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Article

Mindfulness and Defense Mechanisms as Explicit and Implicit Emotion Regulation Strategies against Psychological Distress during Massive Catastrophic Events

by
Mariagrazia Di Giuseppe
1,2,*,
Graziella Orrù
1,
Angelo Gemignani
1,
Rebecca Ciacchini
1,
Mario Miniati
1 and
Ciro Conversano
1
1
Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, 56126 Pisa, Italy
2
Department of History, Culture and Society, University of Rome Tor Vergata, 00133 Rome, Italy
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2022, 19(19), 12690; https://doi.org/10.3390/ijerph191912690
Submission received: 3 August 2022 / Revised: 14 September 2022 / Accepted: 20 September 2022 / Published: 4 October 2022
(This article belongs to the Special Issue Emotion Regulation and COVID-Related Stress Management)
Review Reports Versions Notes

Abstract

:
Emotion regulation is an important aspect of psychological functioning that influences subjective experience and moderates emotional responses throughout the lifetime. Adaptive responses to stressful life events depend on the positive interaction between explicit and implicit emotion regulation strategies, such as mindfulness and defense mechanisms. This study demonstrates how these emotion regulation strategies predict psychological health during the early phase of the COVID-19 pandemic. A convenience sample of 6385 subjects, recruited via snowball sampling on various social media platforms, responded to an online survey assessing psychological reaction to social restrictions imposed to limit the spread of COVID-19 in Italy. Psychological distress, post-traumatic stress symptoms, mindfulness, and defense mechanisms were assessed using SCL-90, IES-R, MAAS, and DMRS-30-SR, respectively. Higher mindfulness was significantly associated with higher overall defensive maturity and a greater use of high-adaptive defenses (p < 0.0001). Both mindfulness and defense mechanisms acted as good predictors of psychological health (R2 = 0.541) and posttraumatic symptoms (R2 = 0.332), confirming the role of emotion regulation in protecting against maladaptive responses to stressful situations.

1. Introduction

The role of emotion regulation as a central aspect of mental health has been widely demonstrated and is still of increasing interest in clinical psychology because of its impact on chronic diseases [1,2,3,4,5,6]. Emotion regulation is defined as the ability to influence subjective experience and expression of emotions and includes all conscious and unconscious strategies activated to moderate emotional responses [7]. The conscious effort to control and change an emotional reaction is defined as explicit emotion regulation [8]. It generally includes cognitive reappraisal and expressive suppression. Recent neurobiological models propose that mindfulness may lead to changes in self-processing through the development of self-awareness, self-regulation, and self-transcendence, which may reflect modulation in neurocognitive networks related to intention and motivation, attention, and emotion regulation [9,10]. Implicit emotion regulation operates outside of conscious awareness and encompasses unintentional and automatic processes, such as defense mechanisms and somatization. Implicit emotion regulation may be even more important than explicit strategies in maintaining psychological health [11,12]. According to the dual-process framework of emotion regulation, adaptive responses depend on the positive interaction between both explicit and implicit emotion regulation processes [13].
Mindfulness is defined as the experience of awareness activated by purposely paying attention to what occurs in the present with a non-judgmental attitude [14]. It is considered a multi-facet construct, involving attention, awareness, and an open-minded acceptance of the present moment, namely an open and accepting attitude, and an ability to take a step back from one’s experience without immediately reacting to it [15]. Psychological interventions based on improving mindfulness disposition have been found to be highly effective in reducing mental health symptoms, such as stress, anxiety, and depression [16], and in enhancing positive coping during the COVID-19 pandemic. For example, Zhu et al. [17], described lower levels of pandemic-related distress in mindfulness practitioners compared to non-practitioners. In a study conducted during the early days of the COVID-19 pandemic, Conversano et al. [18] found that dispositional mindfulness was associated with mental health as the best predictor of lower psychological distress among a number of socio-demographics and psychological factors related to COVID-19; these data are also supported by the application of machine learning [19,20]. Similarly, Kock et al. [21] investigated the impact of specific mindfulness facets on adolescents’ psychological functioning during the COVID-19 pandemic. They found that decentering a mindfulness facet was associated with decreased worry and stress, improved mental health, enhanced quality of life, and increased social connectedness with others.
Defense mechanisms are automatic psychological strategies that subjects might use to protect themselves from anxiety produced by internal conflicts and external stressors. Usually, defense mechanisms are hierarchically organized into a continuum of maturity and adaptiveness [22], with mature defenses sharing several common aspects with so-called coping strategies [23]. A wide body of research has already demonstrated that defense mechanisms might be significant predictors of physical and mental health [24,25,26,27,28], especially under stressful conditions, such as the COVID-19 pandemic [29,30,31]. According to Di Giuseppe et al. [32], greater levels of psychological distress, post-traumatic symptoms, depression, and anxiety might be associated with lower overall defensive functioning (ODF). Moreover, each increased unit of ODF might decrease the chances of developing post-traumatic stress symptoms by 71%. The relationship between life satisfaction and perceived stress could be partially mediated by approach coping, positive attitude, and mature defenses, as confirmed by Gori et al. [33]. Similarly, Di Giuseppe et al. [34] found that mature defensive functioning in healthcare professionals working during the COVID-19 pandemic was associated with resilience and personal accomplishment, while neurotic and immature defenses were related to perceived stress and burnout, known to worsen mental health in various conditions [35,36,37]. Furthermore, Aafjes-van Doorn et al. [38] showed that therapists’ lower defensive functioning was related to higher levels of vicarious trauma and professional doubt, thus enhancing the importance of clinicians’ emotion regulation in the therapeutic process [39,40,41,42,43].
Our study aimed to analyze the role of mindfulness and defense mechanisms in protecting against psychological distress during catastrophic events, such as the COVID-19 pandemic. Although both mindfulness and defense mechanisms may contribute to emotion regulation, most research has been focused on one aspect at time, and has separately investigated the role of explicit and implicit components of emotion regulation in stress management during catastrophic events. To the best of our knowledge, this is the first study investigating both mindfulness and defense mechanisms in a general population sample, namely Italian residents under lockdown restrictions imposed during the first wave of the COVID-19 pandemic. In more detail, we were interested in: (H1) the associations between explicit and implicit emotion regulation strategies as mindfulness and defense mechanisms; (H2) the role of mindfulness and defense mechanisms in protecting from psychological distress and post-traumatic symptoms during the initial spread of COVID-19; and (H3) the role of emotion regulation in predicting specific psychiatric symptoms. We hypothesized that different explicit and implicit emotion regulation strategies might be reciprocally associated, and that emotion regulation might predict lower psychological distress in a general population sample dealing with an unexpected and terrifying situation, such as the first wave of the COVID-19 pandemic.

2. Methods

2.1. Participants and Procedures

A convenience sample of 6385 Italian residents responded to an online survey launched on 13 March 2020 and closed after 2 weeks, on 26 March 2020. This time span corresponded to the very early days of the spread of COVID-19 in Italy, when the Italian government imposed the first national lockdown to limit the pandemic. Subjects were recruited using snowball sampling on various social media platforms (i.e., Facebook, Instagram, WhatsApp, etc.), informed about the purpose of the study, and asked to give their approval for the use of their personal data. Participants provided socio-demographic and COVID-related information, including the presence/absence of positive cases or deaths among relatives and friends and whether they had moved to another location as a result of the pandemic [18,32]. Exclusion criteria were (1) being less than 18 years of age, and (2) not signing the online consent form. The study procedure was reviewed and approved by the local [omitted for peer review] Institutional Review Board.

2.2. Measures

The online survey included the following instruments in addition to socio-demographic information: the Symptoms Checklist-90 (SCL-90) [44], for the assessment of general psychiatric symptoms; the Impact of Event Scale-Revised (IES-R) [45], for post-traumatic stress symptoms; the Mindfulness Attention Awareness Scale (MAAS) [46], for mindfulness disposition; the Defense Mechanisms Rating Scales-Self-Report-30 (DMRS-SR-30) [47], for the assessment of defense mechanisms. All questionnaires were validated in Italian and their internal consistency resulted in Cronbach’s alphas of 0.92, 0.88, 0.87, and 0.890, respectively.
The Symptoms Checklist-90 is a 90-item self-report, assessing psychopathological and somatic symptoms on a 5-point Likert scale. This measure provides scores for a Global Severity Index (GSI) and nine psychiatric symptoms: Somatization (SOM); Obsessive-Compulsive (O-C); Interpersonal Sensitivity (I-S); Depression (DEP); Anxiety (ANX); Hostility (HOS); Phobic Anxiety (PHOB); Paranoid Ideation (PAR); Psychoticism (PSY). Psychometric properties of the scale are widely documented [44,48]. Internal consistency for the present study was 0.97.
The Impact of Event Scale-Revised is a 22-item self-report assessing an overall index of post-traumatic stress symptoms and three subscales reflecting the specific symptoms of intrusion, avoidance, and hyperarousal. The IES-R is often used as a screening instrument for post-traumatic stress disorder and has good psychometric properties [49,50], with an internal reliability of 0.94 in the present study.
The Mindfulness Attention Awareness Scale is a 15-item self-report assessing mindfulness disposition on a 6-point Likert scale. This scale measures the frequency of open and receptive attention to, and awareness of, ongoing events and experiences. MAAS items are presented as negative descriptions of mindfulness, meaning that higher scores indicate lower mindfulness. Adequate test–retest reliability, and convergent and discriminate validity have been demonstrated for this scale [51,52]. Internal consistency for the present study was 0.87.
The Defense Mechanisms Rating Scales-Self-Report-30 (DMRS-SR-30) [31] is a 30-item self-report instrument assessing defense mechanisms on a 5-point Likert scale. It provides scores for Overall Defensive Functioning (ODF), 3 defensive factors, 7 hierarchically ordered defense levels, and 28 defense mechanisms. This measure has good psychometric properties; very good reliability and criterion; and concurrent, convergent and discriminant validity [47,53]. Internal consistency for the present study was 0.89.

2.3. Statistical Analyses

Descriptive data are presented as means, standard deviations, and 95% confidence intervals. The Anderson–Darling test and Normal P-P plot were used to verify the normality of distributions. Pearson correlation coefficients were used to calculate associations between explicit and implicit emotion regulation strategies. Finally, multivariate analysis was used to test mindfulness and defense mechanisms as moderators of psychological symptoms.

3. Results

3.1. Sample’s Psychological Characteristics

Participants were prevalently females (N = 4797; 75,1%); adults younger than 40 years (N = 3465; 54,3%); living with close relatives (N = 4486; 70,3%); and without children (N = 3779; 59,2%). Average scores for all psychological variables analyzed in the study are summarized in Table 1. Mindfulness (M = 1.12; SD = 0.65) and defensive functioning (M = 5.60; SD = 0.73) mean scores were around normative values for healthy individuals. Mean scores of psychological distress and psychiatric symptoms, including post-traumatic stress symptoms, fell within the clinical range [54,55,56].

3.2. Associations between Mindfulness and Defense Mechanisms

Table 2 summarizes correlations between mindfulness dispositions calculated with the MAAS and defense indexes calculated with the DMRS-SR-30. As expected, high significant negative correlations were found between MAAS and both ODF and Factor 1 (r = −0.497 and r = −0.540, respectively; p < 0.0001), suggesting that higher mindfulness was associated with higher defensive maturity and a greater use of mature defenses. Conversely, high significant positive correlations were found between MAAS and Factors 2 and 3, suggesting that lower mindfulness might be associated with greater use of mental inhibition and avoidance defenses as well as immature–depressive defenses.

3.3. Moderating the Role of Emotion Regulation in Protecting against Psychological Problems

A series of multivariate linear regression analyses were performed to assess the moderating role of mindfulness and defense mechanisms in determining psychological conditions, such as overall psychological distress, post-traumatic stress, and other psychiatric symptoms.
Table 3 summarizes the results of multivariate linear regressions for explicit and implicit emotion regulation predicting psychological distress, calculated according to the GSI. Independent variables included in the model were: (1) MAAS, a negative index of mindfulness; (2) ODF, a positive index of defensive maturity; (3) Factor 1, including all mature defense mechanisms; (4) Factor 2, including all mental inhibition and avoidance defense mechanisms; and (5) Factor 3, including all immature–depressive defense mechanisms. All variables acted as good predictors of GSI, explaining 54.1% of the variance. For each one-unit increase in mindfulness and overall defensive maturity the GSI decreased by 0.35 and 0.22, respectively.
Similar results emerged from the multivariate linear regressions for explicit and implicit emotion regulation predicting post-traumatic stress symptoms, calculated as IES-R and displayed in Table 4. The same five variables entered the model and all of them were significant predictors of IES-R, explaining 33.2% of the variance. As for the GSI, mindfulness and defensive functioning were the best predictors of the dependent variable and there was an increase of almost 10 units in the IES-R for each one-unit decrease in MAAS and ODF.
Multivariate linear regression analyses were also performed on several psychiatric symptoms calculated as subscales of the SCL-90 and IES-R. The same model was replicated for each symptom, as reported in Table 5. All independent variables acted as good predictors of all psychiatric symptoms, with the exception of paranoid ideation (SCL-90-PAR) and avoidance (IES-R-Avoidance), which were predicted by mindfulness, defensive functioning and one or two defensive factors instead of all of them. The variance explained by emotion regulation factors on psychiatric symptoms was high, ranging from 21.2% to 49.8%.

4. Discussion

Our study demonstrated the reciprocal contribution of mindfulness and defense mechanisms in helping the management of high stress levels related to the COVID-19 pandemic. Explicit and implicit emotion regulation strategies were both investigated using well-validated measures. In particular, we used the questionnaire based on the gold-standard DMRS theory [47,57] to assess the whole hierarchy of defensive strategies. This methodological accuracy allowed for an in-depth qualitative and quantitative exploration of convergent and divergent aspects of explicit and implicit emotion regulation, usually studied separately [58,59]. The main aim of this study was to explore to what extent both dispositional mindfulness and defensive functioning might influence mental health in specific stressful conditions (such as the COVID-19 pandemic).
With regard to the first hypothesis, the results confirmed our expectations, namely that dispositional mindfulness would be associated with high-adaptive defense mechanisms. Significant high correlations were found between MAAS and DMRS-SR-30 scores, and they were in the positive relationship. The strongest relationship was between mindfulness and mature defenses, confirming a previous finding from Di Giuseppe et al. [23]. The hierarchy of defense mechanisms [22] is a comprehensive description of a continuum from maladaptive to adaptive defensive strategies, where defenses higher in the hierarchy (i.e., mature defenses) might share some overlapping functions with explicit emotion regulation strategies. For instance, the awareness of what the individual might experience in the present moment, which is one fundamental aspect of dispositional mindfulness, was also an important component of the mature defense self-observation, in which “the individual deals with emotional conflicts or conflictual ideas by reflecting on his or her own thoughts, feelings, motivation, and behavior. The person can see himself as others see him in interpersonal situations, and as a result is better able to understand other people’s reactions to him or her” [22]. Conversely, lack of attention, awareness, and open-minded acceptance of the present moment, typical of people with low mindfulness, were common in individuals who frequently might revert to immature defenses.
According to the second hypothesis, mindfulness and defense mechanisms would protect from psychological distress and post-traumatic symptoms during the initial spread of the COVID-19 pandemic. Study findings confirmed the moderating role of both explicit and implicit emotion regulation strategies. Results from multivariate linear regressions showed that dispositional mindfulness and defensive functioning explained up to 54% and 33% of the variance on symptom severity and post-traumatic stress, respectively. Looking at the regression coefficients, the two global indexes of MAAS and ODF were the main contributors to the explained variance.
We should also note that the DMRS-SR-30 [60], a comprehensive self-report instrument based on the gold-standard theory of defenses, was administered during this study, providing several levels of scoring and an overall index of defensive maturity [47,53]. Most of the previously available measures for defensive assessment did not allow for a global evaluation of defensive maturity and were often limited to the assessment of a few defense mechanisms, instead of the full hierarchy of defenses. We believe that these methodological limitations inevitably led to a systematic bias, which could be prevented by using more extensive measures, such as those based on the DMRS [61]. Future studies are needed to further test the validity of the measure according to Modern Test Theory methods [62].
Our last hypothesis was that emotion regulation would predict specific psychiatric symptoms. We found significant results from all multivariate linear regressions carried out on SCL-90 and IES-R subscales. Mindfulness and defense mechanisms together were significant predictors of 12 psychiatric symptoms, with R2 ranging from 0.212 to 0.498. The high values of variance explained by these two variables on all analyzed symptoms confirmed the key role of emotion regulation in the etiopathogenesis of psychological problems. Interestingly, the independent variables that were entered in the model and replicated for each sign were all significant predictors of psychiatric symptoms, except for paranoid ideation and avoidance. The two global indexes of mindfulness and defensive functioning were the best predictors for these two regression models, while immature defenses was the only defensive factor predicting paranoid ideation and the only non-significant factor predicting avoidance. We interpreted these results as an indication of the potential impact of specific defense mechanisms in symptom formation.
Our study had some limitations. Results might be biased by the snowball sampling method because of the introduction of uncontrolled variables. Moreover, the causal relationships between tested variables could not be determined, giving the cross-sectional research design. Furthermore, the use of self-reported measures might have determined response biases typical of self-assessment of psychological variables. Despite these limitations, our study demonstrated associations between different emotion regulation strategies and highlighted the key role of mindfulness and defense mechanisms in moderating the experience of COVID-19-related distress.

5. Conclusions

The impact of emotion regulation in mediating an individual’s adjustment to traumatic experiences is remarkable. The adaptive function of emotion regulation becomes of great importance in massive catastrophic events such as the experience of the COVID-19 pandemic. As an isolated attempt at studying simultaneously explicit and implicit emotion regulation, this study aimed to pave the way for new research on the interplay between psychological resources and stressful life conditions in both general and clinical populations [63,64,65]. The systematic investigation of emotion regulation with appropriate instruments could be an important support in the early detection of vulnerable individuals at risk of developing several psychopathologies. Future research should address the need to validate emotion regulation-based psychological intervention, enhancing resilience to and preventing the development of mental disorders [66,67].

Author Contributions

M.D.G., G.O. and C.C. designed and directed the project. R.C. contributed to sample preparation. M.M. and A.G. contributed to the interpretation of the results. M.D.G. took the lead in writing the manuscript. All authors provided critical feedback and helped shape the research, analysis and manuscript. We confirm that the manuscript has been read and approved by all named authors. All listed authors meet the ICMJE criteria. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of University of Pisa (n.0036344/2020).

Informed Consent Statement

Consent was obtained from all participants included in the study.

Data Availability Statement

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to ethical restrictions.

Conflicts of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

  1. Guendelman, S.; Medeiros, S.; Rampes, H. Mindfulness and Emotion Regulation: Insights from Neurobiological, Psychological, and Clinical Studies. Front. Psychol. 2017, 8, 220. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  2. Dell’Osso, L.; Carmassi, C.; Rucci, P.; Ciapparelli, A.; Conversano, C.; Marazziti, D. Complicated Grief and Suicidality: The Impact of Subthreshold Mood Symptoms. CNS Spectrums 2011, 16, 1–6. [Google Scholar] [CrossRef] [PubMed]
  3. Martino, G.; Caputo, A.; Vicario, C.M.; Feldt-Rasmussen, U.; Watt, T.; Quattropani, M.C.; Benvenga, S.; Vita, R. Alexithymia, Emotional Distress, and Perceived Quality of Life in Patients With Hashimoto’s Thyroiditis. Front. Psychol. 2021, 12, 667237. [Google Scholar] [CrossRef] [PubMed]
  4. Martino, G.; Bellone, F.; Vicario, C.; Gaudio, A.; Caputo, A.; Corica, F.; Squadrito, G.; Schwarz, P.; Morabito, N.; Catalano, A. Anxiety Levels Predict Bone Mineral Density in Postmenopausal Women Undergoing Oral Bisphosphonates: A Two-Year Follow-Up. Int. J. Environ. Res. Public Health 2021, 18, 8144. [Google Scholar] [CrossRef] [PubMed]
  5. Piccinni, A.; Origlia, N.; Veltri, A.; Vizzaccaro, C.; Marazziti, D.; Catena-Dell’Osso, M.; Conversano, C.; Moroni, I.; Domenici, L.; Dell’Osso, L. Plasma β-amyloid peptides levels: A pilot study in bipolar depressed patients. J. Affect. Disord. 2012, 138, 160–164. [Google Scholar] [CrossRef]
  6. Vicario, C.M.; Nitsche, M.A.; Salehinejad, M.A.; Avanzino, L.; Martino, G. Time Processing, Interoception, and Insula Activation: A Mini-Review on Clinical Disorders. Front. Psychol. 2020, 11, 1893. [Google Scholar] [CrossRef]
  7. Gross, J.J.; Richards, J.M.; John, O.P. Emotion Regulation in Everyday Life. In Emotion Regulation in Couples and Families: Pathways to Dysfunction and Health; Snyder, D.K., Simpson, J., Hughes, J.N., Eds.; American Psychological Association: Washington, DC, USA, 2007; pp. 13–35. [Google Scholar] [CrossRef]
  8. Gross, J.J.; John, O.P. Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. J. Personal. Soc. Psychol. 2003, 85, 348–362. [Google Scholar] [CrossRef]
  9. Lutz, A.; Jha, A.P.; Dunne, J.D.; Saron, C.D. Investigating the phenomenological matrix of mindfulness-related practices from a neurocognitive perspective. Am. Psychol. 2015, 70, 632–658. [Google Scholar] [CrossRef]
  10. Vago, D.R.; Silbersweig, D.A. Self-awareness, self-regulation, and self-transcendence (S-ART): A framework for understanding the neurobiological mechanisms of mindfulness. Front. Hum. Neurosci. 2012, 6, 296. [Google Scholar] [CrossRef]
  11. Di Giuseppe, M.; Ciacchini, R.; Piarulli, A.; Nepa, G.; Conversano, C. Mindfulness dispositions and defense style as positive responses to psychological distress in oncology professionals. Eur. J. Oncol. Nurs. 2019, 40, 104–110. [Google Scholar] [CrossRef]
  12. Koole, S.L.; Rothermund, K. “I feel better but I don’t know why”: The psychology of implicit emotion regulation. Cogn. Emot. 2011, 25, 389–399. [Google Scholar] [CrossRef] [PubMed]
  13. Gyurak, A.; Gross, J.J.; Etkin, A. Explicit and implicit emotion regulation: A dual-process framework. Cogn. Emot. 2011, 25, 400–412. [Google Scholar] [CrossRef] [PubMed]
  14. Kabat-Zinn, J. Mindfulness. Mindfulness 2015, 6, 1481–1483. [Google Scholar] [CrossRef]
  15. Shear, J.; Jevning, R. Pure consciousness: Scientific exploration of meditation techniques. J. Conscious. Stud. 1999, 6, 189–210. [Google Scholar]
  16. Reangsing, C.; Punsuwun, S.; Schneider, J.K. Effects of mindfulness interventions on depressive symptoms in adolescents: A meta-analysis. Int. J. Nurs. Stud. 2021, 115, 103848. [Google Scholar] [CrossRef]
  17. Zhu, J.L.; Schülke, R.; Vatansever, D.; Xi, D.; Yan, J.; Zhao, H.; Xie, X.; Feng, J.; Chen, M.Y.; Sahakian, B.J.; et al. Mindfulness practice for protecting mental health during the COVID-19 pandemic. Transl. Psychiatry 2021, 11, 329. [Google Scholar] [CrossRef]
  18. Conversano, C.; Di Giuseppe, M.; Miccoli, M.; Ciacchini, R.; Gemignani, A.; Orrù, G. Mindfulness, Age and Gender as Protective Factors Against Psychological Distress During COVID-19 Pandemic. Front. Psychol. 2020, 11, 1900. [Google Scholar] [CrossRef]
  19. Prout, T.A.; Zilcha-Mano, S.; Aafjes-van Doorn, K.; Békés, V.; Christman-Cohen, I.; Whistler, K.; Kui, T.; Di Giuseppe, M. Identifying predictors of psychological distress during COVID-19: A machine learning approach. Front. Psychol. 2020, 11, 586202. [Google Scholar] [CrossRef]
  20. Orrù, G.; Conversano, C.; Malloggi, E.; Francesconi, F.; Ciacchini, R.; Gemignani, A. Neurological Complications of COVID-19 and Possible Neuroinvasion Pathways: A Systematic Review. Int. J. Environ. Res. Public Health 2020, 17, 6688. [Google Scholar] [CrossRef]
  21. Kock, M.; Kuppens, P.; Van der Gucht, K.; Raes, F. Mindfulness May Buffer Psychological Distress in Adolescents during the COVID-19 Pandemic: The Differential Role of Mindfulness Facets. Psychol. Belg. 2021, 61, 356–376. [Google Scholar] [CrossRef]
  22. Di Giuseppe, M.; Perry, J.C. The Hierarchy of Defense Mechanisms: Assessing Defensive Functioning With the Defense Mechanisms Rating Scales Q-Sort. Front. Psychol. 2021, 12, 718440. [Google Scholar] [CrossRef] [PubMed]
  23. Di Giuseppe, M.; Perry, J.C.; Prout, T.A.; Conversano, C. Editorial: Recent Empirical Research and Methodologies in Defense Mechanisms: Defenses as Fundamental Contributors to Adaptation. Front. Psychol. 2021, 12, 802602. [Google Scholar] [CrossRef] [PubMed]
  24. Conversano, C.; Di Giuseppe, M. Psychological Factors as Determinants of Chronic Conditions: Clinical and Psychodynamic Advances. Front. Psychol. 2021, 12, 635708. [Google Scholar] [CrossRef]
  25. Maffei, C.; Fossati, A.; Lingiardi, V.; Madeddu, F.; Borellini, C.; Petrachi, M. Personality Maladjustment, Defenses, and Psychopathological Symptoms in Nonclinical Subjects. J. Personal. Disord. 1995, 9, 330–345. [Google Scholar] [CrossRef]
  26. San Martini, P.; Roma, P.; Sarti, S.; Lingiardi, V.; Bond, M. Italian version of the defense style questionnaire. Compr. Psychiatry 2004, 45, 483–494. [Google Scholar] [CrossRef]
  27. Tanzilli, A.; Di Giuseppe, M.; Giovanardi, G.; Boldrini, T.; Caviglia, G.; Conversano, C.; Lingiardi, V. Mentalization, attachment, and defense mechanisms: A Psychodynamic Diagnostic Manual-2-oriented empirical investigation. Res. Psychother. Psychopathol. Process Outcome 2021, 24, 31–41. [Google Scholar] [CrossRef]
  28. Vicario, C.M.; Martino, G.; Lucifora, C.; Felmingham, K. Preliminary evidence on the neural correlates of timing deficit in post-traumatic stress disorder. Eur. J. Psychotraumatol. 2022, 13, 2008151. [Google Scholar] [CrossRef]
  29. Aafjes-van Doorn, K.; Békés, V.; Luo, X.; Prout, T.A.; Hoffman, L. Therapists’ resilience and posttraumatic growth during the COVID-19 pandemic. Psychol. Trauma Theory Res. Pract. Policy 2022, 14, S165–S173. [Google Scholar] [CrossRef]
  30. Altwaijri, N.; Abualait, T.; Aljumaan, M.; Albaradie, R.; Arain, Z.; Bashir, S. Defense mechanism responses to COVID-19. PeerJ 2022, 10, e12811. [Google Scholar] [CrossRef]
  31. Conversano, C. The Psychodynamic Approach During COVID-19 Emotional Crisis. Front. Psychol. 2021, 12, 670196. [Google Scholar] [CrossRef]
  32. Di Giuseppe, M.; Zilcha-Mano, S.; Prout, T.A.; Perry, J.C.; Orrù, G.; Conversano, C. Psychological Impact of Coronavirus Disease 2019 among Italians during the First Week of Lockdown. Front. Psychiatry 2020, 11, 576597. [Google Scholar] [CrossRef] [PubMed]
  33. Gori, A.; Topino, E.; Di Fabio, A. The protective role of life satisfaction, coping strategies and defense mechanisms on perceived stress due to COVID-19 emergency: A chained mediation model. PLoS ONE 2020, 15, e0242402. [Google Scholar] [CrossRef] [PubMed]
  34. Di Giuseppe, M.; Nepa, G.; Prout, T.; Albertini, F.; Marcelli, S.; Orrù, G.; Conversano, C. Stress, Burnout, and Resilience among Healthcare Workers during the COVID-19 Emergency: The Role of Defense Mechanisms. Int. J. Environ. Res. Public Health 2021, 18, 5258. [Google Scholar] [CrossRef] [PubMed]
  35. Orrù, G.; Marzetti, F.; Conversano, C.; Vagheggini, G.; Miccoli, M.; Ciacchini, R.; Panait, E.; Gemignani, A. Secondary Traumatic Stress and Burnout in Healthcare Workers during COVID-19 Outbreak. Int. J. Environ. Res. Public Health 2021, 18, 337. [Google Scholar] [CrossRef]
  36. Atzeni, F.; Talotta, R.; Masala, I.F.; Giacomelli, C.; Conversano, C.; Nucera, V.; Lucchino, B.; Iannuccelli, C.; Di Franco, M.; Bazzichi, L. One year in review 2019: Fibromyalgia. Clin. Exp. Rheumatol. 2019, 37, 3–10. [Google Scholar]
  37. Marchi, L.; Marzetti, F.; Orrù, G.; Lemmetti, S.; Miccoli, M.; Ciacchini, R.; Hitchcott, P.K.; Bazzicchi, L.; Gemignani, A.; Conversano, C. Alexithymia and Psychological Distress in Patients With Fibromyalgia and Rheumatic Disease. Front. Psychol. 2019, 10, 1735. [Google Scholar] [CrossRef] [Green Version]
  38. Aafjes-van Doorn, K.; Békés, V.; Luo, X.; Prout, T.A.; Hoffman, L. What Do Therapist Defense Mechanisms Have to Do With Their Experience of Professional Self-Doubt and Vicarious Trauma During the COVID-19 Pandemic? Front. Psychol. 2021, 12, 647503. [Google Scholar] [CrossRef]
  39. Iasevoli, M.; Giantin, V.; Voci, A.; Valentini, E.; Zurlo, A.; Maggi, S.; Siviero, P.; Orru, G.; Crepaldi, G.; Pegoraro, R.; et al. Discussing end-of-life care issues with terminally ill patients and their relatives: Comparisons among physicians, nurses and psychologists. Aging Clin. Exp. Res. 2012, 24, 35–42. [Google Scholar]
  40. Lingiardi, V.; Gazzillo, F.; Colli, A.; De Bei, F.; Tanzilli, A.; Di Giuseppe, M.; Nardelli, N.; Caristo, C.; Condino, V.; Gentile, D.; et al. Diagnosi e valutazione della personalità, alleanza terapeutica e scambio clinico nella ricerca in psicoterapia [Diagnosis and assessment of personality, therapeutic alliance and clinical exchange in psychotherapy research]. Ric. Psicoter./Res. Psychother. Psychopathol. Process Outcome 2010, 13, 98–125. [Google Scholar]
  41. Tanzilli, A.; Gualco, I. Clinician Emotional Responses and Therapeutic Alliance When Treating Adolescent Patients With Narcissistic Personality Disorder Subtypes: A Clinically Meaningful Empirical Investigation. J. Personal. Disord. 2020, 34, 42–62. [Google Scholar] [CrossRef] [Green Version]
  42. Tanzilli, A.; Colli, A.; Gualco, I.; Lingiardi, V. Patient Personality and Relational Patterns in Psychotherapy: Factor Structure, Reliability, and Validity of the Psychotherapy Relationship Questionnaire. J. Personal. Assess. 2018, 100, 96–106. [Google Scholar] [CrossRef] [PubMed]
  43. Tanzilli, A.; Gualco, I.; Baiocco, R.; Lingiardi, V. Clinician Reactions When Working with Adolescent Patients: The Therapist Response Questionnaire for Adolescents. J. Personal. Assess. 2020, 102, 616–627. [Google Scholar] [CrossRef] [PubMed]
  44. Derogatis, L.R.; Lipman, R.S.; Covi, L. SCL-90: An outpatient psychiatric rating scale--preliminary report. Psychopharmacol. Bull. 1973, 9, 13–27. [Google Scholar]
  45. Weiss, D.S.; Marmar, C.R. The Impact of Event Scale-Revised. In Assessing Psychological Trauma and PTSD; Wilson, J.P., Keane, T.M., Eds.; The Guilford Press: New York, NY, USA, 1997; pp. 399–411. [Google Scholar]
  46. Brown, K.W.; Ryan, R.M. The benefits of being present: Mindfulness and its role in psychological well-being. J. Pers. Soc. Psychol. 2003, 84, 822–848. [Google Scholar] [CrossRef]
  47. Di Giuseppe, M.; Perry, J.C.; Lucchesi, M.; Michelini, M.; Vitiello, S.; Piantanida, A.; Fabiani, M.; Maffei, S.; Conversano, C. Preliminary Reliability and Validity of the DMRS-SR-30, a Novel Self-Report Measure Based on the Defense Mechanisms Rating Scales. Front. Psychiatry 2020, 11, 870. [Google Scholar] [CrossRef] [PubMed]
  48. Bonicatto, S.; Dew, M.A.; Soria, J.J.; Seghezzo, M.E. Validity and reliability of Symptom Checklist ‘90 (SCL90) in an Argentine population sample. Soc. Psychiatry 1997, 32, 332–338. [Google Scholar] [CrossRef] [PubMed]
  49. Craparo, G.; Faraci, P.; Rotondo, G.; Gori, A. The Impact of Event Scale—Revised: Psychometric properties of the Italian version in a sample of flood victims. Neuropsychiatr. Dis. Treat. 2013, 9, 1427–1432. [Google Scholar] [CrossRef] [Green Version]
  50. Weiss, D.S. The Impact of Event Scale-Revised. In Assessing Psychological Trauma and PTSD; Wilson, J.P., Keane, T.M., Eds.; The Guilford Press: New York, NY, USA, 2004; pp. 168–189. [Google Scholar]
  51. Black, D.S.; Sussman, S.; Johnson, C.A.; Milam, J. Psychometric Assessment of the Mindful Attention Awareness Scale (MAAS) Among Chinese Adolescents. Assessment 2012, 19, 42–52. [Google Scholar] [CrossRef] [Green Version]
  52. Veneziani, C.A.; Voci, A. The Italian Adaptation of the Mindful Awareness Attention Scale and its Relation with Individual Differences and Quality of Life Indexes. Mindfulness 2015, 6, 373–381. [Google Scholar] [CrossRef]
  53. Prout, T.A.; Di Giuseppe, M.; Zilcha-Mano, S.; Perry, J.C.; Conversano, C. Psychometric Properties of the Defense Mechanisms Rating Scales-Self-Report-30 (DMRS-SR-30): Internal Consistency, Validity and Factor Structure. J. Personal. Assess. 2022, 1–11, advance online publication. [Google Scholar] [CrossRef]
  54. Aben, I.; Verhey, F.; Lousberg, R.; Lodder, J.; Honig, A. Validity of the Beck Depression Inventory, Hospital Anxiety and Depression Scale, SCL-90, and Hamilton Depression Rating Scale as Screening Instruments for Depression in Stroke Patients. J. Psychosom. Res. 2002, 43, 386–393. [Google Scholar] [CrossRef] [PubMed]
  55. Malpas, C.B.; Wang, A.D.; Leong, M.; Johnstone, B.; Rayner, G.; Kalincik, T.; Kwan, P.; O’Brien, T.J.; Velakoulis, D. Abbreviated assessment of psychopathology in patients with suspected seizure disorders. Epilepsy Behav. 2019, 100, 106530. [Google Scholar] [CrossRef]
  56. Morina, N.; Ehring, T.; Priebe, S. Diagnostic Utility of the Impact of Event Scale–Revised in Two Samples of Survivors of War. PLoS ONE 2013, 8, e83916. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  57. Perry, J.C. Anomalies and Specific Functions in the Clinical Identification of Defense Mechanisms. J. Clin. Psychol. 2014, 70, 406–418. [Google Scholar] [CrossRef] [PubMed]
  58. Orrù, G.; Monaro, M.; Conversano, C.; Gemignani, A.; Sartori, G. Machine Learning in Psychometrics and Psychological Research. Front. Psychol. 2020, 10, 2970. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  59. Orrù, G.; Gemignani, A.; Ciacchini, R.; Bazzichi, L.; Conversano, C. Machine Learning Increases Diagnosticity in Psychometric Evaluation of Alexithymia in Fibromyalgia. Front. Med. 2020, 6, 319. [Google Scholar] [CrossRef] [Green Version]
  60. Perry, J.C.; Kardos, M.E.; Pagano, C.J. The Study of Defenses in Psychotherapy Using the Defense Mechanism Rating Scales (DMRS). In The Concept of Defense Mechanisms in Contemporary Psychology; Hentschel, U., Smith, G.J.W., Ehlers, W., Draguns, J.G., Eds.; Springer: New York, NY, USA, 1993. [Google Scholar]
  61. Di Giuseppe, M.; Prout, T.A.; Fabiani, M.; Kui, T. Defensive profile of parents of children with externalizing problems receiving Regulation-Focused Psychotherapy for Children (RFP-C): A pilot study. Mediterr. J. Clin. Psychol. 2022, 8. [Google Scholar] [CrossRef]
  62. Lange, R. Rasch scaling and cumulative theory-building in consciousness research. Psychol. Conscious. Theory Res. Pract. 2017, 4, 135–160. [Google Scholar] [CrossRef]
  63. Barchetta, S.; Martino, G.; Craparo, G.; Salehinejad, M.; Nitsche, M.; Vicario, C. Alexithymia Is Linked with a Negative Bias for Past and Current Events in Healthy Humans. Int. J. Environ. Res. Public Health 2021, 18, 6696. [Google Scholar] [CrossRef]
  64. Lucifora, C.; Martino, G.; Curcuruto, A.; Salehinejad, M.; Vicario, C. How Self-Control Predicts Moral Decision Making: An Exploratory Study on Healthy Participants. Int. J. Environ. Res. Public Health 2021, 18, 3840. [Google Scholar] [CrossRef]
  65. Vicario, C.; Martino, G.; Marcuzzo, A.; Craparo, G. No Evidence of Perceptual Pseudoneglect in Alexithymia. Brain Sci. 2021, 11, 376. [Google Scholar] [CrossRef] [PubMed]
  66. Hoffman, L.; Rice, T. Manual of Regulation-Focused Psychotherapy for Children (RFP-C) with Externalizing Behaviors: A Psychodynamic Approach; Routledge: New York, NY, USA, 2016. [Google Scholar]
  67. Prout, T.A.; Rice, T.; Chung, H.; Gorokhovsky, Y.; Murphy, S.; Hoffman, L. Randomized controlled trial of Regulation Focused Psychotherapy for children: A manualized psychodynamic treatment for externalizing behaviors. Psychother. Res. 2021, 32, 555–570. [Google Scholar] [CrossRef] [PubMed]
Table
Table 1. Descriptive statistics of responders’ psychological characteristics (N = 6385).
Table 1. Descriptive statistics of responders’ psychological characteristics (N = 6385).
Psychological Distress (SCL-90)MinMaxMeanSD95% i0.c0.
LowerUpper
Global Severity Index (GSI)0.0030.600.730.530.0030.60
SCL-90 SOM0.0030.920.620.600.0030.92
SCL-90 O-C0.0030.700.870.680.0030.70
SCL-90 INT0.0040.000.610.590.0040.00
SCL-90 DEP0.0030.920.980.750.0030.92
SCL-90 ANX0.0030.700.860.690.0030.70
SCL-90 HOS0.0040.000.650.610.0040.00
SCL-90 PHOB0.0030.860.480.550.0030.86
SCL-90 PAR0.0040.000.720.660.0040.00
SCL-90 PSY0.0040.000.510.520.0040.00
SCL-90 SLEEP0.0040.0010.080.980.0040.00
Post-traumatic stress symptoms (IES-R)
IES-R0.00860.00250.25160.190.00860.00
Intrusion0.00320.0080.3260.280.00320.00
Avoidance0.00320.0090.7360.620.00320.00
Hyperarousal0.00240.0070.2040.870.00240.00
Mindfulness (MAAS)
MAAS a0.0050.0010.120.650.0040.00
Defense Mechanisms (DMRS-SR-30)
Overall Defensive Functioning (ODF)10.0070.0050.600.7310.0070.00
Factor 1: Mature 0.001000.00550.66190.620.001000.00
Factor 2: Mental inhibition and Avoidance 0.001000.00240.89120.100.001000.00
Factor 3: Immature 0.001000.00170.80130.360.001000.00
Note: a Lower MAAS score indicates higher mindfulness.
Table
Table 2. Pearson correlations between mindfulness disposition and defense mechanisms (N = 6385).
Table 2. Pearson correlations between mindfulness disposition and defense mechanisms (N = 6385).
Mindfulness (MAAS) a
Defense mechanisms (DMRS-SR-30)rp
Overall Defensive Functioning (ODF)−0.497<0.0001
Factor 1: Mature −0.540<0.0001
Factor 2: Mental inhibition and Avoidance 0.385<0.0001
Factor 3: Immature 0.444<0.0001
Note: a Lower MAAS score indicates higher mindfulness.
Table
Table 3. Multivariate linear regressions for mindfulness and defense mechanisms predicting psychological distress (N = 6385).
Table 3. Multivariate linear regressions for mindfulness and defense mechanisms predicting psychological distress (N = 6385).
Overall Psychological Distress (GSI)
BSEtpFpAdjusted R2
MODEL 1507.82<0.00010.541
ODF−0.2200.028−7.874<0.0001
Factor 1−0.0160.00210.253<0.0001
Factor 20.0170.00111.151<0.0001
Factor 30.0220.00213.802<0.0001
MAAS0.3530.00842.234<0.0001
Note: Independent variables entered in the multivariate linear regression model were: ODF, Factor 1, Factor 2, Factor 3, and MAAS. a ODF is the acronym of overall defensive functioning; Factor 1 includes mature defenses; Factor 2 includes mental inhibition and avoidance defenses; Factor 3 includes immature-depressive defenses.
Table
Table 4. Multivariate linear regressions for mindfulness and defense mechanisms predicting post-traumatic stress symptoms (N = 6385).
Table 4. Multivariate linear regressions for mindfulness and defense mechanisms predicting post-traumatic stress symptoms (N = 6385).
Post-Traumatic Stress Symptoms (IES-R)
BSEtpFpAdjusted R2
MODEL 635.02<0.00010.332
ODF a−9.5691.02−9.385<0.0001
Factor 1−0.5000.0598.509<0.0001
Factor 20.4890.0548.992<0.0001
Factor 30.2650.0574.606<0.0001
MAAS10.110.30533.168<0.0001
Note: Independent variables entered in the multivariate linear regression model were: ODF, Factor 1, Factor 2, Factor 3, and MAAS. a ODF is the acronym of overall defensive functioning; Factor 1 includes mature defenses; Factor 2 includes mental inhibition and avoidance defenses; Factor 3 includes immature-depressive defenses.
Table
Table 5. Multivariate linear regressions for mindfulness and defense mechanisms predicting psychiatric symptoms (N = 6385).
Table 5. Multivariate linear regressions for mindfulness and defense mechanisms predicting psychiatric symptoms (N = 6385).
Model Summary
SymptomsFpF
Somatization (SCL-90-SOM)4420.1<0.00014420.1
Obsessive Compulsive (SCL-90-O-C)11,530.10<0.000111,530.10
Interpersonal Sensitivity (SCL-90-I-S)12,670.34<0.000112,670.34
Depression (SCL-90-DEP)9560.68<0.00019560.68
Anxiety (SCL-90-ANX)7020.48<0.00017020.48
Hostility (SCL-90-HOS)9000.31<0.00019000.31
Phobic Anxiety (SCL-90-PHOB)3450.05<0.00013450.05
Paranoid Ideation (SCL-90-PAR) a11,300.15<0.000111,300.15
Psychoticism (SCL-90-PSY)2880.28<0.00012880.28
Intrusion (IES-R-Intrusion)4010.37<0.00014010.37
Avoidance (IES-R-Avoidance) b4270.83<0.00014270.83
Hyperarousal (IES-R-Hyperarousal)7770.04<0.00017770.04
Note: Independent variables entered in the multivariate linear regression model were: ODF, Factor 1, Factor 2, Factor 3, and MAAS. a Regression coefficients for Factor 1 and Factor 2 were non-significant; b regression coefficient for Factor 3 was non-significant.
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Di Giuseppe, M.; Orrù, G.; Gemignani, A.; Ciacchini, R.; Miniati, M.; Conversano, C. Mindfulness and Defense Mechanisms as Explicit and Implicit Emotion Regulation Strategies against Psychological Distress during Massive Catastrophic Events. Int. J. Environ. Res. Public Health 2022, 19, 12690. https://doi.org/10.3390/ijerph191912690

AMA Style

Di Giuseppe M, Orrù G, Gemignani A, Ciacchini R, Miniati M, Conversano C. Mindfulness and Defense Mechanisms as Explicit and Implicit Emotion Regulation Strategies against Psychological Distress during Massive Catastrophic Events. International Journal of Environmental Research and Public Health. 2022; 19(19):12690. https://doi.org/10.3390/ijerph191912690

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Di Giuseppe, Mariagrazia, Graziella Orrù, Angelo Gemignani, Rebecca Ciacchini, Mario Miniati, and Ciro Conversano. 2022. "Mindfulness and Defense Mechanisms as Explicit and Implicit Emotion Regulation Strategies against Psychological Distress during Massive Catastrophic Events" International Journal of Environmental Research and Public Health 19, no. 19: 12690. https://doi.org/10.3390/ijerph191912690

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