D efense mechanisms and coping

1. Defense mechanisms and coping Prof. Dr. DOINA COZMAN

2. The term “defense” was first used by Sigmund Freud in 1894 in the writing “Defense psychoneuroses”. • In 1926, Sigmund Freud defines defense mechanisms in the writing“Inhibitions, symptoms and anxiety”:techniques employed by the Ego in order to solve internal conflicts. • His daughter Anna Freud further assesses 10 defense mechanisms in the work “Defense mechanisms of the Ego” (1936)

3. Definitions • Both S. Freud and A. Freud use the term “defense mechanism” in a restrictive manner, for all the processes that have the same unique purpose: to protect the Ego against instinctual drives Characteristics: • Their exclusive target is (according to psychoanalists) blocking inner drives, not external traumatic events (they only appear between Id and Ego, not between Ego and external reality). • They are post-emotional and have a hierarchy according to degree of maturity (a mechanism is more mature if it is more effective in blocking instrinctual pressures of the Id).

4. Anna Freud • regression • repression • reaction formation • isolation • dissociation • projection • introjection • moral masochism • defensive denial • sublimation • clivage • counterinvestment • denegation • identification • identification with the aggressor • projective identification • intellectualization • removal • rationalization • daydreaming • refusal of reality • apathic withdrawal • humour

5. M. Sillamy: D.M. are unconscious and used in order to diminish the anxiety generated by inner conflicts between instincts and moral-social laws • Vaillant: D.M. are processes of mental regulation, with the purpose of restoring psychological homeostasis: • psychotic: delusional projection, psychotic denial; • immature: projection, hypochondria, passive aggression, acting-out, dissociation; • neurotic: displacement, refulation etc; • mature: altruism, sublimation, repression, humour. • DSM III-R: D.M. are complexes of feelings, thoughts and behaviours which are relatively involuntary and appear as a response to a perceived psychological threat, with the purpose of decreasing or masking anxiety-generating conflicts or stress factors. • Holmes: D. M. are strategies of decreasing or avoiding negative states: internal conflict, frustration, anxiety, stress. • Plutchik: “defense” is an unconscious process meant to dissimulate, avoid or change threats, conflicts or dangers

6. DSM IV • DSM IV (1996): D.M. are automatic psychic processes that protect the individual from anxiety, from stress factors or from perception of danger. It is postulated that the person becomes aware of them only when D.M. are already activated. • Classification on seven layers: • Increased adjustment level: defenses that allow optimal adjustment to stress, perceived gratification, awareness of feelings, thoughts and consequences, appropriate balancing of conflicting motivations (anticipation, affiliation, altruism, humour, self-affirmation, self-observation, repression etc.); • Mental inhibitions level: defenses that keep out of consciousness ideas, feelings, memories, desires or fears that may become potential threats (displacement, dissociation, intellectualization, refulation, affect isolation, reaction formation etc.); • Minor image distorsion level: defenses minimally distort self-image, body image, image of others, with the purpose of regulating self-appraisal (self-deprecation, idealization, omnipotence);

7. DSM IV • Denial level: defenses keep outside consciousness stress factors, and distressing/unacceptable affects, drives or responsibilities, erroneously attributed to external causes (refusal, projection, rationalization) • Major image distorsion level: autistic daydreamingprojective identification, splitting (clivage); • Action level: defenses using action or retreat in front of stress factors (activism, withdrawal, whining with request for help + rejection of help and passive aggression); • Defensive disregulation: failure of the subject’s defensive regulation to stress, which generates a break from objective reality (delusional projection, psychotic negativism, psychotic distorsion).

8. Ş. Ionescu • Ionescu et al.:“D.M. are unconscious processes of the psyche that target the decrease or annulation of unpleasant effects of real or imaginary threats, remodelling inner and/or outer reality, and whose manifestations – behaviours, ideas, affects – may be conscious or unconscious”. • They synthesize 29 D.M.: • The 10 D.M. described by Anna Freud, plus: • activism • Affiliation • affirmation of the self through emotion expression • altruism • Anticipation • Adolescent ascetism • Splitting • counterinvestment • denegation • identification • Identification with the aggressor • Projective Identification • Intellectualization • removal • Rationalization • daydreaming • Refusal of reality • Apathic withdrawal • humour

9. The background of the defense mechanism (D.M.) concept: • What is it? – process, operation, strategy, means, etc? • What is its finality? – decrease of internal conflict of psyche, of anguish/anxiety, restoring of psychological homeostasis, protection against anxiety etc? • What is the defense reported to? – inner or external threats? • What is the defense exerted through? – suppressing of one element of the conflict, remodelling of reality, temporary distortion of reality, dissimulation? • What level does is act on? – conscious or unconscious?

10. Copingmechanisms and stress • Coining the notion of “coping”was controversial and difficult; it may mean ‘dealing with’, facing a situation, controling • French authors use the term strategy of adjustment behaviour • It ultimately refers to mechanisms of stress prevention and adaptation to stress • Lazarus and Folkman: C. is the ensemble of cognitive and behavioural efforts directed towards controlling, decreasing or tollerating internal or internal distress that threatens or exceeds individual resources. It may entail three stages: • Anticipation or warning: prevention or postponing may still occur, the person can prepare for confrontation and assess the strategy and cost of confrontation • Confrontation or impact: the response of the subject to the stressful stimulus occurs, and the situation is reassessed and redefined • Post-confrontation: the person assesses the meaning of what happened

11. Copingmechanisms and stress • Bloch et al.: stress adaptation is the active process through which, based on self-assessment of activities and motivations, the subject faces a stressful situation and manages to control it • Paulhan, Bourgeois: types of coping strategies: • Emotion-centered: focused on regulating emotional disturbances • Problem-centered: management of the problem that generated the distress • Avoidance coping: allows the individual to decrease emotional distress through passive strategies: refusal, resignation, escape • “Vigile” coping: active means of searching resources, information, social support in order to confront and manage the situation

12. Mircea Miclea:“Coping is any mechanism of stress prevention, management and adjustment, any tradeoff between subject and environment with the purpose of decreasing the intensity of stress, not just living with stress, assimilating it, but also removing it through firm action” • Coping mechanisms may enter the stage in anticipation, at the moment when stress is induced or after the action of the stressor • Coping mechanisms may be classified as: • behavioural: all behaviours meant to prevent or decrease stress • A wide number and variety of behaviours, in a given context, may gain adaptive or profilactic function (ex.: fight or flight, seeking social support, perseverance, systematic training, abandoning yourself in daily activities). • They decrease stress only when their cost does not exceed benefits (on the contrary, they generate distress themselves)

13. cognitive: the sum of information processing meansthat help decrease stress. • Stressisdecreased by acting on the way the information isperceived: primary and secondaryappraisals are performedand a chain of assessments of the stressful situation mayfollow; cognitive copingmodulatesthem • C.C. sets itat the moment of primaryappraisal of the situation, or afterittookplace (repression, intellectualization) • C.c.: correctingprimaryappraisals, performingresourcereassessment, problemsolving planning, magicalthinking, rationalizingfailure etc. • neurobiological: stress reactionhas a neurobiological component and means of optimizingbiochemical stress reactionsmay be generatedspontaneously by the organism (ex.: massive endorphin release, NK cellproliferation), or deliberatelyinduced(ex.: drug use, smoking, drinking, medication, relaxationtechniques etc.)

14. Confrontation vs. Avoidance in stress management Confrontation/avoidance is a conceptual pair that provides the vector of coping: • Confrontation:the totality of behavioural, cognitive or neurobiological strategies oriented towards the stresssor/ stressful information/ stress reaction. These strategies set out to directly tackle problems / trauma and to seek optimal solutions in order to decrease their impact. The individual confronted with an issue has a resolutive attitude • Avoidance:the totality of behavioural, cognitive or neurobiological strategies that set out to ellude the stressor, by selectively processing negative information: • Blocking out of negative traumatic information (ignore, deny, repress, avoid, blindside) • Distorting information: reappraisal in a context that tones down negative valence, avoids “danger signals” and directs the subject’s cognitive resources towards the processing of neutral or positive-valence information By combining the vector of the coping mechanism with its nature, Miclea suggests a more comprehensive classification of coping mechanisms:

17. Examples of defense mechanisms • Defensive denial (refusal) After the primary appraisal of the stimulus, defensive denial with its cognitive processes prevents the development of the mental representation of the stimulus as trauma. It is a forceful and effective defense that shields the subject when overwhelming traumatic perception occurs • Repression Strategies that entail avoiding the retrieval of traumatic information in working memory, generating selective retrieval with partial or complete blocking of traumatic memory. Important: the internal representation of trauma has taken place, but its access in consciousness is blocked. Repression may be conscious or not: • conscious: the subject elludes both the trauma per se, and the events (even positive ones) associated with the trauma, which may help remember it • unconscious: partial or total amnesy of an event paired with a strong negative emotion = posttraumatic amnesy

18. Projection The trauma is acknowledged within consciousness, but its negative valence and the responsibility is assigned to more or less defined external factors (fate, destiny, the others). Projecting personal shortcomings or failures upon others allows a positive reappraisal of negative individual features; the subject thus elludes self-blame and the distress of responsibility, while self-esteem and self-image remain unaffected. • Rationalization Positive reappraisal of the stressful situation and disfunctional coping behaviour. Personal responsibility and shortcomings are owned up to, but are reappraised and justified, in order to buffer emotional impact. The justifications are distorted theoretical constructs meant to expiate the individual in front of themselves and others. It should not be erroneously understood as ‘explanation’, which is the search of the accurate causality chain that generated a specific situation. • Intellectualization/isolation Two meanings: • The conflictual mental representation (memory, thought process) remains conscious, while the affect assigned to it is eliminated • Two components are artificially separated, although they have an actual connection, because acknowledging this connection generates a level of anxiety Thus, intellectualization consists of cognitive strategies for the appraisal of traumatic information in the context of dissociating it from its emotional consequences.