Defense functioning in depressed patients treated with medication and group psychotherapy.
Item
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Title
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Defense functioning in depressed patients treated with medication and group psychotherapy.
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Identifier
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AAI9908343
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identifier
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9908343
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Creator
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Little, Suzanne Anastazia S.
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Contributor
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Adviser: Diana Diamond
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Date
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1998
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Language
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English
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Publisher
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City University of New York.
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Subject
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Psychology, Clinical | Health Sciences, Mental Health | Health Sciences, Pharmacy
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Abstract
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This dissertation investigated defense functioning in 30 outpatients treated for DSM-III-R Dysthymic Disorder. Defense mechanisms were conceptualized on a developmental (immature-mature) continuum (Cramer, 1991), reflecting corresponding levels of psychopathology. The study of defense use elucidates psychological factors that promote or forestall symptom recurrence, as well as nosological questions concerning the status of depression as a primary (Axis I) disorder or (Axis II) form of personality. It was hypothesized that brief group therapy, augmented by medication, would effect a greater change in use of defense mechanisms (Denial, Projection, and Identification) than medication alone, and that such change would be associated with positive clinical outcome. It was also hypothesized that initial level of defense would predict clinical improvement, regardless of treatment group.;In this 24-week open label treatment study, patients received 8 weeks of Fluoxetine and were randomized to one of two treatment groups: (1) Medication alone and (2) Combined Medication and Group therapy. Assessments were conducted at intake and termination. Subjects were administered two symptom-based inventories (Beck Depression Inventory; Hamilton Depression Rating Scale), two personality measures (Inventory of Interpersonal Problems, Depressive Experiences Questionnaire), and a projective narrative task, the Thematic Apperception Test, to assess use of defense mechanisms.;As predicted, results showed significantly greater change on Denial for the Combined Medication-Group patients. A significant negative relationship was found between Identification and depressive symptoms at intake, and a positive relationship between improved interpersonal functioning and reduced symptom distress over time. Depressive personality subtypes (Blatt, 1990) predicted use of specific defense mechanisms, with anaclitic (Dependent) depression positively associated with Projection, and introjective (Self-Critical) depression predicting less improvement on Identification over time. Axis II pathology, particularly Cluster C personality disorders, also affected defense use.;This study suggests that change on defenses can occur in brief group treatment, and that type of depressive experience, compared with symptom distress, is a more robust predictor of how much change a patient will show on mature defenses. These findings support a view of depression as a heterogenous disorder with trait-like personality features. The clinical implications of these findings are discussed, with recommendations for more effective treatment designs.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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Ph.D.
