Neurotic Defense Research Articles

An Exploratory Study on Therapeutic Factors of Art Contained in Egon Schiele`s Work from the Perspective of Defense Mechanism

The purpose of this study is to understand th therapeutic function of the art by analyzing how the artist’s desire and dissatisfaction were recognized in the form of the defense mechanism, and how such cognitive structure was expressed as the introspection procedure to defend oneself in unfolding of the Egon Schiele’s painting. For this purpose, we researched the Egon Schiele’s life events to undercover the conflict and agony in his life by reviewing the existing literature. Then, we reviewed the concept and types of the defense mechanisms and the maturity level according to the defense mechanisms used. Next, the characteristics of the Egon Schiele’s works best reflecting his life experience and emotions were analyzed, after dividing his works into six stages according to the chronological order. Finally, with the artist’s changed art world, we tried to find the therapeutic factors of the art. As a result, we found the changing trajectory of Schiele’s defense mechanism in his works; from the immature mechanism like identification, to the Narcissistic defense and Neurotic defense like projection, distortion, repression and conversion, and ultimately to the mature defense like the sublimation. Therefore, we concluded that he succeeded in understanding and accepting himself through expression of himself via the art work, and has grown into the mature individual who grew out from the personal problems and defects, which showed the therapeutic aspects of the art.

Psychological assessment of persons following suicide attempt by self-poisoning

Urgent psychiatric help and effective psychotherapeutic treatments are required soon after revival of a person after suicide attempt by self-poisoning. The aim of this article was to define an assessment of actual psychological characteristics of a person after suicide attempt by self-poisoning in order to apply psychotherapeutic crisis intervention after suicide attempt, as well as to show an approach to the treatment guided by the assessment that uses a psychodynamic model of suicidal crisis intervention based on our clinical experience. Hamilton Depression Rating Scale (HAMD), Center for Epidemiological Studies-Depression Scale (CES-D), Defensive Questionnaire Scale (DSQ-40), Scaling of Life Events (Paykel), and Pierce Suicide Intent Scale (SIS) were applied in 30 hospitalized persons following suicide attempt by self-poisoning and in 30 patients who had asked for psychiatric examination at the outpatient clinic due to various life crises not resulting in suicide attempt. The examinees of both groups were matched by sex, age, and education, professional and marital status. Comparison of the patient groups was done by the t-test. Logistic regression analysis was used for suicidal risk assessment. The suicide attempters were depressed (HAMD = 22.60 +/- 5.93, CES-D = 29.67 +/- 7.99), with medium suicide risk factor (SIS = 4.5 +/- 4.17), using immature (projection, dissociation, devaluation, acting-out) and neurotic (altruism) defense mechanisms. The most important motives for suicide attempt were separation problems, problems with parents and a problem of loneliness. The commonest feelings and thoughts of a subject preceding suicide attempt were a wish to escape an unbearable situation, loss of control, desire to show love for a partner and wish to be helped. After a suicide attempt, 90% of the persons felt relief because the attempt failed, although almost half of them intend to repeat it. The risk of repeated suicide attempt was 1.8 (90% CI = 0.09-37.70, p < 0.001) times higher if values on the SIS Total Score were increased and 1.62 (90% CI = 0.03-81.39, p < 0.001) times higher if values on the SIS 1 (Circumstances Score) subscale were increased, too. Before starting with psychotherapy for persons after suicide attempt by self-poisoning it is very important to define psychological assessment of a person, choose the treatment (out-patient clinic or inpatient/hospital), assess indications for pharmacotherapy and psychotherapy that also must include a selection of patients for application of this therapeutic method. Assessment of conscientious and unconscientious conflicts leading to a suicide attempt represents initial basis for a therapist's work with a patient after suicide attempt and for application of psychotherapeutic crisis intervention.

P01-146 - Defense mechanisms changes after cognitive-behavior group therapy plus motivational interviewing and thought mapping for obsessive-compulsive disorder

ObjectivesStudying defensive styles is typically associated with dynamic theory and therapy. The present study was designed to examine the efficacy of adding two individual sessions of Motivational Interviewing (MI) and Thought Mapping (TM) to cognitive-behavioral group therapy (CBGT) to promote changes in the use of defense mechanisms among obsessive-compulsive disorder (OCD) patients.MethodsForty outpatients meeting OCD DSM-IV criteria were randomly assigned to either a MI+TM group or a control group, before 12 weekly CBGT sessions. To evaluate changes in defense mechanisms, the Defense Style Questionnaire (DSQ) was administered before and after treatment.ResultsThe use of the mature defense mechanisms increased in the MI+TM group at post-treatment, and there were significant differences in the decrease of use of the neurotic defense mechanisms. In addition, patients who achieved full remission differed in the use of the immature defense mechanisms. The control group presented no significant decrease in the use of any defense mechanisms.ConclusionsThese findings suggest that adding two individual sessions of MI and TM to CBGT can facilitate changes in use of defense mechanisms in OCD adult outpatients, as measured by a specific instrument.

Study on the defense styles in patients with hysteria

Objective To explore psychological defense mechanism and its relationship with personality in patients with hysteria(HyS). Method Both HyS patients (n=30) and normal control(NC, n=66) comple-ted Defense Style Questionnaire (DSQ) and Eysenck Personality Questionnaire(EPQ) . Results The scores of projection, isolation, somatization and the factor scores of immature defenses were significantly higher in HyS pa-tients(3.64±1.45, 5.63±2.29,5.33±2.36 and 4.74±1.27, respectively) than those in NC [(2.61±1.09,4.33±2.02, 3.86±1.60 and 3.98±0.91, respectively) (all P<0.01)]. The scores of undoing, idealization, pseudo-altruism and the factor scores of neurotic defenses were also significantly higher in HyS patients compared with NC(P<0.01). The scores of suppression, humor and the factor scores of mature defenses and the lie were found lower significantly in HyS patients compared with NC (P<0.05). The scores of the neuroticism, psychoticism and lie subscale of EPQ in HyS patients were significantly higher than that of NC(P<0.01). The scores of extro-vert subscale were not found difference significantly between HyS patients and NC. The results of correlation analy-sis showed that the scores of the psychoticism subscale of EPQ in HyS patients correlated negatively with the factor scores of mature mechanism and the scores of suppression. Conclusion The HyS patients were more likely than the normal control to endorse the immature mechanism and neurotic defense and less likely to endorse the mature mechanism, which related with unhealthy personality, especially the psychoticism. Key words: Hysteria; Defense mechanism; Personality

Defense Style Changes With the Addition of Psychodynamic Group Therapy to Clonazepam in Social Anxiety Disorder

Psychodynamic Group Therapy (PGT) and clonazepam are strategies to reduce symptoms of generalized social anxiety disorder (GSAD). The addition of PGT might lead to changes in defense styles. The objective of this study is to examine changes in defense styles when comparing clonazepam to psychodynamic group therapy plus clonazepam in GSAD during 12 weeks. Fifty-seven patients that met DSM-IV criteria for GSAD participated. social anxiety disorder symptoms were evaluated with the Liebowitz Social Anxiety Scale, and defense styles with the Defense Style Questionnaire. All defense styles changed overtime for both groups, especially mature defense style, which increased independently of the treatment allocation group. Regression analyses found that overtime there was a reduction in neurotic defenses in the combined group, whereas there was an increase in the clonazepam group. Neurotic defense style can change toward greater adaptiveness with the addition of PGT to clonazepam in GSAD, even in 12 weeks.

Les dérivés conscients des mécanismes de défense au questionnaire de Bond (DSQ 40) : stabilité ou variabilité entre une situation non anxiogène et une situation anxiogène

L’objectif de cette recherche est de tester la stabilité ou la variabilité des dérivés conscients des mécanismes de défense évalués à l’aide du questionnaire de Bond (DSQ 40) dans deux situations différemment anxiogènes afin de les intégrer dans le modèle transactionnel du stress de Lazarus et Folkman. Pour tester l’instabilité intersituationnelle des dérivés conscients des mécanismes de défense, une population de 161 étudiantes a complété le DSQ 40 et le questionnaire d’anxiété-état de Spielberger (STAI-Y), une première fois, en novembre, c’est-à-dire en l’absence d’évaluation de la performance universitaire, puis, une seconde fois, le premier jour de la session d’examen de janvier. Le score d’anxiété-état est significativement plus élevé à la seconde session qu’à la première. La majorité des 20 dérivés conscients des mécanismes de défense sont significativement différents aux deux sessions. L’inconstance intersituationnelle des dérivés conscients des mécanismes de défense observée dans cette recherche semble compatible avec l’hypothèse en faveur de leur variabilité. The aim of this research was to test the stability or variability of conscious by-products of defense mechanisms, evaluated with the Bond Defense Style Questionnaire (DSQ 40) so as to integrate them as transactional variables of stress in the model of Lazarus and Folkman. One hundred and sixty-one college girls (first-year students in a French university) engaged in psychology studies participated in this research. They participated in two collective sessions: a first session took place in November in a non-stressful situation, and a second session during the January examination week. Two questionnaires were used twice in this experiment: (a) the Anxiety State Questionnaire of Spielberger (STAI-Y) which evaluates the anxiety-state and anxiety-traits; (b) the DSQ 40, which estimates 20 conscious by-products of defense mechanisms and distinguishes three factors corresponding to the mature, neurotic and immature styles according to the factorial analyses of Guelfi and al. Two hypotheses were formulated: (a) a first hypothesis postulates that an examination situation increases the State Anxiety score; (b) a second hypothesis postulates a variability of defense mechanisms assessed by Bond's questionnaire (DSQ 40). It verified that the scores of the Bond defensive style questionnaire are significantly different in the two sessions. The mean state-anxiety score is higher in the second session. The great majority of students are described as more anxious during the week of examinations than during the previous month. The first hypothesis is then validated. The situation of evaluation of the university performance appears as a situation more stressful than the courses period. The three defense mechanism factors vary in a significant way from the first to the second session. In the second session the scores in mature and neurotic defense mechanisms increased significantly whereas the average scores in immature defense mechanisms decreased significantly. The majority of the 20 defense mechanisms are not stable between both situations. Indeed, 17 conscious by-products of defense mechanisms differ significantly in both sessions and only three defense mechanisms show a certain stability. Eleven defensive styles (55 %) decreased, six increased (30 %) and three remained stable (15 %). The instability of conscious by-products of defense mechanisms between the two sessions was confirmed by correlations analyses. The results show that the instability between situations is not limited to three categories of defenses (mature, neurotic and immature): 17 out of 20 mean scores in defense styles differed significantly. Conscious by-products of defense mechanisms are, indeed, influenced by situational factors.

P01-63 Women addiction (alcohol and opiates) and defense mechanism style

Very few researches concerning women addictions are done up to day. This paper tries to define basic similarities and differences in defense mechanisms used by women alcohol and opiate addicts.Method:Sample of alcohol and opiate female addicts (30 patients in each group) plus control group (30 women) with no psychiatric diagnosis were questioned with Defense Style Questionnaire - DSQ 40 (Andrews, Singh, Bond, 1993).Results:There were found no statistically relevant differences between two experimental and one control group concerning mature defense mechanism use. Significant differences were found in neurotic and immature defense mechanism use: alcohol addicts use prevalently neurotic mechanisms and immature mechanisms prevail among opiate addicts.Conclusions:In our research mostly used neurotic defense mechanisms by alcohol addicts were: pseudoaltruism, idealization, and undoing. The mostly used immature defense mechanisms among opiate addicts were: phantasy, isolation, devaluation, denial and splitting.

ORIGINAL RESEARCH—PSYCHOLOGY: Condom Use for Penile–Vaginal Intercourse is Associated with Immature Psychological Defense Mechanisms

Freud opined that condom use during penile-vaginal intercourse (PVI), like sexual activities other than PVI, led to a detrimental effect on orgasm that fueled the neuroses. Although this hypothesis had not been empirically tested, Freud's hypothesis that inability to have a (PVI) vaginal orgasm is a sign of psychological immaturity has recently received empirical support. The objective is to examine the hypotheses that use of immature psychological defense mechanisms correlates directly with frequency of condom use during PVI, but inversely with frequency of PVI without condoms. An additional aim is to examine the independent contributions of frequency of PVI with and without condoms, and different triggers of orgasm, in predicting the use of immature defense mechanisms. Two hundred ten Portuguese participants (99 women) reported their frequency of PVI with and without condoms, and frequency of orgasms from different sexual activities during the preceding month, and also completed the Defense Style Questionnaire (DSQ-40). The association of DSQ-40 immature defenses (correlated with indices of psychopathology) with past month frequency of PVI with and without condoms, and orgasms from different sexual behaviors. Frequency of PVI with condoms correlated directly with use of immature defenses. Frequency of PVI without condoms correlated inversely with use of immature and neurotic defenses. Results were not confounded by relationship status, age, cohabitation, or social desirability responding. Regression analyses revealed that immature defenses were independently predicted by condom use for PVI and by masturbation orgasms (for both sexes). For women additional predictors were lack of vaginal orgasm, and orgasm from clitoral masturbation during PVI. The results are consistent with condom use during PVI being associated with psychological immaturity and predisposition to poorer mental health.

Brazilian–Portuguese version of defensive style questionnaire-40 for the assessment of defense mechanisms: construct validity study

The aim of this study is to analyze the reliability and validity of the Brazilian–Portuguese version of the Defensive Style Questionnaire (DSQ). Participants were evaluated by clinical interview and the Mini-International Neuropsychiatric Interview. Reliability was assessed by factor analysis and Cronbach's alpha. The 3-factor model's replication was tested using confirmatory factor analysis (CFA). Controls were reevaluated after 4 months to assess test–retest reliability. Subsamples were also evaluated using the Minnesota Multiphasic Personality Inventory and Defensive Functioning Scale (DFS). Factor analysis of the various defense mechanisms produced a distribution of mechanisms among the factors that was largely similar to previous analyses based on the original instrument. The 3-factor model was supported by CFA. The test–retest evaluation showed sufficient intraclass correlation for all factors. Patients used more immature and neurotic defenses than controls. There was a correlation between DFS and immature defenses. Individuals with pathological personality traits scored higher on the immature and neurotic factors than those without. The Brazilian–Portuguese version of the DSQ-40 has psychometric features that allow the use of this instrument in our culture.

Psychosocial and Psychodynamic Factors Influencing Health Care Utilisation

This paper aims to elucidate some dysfunctional aspects of health care utilisation by combining concepts from modern systems theory and from psychoanalysis. Contemporary health care in industrialised countries can be conceived as a social system in terms of modern systems theory. According to this theory, social systems are operating on the basis of a 'guiding difference,' which in the case of health care is the distinction between 'healthy' and 'ill.' Its rigidity in adhering to the healthy-ill dichotomy exposes health care to being collusively entangled in the interpersonal defence arrangements of patients. In the psychoanalytic view, individual conflicts can be warded off from consciousness not only by intrapsychic defence, but also by interpersonal defence mechanisms. These mechanisms involve the patients' close social environment, often including doctors and hospitals. The functioning and the motivational structure of health care itself shows features of neurotic defence: not only its representatives, but health care as a whole act in a rigid, obsessive manner in order to separate the healthy from the ill and to battle against (presumed) diseases. This obsession sometimes results in excessive diagnostic activism and in inconsiderate application of aggressive medical treatments. Both are inappropriate with regard to the salient problem of modern medicine: the increase of chronic nonfatal diseases like depression and chronic pain. The described defence mechanisms are unconscious not only to patients but also to health care professionals (let alone health politicians), and are contributing to dysfunctional health care overuse.

Do defense mechanisms vary according to the psychiatric disorder?

The aim of this study was to evaluate the defense mechanisms used by depressive and anxious patients without comorbidities compared to those used by controls and to determine whether these patterns differ between diagnoses. The sample was composed of 167 psychiatric patients and 36 controls that were evaluated using the Defense Style Questionnaire 40. All subjects were evaluated through a clinical interview, and each evaluation was confirmed through the application of the Mini International Neuropsychiatric Interview, a structured psychiatric interview. We used ANOVA and discriminant analysis to assess differences between groups. Neurotic defense mechanisms discriminated controls from all patients except those with social anxiety. Immature defense mechanisms differentiated controls from all patients, as well as distinguished depressive patients from panic disorder and obsessive disorder patients. The discriminant analysis indicated that depressive patients are characterized by projection, panic disorder patients by sublimation and obsessive-compulsive patients by acting out. Depressive and anxious patients differ from other individuals in their use of defense mechanisms, and each diagnosis has a particular pattern. These findings could lead to the development of specific psychotherapeutic interventions.

On the psychodynamics of collecting

The urge to collect is a ubiquitous phenomenon which has anthropological, sociobiological and individual psychodynamic roots, but occurs far more frequently among men than women. The author examines the reasons for this gender difference and defi nes systematic collecting to distinguish it from addictive, obsessive and messy collecting, and from related phenomena such as perversion. The mode of collecting and choice of object are important indicators as to the unconscious psychodynamics of a collector and offer opportunity to describe his structural level. Collecting ranges across a broad spectrum, from an ego‐syntonic integrated mode, i.e. sublimation, to a neurotic defence against pre‐oedipal or oedipal traumas and confl icts. Alongside this drive‐theoretical approach, object and Kleinian theory are also applied to the understanding of collecting. Collecting represents a specifi c form of object relating and way of handling primary loss trauma, which is different from addiction, compulsion, or perversion. Under certain circumstances collecting can also result in a successful Gestalt or way of life. The paper concludes with a case study showing how collecting develops from a pre‐oedipal to a more integrated oedipal mode during the course of the analysis, which is refl ected in changes in the transference.

Evaluation of Defense Mechanisms in Adult Patients With Panic Disorder

Patients with acute panic disorder (PD) use a more maladaptive pattern of defense mechanisms. This study investigated the use of defense mechanisms by patients with acute symptomatic PD and those in complete remission. Thirty-three patients and 33 controls were evaluated by the Mini International Neuropsychiatric Interview. The defense mechanisms were evaluated by the Defense Style Questionnaire at the beginning of the study and after 16 weeks of sertraline treatment. Panic disordered patients used more neurotic (4.6 vs. 3.6; p = 0.003) and immature (3.6 vs. 3.0; p = 0.024) defenses at baseline. Patients who achieved complete remission (N=25) differed from the control group in the use of neurotic defenses at the baseline (4.4 vs. 3.6; p = 0.033). After treatment, they showed a reduction in the use of neurotic (4.4 vs. 3.7; p=0.014) and immature (3.4 vs. 3.1; p = 0.019) defenses. Defense mechanisms in PD are influenced by the presence of symptoms, severity, and outcome of the disease.

Étude des troubles psychiatriques et des modalités défensives évaluées par le « Defense Style Questionnaire » (DSQ) dans un échantillon d’hommes stériles consultant en andrologie

Resume Notre etude avait pour objectif d’etudier l’etat psychiatrique d’un echantillon d’hommes infertiles consultant en andrologie, d’evaluer les styles de defense au moyen du Defense Style Questionnaire version 88 items, de rechercher une difference entre les modalites defensives selon leur statut clinique d’azoosperme ou d’oligoasthenosperme et de mettre en evidence une correlation entre les troubles psychiatriques developpes dans cet echantillon et les modalites defensives utilisees. Resultats Nous avons retrouve dans notre echantillon 26,2 % de troubles psychiatriques selon le DSM IV avec une sur-representation significative du trouble anxieux generalise et du trouble somatisation. La comparaison entre patients azoospermes et oligoasthenospermes revelait l’absence de difference significative en ce qui concerne la morbidite psychiatrique et l’utilisation des modalites defensives. Notre echantillon se defendait selon des modalites proches de la population generale et utilisait des mecanismes de defense appartenant preferentiellement au style de defense dit mature, tels que l’humour, la repression et l’anticipation. La pathologie psychiatrique etait significativement correlee avec l’utilisation preferentielle du retrait, de la consommation, de la formation reactionnelle et au defaut d’utilisation de l’humour. Nous confirmons dans notre etude que les sujets qui utilisent preferentiellement le style de defense nevrotique sont plus susceptibles que les autres de developper un trouble psychiatrique. Conclusion Notre etude confirme qu’il est difficile de savoir si certains mecanismes de defense sont des facteurs de vulnerabilite a un trouble psychiatrique donne ou si les mecanismes de defense constituent un epiphenomene d’un trouble psychiatrique particulier. Il est necessaire de realiser des etudes complementaires prospectives qui pourraient permettre d’etablir un lien entre les mecanismes de defense et une pathologie psychiatrique donnee. La connaissance des modalites defensives d’un echantillon d’hommes steriles utilisees dans un contexte psychotherapeutique pourrait prevenir l’emergence de troubles psychiatriques ou pour le moins les anticiper.

Consensus, hédonisme : les coordonnées de la nouvelle famille et ses conséquences sur le développement de l’enfant

Consensus, hédonisme : les coordonnées de la nouvelle famille et ses conséquences sur le développement de l’enfant

Perfectionism, Ego Defense Styles, and Depression: A Comparison of Self‐Reports Versus Informant Ratings

The present study examined the associations among perfectionism, defense styles, and depression in an Israeli community sample of young adults. This study involved a comparison of self-reports and informant ratings on all measures. A community sample of 210 pairs of same-sex best friends from Israel completed the Multidimensional Perfectionism Scale, the Defense Styles Questionnaire - 40, and a depression measure. Analyses confirmed that socially prescribed perfectionism is associated with depression, not only in terms of self-reports but also in terms of informant ratings. In addition, informant ratings revealed a link between other-oriented perfectionism and depression. Both self-reports and informant ratings also indicated that socially prescribed perfectionism is associated with immature defense styles and neurotic defense styles. Further simultaneous Structural Equation Modeling (SEM) analyses of self-reports and informant ratings showed that maladaptive defense styles mediate the link between socially prescribed perfectionism and depression. The practical and theoretical implications of these findings are discussed.

P.2.090 Bipolar patients in the Netherlands according to the EMBLEM

L’objectif de cette recherche est de tester la stabilité ou la variabilité des dérivés conscients des mécanismes de défense évalués à l’aide du questionnaire de Bond (DSQ 40) dans deux situations différemment anxiogènes afin de les intégrer dans le modèle transactionnel du stress de Lazarus et Folkman. Pour tester l’instabilité intersituationnelle des dérivés conscients des mécanismes de défense, une population de 161 étudiantes a complété le DSQ 40 et le questionnaire d’anxiété-état de Spielberger (STAI-Y), une première fois, en novembre, c’est-à-dire en l’absence d’évaluation de la performance universitaire, puis, une seconde fois, le premier jour de la session d’examen de janvier. Le score d’anxiété-état est significativement plus élevé à la seconde session qu’à la première. La majorité des 20 dérivés conscients des mécanismes de défense sont significativement différents aux deux sessions. L’inconstance intersituationnelle des dérivés conscients des mécanismes de défense observée dans cette recherche semble compatible avec l’hypothèse en faveur de leur variabilité.The aim of this research was to test the stability or variability of conscious by-products of defense mechanisms, evaluated with the Bond Defense Style Questionnaire (DSQ 40) so as to integrate them as transactional variables of stress in the model of Lazarus and Folkman.One hundred and sixty-one college girls (first-year students in a French university) engaged in psychology studies participated in this research. They participated in two collective sessions: a first session took place in November in a non-stressful situation, and a second session during the January examination week.Two questionnaires were used twice in this experiment: (a) the Anxiety State Questionnaire of Spielberger (STAI-Y) which evaluates the anxiety-state and anxiety-traits; (b) the DSQ 40, which estimates 20 conscious by-products of defense mechanisms and distinguishes three factors corresponding to the mature, neurotic and immature styles according to the factorial analyses of Guelfi and al.Two hypotheses were formulated: (a) a first hypothesis postulates that an examination situation increases the State Anxiety score; (b) a second hypothesis postulates a variability of defense mechanisms assessed by Bond's questionnaire (DSQ 40). It verified that the scores of the Bond defensive style questionnaire are significantly different in the two sessions.The mean state-anxiety score is higher in the second session. The great majority of students are described as more anxious during the week of examinations than during the previous month. The first hypothesis is then validated. The situation of evaluation of the university performance appears as a situation more stressful than the courses period. The three defense mechanism factors vary in a significant way from the first to the second session. In the second session the scores in mature and neurotic defense mechanisms increased significantly whereas the average scores in immature defense mechanisms decreased significantly. The majority of the 20 defense mechanisms are not stable between both situations. Indeed, 17 conscious by-products of defense mechanisms differ significantly in both sessions and only three defense mechanisms show a certain stability. Eleven defensive styles (55 %) decreased, six increased (30 %) and three remained stable (15 %). The instability of conscious by-products of defense mechanisms between the two sessions was confirmed by correlations analyses.The results show that the instability between situations is not limited to three categories of defenses (mature, neurotic and immature): 17 out of 20 mean scores in defense styles differed significantly. Conscious by-products of defense mechanisms are, indeed, influenced by situational factors.

214-THE IMPACT OF ICD DISCHARGES, ATTACHMENT STYLES AND SOCIAL SUPPORT ON ANXIETY AND DEPRESSION

Insecure attachment styles and immature or neurotic defense mechanisms are related to psychological distress. However, their mutual interaction in influencing psychological distress deserves further investigation.One-thousand-one-hundred-twenty-nine University students were evaluated using the Global Severity Index of Symptoms Check List 90-Revised for psychological distress, Relationship Questionnaire for attachment styles and Defense Style Questionnaire for defense mechanisms. Following exploratory analyses, a Path Analysis was performed with psychological distress as outcome.Fearful and preoccupied attachment styles had a substantial impact on psychological distress. About 30% of their effect was mediated by Immature and Neurotic defenses, with the former having the major effect. Dismissing attachment showed no substantial effect on psychological distress. Secure Attachment and Mature Defenses had a small protective effect on psychological distress, but their inclusion in the path model did not improve overall goodness-of-fit. Attachment style and defense mechanisms accounted for nearly 25% of the variance in psychological distress.The results showed that attachment styles and defense mechanisms have a substantial impact on psychological distress. The effect of attachment style is mediated by defense mechanisms. Individual differences in attachment style and defense mechanisms represent risk factors for psychological distress in young adults.

Toward a Psychodynamic Understanding of Metaphor and Metonymy: Their Role in Awareness and Defense

Metaphor and metonymy, on the mental level temporally rather than syntactically or semantically defined, show a close association to healthy and neurotic defense, respectively. When the mind functions optimally, reverberating issues of past and present domains inform each other bidirectionally like source and target of a metaphor. Neurotic defense, metonymically conflating past and present, is mental access barring (negative metonymy). Metaphor and positive metonymy, fundamental to how the mind works, are autopoietic devices organizing creative change. Trauma (lost metaphoricity) results in negative metonymy. During psychoanalysis metonymic defenses and transferences get remetaphorized. Nested mentational configurations emerge sequentially as markers of increased awareness (clinical vignette): negative metonymy (target enigmatic); positive metonymy (accessing target); metaphor (domains seen in terms of each other).

Treating Medication-Resistant Panic Disorder: Predictors and Outcome of Cognitive-Behavior Therapy in a Brazilian Public Hospital

Background: In Brazil, treatment of panic disorder is most frequently initiated with pharmacotherapy, but only half of the patients can be expected to be panic free after medication. Studies have suggested that individual or group cognitive-behavior therapy (CBT) is an effective treatment strategy for panic patients who have failed to respond to pharmacotherapy. Methods: Thirty-two patients diagnosed with panic disorder with agoraphobia having residual symptoms despite being on an adequate dose of medication were treated with 12 weeks of group CBT. The outcome was evaluated for panic frequency and severity, generalized anxiety, and global severity. Comorbid conditions, a childhood history of anxiety, and defense mechanism styles were assessed as potential predictors of treatment response. Results: Twenty-nine patients completed the 12-week protocol. Treatment was associated with significant reductions in symptom severity on all outcome measures (p < 0.001). Patients with depression had a poorer outcome of the treatment (p = 0.01) as did patients using more neurotic (p = 0.002) and immature defenses (p = 0.05). Conclusion: Consistent with previous reports, we found that CBT was effective for our sample of treatment-resistant patients. Among these patients, depression as well as neurotic defense style was associated with a poorer outcome. The use of CBT in Brazil for treatment-resistant and other panic patients is encouraged.