scholarly journals Defense Mechanisms and Treatment Response in Depressed Inpatients

2021 ◽  
Vol 12 ◽  
Author(s):  
Yves de Roten ◽  
Slimane Djillali ◽  
Fabienne Crettaz von Roten ◽  
Jean-Nicolas Despland ◽  
Gilles Ambresin
Keyword(s):  
Treatment Response ◽  
Psychodynamic Psychotherapy ◽  
Defense Mechanisms ◽  
Rating Scales ◽  
Rating Scale ◽  
Defense Mechanism ◽  
Symptomatic Improvement ◽  
Inpatient Setting ◽  
Therapy Program ◽  
Defensive Functioning

The study investigated the extent to which defensive functioning and defense mechanisms predict clinically meaningful symptomatic improvement within brief psychodynamic psychotherapy for recurrent and chronic depression in an inpatient setting. Treatment response was defined as a reduction in symptom severity of 46% or higher from the baseline score on the Montgomery–Asberg Depression Rating Scale (MADRS). A subsample of 41 patients (19 responders and 22 non-responders) from an RCT was included. For each case, two sessions (the second and the penultimate) of brief inpatient psychodynamic psychotherapy (a manualized 12-session therapy program developed in Lausanne) were transcribed and then coded using the Defense Mechanism Rating Scales (DMRS) and the Psychotic Defense Mechanism Rating Scales (P-DMRS), an additional scale developed to study psychotic defenses. Results showed that defensive functioning and mature and immature defense changed during psychotherapy and predicted treatment response. Patient’s defenses observed throughout therapy also predicted treatment response at 12-month follow-up. The addition of psychotic defenses allows a better prediction of the treatment response. Overall, these results are in line with previous research and provide further validation of defensive functioning as a predictor of outcomes and a mechanism of change in psychotherapy.

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

2021 ◽  
Vol 24 (3) ◽  
Author(s):  
Mariagrazia Di Giuseppe ◽  
Tracy A. Prout ◽  
Lauren Ammar ◽  
Thomas Kui ◽  
Ciro Conversano
Keyword(s):  
Defense Mechanisms ◽  
Rating Scales ◽  
Rating Scale ◽  
Child Psychotherapy ◽  
Self Report ◽  
Ample Evidence ◽  
Defensive Functioning ◽  
Mental Health Literature ◽  
The Individual ◽  
Q Sort

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.

scholarly journals Beyond the mask of deference: exploring the relationship between ruptures and transference in a single-case study

2016 ◽  
Vol 19 (2) ◽  
Author(s):  
Francesca Locati ◽  
Pietro De Carli ◽  
Emanuele Tarasconi ◽  
Margherita Lang ◽  
Laura Parolin
Keyword(s):  
Sequential Analysis ◽  
Rating Scales ◽  
Rating Scale ◽  
Defense Mechanism ◽  
Single Case ◽  
Assessment Procedure ◽  
Single Case Study ◽  
Alliance Ruptures ◽  
The Relationship

The relationship between transference and therapeutic alliance has been long discussed. It is only recently, however, that empirical evidence has provided support for a tight correspondence between several transference dimensions and rupture and resolution processes. In the present single-case study, we used alliance ruptures as a key dimension to understand patient’s transference dynamics. This was achieved in a particular form of patient’s behavior, i.e., patient’s deference and acquiescent behavior, which describes a significant submission to assertions, skills, judgments and point of views of another person. Therapeutic process was measured by means of the Rupture Resolution Rating Scale, the Core Conflictual Relationship Theme and the Defense Mechanism Rating Scales, whereas therapeutic outcome was measured by means of the Shedler-Westen Assessment Procedure-200. Results of sequential analysis yielded a significant correspondence between rupture markers, characterized by avoidance and shifting of session’s topic, and patient’s narrations. Furthermore, a systematic correspondence between alliance ruptures and patient’s avoidant functioning, which emerged both in transference relationship and in the quality of the defense structure, was found. Together, these findings indicate that patient’s deference inhibits the expression of relational themes, with ruptures in alliance that seem to be supported by a strong defensive structure. In particular, patient’s avoidance played a double role in the treatment. On the one hand, avoidance was the main characteristic of her transference structure, based on extreme intellectualization and emotional closure. On the other hand, it contributed to create an impasse in the treatment, based on a withdrawal ruptures model and on obsessive level defences.

Biomarkers of depressive disorders: A multiplex analysis of blood serum

2017 ◽  
Vol 41 (S1) ◽  
pp. S524-S524 ◽  
Author(s):  
A.S. Boiko ◽  
I.S. Losenkov ◽  
L.A. Levchuk ◽  
G.G. Simutkin ◽  
N.A. Bokhan ◽  
...  
Keyword(s):  
Treatment Response ◽  
Depressive Disorders ◽  
Rating Scales ◽  
Rating Scale ◽  
Basic Research ◽  
Serum Markers ◽  
Control Group ◽  
Clinical Indicators ◽  
Feasible Option ◽  
Potential Biomarkers

Depressive disorders are a great burden for individual patients and society. Blood-based biomarkers are regarded as a feasible option for investigation of depressive disorders. Several potential biomarkers for depression were selected. We studied the following serum markers: cortisol, melatonin, brain-derived neurotrophic factor (BDNF), prolactin, insulin-like growth factor 1 (IGF-1), β-endorphin, orexin A. The patient sample consisted of 78 persons with depressive disorders. Patients were divided into two groups: 46 patients with a first depressive episode and 32 patients with recurrent depressive disorder. Control group consisted of 71 healthy individuals of corresponding age and sex. All markers were measured in serum using MILLIPLEX® MAP panels (Merck, Darmstadt, Germany) by analyzer MAGPIX (Luminex, USA). Statistical analyses were performed using SPSS software. Results were expressed as median and quartile intervals [Q1–Q3]. There was a significant increase of serum concentrations of cortisol (663.69 [467.5–959.49] nmol/L, Р < 0.001) and melatonin (66.31 [33.6–132.59] pg/mL, P = 0.029) in patients compared with the control group (526.1 [367,24–654,7] nmol/L and 45.11 [27.47–73.47] pg/mL). In addition, correlations were found between potential biomarkers, clinical indicators and treatment response measured by applying the Hamilton Depression rating scale and the Clinical Global Impression rating scales. A significant correlation was found between the concentration of prolactin and high response to pharmacotherapy (r = –0.267, P = 0.029). Identifying biomarkers that can be used as diagnostics or predictors of treatment response in people with depressive disorders will be an important step towards being able to provide personalized treatment.Disclosure of interestThe work is supported by the project of Russian Foundation of Basic Research No 14-04-01157a.

scholarly journals What Do Therapist Defense Mechanisms Have to Do With Their Experience of Professional Self-Doubt and Vicarious Trauma During the COVID-19 Pandemic?

2021 ◽  
Vol 12 ◽  
Author(s):  
Katie Aafjes-Van Doorn ◽  
Vera Békés ◽  
Xiaochen Luo ◽  
Tracy A. Prout ◽  
Leon Hoffman
Keyword(s):  
Clinical Supervision ◽  
Vicarious Trauma ◽  
Defense Mechanisms ◽  
Rating Scales ◽  
Defense Mechanism ◽  
Self Report ◽  
Defense Style ◽  
Work Related ◽  
Professional Self

This is the first study to examine psychotherapists' levels of defense mechanisms, their concurrent relationship with professional work-related stress (professional self-doubt and vicarious trauma), and how their levels of defense mechanisms predict the changes in these professional stresses over the course of 3 months since the start of the COVID-19 pandemic. Data from two online studies (Study 1; N = 105 and Study 2; N = 336), using two self-report measures of therapists' defense mechanisms (Defense Style Questionnaire-40 in Study 1 and Defense Mechanism Rating Scales Self-Report-30 in Study 2), are presented. Therapists reported higher levels of mature defense mechanisms, and lower levels of immature defense mechanisms, compared to published community and clinical populations assessed before and during the pandemic. Therapists' lower level of mature defense mechanisms and higher levels of neurotic and immature defense mechanisms were related to higher concurrent levels of vicarious trauma and professional doubt. Therapists who reported higher levels of mature defense mechanisms at 3-month follow-up showed less vicarious trauma and professional self-doubt at follow-up, after controlling for these professional stressors at baseline. Implications for clinical supervision and training are discussed. The context and professional challenges during the pandemic are unique and future replications of the results outside the pandemic context are warranted.

scholarly journals Defensive Functioning of Individuals Diagnosed With Gender Dysphoria at the Beginning of Their Hormonal Treatment

2021 ◽  
Vol 12 ◽  
Author(s):  
Guido Giovanardi ◽  
Marta Mirabella ◽  
Mariagrazia Di Giuseppe ◽  
Francesco Lombardo ◽  
Anna Maria Speranza ◽  
...  
Keyword(s):  
Gender Dysphoria ◽  
Defense Mechanisms ◽  
Rating Scales ◽  
Hormonal Treatment ◽  
The Body ◽  
Assessment Procedure ◽  
Transgender People ◽  
Defensive Functioning ◽  
Wide Range ◽  
Body Uneasiness

Defense mechanisms are relevant indicators of psychological functioning and vulnerability to psychopathology. Their evaluation can unveil individuals' unconscious strategies for mediating reactions to emotional conflict and external stressors. At the beginning of their journey toward gender reassignment, individuals diagnosed with gender dysphoria (GD) may experience conflict and stressful experiences that trigger a wide range of defense mechanisms. Mature defenses may strengthen these individuals as they travel along this important path, while neurotic and immature defenses may exacerbate their body dissatisfaction (BD) and hinder their processing of change. Only a few studies have investigated self-reported defensive functioning in transgender people, finding a higher frequency of maladaptive defense mechanisms relative to controls. The present study was the first to apply an in-depth clinician-rated tool to assess the entire hierarchy of defense mechanisms within a sample of transgender people. Defensive functioning and personality organization were assessed in 36 individuals diagnosed with GD (14 trans women, 22 trans men, mean age 23.47 years), using the Defense Mechanisms Rating Scales (Perry, 1990) and the Shedler-Westen Assessment Procedure-200 (Shedler et al., 2014). Body uneasiness was assessed using the Body Uneasiness Test (BUT; Cuzzolaro et al., 2006). The findings showed that defensive functioning correlated positively with healthy personality functioning and negatively with BD. Compared to cisgender controls, participants with GD who presented greater defensive functioning were found to be more immature and to demonstrate significant differences in many levels of functioning. The clinical implications of the results suggest that psychological interventions aimed at improving defensive functioning in individuals with GD will be important in helping them manage the challenges posed by their gender transition.

scholarly journals Implementing the Rating Scale for Aggressive Behaviours in the Elderly: Can it Make a Difference to Nursing Management of Aggressive Behaviours in Elderly Patients with Dementia?

2021 ◽  
Author(s):  
◽  
Bernadette Lidiard
Keyword(s):  
Elderly Patients ◽  
Aggressive Behaviour ◽  
Quantitative Methods ◽  
Rating Scales ◽  
Rating Scale ◽  
The Elderly ◽  
Inpatient Setting ◽  
Management Problem ◽  
Nursing Management ◽  
Aggressive Behaviours

<p><b>Aggressive behaviour is the most common clinical and nursing management problem for patients with dementia. Many elderly patients with dementia show sexual, physical, and verbal aggressive behaviours that complicate their management and make day-to-day nursing care difficult. These behaviours include yelling, hitting, swearing and verbal abuse. Despite this there is no consistent use of rating scales for assessing aggressive behaviour in this population. Nurses in the inpatient setting are often the main target for this aggression and without a rating scale the assessment of the behaviour is open to interpretation of the individual. While aggressive behaviours can be the most difficult behaviours for nursing staff to manage, these behaviours can also disrupt the milieu on inpatient psychogeriatric settings and frequently distress other patients, visiting families/whanau and friends.</b></p> <p>The Rating Scale for Aggressive Behaviours in the Elderly (RAGE) is a twenty-one item rating scale, designed specifically to measure aggressive behaviours in the elderly in the psychogeriatric inpatient setting. The purpose of the scale is to qualify the aggressive behaviour, note any changes in the behaviour, and record intervention and/or treatments. This study combines both qualitative and quantitative methods with exploratory and descriptive designs to explore nurses’ experiences of using a consistent tool for monitoring, measuring and managing aggressive behaviours.</p> <p>Data gathered over a three month period of implementing RAGE will provide a ‘snapshot’ of the prevalence, extent and type of aggressive behaviours within the inpatient setting, providing evidence to nurses in developing strategies for the management of aggression. Focus group interviews were used to enable nurses to discuss their experiences of utilising a clinically validated tool in their practice and how this made a difference to their practice.</p> <p>Findings from this research indicate that nurses within the setting found that RAGE is a consistent tool with which nurses can record, measure and monitor aggressive behaviours. Responses from nurses’ experiences of utilising RAGE in their practice were varied, with some being unable to articulate how RAGE had made a difference to their practice. Despite this there was an overwhelming positive response for the continued use of RAGE within the setting as a clinically validated tool by which to measure, record and manage aggressive behaviours.</p>

scholarly journals Defense Mechanisms in Adolescents at High Risk of Developing Psychosis: An Empirical Investigation

2020 ◽  
Vol 23 (1) ◽  
Author(s):  
Tommaso Boldrini ◽  
Gabriele Lo Buglio ◽  
Guido Giovanardi ◽  
Vittorio Lingiardi ◽  
Silvia Salcuni
Keyword(s):  
At Risk ◽  
High Risk ◽  
Defense Mechanisms ◽  
Rating Scales ◽  
Defense Mechanism ◽  
Psychotic Symptoms ◽  
Ultra High Risk ◽  
Risk Patients ◽  
Not At Risk ◽  
The Relationship

Research within psychotherapy and psychopathology frameworks has been inspired by the central concept of defense mechanisms, which play a pivotal role in psychoanalysis. Defense specificities have only recently been studied systematically in the context of several clinical diagnoses. The present study aimed to explore the specificities of defense mechanisms in adolescents at ultra-high risk of developing psychosis and test the relationship between defensive functioning and attenuated psychotic symptoms. Twenty-six adolescent inpatients at ultra-high risk of developing psychosis and a matched clinical control group of inpatients not at risk of psychosis were interviewed. Two observer-rater methods, the Defense Mechanism Rating Scales and the Psychotic-Defense Mechanism Rating Scales were applied to interview transcripts to assess the individual use of defenses. Ultra-high-risk patients demonstrated lower defense mechanisms (i.e., total instances of defense mechanisms observed) and lower overall adaptiveness of the defenses presented. When specific differences between groups were observed, psychotic defenses were the sole defenses that could partially discriminate between ultra-high-risk and not at-risk patients. Regarding the relationship between defense mechanisms and subthreshold psychotic symptoms, psychotic defenses were associated with negative and disorganization symptoms, rather than with positive symptoms. The psychological vulnerability of ultra-high-risk patients is discussed and treatment implications for psychotherapy with such challenging patients are addressed.

Clinical assessment of defense mechanisms using the defense mechanism rating scale (DMRS) by J.C. Perry

1996 ◽  
Vol 11 ◽  
pp. 238s-239s ◽  
Author(s):  
V. Lingiardi ◽  
L. Vanzulli ◽  
M. Simula ◽  
C. Lonati ◽  
A. Fossati ◽  
...  
Keyword(s):  
Clinical Assessment ◽  
Defense Mechanisms ◽  
Rating Scale ◽  
Defense Mechanism
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