Reliability of an idiographic Q-sort measure of defense mechanisms

Despite the important insights the concept of defense mechanisms may offer to our understanding of human behavior, no standardized definitions of defense mechanisms have been universally accepted. Inconsistencies in the definition and conceptualization of defense mechanisms has limited the practical utility of research involving these constructs. In addition, lack of interrater reliability, use of anecdotal evidence, and reliance on self-reports has retarded their investigation. Conducting methodologically rigorous investigations with a psychometrically sound instrument is the first step in addressing some of the issues concerning defense mechanisms and their theoretical postulates. This study was conducted to determine the reliability associated with the Defense-Q, an observer-based Q-sort measure of defense mechanisms. Thirty participants who had undergone an interpersonally stressful interview (the Type A Structured Interview; Rosenman, 1978) were rated by 11 trained coders, both for their use of the 25 defense mechanisms and for their ego strength. Reliability was assessed using Cronbach's alpha. Individual defense mechanisms demonstrated reliability ranging from .28 (undoing) to .92 (humor), with an average reliability of .73. Coder reliability ranged from .63 to .76, with an average of .69. These results indicate that defense mechanisms can be reliably assessed by the Defense-Q. Reliability of the Defense-Q is compared to existing observational measures of defense mechanisms.     

The relation between defense use and adaptive behavior

In two studies we examine the association between a person’s pattern of defense use, assessed by a new measure called the Defense-Q, and their adaptive behavior. We compare each person’s Defense-Q profile to a theoretical Adaptive Defense Profile (ADP) to obtain an ADP similarity score. In Study 1 we show in a student sample that ADP similarity scores are positively related to observed empathy and competence and negatively to hostility. In Study 2 we demonstrate in a population-based community sample that ADP similarity scores are positively related to nurse’s ratings of competence and nutritional based weight control programs and negatively related to hostility, depression, alcohol use, and weight control through the use of pills. These results suggest that defense use is related to adaptive behavior in a theoretically consistent manner, and that the Defense-Q shows promise as an observer-based instrument to assess defenses.     

Girls' use of defense mechanisms following peer rejection

This study explores the relation between girls' social adjustment and their use of defense mechanisms. We recruited girls representing four sociometric status classifications (rejected, neglected, average, and popular), and assessed their use of defense mechanisms both before and after encountering a peer rejection experience in the laboratory. We hypothesized that increasing degrees of social maladjustment would be associated with higher levels of defense use, particularly after encountering a rejection experience. Our results supported these hypotheses. There was a significant negative relationship between social adjustment and defense use, both prior to and immediately following the rejection experience. Categorical analyses revealed that rejected and neglected girls used more defenses following the rejection experience than did popular and average girls.     

Defense use and defense understanding in children

This study investigated the relation between children's use of defense mechanisms and their understanding of those defenses. We hypothesized that, once a child understands how a particular defense functions, the use of that defense will no longer be successful and will be replaced by another defense mechanism that is not yet understood. Defense use was assessed from the Thematic Appreception Test (TAT) stories told by 122 children; defense understanding was determined from the children's understanding of stories portraying defenses. The results indicated that younger children (mean age = 7-8) used the defense of denial more than the older children (mean age = 9-11). Older children understood the functioning of denial and projection better than the younger children. A comparison of children who did and did not understand a defense showed that younger children who understood the functioning of denial were less likely to themselves use denial. Likewise, older children who understood the functioning of projection were less likely to use this defense.     

The Effects of Success and Failure on Children's Use of Defense Mechanisms

ABSTRACT The effects of moderate stress on the use of defense mechanisms by 64 second- and sixth-graders were determined The use of denial, projection, and identification was assessed from stones told to the Thematic Apperception Test (TAT) prior to, and subsequent to, an experimentally controlled experience of success or failure Subjects who experienced failure were more likely to use the lower level defenses of denial and projection, while the experience of success was followed by greater use of identification The results also were consistent with previous studies in demonstrating age and sex differences in the use of defense mechanisms     

Classification of Antisocial Behaviors Along Severity and Frequency Parameters

Antisocial behaviors were systematically classified along a hierarchy of seriousness or severity that also accounted for frequency of occurrence and heterogeneity of behaviors. Items from the CD and ODD schedules of the NIMH DISC-IV and from the Elliot Delinquency Scales were listed at specified frequencies. Nine mental health clinicians rated the level of seriousness of each alternative on a scale from 0 (trivial) to 5 (very serious). Reliability of the ratings was assessed. Over two thirds of the items showed excellent agreement among the raters, 8% showed poor agreement and 21% showed fair to moderate agreement. The overall reliability of a single rater’s score was 0.56 and the reliability of the average was 0.84. The classification meets high psychometric standards for reliability and has face validity. The final output provides a classification along a spectrum that takes into account severity, frequency of occurrence during the previous year, and presence of multiple behaviors. It is useful for classification purposes and for longitudinal tracking of antisocial behavior.     

Ontario Child Health Study: reliability and validity of the general functioning subscale of the McMaster Family Assessment Device

The reliability and validity of the 12-item General Functioning (GF) subscale of the McMaster Family Assessment Device (FAD) is reported here. Psychometric properties of the FAD have been previously determined, but no independent assessment has been made of the GF subscale, which was used to measure family functioning in the Ontario Child Health Study (OCHS). Reliability was measured by Chronbach's alpha and split-half correlation. Validity was assessed by hypothesizing the relationships expected between the GF scores and other family variables included in the OCHS data set. The results indicate good reliability, and all hypotheses of validity were supported. The brevity and ease of administering the GF subscale recommend it for further use in survey research in which a global assessment of family functioning is required.     

Identification and the development of competence: a 44-year longitudinal study from late adolescence to late middle age

The role of defense mechanisms in the development of planful competence (J. A. Clausen, 1993) was studied over a period of 44 years in participants from the Oakland Growth Study, who are part of the Intergenerational Studies of the Institute of Human Development. Planful competence was assessed on 4 occasions, from late adolescence (ages 15-18) to late middle age (age 62). The use of the defense mechanisms of denial, projection, and identification was assessed in late adolescence, based on Thematic Apperception Test (H. A. Murray, 1943) stories coded with the Defense Mechanism Manual (P. Cramer, 1991b). In late adolescence, the defense mechanism of identification was found to be positively related to competence, whereas the less mature defense of projection was related to lower levels of competence. For the group as a whole, hierarchical linear modeling (Bryk & Raudenbush, 1992) indicated that competence increased across the adult years, with a modest decline at late middle age. Individual differences for intraindividual change in competence were related to the use of identification: high use of identification in late adolescence was associated with relative stability in adult competence, whereas low use of identification in adolescence predicted changes in adult competence.     

Use of the TAT to measure change in defense mechanisms following intensive psychotherapy

Changes in the use of defense mechanisms (denial, projection, and identification) were examined over a period of approximately 15 months of intensive treatment of 90 seriously disturbed young adults who were hospitalized in an intensive, open, long-term treatment setting. Patients independently judged to have primarily an anaclitic or an introjective personality configuration (Blatt, 1974; Blatt & Shichman, 1983) were assessed for psychiatric symptoms and aspects of interpersonal behavior both on admission and after an average of 15 months of treatment. Findings based on an independent assessment of TAT protocols at these two times indicated a significant (p less than .05) decline in total use of defenses for the entire sample, but especially for introjective patients. Further, this decline in total use of defenses in the TAT was significantly associated with a reduction in psychiatric symptoms. Also, sex-incongruent patients (anaclitic men and introjective women) were found to use different defenses and to change in ways different from sex-congruent patients (anaclitic women and introjective men).     

Use of the TAT to Measure Change in Defense Mechanisms Following Intensive Psychotherapy

Changes in the use of defense mechanisms (denial, projection, and identification) were examined over a period of approximately 15 months of intensive treatment of 90 seriously disturbed young adults who were hospitalized in an intensive, open, long-term treatment setting. Patients independently judged to have primarily an anaclitic or an introjective personality configuration (Blatt, 1974, Blatt & Shichman, 1983) were assessed for psychiatric symptoms and aspects of interpersonal behavior both on admission and after an average of 15 months of treatment. Findings based on an independent assessment of TAT protocols at these two times indicated a significant (p < .05) decline in total use of defenses for the entire sample, but especially for introjective patients. Further, this decline in total use of defenses in the TAT was significantly associated with a reduction in psychiatric symptoms. Also, sex-incongruent patients (anaclitic men and introjective women) were found to rise different defenses and to change in ways different from sex-congruent patients (anaclitic women and introjective men).     

Defense mechanisms and physiological reactivity to stress

The relation between the use of defense mechanisms and autonomic nervous system reactivity, under conditions of laboratory stress, was studied in 78 men and women. Both diastolic blood pressure (DBP) and skin conductance level (SCL) were monitored during exposure to ten stress tasks; concurrently, the use of three defense mechanisms was assessed by coding Thematic Apperception Test stories. Autonomic reactivity was found to be related to defenses; the nature of that relation differed across the defenses. DBP, typically found to be associated with cognitive work, was higher in those individuals who used more Identification, a defense that requires greater cognitive activity. The use of Projection, on the other hand, was associated with lower DBP. In addition, the use of Identification showed a tendency to be associated with lower SCL.     

An empirical look at the Defense Mechanism Test (DMT): reliability and construct validity

Although the Defense Mechanism Test (DMT) has been in use for almost half a century, there are still quite contradictory views about whether it is a reliable instrument, and if so, what it really measures. Thus, based on data from 39 female students, we first examined DMT inter-coder reliability by analyzing the agreement among trained judges in their coding of the same DMT protocols. Second, we constructed a "parallel" photographic picture that retained all structural characteristic of the original and analyzed DMT parallel-test reliability. Third, we examined the construct validity of the DMT by (a) employing three self-report defense-mechanism inventories and analyzing the intercorrelations between DMT defense scores and corresponding defenses in these instruments, (b) studying the relationships between DMT responses and scores on trait and state anxiety, and (c) relating DMT-defense scores to measures of self-esteem. The main results showed that the DMT can be coded with high reliability by trained coders, that the parallel-test reliability is unsatisfactory compared to traditional psychometric standards, that there is a certain generalizability in the number of perceptual distortions that people display from one picture to another, and that the construct validation provided meager empirical evidence for the conclusion that the DMT measures what it purports to measure, that is, psychological defense mechanisms.     

An Increase in Early Adolescent Undercontrol Is Associated With the Use of Denial

This is a longitudinal study of change in undercontrol and its relation to the use of defense mechanisms with participants from the Berkeley Guidance Study of the Institute of Human Development, University of California, Berkeley. I predicted that use of the immature defense of Denial, but not Projection or Identification, would be related at early adolescence to an increase in undercontrol as assessed from 2 independent measures. The assessment of Ego Undercontrol indicated that the majority of children decreased with age, but for those who increased at early adolescence, the increase was significantly related to the use of Denial. Similarly, assessment of Externalizing Behavior Problems at early adolescence indicated that an increase in Externalizing Problems was related to the use of Denial. In addition to indicating psychological immaturity, the use of Denial prevents these children from recognizing the negative impact of their undercontrolled behavior.     

Reliability and Validity of EQ-5D in Malaysian Population

This cross-sectional study, involving conveniently chosen respondents in the Klang Valley area, was designed to answer the question “Can EQ-5D be used as a QOL instrument in the National Health Morbidity Survey in Malaysia?”. The chosen versions (Malay, Tamil, and Mandarin) of the translated EQ-5D were tested for their reliability and validity. After a written consent was obtained from each respondent, a standardized questionnaire for self-completion was given. It took an average of 10–15 min to complete the questionnaire. Each respondent who returned the completed questionnaire was approached again with an identical copy of the questionnaire to assess the test-retest reliability after a 2-week interval. Reliability was assessed by analyzing the study instrument’s test-retest reliability, while a predictive validity was used to investigate the predictive strength of a composite index of the five factors of EQ-5D (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) on the overall perceived health (EQ VAS). An intraclass correlation (ICC), generated based on a single rate using the one way analysis of variance (ANOVA) model, was used to evaluate the test-retest reliability (Streiner and Norman 1995), while spearman rank correlation coefficient was used to quantify the predictive strength of a composite index of the five factors of EQ-5D on the overall perceived health (EQ VAS) (Elmes et al. 2006). It was surprising to note 1–2 folds increase in the reported cases for pain/discomfort and anxiety/depression, the same trend was observed across different versions of EQ-5D. The ICC values were found to be in the range of <0.01 to 0.92, while 0.61–0.86 were the range for the spearman rank correlation coefficient value. The findings in this study demonstrated the EQ-5D questionnaires translated by the EuroQOL Group had reasonable test-retest reliability and predictive validity results. With these results, it is hoped that these instruments will be incorporated into future National Health Morbidity Survey in Malaysia.     

Seven Pillars of Defense Mechanism Theory

Defense mechanisms are cognitive processes that function to protect the individual from excessive anxiety or other negative emotions. They also protect the person from loss of self‐esteem and, in the extreme, the loss of self‐integration. Although past critics questioned the existence of defense mechanisms, recent research has supported seven basic tenets regarding defenses. These include: (1) defenses function outside of awareness; (2) there is a chronology of defense development; (3) defenses are present in the normal personality; (4) defense use increases under conditions of stress; (5) defense use reduces the conscious experience of negative emotions; (6) defense function is connected to the autonomic nervous system; (7) excessive use of defenses is associated with psychopathology. Research supporting the seven pillars of defense mechanism theory is described in this essay.     

Evaluation of an indirect assessment for identifying tasks for functional analysis

Although a demand analysis is helpful for identifying potential establishing operations for the functional analysis (FA) demand condition, it may not always be practical due to time constraints. A potential alternative is the Negative Reinforcement Rating Scale (NRRS), an indirect assessment tool that may serve as a time efficient alternative to a demand analysis. The experimenter assessed the reliability and validity of the NRRS for 5 individuals with autism spectrum disorder who exhibited problem behavior. Multiple types of interrater reliability were assessed across 2 informants, and NRRS outcomes were compared to a subsequent demand analysis and FA to assess its validity. Reliability was high (M = 84%) for NRRS numerical ratings of categories but low (M = 32.9%) for specific examples provided. NRRS-identified highly aversive tasks yielded better correspondence with demand analysis outcomes than did NRRS-identified less aversive tasks.     

Psychological maturity and change in adult defense mechanisms

Change in the use of defense mechanisms between late adolescence and adulthood was assessed in two different longitudinal studies from the Institute of Human Development. The results were virtually identical: the use of Identification decreased, the use of Denial increased, and there was little change in the use of Projection. Both the use of Identification at adolescence, and its subsequent decrease in adulthood were found to be predicted by ego strength and committed Identity - that is, by evidence of developmental maturity at late adolescence. The decrease in Identification is consistent with predictions from the theory of defense mechanism development: defenses are related to developmental period; once that period is concluded, the use of the related defense declines.     

Examining the reliability of ADAS-Cog change scores

The purpose of this study was to estimate and examine ways to improve the reliability of change scores on the Alzheimer’s Disease Assessment Scale, Cognitive Subtest (ADAS-Cog). The sample, provided by the Alzheimer’s Disease Neuroimaging Initiative, included individuals with Alzheimer’s disease (AD) (n = 153) and individuals with mild cognitive impairment (MCI) (n = 352). All participants were administered the ADAS-Cog at baseline and 1 year, and change scores were calculated as the difference in scores over the 1-year period. Three types of change score reliabilities were estimated using multivariate generalizability. Two methods to increase change score reliability were evaluated: reweighting the subtests of the scale and adding more subtests. Reliability of ADAS-Cog change scores over 1 year was low for both the AD sample (ranging from .53 to .64) and the MCI sample (.39 to .61). Reweighting the change scores from the AD sample improved reliability (.68 to .76), but lengthening provided no useful improvement for either sample. The MCI change scores had low reliability, even with reweighting and adding additional subtests. The ADAS-Cog scores had low reliability for measuring change. Researchers using the ADAS-Cog should estimate and report reliability for their use of the change scores. The ADAS-Cog change scores are not recommended for assessment of meaningful clinical change.     

Reliability of the Halstead-Reitan Battery in individuals displaying acutely psychotic behavior

The purpose of the present study is to examine the test-retest reliability of the Halstead-Reitan Battery (HRB) in an acutely psychotic population. Ten acutely psychotic patients, initially tested upon admission to an inpatient unit of the Austin State Hospital, were selected for retesting on the basis of showing the most complete remission of psychotic symptoms of all patients tested over the 14-month period from June 1978 to August 1979. Only patients showing good remission were selected in order to maximize the potential for changes in test performance to occur and, thus, provide a conservative estimate of test-retest reliability. The average retest interval was 10.4 weeks (SD=6.67), with retest being completed just prior to discharge. Reliability was examined for each HRB subtest across subjects, as well as for each subject across subtest. While the patients generally showed an improved performance at retest, the reliability of the HRB was relatively high.     

Some EPI Reliability Estimates

The stability of the EPI over one month was estimated with 80 American university students, separately by sex (40 males, 40 females). The estimates for the extraversion-introversion (E-I), neuroticism (N) and lie scales ranged from 0.50 to 0.87. Reliability data (alternate-forms) from other sources were compared to the present results. It was concluded that the EPI has demonstrated generally high reliability for a personality measure, with reservations where the lie scale is concerned, and that the E-I scale alternate-forms, but not test-retest, reliability was generally lower than that for the N scale, suggesting that the alternate-forms are somewhat more equivalent for N than for E-I.