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

Defense mechanisms are unconscious and automatic psychological processes that serve to protect the individual from painful emotions and thoughts. There is ample evidence from the adult psychotherapy and mental health literature suggesting the salience of defenses in the maintenance and amelioration of psychological distress. Although several tools for the assessment of children’s defenses exist, most rely on projective and self-report tools, and none are based on the empirically derived hierarchy of defenses. This paper outlines the development of the defense mechanisms rating scale Q-sort for children (DMRS-Q-C), a 60-item, observer-rated tool for coding the use of defenses in child psychotherapy sessions. Modifications to the Defense Mechanisms Rating Scale Q-Sort for adults to create a developmentally relevant measure and the process by which expert child psychotherapists collaborated to develop the DMRS-Q-C are discussed. A clinical vignette describing the child’s defensive functioning as assessed by the innovative DMRS-Q-C method is also reported. Finally, we provide an overview of forthcoming research evaluating the validity of the DMRS-Q-C.

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Defense Mechanisms and Treatment Response in Depressed Inpatients

Frontiers in Psychology ◽

10.3389/fpsyg.2021.633939 ◽

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.

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Qualitative and quantitative analysis of the defensive profile in breast cancer women: A pilot study

Health Psychology Open ◽

10.1177/2055102919854667 ◽

2019 ◽

Vol 6 (1) ◽

pp. 205510291985466 ◽

Cited By ~ 6

Author(s):

Mariagrazia Di Giuseppe ◽

Annarita Di Silvestre ◽

Rosa Lo Sterzo ◽

Paul Hitchcott ◽

Angelo Gemignani ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Defense Mechanisms ◽

Rating Scale ◽

Qualitative And Quantitative Analysis ◽

Breast Cancer Patients ◽

Internal Conflicts ◽

Defensive Functioning ◽

Mean Differences ◽

Q Sort

This study analyzed the defensive functioning and profile of nine breast cancer women and identifies the differences from other cancer patients (N0) in the way they deal with internal conflicts and stressful situations related to the illness. Patients were interviewed and evaluated using the Defense Mechanisms Rating Scale Q-sort. Mean differences analysis showed that breast cancer patients use more reaction formation, omnipotence, and rationalization and less idealization of others-image and autistic fantasy, compared with other-site cancer patients. From the qualitative analysis of the defensive profile, displacement and repression appeared among the most representative defense mechanisms of breast cancer patients.

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The Hierarchy of Defense Mechanisms: Assessing Defensive Functioning With the Defense Mechanisms Rating Scales Q-Sort

Frontiers in Psychology ◽

10.3389/fpsyg.2021.718440 ◽

2021 ◽

Vol 12 ◽

Author(s):

Mariagrazia Di Giuseppe ◽

J. Christopher Perry

Keyword(s):

Psychological Functioning ◽

Defense Mechanisms ◽

Rating Scales ◽

Full Range ◽

Well Being ◽

Research Fields ◽

Defensive Functioning ◽

And Function ◽

The Impact ◽

Q Sort

The psychodynamic concept of defense mechanisms is nowadays considered by professionals with various theoretical orientations of great importance in the understanding of human development and psychological functioning. More than half century of empirical research has demonstrated the impact of defensive functioning in psychological well-being, personality organization and treatment process-outcome. Despite the availability of a large number of measures for their evaluation, only a few instruments assess the whole hierarchy of defenses, based on the Defense Mechanisms Rating Scales (DMRS), which arguably offers an observer-rated gold standard of assessment. The present article illustrates the theoretical and methodological background of the DMRS-Q, the Q-sort version of the DMRS for clinical use. Starting from the definition and function of the 30 defense mechanisms included in the hierarchy, we extracted 150 items that captured a full range of defensive manifestations according to the DMRS theory. The DMRS-Q set is described in this paper with reference to the DMRS manual. Directions are also provided for using the DMRS-Q online software for the free and unlimited coding of defense mechanisms. After each coding, the DMRS-Q software provides a report including qualitative and quantitative scores reflecting the individual’s defensive functioning. Qualitative scores are displayed as the Defensive Profile Narratives (DPN), while quantitative scores are reported as Overall Defensive Functioning (ODF), defensive categories, defense levels, and individual defense mechanisms. Syntax for the scoring is displayed in the results and a clinical vignette of a psychotherapy session coded with the DMRS-Q is provided. The DMRS-Q is an easy-to-use, free, computerized measure that can help clinicians in monitoring changes in defense mechanisms, addressing therapeutic intervention, fostering symptoms decreasing and therapeutic alliance. Moreover, the DMRS-Q might be a valid tool for teaching the hierarchy of defense mechanisms and increase the observer-rated assessment of this construct in several research fields.

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Item Response Theory Analyses of Barkley’s Adult Attention-Deficit/Hyperactivity Disorder Rating Scales

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa041 ◽

2020 ◽

Vol 35 (7) ◽

pp. 1094-1108

Author(s):

Morgan E Nitta ◽

Brooke E Magnus ◽

Paul S Marshall ◽

James B Hoelzle

Keyword(s):

Item Response Theory ◽

Item Response ◽

Adult Adhd ◽

Rating Scales ◽

Rating Scale ◽

Self Report ◽

Clinical Population ◽

Response Theory ◽

Item Level ◽

Latent Traits

Abstract There are many challenges associated with assessment and diagnosis of ADHD in adulthood. Utilizing the graded response model (GRM) from item response theory (IRT), a comprehensive item-level analysis of adult ADHD rating scales in a clinical population was conducted with Barkley's Adult ADHD Rating Scale-IV, Self-Report of Current Symptoms (CSS), a self-report diagnostic checklist and a similar self-report measure quantifying retrospective report of childhood symptoms, Barkley's Adult ADHD Rating Scale-IV, Self-Report of Childhood Symptoms (BAARS-C). Differences in item functioning were also considered after identifying and excluding individuals with suspect effort. Items associated with symptoms of inattention (IA) and hyperactivity/impulsivity (H/I) are endorsed differently across the lifespan, and these data suggest that they vary in their relationship to the theoretical constructs of IA and H/I. Screening for sufficient effort did not meaningfully change item level functioning. The application IRT to direct item-to-symptom measures allows for a unique psychometric assessment of how the current DSM-5 symptoms represent latent traits of IA and H/I. Meeting a symptom threshold of five or more symptoms may be misleading. Closer attention given to specific symptoms in the context of the clinical interview and reported difficulties across domains may lead to more informed diagnosis.

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Nominations, Ratings, and the Dimensions of Sociometric Status

International Journal of Behavioral Development ◽

10.1080/016502597385045 ◽

1997 ◽

Vol 21 (1) ◽

pp. 179-199 ◽

Cited By ~ 11

Author(s):

Gerard H. Maassen ◽

Jos L. van der Linden ◽

Wies Akkermans

Keyword(s):

Rating Scales ◽

Rating Scale ◽

Sociometric Status ◽

Dimensional Model ◽

One Dimensional ◽

Individual Level ◽

Research Designs ◽

The One ◽

The Individual ◽

Group Member

In 1944, U. Bronfenbrenner remarked on the need for a two-dimensional model of sociometric status. The low value of the correlation between the variables liking and disliking-assumed basic dimensions of sociometric status-is often cited as evidence for the correctness of Bronfenbrenner’ssuggestion. Sociometric status is derived from a coalescence of judgements at the individual level. In this article we argue that score attribution at this level (where one group member assesses another) is one-dimensional along the liking-disliking continuum. Two-dimensionality of sociometric status arises at the group level. However, we also show that at this level liking and disliking are not two distinct dimensions, but the poles of just one, the other being visibility (or impact). If the one-dimensional model of liking score attribution on the individual level is accepted, the obvious thing to do is to instruct respondents accordingly. Rating scales are suitable for this. The rating-scale methods we suggested in previous publications (e.g. Maassen, Akkermans, & van der Linden, 1996) are in keeping with this argument. Moreover, these methods may be recommended for their reliability, validity and for the variety of research designs to which they can be applied.

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Defense Mechanisms and Repressive Coping Among Male Breast Cancer Patients

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.718076 ◽

2021 ◽

Vol 12 ◽

Author(s):

Rainer Weber ◽

Johannes C. Ehrenthal ◽

Evamarie Brock-Midding ◽

Sarah Halbach ◽

Rachel Würstlein ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Male Breast Cancer ◽

Defense Mechanisms ◽

Male Breast ◽

Self Report ◽

Repressive Coping ◽

Breast Cancer Patients ◽

Defensive Functioning ◽

Fear Of Progression

Objectives: The concept of defense mechanisms has undergone extensive revision and expansion since Freud first described these processes. Initially formulated as an unconscious repression of unpleasant memories, with further development focusing on the role of defense mechanisms in the regulation of internal conflicts, the concept shifted and evolved to incorporate the adaptation to external demands, including intrapsychic and interpersonal handling of burden of illness. In addition to defense mechanisms, coping provides another perspective on human adjustment to difficult life events. While there is substantial research on both coping and defense mechanisms in various psychiatric and somatic diseases, including cancer, little is known about defensive regulation, coping, and their interaction in male breast cancer patients.Methods: The present study is part of the N-Male project conducted between 2016 and 2018 in Germany (Male breast cancer: patients' needs in prevention, diagnosis, treatment, rehabilitation, and follow-up care). Semi-standardized interviews with 27 male breast cancer patients were analyzed with regard to defense mechanisms. In addition, fear of progression and repressive coping was assessed by self-report.Results: There was considerable variety in levels of defensive functioning as well as repressive coping in our sample. We found no difference in overall levels of defensive functioning between men with vs. without repressive coping. However, patients with repressive coping demonstrated a decopupled association between fear of progression and defensive functioning as compared to patients without repressive coping.Discussion: The study provides the first evidence of disease processing in male breast cancer patients Knowledge of patients' defense patterns and repressive coping seems promising for better planning targeted intervention strategies.

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Individual response to antidepressants for depression in adults – a meta-analysis and simulation study

10.31219/osf.io/srzx5 ◽

2019 ◽

Author(s):

Klaus Munkholm ◽

Stephanie Winkelbeiner ◽

Philipp Homan

Keyword(s):

Rating Scales ◽

Rating Scale ◽

Meta Analysis ◽

Simulated Data ◽

Individual Treatment ◽

Depression Symptom ◽

Individual Response ◽

Inverse Variance ◽

The Individual ◽

Symptom Rating

Background The observation that some patients appear to respond better to antidepressants for depression than others encourages the assumption that the effect of antidepressants differs between individuals and that treatment can be personalized. Objective To compare the outcome variance in patients receiving antidepressants with the outcome variance in patients receiving placebo in randomized controlled trials (RCTs) of adults with major depressive disorder (MDD) and to illustrate, using simulated data, components of variation of RCTs. Methods From a dataset comprising 522 RCTs of antidepressants for adult MDD, we selected the placebo-controlled RCTs reporting outcomes on the 17 or 21 item Hamilton Depression Rating Scale or the Montgomery-Asberg Depression Rating Scale and extracted the means and SDs of raw endpoint scores or baseline to endpoint changes scores on eligible depression symptom rating scales. We conducted inverse variance random-effects meta-analysis with the variability ratio (VR), the ratio between the outcome variance in the group of patients receiving antidepressants and the outcome variance in the group receiving placebo, as the primary outcome. An increased variance in the antidepressant group would indicate individual differences in response to antidepressants. Results We analysed 222 RCTs that investigated 19 different antidepressants compared with placebo in 345 comparisons, comprising a total of 61144 adults with an MDD diagnosis. Across all comparisons, the VR for raw endpoint scores was 0.98 (95% CI 0.96 to 1.00, I^2^ = 0%) and 1.00 (95% CI 0.99 to 1.02, I^2^ = 0%) for baseline-to-endpoint change scores. Conclusion Based on these data, we cannot reject the null hypothesis of equal variances in the antidepressant group and the placebo group. Given that RCTs cannot provide direct evidence for individual treatment effects, it may be most reasonable to assume that the average effect of antidepressants applies also to the individual patient.

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Aspects of Pain, Its Assessment and Evaluation from An Acupuncture Perspective

Acupuncture in Medicine ◽

10.1136/aim.24.3.109 ◽

2006 ◽

Vol 24 (3) ◽

pp. 109-117 ◽

Cited By ~ 15

Author(s):

Iréne Lund ◽

Thomas Lundeberg

Keyword(s):

Pain Assessment ◽

Individual Variation ◽

Rating Scales ◽

Pain Treatment ◽

Clinical Problem ◽

Self Report ◽

Assessment And Evaluation ◽

Metric Properties ◽

Perceived Pain ◽

The Individual

Pain is a major clinical problem that causes great suffering for the individual and incurs costs for society. Accurate assessment and evaluation of perceived pain is necessary for diagnosis, for choice of treatment, and for the evaluation of treatment efficacy. The assessment of an individual's pain is a challenge since pain is a subjective, multidimensional experience, and assessment is based on the person's own self-report. The results are often varied, possibly due to inter-individual variation, but also in relation to gender and aetiology. A gold standard for pain assessment is still lacking, but rating scales, questionnaires, and methods derived from psychophysical concepts, such as threshold assessments and perceptual matching, are used. In the evaluation of pain and associated variables, both systematic and individual variation should be taken into account, as should pain-associated symptoms. Recommendations for pain treatment should be based on the patient's specific needs. Therefore, it is important to assess the level of perceived pain taking individual variation into account. The methods used should preferably have proved to be useful in randomised controlled trials, and analysis of pain assessment should consider its non-metric properties. In the future, the use of studies with a naturalistic protocol together with individual assessment of individual pain responses could increase the internal and external validity.

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

Frontiers in Psychology ◽

10.3389/fpsyg.2021.647503 ◽

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.

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

Frontiers in Psychology ◽

10.3389/fpsyg.2021.665547 ◽

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.

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