Comparison and change of defense mechanisms over the course of psychotherapy in patients with depression or anxiety disorder: Evidence from a randomized controlled trial

Babl, Anna; Holtforth, Martin Grosse; Perry, J. Christopher; Schneider, Noemi; Dommann, Eliane; Heer, Sara; Stähli, Annabarbara; Aeschbacher, Nadine; Eggel, M.; Eggenberg, Jelena; Sonntag, Meret; Berger, Thomas; Caspar, Franz

doi:10.1016/j.jad.2019.04.021

Cited by 46 publications

(44 citation statements)

References 36 publications

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“…One possible explanation as put forward by Vaillant (1993) is that defenses change up the hierarchy in a stepwise fashion with maladaptive defenses moving up to neurotic and eventually adaptive defenses. On the contrary, other studies did not confirm such stepwise changes (Albucher, Abelson, & Nesse, 1998;Akkermann et al, 1999;Babl et al, 2019). Our third hypothesis was upheld: the within-patient effect of ODF, adaptive and maladaptive defenses on symptom severity of depression reached the significance level, indicating that an increase in adaptive defenses and a decrease in maladaptive defenses over the course of psychotherapy is accompanied by an improvement in depressive symptoms.…”

Section: Discussioncontrasting

confidence: 53%

“…Psychoanalytic and dynamic therapy specifically addresses defenses in-session aiming to develop more adaptive defensive functioning. However, even therapeutic approaches not aiming at changing defensive functioning, as the integrative interventions applied in this study, seem to exhibit a favorable effect on defenses (Babl et al, 2019). This indicates that despite their psychodynamic roots, defenses can be applied as trans-theoretical constructs, suggesting that knowledge about a patient's predominant defense mechanisms could be helpful to therapists of all orientations.…”

Section: Discussionmentioning

confidence: 68%

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Disentangling within- and between-patient effects of defensive functioning on psychotherapy outcome using mixed models

Babl

Berger

Holtforth

et al. 2019

Psychotherapy Research

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There is a great need to identify predictors of treatment response, and the analysis of defense mechanisms is a promising approach. Defensive functioning may influence psychotherapy outcome in two ways: First, when it is generally higher or lower for some patients relative to others and second, as it shifts in individual patients over time. The present study examined both within-and between patient effects of defenses using hierarchical linear modeling. Forty-seven patients diagnosed with depression, anxiety, or adjustment disorders received 25±3 sessions of integrative cognitive-behavioral therapy in a university outpatient clinic. The Defense Mechanism Rating Scale (DMRS) was used to assess defenses in the 1 st , 8 th , 16 th , and 24 th session and relate them to symptom severity of depression and anxiety. A higher number of adaptive defense mechanisms was associated with less severe depressive symptoms during treatment while a higher number of immature defenses was related to more severe depressive and anxiety symptoms. An increase in adaptive and a decrease in immature defenses over the course of treatment predicted symptom reduction of depression whereas a decrease in neurotic and immature defenses was associated with reductions in anxiety symptoms. Our results empirically support defensive functioning as a mechanism of change in psychotherapy.

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 68%

Disentangling within- and between-patient effects of defensive functioning on psychotherapy outcome using mixed models

Babl

Berger

Holtforth

et al. 2019

Psychotherapy Research

Self Cite

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“…Notably, explicit emotion regulation strategies did not appear to statistically predict psychological wellbeing during the pandemic. This highlights the salience of implicit ways of coping and suggests the importance of interventions that focus on identifying and modifying these capacities (Heldt et al, 2007;Babl et al, 2019;Kramer et al, 2010;Perry et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Identifying Predictors of Psychological Distress During COVID-19: A Machine Learning Approach

et al. 2020

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“…The “capacity for defensive functioning” has recently been included among the 12 categories of basic mental functioning in the second edition of the Psychodynamic Diagnostic Manual (Lingiardi & McWilliams, 2017 ). In fact, assessing defenses can be particularly useful for both routine clinical work and process-outcome research in psychotherapy (Babl et al, 2019 ; Di Giuseppe, Perry, Petraglia, Janzen, & Lingiardi, 2014; Hilsenroth, Katz, & Tanzilli, 2018 ; Prout, Malone, Rice, & Hoffman, 2019 ). A strong understanding of defenses can assist clinicians in better understanding the strengths and difficulties of patients and helping them make sense of their experiences to develop adaptive responses to internal and external stressors.…”

Section: Introductionmentioning

confidence: 99%

Defense mechanisms in adolescents at high risk of developing psychosis: An empirical investigation

Boldrini

Buglio

Giovanardi

et al. 2020

ResPsy

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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.

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Comparison and change of defense mechanisms over the course of psychotherapy in patients with depression or anxiety disorder: Evidence from a randomized controlled trial

Cited by 46 publications

References 36 publications

Disentangling within- and between-patient effects of defensive functioning on psychotherapy outcome using mixed models

Disentangling within- and between-patient effects of defensive functioning on psychotherapy outcome using mixed models

Identifying Predictors of Psychological Distress During COVID-19: A Machine Learning Approach

Defense mechanisms in adolescents at high risk of developing psychosis: An empirical investigation

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