Which defense mechanism is most commonly used by clients who are alcoholics?

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Abstract

Background

The problem of coping with stress is an important one in the context of development and persistence of alcohol dependence. In the literature to date very little attention has been paid to coping patterns construed as a configuration of specific coping styles, particularly as regards the functioning of addicted individuals. The aim of the study was to verify whether individuals with alcohol dependence characterized by different coping patterns differ with respect to the severity of psychopathological symptoms, defense mechanisms and time perspectives.

Methods

Participants were given a battery of psychological tests—Coping Inventory for Stresfull Situations (CISS), Defense Style Questionnaire (DSQ 40), Syndrom Checklist (SCL-90) and Short Zimbardo Time Perspective Inventory (SZPTI-PL). The sample comprised 112 individuals with alcohol dependence, aged 20 to 63 years old, the average age was 37.86; 78 percent were men. There were identified three sub-groups of individuals characterized by a distinctive patterns of coping with stress —“emotional-avoidant”, “task oriented” and a “mixed one”.

Results

Individuals with the predominant emotional-avoidant coping pattern are characterized by significantly higher severity of psychopathological symptoms, less mature defense mechanisms and past time perspectives. Subjects reliant on task-oriented coping pattern were characterized by the highest level of adaptation and the most constructive way of functioning in the face of difficulties.

Conclusion

It is worth regarding the examination of patterns of coping as an indispensable element of collecting medical history from alcohol dependent individuals.

Keywords: Defense mechanisms, Patterns of coping with stress, Stress, Cluster analysis, Time perspectives, Psychopathological symptoms, Alcohol dependence

Introduction

According to , coping with stress consists of cognitive and behavioral efforts to manage external or internal demands that are appraised as taxing, exceeding the resources of the person or endangering his or her welfare. A coping style is a relatively permanent repertoire of coping strategies specific to an individual. distinguished between three basic stress coping styles: (1) a task-oriented style which involves taking problem-solving actions and plans, (2) an emotion-oriented style which concerns thoughts and actions aimed solely at reducing the tension caused by emotional stress, and (3) an avoidance-oriented style which is described as withdrawal from experiencing and engaging in solving a stressful situation. There are two avoidant coping subscales on the Coping Inventory for Stressful Situations (CISS) scale—distraction and social diversion. The first one involves engaging in substitute activities, which consists of redirecting attention to activities such as watching TV or reading a newspaper, while the second one involves seeking social interaction, which relates to the desire to obtain social support to reduce the tension. indicated that both task-oriented coping and emotion-oriented coping contributed significantly to the prediction of resilience. It was also suggested () that engagement in adaptive coping strategies negatively correlates with levels of psychopathological symptoms only when levels of maladaptive strategies are elevated.

The problem of coping with stress seems to be important in the context of the development and persistence of alcohol dependence (AD) and has long been raised in the literature on the subject (). Resorting to psychoactive substances in itself can be construed as an avoidant coping strategy (; ). indicated that both the emotion-oriented coping style and the avoidance-oriented style are strong predictors of AD. Further studies conducted among recovering AD individuals have shown that those who rely on the avoidance-oriented style, which manifests itself in shifting responsibility to others or dissociating from thinking about the difficulties in stressful situations, are more likely to resort to alcohol, which seems to be the main tension-reducing measure (). Developing alternative effective coping strategies seems to be crucial in the treatment of AD individuals. As shown by various studies, a change in the configuration of coping styles can occur as a result of therapeutic interventions carried out during a primary treatment program on an inpatient unit ().

defines defense mechanisms as constructs acting as a counterforce against the push of the drives for discharge. Individuals using more adaptive coping styles, such as task-oriented coping, are characterized by greater ego strength and the use of more mature defense mechanisms than those presenting less adaptive styles such as emotional and avoidant oriented (). Studies have shown that AD is associated with more frequent use of immature defense mechanisms such as pseudo-altruism, autistic fantasy, acting out and isolation. Studies have shown that AD individuals use immature and neurotic defense mechanisms such as pseudo-altruism, autistic fantasy, acting out, isolation, projection, splitting or somatization more frequently than healthy people (; ). At the same time, a positive correlation between the tendency to use immature defense mechanisms and the extent of AD and a tendency to antisocial behavior was observed (). also found that AD women score significantly higher than healthy women with respect to defense mechanisms such as acting out or autistic fantasy, while achieving lower scores for mature defense mechanisms such as sublimation. In young people with AD a stronger manifestation of the acting out mechanism is associated with a higher risk of self-injury, while less frequent use of anticipation, classified as a mature defense mechanism, is a predictor of suicidal behavior ().

Coping strategies tend to be perceived as mature, voluntary and intentional whereas defense mechanisms are considered to be unconscious, involuntary, rigid and automatic (; ). Furthermore, coping styles contrary to defense mechanism, which are oriented towards internal conflicts, are crucial to positive adaptation to external reality (). However, empirical data suggest that these differences are much more blurred than in theoretical models (). proposed a sequential model where defense mechanism precede coping processes. According to that theory, defense mechanism and coping strategies are different psychological constructs which are functionally linked. Defense mechanisms influence reality perception and create threat representations, secondarily affecting coping strategies. Thus, adaptive coping mechanisms may be preceded by non-adaptive defense mechanisms or vice versa (). That model has important implications in terms of therapeutic approach and directs attention to analysis of defense mechanisms as an indispensable step in improvement of coping resources (; ). Therefore, assessment of defense mechanisms in relation to preferred stress coping patterns in AD individuals seems to be interesting and helpful in therapy.

indicated that AD individuals presented significantly higher severity of psychopathological symptoms, especially psychoticism (reflecting the continuum of behaviors from mild social withdrawal to the first rank symptoms of psychosis) than healthy individuals. AD individuals often report various somatic ailments such as headaches, joint pain, a burning sensation in the chest, weakness and difficulty in breathing (; ). When compared to the control group, AD individuals are characterized by more severe depressive symptoms (; ; ; ). It has been suggested that a high severity of psychopathological symptoms, particularly of anxiety and depression in AD individuals, is associated with a higher risk of relapse (). AD individuals, compared with the control group, obtain significantly higher scores on the psychoticism scale (). Moreover, AD individuals more frequently experience hostility, irritability, and aggression (both verbal and nonverbal) in comparison with the healthy population (). found a positive association between an emotion-oriented coping style and various measures of psychopathology in the MMPI-2 scale, including depression, anxiety, obsessiveness, anger, and low self-esteem. Task-oriented coping-styles were unrelated to scores on these measures.

The way people experience their past and plan their future influences their behavior and their choice of the coping strategies (). Time perspective can be defined as an often unconscious personal attitude that every individual manifests towards time (). It is also the process by which the continuum of life is divided into categories of time to help give individuals’ lives order, cohesion and importance. identified five time perspectives. The first of them, past negative, characterizes individuals who may misremember the past in a negative way. They might experience higher levels of anxiety and depression, as well as rumination. People with a past positive time perspective concentrate on positive aspects of their life history. They tend to be more nostalgic and bound to rituals. The third time perspective, present fatalism, characterizes individuals who believe they are powerless and that they can not influence their future. People presenting present hedonism, the fourth time perspective, strive to maximize perceived pleasure. They can be characterized by a high level of novelty and sensation seeking. The last but not least time perspective is a future one, associated with the representation of future states and organising the individual’s activity around life goals. indicated that there is a negative correlation between a future time perspective and reported substance use, but a positive correlation between present time perspective and reported substance use. As shown by the studies, more frequent reliance on action-oriented coping strategies is accompanied by a heightened future time perspective. By contrast, those with high scores on the present time perspective scale frequently use maladaptive strategies such as a focus on avoidance, collapsing into helplessness or experiencing difficult emotions such as anger (). It has, however, been suggested that participation in rehabilitation treatment may entail a change in time perspective as well as an orientation toward the future (). Furthermore, a future time perspective is a strong predictor of abstinence upon completion of the treatment program (). indicated that individuals with greater future oriented time perspective are less prone to addictive health behaviors like alcohol abuse, since they rather concentrate on long term negative effects of drinking then short term positive outcomes. Time perspective, as a fairly stable construct, has an impact on the action strategies taken by individuals. showed that in a conflict situation, future and past oriented people are more prone to cooperate than present oriented ones. It seems important to examine the relationship between time perspectives and coping styles among AD individuals, who in this study find themselves in specific circumstances of hospitalization at the addiction treatment ward.

In the literature to date some researchers’ attention has been focused on coping patterns (called sometimes “profiles”), described as a configuration of specific coping styles, in the functioning of AD individuals (). However, most research on coping styles and their correlates has focused on healthy populations (; ; ) or somatically ill patients (; ; ). A key question to be answered by our study is which patterns of coping with stress can be distinguished among individuals with alcohol dependence. Moreover, the study presented in this paper is intended to complement existing research on the functioning of individuals with alcohol dependence presenting different patterns of coping in terms of the severity of their psychopathological symptoms, defense mechanisms and time perspectives. In light of studies mentioned in the introduction, it can be concluded that variables such as severity of psychopathological symptoms, defense mechanisms and time perspective seem to be strong indicators of psychological well-being and are strongly connected with a higher risk of relapse among alcohol dependent individuals.

Materials and Methods

Participants

A total of 112 AD individuals (N = 91 males, M = 38; SD = 20.87) took part in the study. They were participants in an 8-week abstinence-based inpatient treatment program the research was conducted within first two weeks of the treatment. The diagnosis of alcohol dependence was based on the ICD-10 classification criteria () and a psychiatric assessment (structured interview based on the ADIT questionnaire and list of other questions allowing carrying out a differential diagnosis). The conditions for inclusion in the study were as follows: the participant had to (1) be at least 18 years of age (2) sign an informed consent form and (3) have abstained from alcohol for at least two weeks. Since with this length of abstinence withdrawal symptoms did not occur among participants, no psychopharmacological treatments were given. The study was approved by the Committee on Bioethics of the Medical University of Lublin (No. KE-0254/145/2011).

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