic models to account for the full complexity underlying psychological processes that influence reactive aggressive behavior.

Personality, Defense Mechanisms and Psychological Distress in Women with Fibromyalgia.

Background: Previous studies have shown that many personality traits are associated with fibromyalgia (FM), worsening both the quality of life and psychological distress of patients. Despite the high comorbidity of psychopathological disorders in this syndrome and their association with immature defense styles, few studies have examined the defense mechanisms used by FM patients. The main aim of our study was to investigate personality traits and defense mechanisms in FM patients compared to in a healthy control group (HC). Moreover, we investigated the effect of personality traits and defense mechanisms on psychological distress in both FM and HC groups. Methods: A total of 54 women with FM and 54 healthy women completed the (1) Temperament and Character Inventory—Revised; (2) the Toronto Alexithymia Scale; (3) the Defense Style Questionnaire; and (4) the Hospital Anxiety and Depression Scale. Results: The results indicated that FM patients display higher alexithymia, higher harm avoidance, lower self-directedness, lower persistence, and the higher use of a maladaptive defense style compared to HC. We found that alexithymia, harm avoidance, and maladaptive defense style are significant predictors of patients’ psychological distress. Moreover, harm avoidance and adaptive defense style significantly predicted psychological distress in the HC group. Conclusion: The present study is the first to explore the contribution of both defense mechanisms and personality characteristics on the psychological distress of FM patients. Our findings have important clinical implications and may help diagnose and treat FM patients more in depth.

Factors related to the adverse events of antiepileptic drugs

ObjectiveThe aim of the present study was to explore the factors related to the severity of the adverse effects of antiepileptic drugs (AEDs), experienced by patients with epilepsy. Materials and methodsA case study was conducted in adult patients with epilepsy and followed up at the Epilepsy Outpatients of the University Hospital of Ioannina in Northwest Greece.The Adverse Event Profile (AEP) questionnaire for AEDs adverse effects assessment, the Defense style questionnaire (DSQ-88) and the Patient Health Questionnaire (PHQ-9) for depression’ severity evaluation were used to estimate the severity of adverse effects, the defense style, and the depressive symptoms, respectively. ResultsSixty-three patients with epilepsy (M/F:28/35), with a mean age of 37.6 ± 13.41, were recruited in the study.The univariate analysis showed that both the Maladaptive style of defense and the PHQ-9 score were significantly associated with the AEP score.After multivariate regression analysis female gender, the load of AEDs, the PHQ-9 score, and the Adaptive defense style remained significant coefficients. ConclusionThere are also nonpharmacological factors that may contribute to the severity of the adverse effects of AEDs, experienced by the patients with epilepsy.

Psychological Development during Medical School Clerkship: Relationship to Resilience

The authors investigated changes in medical students' defenses during clerkship and examined the effects of these changes on students' resilience. Between 2012 and 2014, all year-2 preclinical students (N = 249) at Gyeongsang National University Medical School were asked to participate. Those who agreed to participate (N = 237) completed the Korean version of the Defense Style Questionnaire (K-DSQ) and the Connor-Davidson resilience scale-10 (CD-RISC-10). After clerkship, students who proceeded to year 4 in 2years (n = 187 (93 females), aged 24-38years (mean, 28.9 ± 2.8years)) completed the K-DSQ, CD-RISC-10, and the Korean version of the Hospital Anxiety and Depression Scale (K-HADS) in September 2014, 2015, and 2016. The use of adaptive (W = 11,603.5, p < 0.001, r = 0.39) and self-inhibiting (W = 10,901.5, p < 0.001, r = 0.32) styles increased significantly after clerkship. A multiple linear regression analysis showed that changes in adaptive defense styles (B = 1.336, SE = 0.386, β = 0.218, p = 0.001) during clerkship were significantly related to resilience after adjusting for age, sex, depression, and anxiety. Both positive personality development and maladaptive changes in defenses were evident. An increase in the adaptive defense style score was related to resilience.

Association among defense mechanisms, causes of procrastination and well- being; Gender differences

Abstract Background Defense mechanisms have been a central concept in the field of mental health and psychotherapy. Recently, there has been some research interest in defence mechanisms in empirical psychology. Causes of procrastination are shown to be related to defence mechanisms in terms of students’ dilatory behaviour. Furthermore, the causes of procrastination seem to affect students’ well-being. The aim of the present study is to investigate the effect of defence mechanisms and causes of procrastination on well-being, separately for each gender. Methods A cross-sectional study was conducted in Greece with 628 college students at the University of Ioannina (490 females and 138 males). Specially designed and validated instruments were used to record students’ sociodemographic characteristics, defence mechanisms (DM), causes of procrastination (CP) and well-being (WB). Analysis of Variance (ANOVA) and Covariance (ANCOVA) was used to investigate the effect of DM and CP on students’ WB separately for each gender. Results Students’ defence mechanisms and causes of procrastination had a statistically significant effect on their well-being. More specifically, female students with a lower percentage of fear of success/ influence of peers (p &amp;lt; 0.001) and maladaptive defense style (p &amp;lt; 0.001) as well as those with higher image-distorting (p &amp;lt; 0.001), self-sacrificing (p = 0.004) and adaptive defense styles (p &amp;lt; 0.001) seemed to have a significantly higher percentage of well-being. On the other hand, male students with a lower percentage of lack of duty/ tolerance of frustration (p = 0.039) and maladaptive style (p &amp;lt; 0.001) but a higher percentage of image distorting (p &amp;lt; 0.001) and adaptive defence styles (p &amp;lt; 0.001) had a significantly higher percentage of well-being. Conclusions Students’ causes of academic procrastination in the combination with the use of defence mechanisms significantly affect their well-being despite, being differentiated according to their gender. Key messages Defense mechanisms play a crucial role in students’ adaptation at the university as well as in their mental health. Emphasis should be given on the design of intervention on students’ procrastination involving non-conscious processes and more structural elements of personality.

교대근무자의 회복력과 수면 및 방어 특성

목 적 : 교대근무는 상당한 스트레스 상황이며 교대근무에 잘 적응하는 정도와 관련된 요인들을 아는 것은 중요하다. 본 연구에서는 교대근무 간호사들의 회복력과 관련된 수면 및 성격 관련 요인들을 조사해보고자 했다. 방 법 : 일 대학병원에서 3교대 근무를 하고 있는 간호사 95명을 대상으로 자가 설문지 조사를 시행했다. 코너-데이비드슨 회복력 척도, 병원 불안-우울 척도, 아침형-저녁형 질문지와 피츠버그 수면의 질 지수를 포함한 수면 관련 설문, 한국판 방어유형 질문지를 이용했다. 결 과 : 회복력과 유의한 상관을 보인 요소들은 근무자들의 나이, 근무 기간, offday oversleep, HAD-D 및 HAD-A 점수, DSQ의 적응적 방어유형, 자기억제적 방어유형이었다(p < 0.05). 다중회귀분석에서는 나이가 많을 수록(<TEX>${\beta}=0.34$</TEX>, p < 0.05), 우울 증상이 적을 수록(<TEX>${\beta}=-0.25$</TEX>, p < 0.05), 적응적 방어유형을 많이 사용할 수록(<TEX>${\beta}=0.45$</TEX>, p < 0.001), 자기억제적 방어유형을 적게 사용할 수록(<TEX>${\beta}=-0.19$</TEX>, p < 0.05) 회복력이 높은 것으로 나타났다. 방어기제들의 경우 체념이 적을 수록(<TEX>${\beta}=-0.20$</TEX>, p < 0.05), 승화(<TEX>${\beta}=0.19$</TEX>, p < 0.05)와 전능(<TEX>${\beta}=0.19$</TEX>, p < 0.05), 유머(<TEX>${\beta}=0.20$</TEX>, p < 0.05)를 많이 사용할 수록 회복력이 높은 것으로 나타났다. 결 론 : 본 연구에서는 일 대학병원의 3교대 근무 간호사들의 특정 방어유형 및 방어기제가 회복력과 관계된다는 것을 밝힐 수 있었다. 추후 더 많은 교대근무 간호사들을 대상으로 회복력과 관련된 수면 및 성격 관련 인자들을 밝히는 전향적 연구가 가능할 것이다. Objectives: Shift work is a stressful situation. It is important to know the factors associated with the ability to adapt to a shift work schedule. The aim of the present study was to investigate the association between sleep, as well as personality variables, and the resilience of shift work nurses. Method: Self-report questionnaires were administered to 95 nurses who worked in one national university hospital. Connor-Davidson resilience scale, hospital anxiety and depression scale, morningness-eveningness scale, Pittsburgh sleep quality index, other sleep-related questionnaires, and Korean defense style questionnaires were used. Results: Age, shift work duration, off-day oversleep, depression, anxiety, adaptive defense style, and self-suppressive defense style were significantly associated with resilience (p < 0.05). Multiple regression analysis showed that age (<TEX>${\beta}=0.34$</TEX>, p < 0.05), depression (<TEX>${\beta}=-0.25$</TEX>, p < 0.05), adaptive defense style (<TEX>${\beta}=0.45$</TEX>, p < 0.001), and self-suppressive defense style (<TEX>${\beta}=-0.19$</TEX>, p < 0.05) significantly predicted the resilience of shift work nurses. Concerning individual defense mechanisms, resignation (<TEX>${\beta}=-0.20$</TEX>, p < 0.05), sublimation (<TEX>${\beta}=0.19$</TEX>, p < 0.05), omnipotence (<TEX>${\beta}=0.19$</TEX>, p < 0.05), and humor (<TEX>${\beta}=0.20$</TEX>, p < 0.05) significantly predicted the resiliency. Conclusion: The findings indicate that a specific defense style and other mechanisms were associated with the resilience of shift work nurses. A future prospective study with more participants could further clarify the relationship between sleep-related variables, as well as personality factors, and resilience of shift work nurses.

Ego mechanisms of defense are associated with patients&amp;rsquo; preference of treatment modality independent of psychological distress in end-stage renal disease

Several parameters mediate the selection of treatment modality in end-stage renal disease (ESRD). The nephrology community suggests that patient preference should be the prime determinant of modality choice. We aimed to test whether ego mechanisms of defense are associated with patients' treatment modality preferences, independent of psychological distress. In 58 eligible ESRD patients who had themselves chosen their treatment modality, we administered the Symptom Distress Checklist-90-R and the Defense Style Questionnaire. Thirty-seven patients (53.4%) had chosen hemodialysis and 21 (46.6%) peritoneal dialysis. Patients who preferred peritoneal dialysis were younger (odds ratio [OR], 0.89; 95% confidence interval [CI]: 0.804-0.988), had received more education (OR, 8.84; 95% CI: 1.301-60.161), and were twice as likely to adopt an adaptive defense style as compared to patients who preferred hemodialysis (57.1% vs 27.0%, respectively; P < 0.033). On the contrary, the latter were more likely to adopt an image-distorting defense style (35.1% vs 14.3%; P = 0.038) and passive-aggressive defenses (OR, 0.73: 95% CI: 0.504-1.006). These results were independent of psychological distress. Our findings indicate that the patient's personality should be taken into account, if we are to better define which modalities are best suited to which patients. Also, physicians should bear in mind passive-aggressive behaviors that warrant attention and intervention in patients who preferred hemodialysis.

Predictors of Treatment Duration and Retention in a Study of Long-Term Dynamic Psychotherapy: Childhood Adversity, Adult Personality, and Diagnosis

Systematic knowledge about patient characteristics that predict the duration of long-term psychotherapy is largely absent. We examined predictors of attrition, retention, and duration of long-term dynamic psychotherapy to delineate the naturalistic history of psychotherapy, specifically focusing on childhood emotional neglect and abuse, adult diagnosis, personality, and functioning as predictors. Fifty-three adults with depressive, anxiety, and/or personality disorders (PDs) were offered at least 3 years of long-term dynamic psychotherapy. The median duration of therapy for the study group was 110 sessions (95% confidence interval [CI] 52-141). Nondynamic characteristics (including demographics; most Axis I diagnoses; depression, anxiety, and distress scores; social and global functioning; and the five personality factors) did not predict number of sessions. Dysthymic disorder, presence of any PD (particularly dependent PD [DPD]), emotional neglect in childhood, and higher adaptive defense style scores predicted a greater number of sessions, while obsessive-compulsive PD (OCPD) predicted fewer sessions. Emotional neglect, DPD, higher adaptive defenses, and OCPD were each unique predictors of duration. A session frequency less than 0.7 sessions per week (36 sessions per year) was associated with a three-fold higher risk for intrinsic attrition (relative risk = 3.04, 95% CI 1.10-8.44). Childhood emotional neglect as well as adult dependency may predispose patients to remain in therapy for longer durations, while some adaptive defenses may allow patients to contain the distressing affects that might otherwise lead to early termination. It remains to be seen whether longer durations of treatments are associated with respectively greater improvement, other things being equal, and whether these findings generalize to other types of treatment.

Psychological distress and personality traits in early rheumatoid arthritis: a preliminary survey

To investigate psychiatric manifestations, personality traits, and ego mechanisms of defense involved in early rheumatoid arthritis (RA). Twenty-two unselected early RA outpatients with disease duration less than 1 year participated in the study. The majority of participants were females (72.7%), married (81.8%), aged 51.0+/-14.6 years. Thirty-four subjects matched for age, sex and educational level served as "healthy" controls. General Heath Questionnaire, Symptom Distress Checklist, Defense Style Questionnaire and Hostility and Direction of Hostility Questionnaire were used; disease activity was estimated by disease activity for 28-joint indices score. Seven patients (31.8%) presented psychological distress scores indicative of possible psychiatric caseness, expressing obsessive-compulsive symptoms and depression, as compared to six (17.6%) of controls. Social dysfunction distress and somatization were prominent psychiatric manifestations in early RA group. Early RA patients tend to adopt a less adaptive defense style than controls. Although disease activity was not correlated to psychological distress, a significant association between disease activity and patients' defensive style was observed: as the disease is exacerbated, there was a shift from "non-adaptive" to "immature image distorting or borderline" defense style, suggesting a rather fragile underlying personality structure. Psychological distress is a relatively common experience in early RA. Social dysfunction, along with the less adaptive defense style, which under the stress of the disease exacerbation turns to "borderline", underlines the importance of a careful assessment and consultation in early RA patients in order to face the distress shortly after diagnosis and highlights potential risk factors for future adaptation to exacerbations of the disease.

The Relationship Between Emotional Intelligence and Ego Defense Mechanisms

The author examined the relationship between the components of emotional intelligence (perception of emotion, affect regulation, and emotional knowledge) and personality factors associated with adaptation, represented by the hierarchical model of defense mechanisms (M. Bond, S. Gardner, J. Christian. & J. Sigal, 1983). Bivariate correlation analyses yielded mixed results; the adaptive defense styles were correlated with overall emotional intelligence but not with the emotional perception and regulation components, as was hypothesized. Emotional knowledge was correlated with both adaptive and maladaptive defense styles and with general intelligence, as was expected. Implications for counseling and psychoeducational interventions are suggested.

Defense styles and Personality dimensions of research subjects with anxiety and depressive disorders.

We used the Bond Defense Style and Cloninger Tridimensional Personality questionnaires to assess defense styles and personality dimensions in subjects with anxiety and depressive disorders. When measured against a comparison group, maladaptive defense style scores were significantly higher in those with major depression, panic disorder, generalized anxiety disorder, and social phobia, and higher at a trend level in the subjects with obsessive-compulsive disorder and mixed anxiety and depression. However, there were no differences in adaptive defense style scores between the subjects and the comparison group. The harm avoidance personality dimension scores were significantly higher in subjects with both anxiety and depressive disorders than in the comparison group. The harm avoidance scores correlated positively with the maladaptive defense scores, but negatively with the adaptive defense scores. These findings are discussed in terms of severity of illness, level of functioning, and relationships between Axis I and II disorders.

Defense Styles and Borderline Personality Disorder

Seventy-eight borderline and 72 nonborderline personality' disordered patients were compared on scores on the Defense Style Questionnaire (DSQ). The borderline group reported using maladaptive and image-distorting defense styles more often and adaptive defense styles less often than the nonborderline group. These findings empirically validated clinical observations and theory. It is striking that, not only did the borderline group use more splitting and acting out. but they underused the defenses of suppression, sublimation, and humor. This suggests that borderlines' deficit in mastering anxiety, painful emotion, and threatening impulse is related to an underutilization of adaptive defenses and not only an overreliance on the characteristic image-distorting defenses.