Psychological defense mechanisms and coping strategies in people with disability and traumatic spinal cord injury with different levels of neuropsychiatric adaptation

Abstract

BACKGROUND: Despite the multitude of publications on the mechanisms of psychological adaptation in people with spinal and spinal cord injuries, there is a shortage of complex studies that explore the features of these mechanisms depending on the level of neuropsychic adaptation.

AIM: This study aimed to explore the relationships between the mechanisms of psychological adaptation and the level of neuropsychic adaptation in patients with traumatic spinal cord injury.

MATERIAL AND METHODS: Altogether, 80 patients with <3 years of traumatic spinal cord injury were examined: 65 (81.2%) were men, and 15 (18.8%) were women. The mean age was 37.5±11.61 years, and 46 (57.5%) patients had paraplegia and 34 (42.5%) had tetraplegia. The level of neuropsychic adaptation was determined using the I.N. Gurvich test: a person is considered psychologically adapted if the sum score ranges from 0 to 20, and a person is considered maladapted if the sum score is >20. Psychological defense mechanisms were assessed using the “Lifestyle Index” of Plutchik–Kellerman. To determine strategies for coping with stress, we used the “Ways of Coping Questionnaire” of Folkman and Lazarus.

RESULTS: According to the findings, 64.6% of the participants had manifestations of neuropsychiatric maladaptation due to aspects of personality development and personal background. Psychologically maladapted individuals had a higher intensity of defense mechanisms (regression, compensation/identification, substitution, and projection) and coping strategies (escape–avoidance, search for social support, and confrontation). Positive correlations were found between the total index of defense intensity and levels of maladaptive coping (escape–avoidance, confrontation, distancing, acceptance of responsibility, and self-control).

CONCLUSION: People with traumatic spinal cord disease and symptoms of neuropsychiatric maladaptation tend to have a combination of an increased level of tension of psychological defenses with the actualization of regression, substitution, compensation/identification, and projection. People with traumatic spinal cord disease were also found to have a preference for coping strategies aimed primarily at avoiding the problem and reducing emotional discomfort.

Keywords

traumatic spinal cord injury / neuropsychic adaptation / psychological defense mechanisms / stress / coping strategies

References

[1] Ehrmann C, Reinhardt JD, Joseph C, et al. Describing functioning in people living with spinal cord injury across 22 countries: a graphical modeling approach. Arch Phys Med Rehabil. 2020;101(12):2112–2143. doi: 10.1016/j.apmr.2020.09.374

[2] Ehrmann C., Reinhardt J.D., Joseph C., et al. Describing functioning in people living with spinal cord injury across 22 countries: a graphical modeling approach // Arch Phys Med Rehabil. 2020. Vol. 101, N 12. Р. 2112–2143. doi: 10.1016/j.apmr.2020.09.374

[3] Pilusa SI, Myezwa H, Potterton J. Experiences of secondary health conditions amongst people with spinal cord injury in South Africa: a qualitative study. S Afr J Physiother. 2021;77(1):1530. doi: 10.4102/sajp.v77i1.1530

[4] Pilusa S.I., Myezwa H., Potterton J. Experiences of secondary health conditions amongst people with spinal cord injury in South Africa: a qualitative study // S Afr J Physiother. 2021. Vol. 77, N 1. Р. 1530. doi: 10.4102/sajp.v77i1.1530

[5] Cao Y, Di Piro N, Krause JS. Association of secondary health conditions with future chronic health conditions among persons with traumatic spinal cord injury. Top Spinal Cord Inj Rehabil. 2020;26(4):283–289. doi: 10.46292/sci20-00020

[6] Cao Y., Di Piro N., Krause J.S. Association of secondary health conditions with future chronic health conditions among persons with traumatic spinal cord injury // Top Spinal Cord Inj Rehabil. 2020. Vol. 26, N 4. Р. 283–289. doi: 10.46292/sci20-00020

[7] Barclay L, McDonald R, Lentin P, Bourke-Taylor H. Facilitators and barriers to social and community participation following spinal cord injury. Aust Occup Ther J. 2016;63:19–28. doi: 10.1111/1440-1630.12241

[8] Barclay L., McDonald R., Lentin P., Bourke-Taylor H. Facilitators and barriers to social and community participation following spinal cord injury // Aust Occup Ther J. 2016. Vol. 63. Р. 19–28. doi: 10.1111/1440-1630.12241

[9] LaVela SL, Etingen B, Miskevics S, Heinemann AW. What determines low satisfaction with life in individuals with spinal cord injury? J Spinal Cord Med. 2019;42(2):236–244. doi: 10.1080/10790268.2018

[10] LaVela S.L., Etingen B., Miskevics S., Heinemann A.W. What determines low satisfaction with life in individuals with spinal cord injury? // J Spinal Cord Med. 2019. Vol. 42, N 2. Р. 236–244. doi: 10.1080/10790268.2018

[11] Aaby A, Ravn SL, Kasch H, Andersen TE. The associations of acceptance with quality of life and mental health following spinal cord injury: a systematic review. Spinal Cord. 2020;58(2):130–148. doi: 10.1038/s41393-019-0379-9

[12] Aaby A., Ravn S.L., Kasch H., Andersen T.E. The associations of acceptance with quality of life and mental health following spinal cord injury: a systematic review // Spinal Cord. 2020. Vol. 58, N 2. Р. 130–148. doi: 10.1038/s41393-019-0379-9

[13] Bonanno GA, Kennedy P, Galatzer-Levy IR, et al. Trajectories of resilience, depression, and anxiety following spinal cord injury. Rehabil Psychol. 2012;57(3):236–247. doi: 10.1037/a0029256

[14] Bonanno G.A., Kennedy P., Galatzer-Levy I.R., et al. Trajectories of resilience, depression, and anxiety following spinal cord injury // Rehabil Psychol. 2012. Vol. 57, N 3. Р. 236–247. doi: 10.1037/a0029256

[15] Kennedy P, Evans M, Sandhu N. Psychological adjustment to spinal cord injury: the contribution of coping, hope and cognitive appraisals. Psychol Health Med. 2009;14(1):17–33. doi: 10.1080/13548500802001801

[16] Kennedy P., Evans M., Sandhu N. Psychological adjustment to spinal cord injury: the contribution of coping, hope and cognitive appraisals // Psychol Health Med. 2009. Vol. 14, N 1. Р. 17–33. doi: 10.1080/13548500802001801

[17] Craig A, Tran Y, Guest R, Middleton J. Trajectories of self-efficacy and depressed mood and their relationship in the first 12 months following spinal cord injury. Arch Phys Med Rehab. 2019;100(3):441–447. doi: 10.1016/j.apmr.2018.07.442

[18] Craig A., Tran Y., Guest R., Middleton J. Trajectories of self-efficacy and depressed mood and their relationship in the first 12 months following spinal cord injury // Arch Phys Med Rehab. 2019. Vol. 100, N 3. Р. 441–447. doi: 10.1016/j.apmr.2018.07.442

[19] Bhattarai M, Maneewat K, Sae-Sia W. Psychosocial factors affecting resilience in Nepalese individuals with earthquake-related spinal cord injury: a cross-sectional study. BMC Psychiatry. 2018;18(60):1–8. doi: 10.1186/s1288-018-1640-z

[20] Bhattarai M., Maneewat K., Sae-Sia W. Psychosocial factors affecting resilience in Nepalese individuals with earthquake-related spinal cord injury: a cross-sectional study // BMC Psychiatry. 2018. Vol. 18, N 60. Р. 1–8. doi: 10.1186/s1288-018-1640-z

[21] Mazur A, Sojka A, Stachyra-Sokulska A, Lukasiewicz J. The role of individual predispositions in coping with sudden loss of mobility caused by a traffic accident. ACTA Neuropsychologica. 2019;17(2):151–165.

[22] Mazur A., Sojka A., Stachyra-Sokulska A., Lukasiewicz J. The role of individual predispositions in coping with sudden loss of mobility caused by a traffic accident // ACTA Neuropsychologica. 2019. Vol. 17, N 2. Р. 151–165.

[23] Geyh S, Kunz S, Müller R, Peter C. Describing functioning and health after spinal cord injury in the light of psychological-personal factors. J Rehabil Med. 2016;48(2):219–234. doi: 10.2340/16501977-2027

[24] Geyh S., Kunz S., Müller R., Peter C. Describing functioning and health after spinal cord injury in the light of psychological-personal factors // J Rehabil Med. 2016. Vol. 48, N 2. Р. 219–234. doi: 10.2340/16501977-2027

[25] Jenkins HT, Cosco TD. Spinal cord injury and aging: an exploration of the interrelatedness between key psychosocial factors contributing to the process of resilience. Health Psychol Behav Med. 2021;9(1):315–321. doi: 10.1080/21642850.2021.1911656

[26] Jenkins H.T., Cosco T.D. Spinal cord injury and aging: an exploration of the interrelatedness between key psychosocial factors contributing to the process of resilience // Health Psychol Behav Med. 2021. Vol. 9, N 1. Р. 315–321. doi: 10.1080/21642850.2021.1911656

[27] Van Koppenhagen CF, Post MW, van der Woude LH, et al. Changes and determinants of life satisfaction after spinal cord injury: a cohort study in the Netherlands. Arch Phys Med Rehabil. 2008;89:1733–1740. doi: 10.1016/j.apmr.2007.12.042

[28] Van Koppenhagen C.F., Post M.W., van der Woude L.H., et al. Changes and determinants of life satisfaction after spinal cord injury: a cohort study in the Netherlands // Arch Phys Med Rehabil. 2008. Vol. 89. Р. 1733–1740. doi: 10.1016/j.apmr.2007.12.042

[29] Nesterova IN, Prudnikova OG, Baranskaya LT, Gubin AV. Psycho-emotional status and coping strategies in patients with long-term consequences of traumatic disease of spinal cord. Siberian journal of psychology. 2017;(64):106–119. (In Russ). doi: 10.17223/17267080/64/7

[30] Нестерова И.Н., Прудникова О.Г., Баранская Л.Т., Губин А.В. Психоэмоциональный статус и копинг-стратегии у пациентов с отдаленными последствиями травматической болезни спинного мозга // Сибирский психологический журнал. 2017. № 64. С. 106–119. doi: 10.17223/17267080/64/7

[31] Gurvich IN. Test of neuropsychic adaptation. Bulletin of hypnology and psychotherapy. 1992;(3):46–53. (In Russ).

[32] Гурвич И.Н. Тест нервно-психической адаптации // Вестник гипнологии и психотерапии. 1992. № 3. С. 46–53.

[33] Borovko IR, Vlasenko VI. Experience in application psychometric method “Test of neuropsychic adaptation”. Military medicine. 2010;(1):112–115. (In Russ).

[34] Боровко И.Р., Власенко В.И. Опыт применения психометрической методики «Тест нервно-психической адаптации» // Военная медицина. 2010. № 1. С. 112–115.

[35] Gorbachev AI, Shirko SM. Psychological instruments in management of psychological work in extreme conditions: educational materials for students and trainees. Minsk: Belarusian State University; 2016. 42 p. (In Russ).

[36] Горбачев А.И., Ширко С.М. Психологический инструментарий по организации психологической работы в экстремальных ситуациях: Учебные материалы для студентов и курсантов. Минск: БГУ, 2016. 42 с.

[37] Vasserman LI, Eryshev OF, Klubova EB, et al. Psychological diagnosis of life style index. Ed. L.I. Wasserman. Saint Petersburg: V.M. Bekhterev St. Petersburg Research Psychoneurological Institute; 2005. 54 p. (In Russ).

[38] Вассерман Л.И., Ерышев О.Ф., Клубова Е.Б., и др. Психологическая диагностика индекса жизненного стиля: Пособие для психологов и врачей. Санкт-Петербург: Санкт-Петербургский научно-исследовательский психоневрологический институт им. В.М. Бехтерева, 2005. 54 с.

[39] Kryukova TL, Kuftyak EV. Questionnaire of coping methods (adaptation of the WCQ technique). J Pract Psychol. 2007;(3):93–112. (In Russ).

[40] Крюкова Т.Л., Куфтяк Е.В. Опросник способов совладания (адаптация методики WCQ) // Журнал практического психолога. 2007. № 3. С. 93–112.

[41] Vasserman LI, Iovlev BV, Isaeva ER, et al. Procedure for psychological diagnosis of coping behaviour in stressful and challenging situations: a textbook for doctors and medical psychologists. Saint Petersburg: V.M. Bekhterev St. Petersburg Research Psychoneurological Institute; 2008. 35 p. (In Russ).

[42] Вассерман Л.И., Иовлев Б.В., Исаева Е.Р., и др. Методика для психологической диагностики совладающего поведения в стрессовых и проблемных для личности ситуациях: Пособие для врачей и медицинских психологов. Санкт-Петербург: Санкт-Петербургский научно-исследовательский психоневрологический институт им. В.М. Бехтерева, 2008. 35 с.

[43] Isaeva ER. Stress coping and defensive behaviour in adjustment disorder of different origin [dissertation]. Saint Petersburg; 2010. 367 p.

[44] Исаева Е.Р. Совладающее со стрессом и защитное поведение личности при расстройствах психической адаптации различного генеза: Дис. … докт. психолог. наук. Санкт-Петербург, 2010. 367 с.

[45] Li Y, Chien WT, Bressington D. Effects of a coping-oriented supportive programme for people with spinal cord injury during inpatient rehabilitation: a quasi-experimental study. Spinal Cord. 2020;58(1):58–69. doi: 10.1038/s41393-019-0320-2

[46] Li Y., Chien W.T., Bressington D. Effects of a coping-oriented supportive programme for people with spinal cord injury during inpatient rehabilitation: a quasi-experimental study // Spinal Cord. 2020. Vol. 58, N 1. Р. 58–69. doi: 10.1038/s41393-019-0320-2

[47] Nabiullina RR, Tukhtarova IV. Mechanisms of psychological defense and stress coping (definition, structure, functions, types, psychotherapeutic treatment): a textbook. Kazan; 2003. 98 p. (In Russ).

[48] Набиуллина Р.Р., Тухтарова И.В. Механизмы психологической защиты и совладания со стрессом (определение, структура, функции, виды, психотерапевтическая коррекция): Учебное пособие. Казань, 2003. 98 с.

[49] Kuftyak EV, Lebedev AP, Reunova AA. Psychological mechanisms and coping behaviour as adjustment resources in persons with special needs. In: Humanitarian foundation of the social progress: Russia and modernity: proceedings of the International scientific and practical conference. Part 3. Ed. by V.S. Belgorodskiy, O.V. Kashcheev, V.V. Zotov, I.V. Antonenko. Moscow; 2016. 289 p. (In Russ).

[50] Куфтяк Е.В., Лебедев А.П., Реунова А.А. Психологические механизмы и совладающее поведение как адаптационные ресурсы лиц с особыми потребностями // Гуманитарные основания социального прогресса: Россия и современность. Сборник статей Международной научно-практической конференции (в 8 частях), часть 3 / Под ред. В.С. Белгородского, О.В. Кащеева, В.В. Зотова, И.В. Антоненко. Москва, 2016. 289 с.

[51] Crasovan DI. Psychological defense mechanisms and coping mechanisms in non-psychotic major depressive disorder. J Educat Sci Psychol. 2013;3(2):89–98.

[52] Crasovan D.I. Psychological defense mechanisms and coping mechanisms in non-psychotic major depressive disorder // J Education Sci Psychol. 2013. Vol. 3, N 2. Р. 89–98.

[53] Bowins B. Psychological defense mechanisms: a new perspective. Am J Psychoanal. 2004;64(1):1–26. doi: 10.1023/B:TAJP.0000017989.72521.26

[54] Bowins B. Psychological defense mechanisms: a new perspective // Am J Psychoanal. 2004. Vol. 64, N 1. Р. 1–26. doi: 10.1023/B:TAJP.0000017989.72521.26

[55] Santana MR, Zatti C, Spader ML, et al. Acute stress disorder and defense mechanisms: a study of physical trauma patients admitted to an emergency hospital. Trends Psychiatry Psychother. 2017;39(4):247–256. doi: 10.1590/2237-6089-2016-0071

[56] Santana M.R., Zatti C., Spader M.L., et al. Acute stress disorder and defense mechanisms: a study of physical trauma patients admitted to an emergency hospital // Trends Psychiatry Psychother. 2017. Vol. 39, N 4. Р. 247–256. doi: 10.1590/2237-6089-2016-0071

[57] Morozova EV, Shmeleva SV, Sorokoumova EA, et al. Acceptance of disability: determinants of overcoming social frustration. Glob J Health Sci. 2015;7(3):317–323. doi: 10.5539/gjhs.v7n3p317

[58] Morozova E.V., Shmeleva S.V., Sorokoumova E.A., et al. Acceptance of disability: determinants of overcoming social frustration // Glob J Health Sci. 2015. Vol. 7, N 3. Р. 317–323. doi: 10.5539/gjhs.v7n3p317

[59] Krause JS, Carter R, Pickelsimer E. Behavioral risk factors of mortality after spinal cord injury. Arch Phys Med Rehabil. 2009;90(1):95. doi: 10.1016/j.apmr.2008.07.012

[60] Krause J.S., Carter R., Pickelsimer E. Behavioral risk factors of mortality after spinal cord injury // Arch Phys Med Rehabil. 2009. Vol. 90, N 1. Р. 95. doi: 10.1016/j.apmr.2008.07.012

[61] Bulyubash ID, Morozov IN. Emotional state and aspects of motivation in rehabilitative treatment of patients with the consequences of spinal injury. Palliative medicine and rehabilitation: scientific and practical journal. 2012;(4):51–56. (In Russ).

[62] Булюбаш И.Д., Морозов И.Н. Эмоциональное состояние и особенности мотивации в восстановительном лечении пациентов с последствиями спинальной травмы // Паллиативная медицина и реабилитация. 2012. № 4. С. 51–56.

[63] Yazdanshenas GM, Tavakoli SA, Latifi S, et al. Psychological defense mechanisms among individuals with SCI with adjustment disorder. J Spinal Cord Med. 2017;40(5):538–547. doi: 10.1080/10790268.2016.1140389

[64] Yazdanshenas G.M., Tavakoli S.A., Latifi S., et al. Psychological defense mechanisms among individuals with SCI with adjustment disorder // J Spinal Cord Med. 2017. Vol. 40, N 5. Р. 538–547. doi: 10.1080/10790268.2016.1140389

[65] Shakeri J, Yazdanshenas GM, Rakizadeh E, et al. Do spinal cord-injured individuals with stronger sense of coherence use different psychological defense styles? Spinal Cord. 2016;54(10):843–848. doi: 10.1038/sc.2015

[66] Shakeri J., Yazdanshenas G.M., Rakizadeh E., et al. Do spinal cord-injured individuals with stronger sense of coherence use different psychological defense styles? // Spinal Cord. 2016. Vol. 54, N 10. Р. 843–848. doi: 10.1038/sc.2015

[67] Kennedy P, Kilvert A, Hasson L. A 21-year longitudinal analysis of impact, coping, and appraisals following spinal cord injury. Rehabil Psychol. 2016;61(1):92–101. doi: 10.1037/rep0000066

[68] Kennedy P., Kilvert A., Hasson L. A 21-year longitudinal analysis of impact, coping, and appraisals following spinal cord injury // Rehabil Psychol. 2016. Vol. 61, N 1. Р. 92–101. doi: 10.1037/rep0000066

[69] Eaton R, Jones K, Duff J. Cognitive appraisals and emotional status following a spinal cord injury in post-acute rehabilitation. Spinal Cord. 2018;56(12):1151–1157. doi: 10.1038/s41393-018-0151-6

[70] Eaton R., Jones K., Duff J. Cognitive appraisals and emotional status following a spinal cord injury in post-acute rehabilitation // Spinal Cord. 2018. Vol. 56, N 12. Р. 1151–1157. doi: 10.1038/s41393-018-0151-6

[71] Lee KH, Besthorn FH, Bolin BL, Jun JS. Stress, spiritual, and support coping, and psychological well-being among older adults in assisted living. J Relig Spiritual Soc Work. 2012;31(4):328–347. doi: 10.1080/15426432.2012.716287

[72] Lee K.H., Besthorn F.H., Bolin B.L., Jun J.S. Stress, spiritual, and support coping, and psychological well-being among older adults in assisted living // J Relig Spiritual Soc Work. 2012. Vol. 31, N 4. Р. 328–347. doi: 10.1080/15426432.2012.716287

[73] Khokhlova OI. Rehabilitation potential of personality and functional independence of persons with traumatic spinal cord injury. Polytrauma. 2020;(3):100–107. (In Russ). doi: 10.24411/1819-1495-2020-10038

[74] Хохлова О.И. Реабилитационный потенциал личности и функциональная независимость лиц с травматической болезнью спинного мозга // Политравма. 2020. № 3. С. 100–107. doi: 10.24411/1819-1495-2020-10038

[75] Culver JL, Arena PL, Wimberly SR, et al. Coping among African-American, Hispanic, and non-Hispanic white women recently treated for early stage breast cancer. Psychol Health. 2004;19(2):157–166. doi: 10.1080/08870440310001652669

[76] Culver J.L., Arena P.L., Wimberly S.R., et al. Coping among African-American, Hispanic, and non-Hispanic white women recently treated for early stage breast cancer // Psychol Health. 2004. Vol. 19, N 2. Р. 157–166. doi: 10.1080/08870440310001652669

[77] Kershaw T, Northouse L, Kritpracha C, et al. Coping strategies and quality of life in women with advanced breast cancer and their family caregivers. Psychol Health. 2004;19(2):139–155. doi: 10.1080/08870440310001652687

[78] Kershaw T., Northouse L., Kritpracha C., et al. Coping strategies and quality of life in women with advanced breast cancer and their family caregivers // Psychol Health. 2004. Vol. 19, N 2. Р. 139–155. doi: 10.1080/08870440310001652687

[79] Kim J, Han A, Piatt JA, Kim J. Investigating relationships among coping, personal growth, and life satisfaction among individuals with physical disabilities. Health Promot Perspect. 2020;10(4):401–408. doi: 10.34172/hpp.2020.59

[80] Kim J., Han A., Piatt J.A., Kim J. Investigating relationships among coping, personal growth, and life satisfaction among individuals with physical disabilities // Health Promot Perspect. 2020. Vol. 10, N 4. Р. 401–408. doi: 10.34172/hpp.2020.59

RIGHTS & PERMISSIONS

Eco-Vector