research questions about defense mechanisms

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Defense Mechanisms

• George E. Vaillant 3  
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Adaptive mental mechanisms ; Ego mechanisms of defense ; Involuntary coping mechanisms ; Unconscious adaptive mechanisms

Defense mechanisms (sometimes called adaptive mental mechanisms) reduce conflict and cognitive dissonance during sudden changes in internal and external reality. If such changes in reality are not “distorted” and “denied,” they can result in disabling anxiety and/or depression. Choice of defense is involuntary, but such choice can lead to enormous differences in mental health.

Defense mechanisms can restore psychological homeostasis by ignoring or deflecting sudden increases in impulse, affect, and emotion. Defense mechanisms can provide a mental time-out to adjust to sudden changes in reality or self-image. Defenses can mitigate sudden irresolvable conflict with important people , living or dead. Finally, defenses can mitigate conflict due to social learning or conscience.

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The boundary between pathology and adaptation is ambiguous....

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Vaillant, G.E. (2020). Defense Mechanisms. In: Zeigler-Hill, V., Shackelford, T.K. (eds) Encyclopedia of Personality and Individual Differences. Springer, Cham. https://doi.org/10.1007/978-3-319-24612-3_1372

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Defense Mechanisms

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Defense mechanisms are unconscious strategies whereby people protect themselves from anxious thoughts or feelings.

Defense mechanisms aren’t inherently bad—they can allow people to navigate painful experiences or channel their energy more productively. They become problematic, however, when applied too frequently or for too long.

The concept arose from the work of Sigmund Freud and his daughter Anna. Freud’s framework has proven nearly impossible to empirically validate, and his methods are no longer widely used in therapy . Still, his theories spurred the growth of psychology, and some of his ideas—like defense mechanisms—still stand today. Identifying when a patient employs a defense mechanism, such as projection , for instance, can be a helpful catalyst in the therapeutic process.

Schools of therapy other than Freud's psychoanalytic approach, such as cognitive behavioral therapy, observe similar tendencies and behaviors but attribute them to irrational beliefs rather than to the unconscious. The overarching idea that people act out inner conflicts in specific ways is widely accepted.

• 10 Major Defense Mechanisms
• Theories of Defense Mechanisms
• Defense Mechanisms in Everyday Life

Projection : Attributing one’s unacceptable feelings or desires to someone else. For example, if a bully constantly ridicules a peer about insecurities, the bully might be projecting his own struggle with self-esteem onto the other person .

Denial : Refusing to recognize or acknowledge real facts or experiences that would lead to anxiety . For instance, someone with substance use disorder might not be able to clearly see his problem.

Repression : Blocking difficult thoughts from entering into consciousness, such as a trauma survivor shutting out a tragic experience.

Regression : Reverting to the behavior or emotions of an earlier developmental stage.

Rationalization : Justifying a mistake or problematic feeling with seemingly logical reasons or explanations.

Displacement : Redirecting an emotional reaction from the rightful recipient to another person altogether. For example, if a manager screams at an employee, the employee doesn't scream back—but the employee may yell at her partner later that night.

Reaction Formation : Behaving or expressing the opposite of one’s true feelings. For instance, a man who feels insecure about his masculinity might act overly aggressive.

Sublimation : Channeling sexual or unacceptable urges into a productive outlet, such as work or a hobby.

Intellectualization : Focusing on the intellectual rather than emotional consequences of a situation. For example, if a roommate unexpectedly moved out, the other person might conduct a detailed financial analysis rather than discussing their hurt feelings.

Compartmentalization : Separating components of one’s life into different categories to prevent conflicting emotions.

Defense mechanisms are rooted in Freud’s theory of personality . According to his model, the mind has three dueling forces: the id ( unconscious and primitive urges for food, comfort, and sex), the superego (a partly conscious drive toward moral and social values), and the ego (a partly conscious force that moderates the id and superego).

Anxiety, in this paradigm, emerges when the needs of the id clash with the needs of the superego. To mitigate the tension, the ego deploys strategies of self-deception to avoid the discomfort. The unacceptable thought or emotion may be denied, for example, or rationalized or projected onto someone else.

Many of Freud’s ideas have not stood up to modern scientific scrutiny. But psychological defenses have proven to be an enduring concept, one that researchers and clinicians continue to explore today.

In a testament to the intuitive appeal and potential utility of the idea of psychological defenses, multiple post- Freudian theorists and researchers independently converged on the same concept. Alfred Adler developed a similar idea of “safeguarding strategies,” while Karen Horney described protective strategies used by children of abusive or neglectful parents. Leon Festinger developed the well-known concept of “ cognitive dissonance ,” Carl Rogers discussed the process of defense as denial and perceptual distortion, and Albert Bandura conceptualized defenses as “self-exoneration mechanisms.”

The influential psychiatrist George Vaillant organized defenses on a scale of immature to mature, defining them as “unconscious homeostatic mechanisms that reduce the disorganizing effects of sudden stress .” Current discussions of coping mechanisms and emotion regulation embody the idea of defenses as well.

Like all living systems, human beings have evolved multiple strategies for defending against threats to our survival and physical integrity. The immune system is one example; the fight-or-flight mechanism embedded in our nervous system another. Similar defensive mechanisms have likely evolved to protect and promote the integrity of our psychological architecture—our sense of self, identity , and esteem.

Not always. More of the commonly discussed defenses, such as denial and projection, may be maladaptive and worth addressing in therapy . But the purpose of defense mechanisms is to protect the self from anxiety or distress —and sometimes that’s a good thing. For example, a guest at a party might use humor to diffuse an uncomfortable situation. Or someone in an emotionally draining profession, such as a counselor for suicidal individuals, may decide to compartmentalize their work to better function in daily life.

Life is full of unexpected or challenging situations, and defense mechanisms can potentially alleviate that discomfort. They can manifest, for example, in passive-aggressive behavior when two friends can’t confront conflict or when an employee displaces anger toward her boss onto her daughter that night at dinner. Defense mechanisms can reflect isolated incidents, both beneficial and maladaptive, or a consistent pattern of behavior that can be explored with the help of a therapist.

Defense mechanisms might emerge more severely and consistently in some people due to insecurities in childhood , some psychologists believe. Children may not know how to grapple with or overcome certain challenges, which leads them to question themselves and enact defenses against those challenges. Adults have the ability to address those challenges, but obsolete defense mechanisms might occasionally reappear to alleviate the stress.

Close relationships often arouse our deepest emotions, and sometimes we turn to defenses to manage those emotions. Yet this can lead to more anxiety by driving a wedge into the relationship, so it’s valuable to reflect on whether you or your partner use certain defenses. These include:

• Projection: Do you blame your partner for your own flaws? Rather than admit it, do you accuse your partner of being messy or careless?

• Denial: Do you pretend that negative experiences haven’t occurred? Do you close your eyes and think that everything is going to be fine, even when your partner seems upset?

• Compensation: Do you turn to alcohol or drugs instead of confronting negative emotions? Is it easier to have an extra glass of wine or beer rather than talk to your partner about what's bothering you?

When a person in therapy deploys psychological defenses, it can be an opportunity for the therapist to explore those patterns with the patient. For example, a therapist might work with a patient who denies that they have a problem with drugs or a patient who seems to project their insecurities onto their partner. These instances of self-deception can be an invitation to discuss underlying challenges that may help the patient move forward.

Sometimes it can be helpful to explore a child’s motivations to see if disruptive or bad behavior may be defense mechanisms masking difficult emotions. For example, a 5-year-old might begin acting out after a new baby is born. The anger could mask his sadness at feeling displaced by the new baby in the family. Parents could then approach the angry outbursts by speaking to the child about the change and balancing their attention between the two when possible instead of disciplining the child. A child’s ability to accept and master painful feelings will help him or her mature into a well-adjusted adult.

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Defense Mechanisms Worksheets: 10 Tools for Practitioners

Less widely known is our reliance on psychological defenses to manage our responses to such life events and reduce anxiety (Fang, Chung, & Wang, 2020).

Such automatic and typically unconscious processes act as defense mechanisms, protecting and defending us from further distress while reducing our awareness of internal danger.

Primitive and less effective defense mechanisms are often adopted by those who fail to learn better ways of coping with stressful events (Metzger, 2014).

This article introduces the concept of defense mechanisms and several tools practitioners use to uncover and examine them during therapy.

Before you continue, we thought you might like to download our three Positive CBT Exercises for free . These science-based exercises will provide you with detailed insight into positive Cognitive-Behavioral Therapy (CBT) and give you the tools to apply it in your therapy or coaching.

This Article Contains:

Uncovering defense mechanisms: 4 questionnaires & tests, 6 valuable worksheets for your clients, best books on the topic, positivepsychology.com’s helpful tools, a take-home message.

Our psychological defenses are vital in explaining how we differ in our reactions to trauma and stress (Fang et al., 2020).

Psychology defines such mental processes as “mechanisms that mediate the individual’s reaction to emotional conflicts and to external stressors” (American Psychiatric Association, 2013, p. 819).

Defense mechanisms are typically “ordered hierarchically and divided into four categories according to their psychosocial maturity and level of adaptedness” (Fang et al., 2020, p. 2), as follows:

• Psychotic defenses Mechanisms in place to avoid conflicts experienced in relating to the external world, such as the denial and distortion of what has happened
• Immature defenses Psychological processes that reduce anxiety and distress caused by threatening individuals and reality, such as projection, acting out, and passive aggression
• Neurotic defenses Psychological defenses that intend to keep associated feelings, fears, and ideas outside of awareness, such as repression, displacement, and isolation
• Mature defenses Mental processes that are successful in increasing our sense of gratification  while allowing a conscious awareness of related feelings and ideas, such as humor and altruism

Ultimately, immature psychological defense mechanisms are likely to become associated with psychiatric illness. As such, the development of psychological problems can be managed and moderated by the defense mechanisms used by the individual (Fang et al., 2020).

Therefore, it is valuable for mental health professionals and clients to become more aware of which defense mechanisms mediate the client’s reaction to emotional conflicts and external stressors (Boldrini, Lo Buglio, Giovanardi, Lingiardi, & Salcuni, 2020; Lengfelder, n.d.).

Researchers have developed a series of tests to identify and score defense mechanisms; we describe some of the more popular and well-validated ones below.

Defense Mechanism Rating Scale

The Defense Mechanism Rating Scale (DMRS) is a psychological assessment used to review transcripts of clinical interviews and therapy sessions and assess the use of defense mechanisms.

Each one (from a list of 30) is rated as  no use, probable use, or definite use according to a set of definitions, descriptions, and distinguishing rules (Boldrini et al., 2020).

Three further ratings include:

• Overall defensive functioning – the frequency of each defense mechanism combined with an associated weighting
• Defense level scores – a percentage based on seven defense levels
• Individual defense scores – proportional scores that enable the ordering of the defense mechanisms

Based on the assessment, each defense mechanism is assigned to one of the following seven defense levels, from the least to the most adaptive, as follows:

• Action defenses Used to act or withdraw to deal with stressors (including acting out, passive aggression, etc.)
• Major image distortion defenses Used to eliminate ambivalence by forming a single emotional view (including the splitting of self-image and others’ images)
• Disavowal defenses Used to avoid the reality of stressful events (including denial and projection)
• Minor image distortion defenses Used to dismiss problems by distorting the image of self (including omnipotence or devaluation of self and others)
• Neurotic defenses Used to maintain a lack of awareness regarding conflicting needs and desires (including repression, disassociation, etc.)
• Obsessional defenses Used to distance the individual from threatening feelings while maintaining cognitive awareness without distortion (including undoing, intellectualization, etc.)
• High adaptive defenses Demonstrating the highest (most mature) adaptation to life while integrating feelings, ideas, and consequences (including affiliation, humor, and altruism)

The DMRS can help identify patients at risk of psychosis and is a valuable tool for therapy (Boldrini et al., 2020).

Psychotic-Defense Mechanism Rating Scales (P-DMRS)

• Psychotic denial
• Autistic withdrawal
• Delusional projection
• Fragmentation
• Concretization

The P-DMRS provides another helpful tool for health professionals to identify patients at risk of psychosis (Boldrini et al., 2020).

Defense Style Questionnaire

The Defense Style Questionnaire (DSG-40) is a research-based assessment tool  helpful in identifying the hierarchy of defense mechanisms used by an individual in dealing and coping with conflict (Fang et al., 2020; Giovazolias, Karagiannopoulou, & Mitsopoulou, 2017).

The 40-item questionnaire measures three types of defense styles ( immature , neurotic , and mature ) on a nine-point Likert scale between 1 (strongly disagree) and 9 (strongly agree).

Sample statements include (Fang et al., 2020):

• Immature style – I often act impulsively when something is bothering me.
• Neurotic style – If someone mugged me and stole my money, I’d rather the person be helped than punished .
• Mature style – I work out my anxiety through doing something constructive and creative like painting or woodwork .

The DSG-40 is widely used in research and therapy and is shown to be valid and helpful across various clinical groups. It has proven successful in identifying individuals at risk of bullying and victimization and is particularly helpful in younger populations (Giovazolias et al., 2017).

Life Style Index

The Life Style Index (LSI) is a self-administered questionnaire created to assess eight defense mechanisms. It has been widely used, having been translated into many languages (Hyphantis et al., 2011).

Created by Plutchik, Kellerman, and Conte (1979), the LSI is a 97-item, self-report questionnaire that assesses eight ego defense mechanisms:

• Compensation
• Displacement
• Intellectualization
• Reaction formation

Examples of statements used for assessment include:

I am a very easy person to get along with. When I want something, I just can’t wait to get it. People do not consider me to be an emotional person.

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Identifying and understanding defense mechanisms is essential during the process of psychotherapy.

After all, “not recognizing reality can result in self-injurious behavior” (Cramer, 2015, p. 523).

However, it is important to note that psychological defense mechanisms are an essential element of the human mind, offering protection from psychological upset. As with coping mechanisms , they are part of normal psychological functioning (Cramer, 2015).

Repeated reliance on immature defense mechanisms, however, can be harmful to psychological wellbeing.

The following worksheets focus attention on the recognition and replacement of defense mechanisms adopted by the client and promote self-reflection.

Understanding Your Problem-Solving Approach

Over time, the way we approach and resolve problems becomes habitual and part of our usual way of thinking.

It can be helpful to reflect on how we tackle problems and obstacles and the psychological mechanisms we employ.

Think of an event that has happened or one that you are expecting in the future and use the Understanding Your Problem-Solving Approach  worksheet to answer the following questions:

• What is the situation?
• What were your thoughts (or what are they likely to be)?
• How did you feel (or how do you expect to feel)?
• How did (or will) you react? What behavior did (or will) you show?
• What was (or do you expect to be) the outcome?

Becoming more aware of how you typically react can help you stop, think, and consider if your approach is working or whether it is time to try something new.

What’s the Truth?

People damaging our psychological wellbeing inflict harm by what they say.

While usually false, such statements can cause us to draw upon, sometimes unhelpful, psychological defense mechanisms.

Reflecting on what was said and comparing it with the truth or what we believe to be true can be a positive handling technique.

Use the What’s the Truth? worksheet and capture what was said versus what you know to be true.

Reflect on the ‘truths’ and use them to challenge or replace what was said during or after conversations.

What Should I Say?

Our automatic thoughts and responses can be unhelpful, harming how we react to situations and our cognitive, emotional, and behavioral responses.

Use the What Should I Say? worksheet to rewrite negative thoughts using more positive wording.

In the future, try to replace each negative thought with a more positive one to build a helpful and positive mindset and a growth outlook.

For example:

‘I am useless at doing this’ becomes ‘I am new to this, but with help and hard work, I will soon learn.’

‘No one likes me’ becomes ‘These people don’t know me yet, but I have plenty of other friends.’

Do you know your 12 defense mechanisms? – Kati Morton

What Behavior Do I Want to Change?

Problematic behavior can arise from unhelpful thinking habits, but that does not mean we have to continue with it into the future.

Through reflecting on what has happened, our thinking, and our behavior, we can consider new responses and learn to react in a more positive, helpful way.

Use the questions in the What Behavior Do I Want to Change? worksheet to identify what behavior must be addressed and how this could be achieved, including:

• What is the behavior? (such as, arguing or yelling)
• What can I do to start preparing to change? (such as focusing on relaxation, taking time out when needed)
• What steps should I take to make this happen? (such as enrolling in a mindfulness class or taking some online training)
• What can other people do to help me change my behavior? (such as supporting you and remaining patient after you explain the changes you want to make)

Changing how we think and react can take time, effort, and patience, yet the rewards make it worthwhile.

Tracking My Anger

Immature or unhelpful psychological responses often lead to us lashing out and responding angrily.

Typically, this is hurtful to ourselves and others and damaging to our relationships.

Identifying patterns in our reactions and behavior can help us recognize opportunities to improve.

Use the seven-day tracker in the Tracking My Anger sheet to monitor your anger or any other unwanted reactions over the course of a week.

At the end of the week, review the tracker and consider the triggers and your response.

Ask yourself, what patterns form? Were my responses justified? How else could I handle these situations in the future?

Recognizing How We Think, Feel, and Behave

Our mental and physical responses overlap and impact how we think, feel, and behave.

Creating a physical picture of how we respond – cognitively, emotionally, and physically – can help us understand why we behave as we do.

Identifying patterns in our reactions and behavior can help us recognize opportunities to change unhelpful beliefs, thoughts, and automatic psychological processes.

Download the Recognizing How We Think, Feel, and Behave worksheet. Print out the diagram and think of a difficult situation that you have faced recently.

Scribble or draw pictures beside each label to capture the impact of the event on each element.

Ask yourself, what can I learn from my thoughts, behavior, physical sensations, and emotions? Were they justified, rational, or appropriate?

If not, what could I change in the future?

Several books review the history and the most recent research and findings in psychological defense mechanisms. We have included three of our favorites.

1. Protecting the Self: Defense Mechanisms in Action – Phebe Cramer

This valuable book provides a comprehensive insight into psychological defense mechanisms and their role in human development and psychopathology.

Phebe Cramer provides a detailed examination of the defenses we adopt and engage in as we develop to maintain psychological equilibrium.

Find the book on Amazon .

2. Why Do I Do That? Psychological Defense Mechanisms and the Hidden Ways They Shape Our Lives – Joseph Burgo

Taking strategies from psychotherapy, Joseph Burgo guides the reader on a voyage of self-exploration to understand the role of psychological defenses in excluding difficult emotions from our awareness.

Burgo concludes with a description of how we can disarm our defenses and manage our feelings more successfully.

3. Vital Lies, Simple Truths: The Psychology of Self-Deception – Daniel Goleman

A lighter read, this book is a valuable and fascinating exploration of how we deceive ourselves, from renowned writer Daniel Goleman.

Goleman explains why self-deception is a basic and typically benign human trait, yet it can be damaging and must be kept in check to avoid limiting what we experience and achieve.

We have many tools to help your clients adopt more healthy, helpful, and successful coping strategies and move away from harmful thinking styles and approaches.

To help, check out the following free worksheets and handouts.

• Coping Styles Formulation This CBT coping styles worksheet is based on case conceptualization and can help therapists and clients come to a shared understanding of a presenting problem and develop more adaptive coping strategies.
• Explore Coping Modes This worksheet can help clients systematically track the origin, triggers, and consequences of positive and negative coping strategies.
• TRAPS to Avoid and TIPS for Success This handout puts forward a range of suggestions to facilitate better conflict resolution in families or with kids .
• Challenging Catastrophic Thinking This worksheet invites clients to select an upcoming event they are worried about, explore catastrophic thinking surrounding that event, and realistically evaluate different outcomes and coping resources at their disposal.
• Thought Record Worksheet This worksheet helps clients systematically recognize and review dysfunctional thinking triggered in response to particular situations or events.

17 Positive CBT Exercises If you’re looking for more science-based ways to help others through CBT, this collection contains 17 validated positive CBT tools for practitioners . Use them to help others overcome unhelpful thoughts and feelings and develop more positive behaviors.

17 Science-Based Ways To Apply Positive CBT

These 17 Positive CBT & Cognitive Therapy Exercises [PDF] include our top-rated, ready-made templates for helping others develop more helpful thoughts and behaviors in response to challenges, while broadening the scope of traditional CBT.

Created by Experts. 100% Science-based.

Immature psychological defense mechanisms are associated with mental health issues. At the same time, more mature processing of positive and negative events can benefit psychological wellbeing (Cramer, 2015).

Therapists and clients need to understand the defense strategies being employed, especially those that are ongoing and used to handle troublesome life events.

Using verified questionnaires can provide a more complete picture of psychological wellness and valuable insight into interventions that promote a healthy outlook and an increased awareness of (typically) unconscious, automatic thinking.

Choosing mature defense mechanisms will help the client tackle life head on while being engaged and present in the negatives and the positives they face. Strategies such as humor protect us from stress and anxiety while promoting positive mental health, resilience , and greater engagement.

Try out some of the questionnaires and worksheets, and use them for client psychoeducation to increase their awareness of the strategies they adopt and give them the power of choice and control over how they respond to life events.

We hope you enjoyed reading this article. Don’t forget to download our three Positive CBT Exercises for free .

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Author.
• Boldrini, T., Lo Buglio, G., Giovanardi, G., Lingiardi, V., & Salcuni, S. (2020). Defense mechanisms in adolescents at high risk of developing psychosis: An empirical investigation. Research in Psychotherapy: Psychopathology, Process and Outcome, 23 (1).
• Burgo, J. (2012).  Why do I do that? Psychological defense mechanisms and the hidden ways they shape our lives.  New Rise Press.
• Cramer, P. (2006).  Protecting the self: Defense mechanisms in action.  Guilford Press.
• Cramer, P. (2015). Understanding defense mechanisms. Psychodynamic Psychiatry , 43 (4), 523–552.
• Fang, S., Chung, M. C., & Wang, Y. (2020). The impact of past trauma on psychological distress: The roles of defense mechanisms and alexithymia. Frontiers in Psychology , 11 .
• Giovazolias, T., Karagiannopoulou, E., & Mitsopoulou, E. (2017). Can the factor structure of Defense Style Questionnaire (DSQ-40) contribute to our understanding of parental acceptance/rejection, bullying, victimization and perceived well-being in Greek early adolescents? Europe’s Journal of Psychology , 13 (2), 269–285.
• Goleman, D. (1996).  Vital lies, simple truths: The psychology of self-deception.  Simon & Schuster.
• Hyphantis, T., Goulia, P., Floros, G. D., Iconomou, G., Pappas, A. I., Karaivazoglou, K., & Assimakopoulos, K. (2011). Assessing ego defense mechanisms by questionnaire: Psychometric properties and psychopathological correlates of the Greek version of the Plutchik’s Life Style Index. Journal of Personality Assessment , 93 (6), 605–617.
• Lengfelder, B. (n.d.). Clinical education and interventions for defense structures of co-occurring populations . Retrieved August 4, 2021, from https://www.naadac.org/assets/2416/brian_lengfelder_ac17ppt.pdf
• Metzger, J. A. (2014). Adaptive defense mechanisms: Function and transcendence. Journal of Clinical Psychology , 70 (5), 478–488.
• Plutchik, R., Kellerman, H., & Conte, H. R. (1979). A structural theory of ego defenses and emotions. In C. E. Izard (Ed.), Emotions in personality and psychopathology (pp. 229–256). Plenum.

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Article contents

Defense mechanisms.

• Phebe Cramer Phebe Cramer Williams College, Emerita
• https://doi.org/10.1093/acrefore/9780190264093.013.896
• Published online: 30 June 2020

Defense mechanisms are mental operations that function outside of awareness. In this sense, they operate in the unconscious mind. Such mechanisms were first identified by Sigmund Freud in connection with psychopathology but later were understood to be part of normal everyday functioning. Defenses serve the purpose of protecting the individual from excessive anxiety and loss of self-esteem.

Defense mechanisms have been found to change with age, based on the complexity of the mental operations involved. Once a child understands how a defense mechanism functions, the mechanism tends to be used less frequently and a cognitively more complex mechanism is adopted.

• defense mechanism development

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date: 25 April 2024

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Common Defense Mechanisms and How They’re Used

Common defense mechanisms.

• How Are They Used
• Are They Okay To Use
• Stop Unhealthy Use

Frequently Asked Questions

Sigmund Freud , the creator of psychoanalysis , coined the term "defense mechanisms" (also sometimes called ego defense mechanisms or coping styles) in 1926.

Freud's term attempted to explain how individuals manage stress and described them as relatively involuntary responses to internal or external factors surrounding thoughts, feelings, and behaviors.

Defense mechanisms consciously or unconsciously aim to protect against anxiety and emotional stress. They can also kick in when a person's self-esteem feels threatened.

Over 40 different defense mechanisms have been identified as others continue to expand upon Freud's original theory. Read on to learn about some of the more common ones.

laflor / Getty Images

There are too many identified defense mechanisms to cover in-depth here, but some stand out as more commonly described.

• Denial : Not admitting to or not accepting the reality of a painful situation
• Displacement : Shifting negative urges or emotions to a safer or neutral substitute object or person
• Repression : Something that a person was once aware of is removed from conscious awareness, moving to the unconscious part of the mind ("forgetting" the stressful event or thoughts)
• Projection : The extension, shifting, or attributing of a person's own feelings or thoughts about themselves onto another person
• Sublimation : Shifting, diverting, or deflecting undesirable feelings or thoughts, or unattainable impulses toward something more goal-oriented or socially acceptable
• Regression : Returning to an earlier developmental stage or childlike state in response to a stressor in the current stage
• Rationalization : Replacing a real (but stressful) cause of behavior with an easier-to-handle excuse or explanation
• Intellectualization : Using abstract, rational, and/or logical reasoning (often to excess) to distance from stress and avoid reacting or changing
• Reaction formation : Denying or rejecting unacceptable, painful, or offensive traits or impulses by behaving in an opposite manner
• Introjection : The opposite of projection, this entails incorporating external beliefs or traits (often from other people) into a person's sense of self and set of beliefs—the absorbed traits, behaviors, or qualities can be positive or negative
• Suppression : Intentionally and consciously postponing or holding back a painful or undesirable thought, idea, or impulse
• Splitting : "All or nothing" thinking about a subject, person (including self), or group
• Distortion : Altering perception of reality to fit their own needs or wants ("seeing what they want to see"), which can include hallucinations or wish-fulfilling delusions
• Altruism : Getting personal satisfaction and coping with stressors by helping others
• Humor : Expressing negative feelings or thoughts using humor, instead of discussing them directly, to ease personal discomfort and the discomfort of others
• Anticipation : Planning for future discomforts in a realistic, actionable way
• Compartmentalization : Keeping conflicting ideas and self-concepts separate to avoid confusion, shame, guilt, or anxiety

Outward Manifestations

Tactical defense mechanisms (also called character defense mechanisms) work to distance you from others. They include:

• Speaking in generalities
• Contradictory statements
• Changing the subject
• Argumentativeness
• Dismissiveness
• Some non-verbal expressions

How Do Defense Mechanisms Work?

Examples of defense mechanisms in use include:

• Denial : A person who has received a cancer diagnosis does not acknowledge their condition and plans a vacation during the time treatments will be starting.
• Displacement : A person gets angry with their spouse instead of confronting their boss, who is the real source of their anger.
• Repression : An adult who has a fear of water does not recall that they almost drowned in a pool as a child.
• Projection : An unfaithful spouse accuses their partner of cheating.
• Sublimation : A marathon runner uses their feelings of anger as motivation during training.
• Regression : A toilet-trained child begins to wet the bed or their clothing after a sibling is born.
• Rationalization : A university student attributes a low test score to the professor not liking them, rather than their lack of studying.
• Intellectualization : A person does in-depth research on their condition to try to avoid emotions brought on by a serious medical diagnosis.
• Reaction formation: A person who despises their co-worker behaves overly friendly toward them.
• Introjection : A teenager dresses in a style similar to their favorite singer's.
• Suppression : After a long day at work, a person tells their spouse, "I don't want to talk about it."
• Splitting : A person has a negative interaction with a therapist and decides all therapists are unhelpful.
• Distortion : Reading a horoscope and noticing only the parts that fit accurately.
• Altruism : A person volunteers at a food bank regularly when stressed.
• Humor : A person spills their coffee on a table in a cafe and makes a joke to avoid embarrassment
• Anticipation : A student learns deep breathing and other measures to calm their nerves before making a speech in front of the school.
• Compartmentalization : A parent has a job that requires them to be strict at work, but they are loving and gentle with their family at home.

Is It Okay to Use Defense Mechanisms?

Defense mechanisms can be helpful or harmful, depending on the situation, the mechanism, and how it is used.

Though some nuance is involved, Harvard psychiatrist George Vaillant categorized defense mechanisms into four general levels:

• Level 1—Pathological : Includes splitting, projection, denial, distortion
• Level 2—Immature (Primitive) : Includes regression, acting out, primitive idealization, blocking, hypochondriasis , identification, passive aggression , somatization , undoing, fixation, fantasy
• Level 3—Neurotic : Includes displacement, intellectualization, rationalization, reaction formation, repression, controlling, isolation of affect, externalization, dissociation, sexualization, inhibition
• Level 4—Mature (Sophisticated) : Includes sublimation, altruism, suppression, humor, anticipation

Some defense mechanisms—such as projection, splitting, and acting out—are maladaptive by nature and unlikely to be helpful regardless of the situation.

Others, such as suppression, can be adaptive or maladaptive, depending on how they are used. For example, a person who holds in their emotions instead of talking to someone or working through them in a healthy way would be using suppression in a maladaptive manner and likely to experience negative consequences.

On the flip side, a person who is scared of needles but suppresses their feelings of fear while they receive their flu shot would be using suppression adaptively and likely to experience positive results.

How to Eliminate Unhealthy Defense Mechanisms

Changing unhealthy defense mechanisms can be challenging because they provide comfort in the moment, and not using them can make you feel vulnerable at first.

Making changes to unhealthy defense mechanisms that hold you back in favor of more adaptive ones may be difficult but is worth it for the long-term gains.

Psychotherapy is a good place to start for learning how to cope in healthy ways.

Therapies that can help develop healthy defense mechanisms and coping strategies include:

• Cognitive behavioral therapy (CBT) : Identifying and recognizing dysfunctional thought processes and behaviors, then changing them (over time) into functional ones
• Schema therapy : Builds on previously existing therapies such as CBT and helps change long-term patterns, including how a person interacts with others

In addition to professional help, some ways to help with recognizing and addressing your defense mechanisms include:

• Keep your mindset about your emotional experiences constructive and nonjudgmental.
• Investigate the things that most "set you off."
• Consider the roles fear, shame, guilt, and anger play in your emotional experiences.
• Recognize that feelings that seem imbalanced or disproportionate may be more representative of the past than the present.
• Look for needs that are unmet or that conflict.
• Examine your responses in relationships.

Defense mechanisms are conscious or unconscious reactions to stressful situations aimed at protection from negative feelings, particularly anxiety .

There are dozens of identified defense mechanisms, some more commonly recognized than others.

Defense mechanisms can be adaptive or maladaptive. Some defense mechanisms can be either, depending on the circumstances and how they are used.

Changing maladaptive defense mechanisms into adaptive ones can be difficult but is possible. Psychotherapies such as CBT and schema therapy may be especially helpful.

A Word From Verywell 

Chances are you recognize some of these defense mechanisms as ones you employ. That's natural. Everyone uses defense mechanisms in one form or another.

If you feel your go-to defense mechanisms are not benefiting you in the long run, it's worth putting in the work to develop more adaptive coping strategies. If you want to address your coping behaviors, see a mental health professional .

Crying can be considered a self-soothing behavior because of its effects as a stress reducer and mood enhancer. It can provide a release for stress and emotional pain and bring feelings of relief.

A person uses defense mechanisms when they feel emotionally threatened. They are an attempt to avoid feeling negative feelings, particularly anxiety .

It depends on how they are used, but defense mechanisms that are considered highly adaptive include:

• Affiliation
• Anticipation
• Self-assertion
• Self-observation
• Sublimation
• Suppression

Panfil AL, Frandes M, Nirestean A, et al. Interrelation between defensive mechanisms and coping strategies in psychiatry trainees in Romania: a multicenter study . Ann Gen Psychiatry. 2020;19(1):56. doi:10.1186/s12991-020-00307-1

NAADAC, the Association for Addiction Professionals. Clinical education and interventions for defensive structures of co-occurring populations .

Nurselabs. Defense mechanisms .

Paradiso S, Brown WS, Porcerelli JH, Tranel D, Adolphs R, Paul LK. Integration between cerebral hemispheres contributes to defense mechanisms . Front Psychol. 2020;11:1534. doi:10.3389/fpsyg.2020.01534

Seattle Anxiety. Defense mechanisms .

Amboss. Psychotherapy and defense mechanisms .

Békés V, Ferstenberg YA, Perry JC. Compartmentalization . In: Zeigler-Hill V, Shackelford TK, eds. Encyclopedia of Personality and Individual Differences. Springer International Publishing; 2018:1-5. doi:10.1007/978-3-319-28099-8_1939-1

Britannica. Defense mechanism .

Foundation For Change. Ego defense mechanisms handout .

PsychAlive. Defense mechanisms .

Harvard Health. Is crying good for you?

Gračanin A, Bylsma LM, Vingerhoets AJJM. Is crying a self-soothing behavior? Front Psychol. 2014;5. doi:10.3389/fpsyg.2014.00502

Di Giuseppe M, Perry JC. The hierarchy of defense mechanisms: assessing defensive functioning with the defense mechanisms rating scales Q-sort . Front Psychol. 2021;12:718440. doi:10.3389/fpsyg.2021.718440

By Heather Jones Jones is a freelance writer with a strong focus on health, parenting, disability, and feminism.

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Mature vs. Primitive Defense Mechanisms

Toketemu has been multimedia storyteller for the last four years. Her expertise focuses primarily on mental wellness and women’s health topics. 

Ivy Kwong, LMFT, is a psychotherapist specializing in relationships, love and intimacy, trauma and codependency, and AAPI mental health.  

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Types of Defense Mechanisms

Common defense mechanisms.

• Why People Use Defense Mechanisms
• When You Might Need Help

Defense mechanisms are methods people use to cope with feelings of stress or anxiety. These methods can vary widely in their degree of helping or potentially causing further harm. For most people, defense mechanisms are unconscious behaviors.

Identifying and recognizing adaptive and maladaptive defense mechanisms, as well as their root causes or triggers, can help you understand and care for yourself better.

Sigmund Freud, the renowned psychoanalyst, was the first person to propose the idea of  defense mechanisms . Freud believed people unconsciously used defense mechanisms to help protect themselves from difficult or uncomfortable thoughts, feelings, or situations.

At a Glance

Defense mechanisms are ways to manage feelings of anxiety. These can be mature and adaptive, such as using humor or sublimation to cope. They can also be primitive, immature, or maladaptive, such as using projection or passive-aggressiveness.

This article discusses the most frequently used defense mechanisms and why people use them. It also looks at situations where you might need help and what kind of help would be available to you. 

Defense mechanisms are sometimes broadly classified into either primitive defenses or mature defenses. Mature defense mechanisms are more adaptive, and primitive defenses are less adaptive.

Primitive Defense Mechanisms

Primitive defense mechanisms are the first to occur developmentally and include regression, denial, splitting, projection, fixation, fantasy, identification, passive aggression, rationalization, reaction formation, idealization, and acting out.

Primitive mechanisms are sometimes further broken down into either neurotic or immature defenses. Neurotic defenses include intellectualization, undoing, repression, dissociation, reaction formation, and displacement.

Examples of immature defense mechanisms include denial, rationalization, projection, splitting, and acting out.

Mature Defense Mechanisms

Mature defense mechanisms may be more helpful and inflict less harm upon yourself and others. The mature defenses involve accepting reality even if it is disliked. Uncomfortable thoughts, feelings, and situations are interpreted and addressed in less threatening forms instead of being denied.

People can practice choosing to use mature defense mechanisms as they may not happen naturally. They often require intention, practice, and effort. Mature defense mechanisms include altruism, anticipation, humor, sublimation, and suppression.

In the early twentieth century, Anna Freud, the daughter of Sigmund Freud, highlighted ten of the most common defense mechanisms people use. Psychoanalysts are constantly expanding on this number. Here’s a breakdown of the most common types of defense mechanisms people use.

Avoidance is a defense mechanism people use to avoid handling a problem at hand. With  avoidance , you’ll dismiss any uncomfortable or negative thoughts or feelings without trying to understand them.

You might also avoid people or places that make you uncomfortable to the extent that it disrupts your personal life. 

In the long run, avoidance may not be a sustainable solution and can compound a stressful situation. If it is safe and possible to do so, addressing and resolving a stressful situation directly can be more helpful. Using drugs or alcohol to circumvent dealing with your feelings or a difficult situation is also a form of avoidance.

Denial is used to avoid dealing with a stressful or overwhelming situation. When a person is in denial, they refuse to accept the reality of their situation.

For instance, if you are going through a rough divorce, you might stay in denial about the fact that your partner is about to leave you until it happens. The problem with denial is that it stops you from dealing with a situation when you should.

If you've just received shocking or life-changing news, denial can give you some time to come to terms with your new reality. However, if you remain in a state of denial, it could disrupt your life by keeping you disconnected from reality.

Projection is an unconscious act of taking unwanted emotions or traits you don't like or refuse to accept about yourself and attributing them to someone else. For instance, a person who is cheating might suspect or accuse their partner of cheating.

Projection tends to be rooted in all-or-nothing, black-and-white thinking , where people view things as either all-good or all-bad. 

Researchers have found that this type of defense mechanism tends to emerge during adolescence. In many cases, people use it less frequently as they begin to develop more mature defense mechanisms.

Distortion 

Distortion is the misinterpretation of your environment to see what you want to see, the way you want to see it. Your unconscious brain may seek out data that supports your beliefs and ignores evidence against it to protect your ego so you can perceive yourself as right or good instead of having made a mistake.

A delusion is a type of distortion. It may arise in response to feelings such as loneliness or inadequacy.

Delusions, like most defense mechanisms, show up in ways that range from adaptive to maladaptive. A person might have an adaptive delusion when they read and believe in horoscopes, picking out only what's true for them, and being amazed that they are so accurate—while ignoring or dismissing anything from the horoscope that does not resonate with them.

An example of a maladaptive delusion could be a person denying COVID-19 exists and refusing to wear a mask to prevent the spread of the illness. They may find information to support their belief, and ignore all evidence that suggests otherwise—even to the detriment to their own or a loved one's health.

Repression 

With repression , a person will block out painful or overwhelming feelings and emotions in situations where they experience them. You often have no control over the thoughts and emotions you repress. 

Repressed memories or feelings don’t just disappear, however. During therapy, or in certain unsuspecting moments, you might find yourself uncovering them. A person who was abused by their parents as a child, for instance, may repress the memories and be unaware of them as an adult, insisting their parents were wonderful and never hurt them.

Suppression, on the other hand, is a conscious and intentional form of repression where you choose not to interact with or talk about distressing thoughts, feelings, or situations. You are aware of them, but you may put off addressing them until a later time. The ways suppression may be used can range from maladaptive to adaptive.

Identification

Identification involves a person adopting the thoughts and behaviors of a person who has power over them. In many identification cases, the person using it as a coping mechanism is being abused.

A great example of identification is in people who have Stockholm Syndrome . In such cases, they form an emotional bond with their captor or abuser and adapt their negative traits and behaviors.

Intellectualization 

With intellectualization, people use reason, logic, and facts to avoid uncomfortable feelings or situations. Many times, people use intellectualization to avoid dealing with their emotions. For instance, they might justify cheating on a test because they needed the grade to graduate. 

Regression 

Regression involves an individual coping with a traumatic, stressful, or anxiety-provoking situation by returning to an earlier developmental stage, or going psychologically back to a period in time.

For instance, a child who was abused and has been potty trained might start bedwetting again. It's possible for regression to occur at any stage of your life.

Sublimation 

Sublimation , in many cases, is a positive defense mechanism. People who use it as a defense mechanism will substitute their more aggressive or problematic impulses with healthier and more positive alternatives.

For instance, a person who has been feeling a lot of pent-up anger and frustration might start playing a contact sport like football to channel these emotions healthily.

Dissociation 

Dissociation involves disconnecting from yourself  and your own thoughts, feelings, memories, or sense of identity. It often happens in response to a traumatic situation, like when a person is being abused. Like all defense mechanisms, forms of dissociation can range from mild to extreme.

Symptoms of dissociation may include having an out-of-body experience (which may happen during extreme physical violence such as rape or assault), feeling like you're a different person, feeling emotionally or physically numb or detached , and not feeling any pain. "Zoning out" is a very mild form of dissociation.

A person who frequently uses dissociation as a defense mechanism might develop a dissociative disorder. If you have a dissociative disorder, you’ll have no control over the situations and scenarios you dissociate from.  Dissociation often happens unconsciously.

Displacement 

Displacement involves taking out difficult feelings, frustrations, and impulses on a less threatening person or object. For example, someone who is yelled at by their boss and has a bad day at work might not say anything directly to their boss. However, they may come home and yell at or take their frustrations out on their child.

Why People Use Defense Mechanisms 

Many defense mechanisms happen unconsciously as attempts to protect your ego and to avoid uncomfortable feelings, thoughts, or impulses. They can range from mild to extreme and maladaptive to adaptive.

People who have been abused and have  mental health conditions like anxiety and depression often use defense mechanisms to cope in their day-to-day lives. While using defense mechanisms in the short term might make you feel good, you should avoid them as often as you can. 

It can be helpful to work with a therapist to help identify and understand how defense mechanisms show up in your life, psyche, and reactions so you can deepen your awareness and expand your choice about how to react when stressful situations or feelings arise.

When You Might Need Help 

If you find that you are routinely falling back on defense mechanisms to cope even in the slightest of uncomfortable situations, you might need help.

Help for people who depend on defense mechanisms is often therapy. In therapy, you’ll be equipped with the means to develop adaptive ways to deal with stressful, uncomfortable, or overwhelming situations.

If your unconscious usage of defense mechanisms results in significant functional impairment, you may want to consult with a psychiatrist or physician to explore how medication may help.

What This Means For You

Defense mechanisms are common and expected. Using a defense mechanism to protect yourself in specific scenarios can be adaptive. For instance, intellectualizing a challenging situation can help you realize that maybe some positive change came from it.

However, it would be best not to rely on harmful defense mechanisms whenever you are in a difficult situation because it may cause you to disconnect from reality. If you need assistance, don't hesitate to reach out to a mental health professional .

Di Giuseppe M, Perry JC. The hierarchy of defense mechanisms: assessing defensive functioning with the defense mechanisms rating scales q-sort . Front Psychol . 2021;12:718440. doi:10.3389/fpsyg.2021.718440

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Békés V, Perry JC. Identification. In: Zeigler-Hill V, Shackelford TK, eds. Encyclopedia of Personality and Individual Differences. Springer International Publishing; 2017:1-4.

Costa RM. Regression(Defense mechanism). In: Zeigler-Hill V, Shackelford TK, eds. Encyclopedia of Personality and Individual Differences. Springer International Publishing; 2020:4346-4348.

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By Toketemu Ohwovoriole Toketemu has been multimedia storyteller for the last four years. Her expertise focuses primarily on mental wellness and women’s health topics.

• Open access
• Published: 25 April 2024

Two putative calcium-dependent protein kinases are involved in the regulation of sugarcane defense genes

• Xiangguo Li 1 , 2   na1 ,
• Jiajie Zhong 2 , 3   na1 ,
• Baiyang Li 2 , 3 ,
• Yingfeng Luo 2 ,
• Kailun Wang 2 ,
• Yu Wang 2 , 3 ,
• Ziqin Ye 2 , 3 ,
• Lifan Sun 2 ,
• Jinghan Zhang 2 , 4 ,
• Liu Yang 5 ,
• Lixiang Wang 1 &
• Jie Zhang   ORCID: orcid.org/0000-0003-2781-8956 2  

Phytopathology Research volume  6 , Article number:  22 ( 2024 ) Cite this article

Metrics details

Sugarcane is a primary sugar crop and an important source of bioenergy. Pathogens are the major factors affecting sugarcane yield and sugar content. However, the mechanisms of sugarcane defense regulation remain largely unknown, and research on prospective genetic targets for modification is scarce. As the main class of calcium sensors, calcium-dependent protein kinases (CDPKs/CPKs) play a crucial role in the immune regulatory network. Using sugarcane genomic data, we identified 229 putative ScCDPKs in primordial specie Saccharum officinarum . Searching the putative CDPKs in sugarcane cultivars from National Center for Biotechnology Information (NCBI), 12 putative ScCDPKs in cultivars were identified. Phylogenetic analysis revealed evolutionary relationships among these CDPKs in sugarcane cultivars and those in S. officinarum , Arabidopsis thaliana , and rice. Truncation mutants of ScCDPKs were introduced into the reporter system and examined for activity in inducing Sugarcane Pathogenesis Related Protein 1 ( ScPR1 ). The results showed that truncated ScCDPK1 and ScCDPK8 induce higher expression of ScPR1 than full-length ScCDPK1 and ScCDPK8. Additionally, transient expression of truncated ScCDPK1 and ScCDPK8 exhibit stronger activity in sugarcane protoplasts for activation of ScPR1 and sugarcane Serine Protease Inhibitor ( ScSPI ). These results demonstrate that ScCDPK1 and ScCDPK8 possess auto-inhibitory activity. The findings of this study provide a basis for an in-depth study of the sugarcane CDPK gene family and lay the foundation for further genetic improvement.

Plants have evolved sophisticated signaling pathways in response to abiotic and biotic stresses in the natural environment (Hepler 2005 ). Within many pathways, calcium serves as an important secondary messenger in cellular signal transduction (Sanders et al. 2002 ). External environmental stimuli lead to a transient cytoplasmic increase in Ca 2+ . Cytoplasmic Ca 2+ signals are detected by several types of calcium-sensing proteins, which usually contain a conserved helix-loop-helix EF-hand motif that directly binds Ca 2+ to the sensors. Three major classes of calcium-sensing proteins have been characterized in plants, including Calmodulin (CaM/CAM) and CaM-like (CML) proteins, calcium-dependent protein kinases (CDPKs/CPKs), calcineurin B-like (CBL) proteins, and CBL-interacting protein kinases (CIPKs) (Luan et al. 2002 ; Bouché et al. 2005 ; McCormack et al. 2005 ; Kashir et al. 2013 ). Different sensors decode specific calcium signatures and transduce them into downstream effects, including oxidative burst, cell death, stomatal movements, hormonal signaling, and gene expression (Martín and Busconi 2000 ; Harmon et al. 2001 ; Luan 2009 ; Yip Delormel and Boudsocq 2019 ).

CDPKs are Ser/Thr protein kinases widely distributed in plants and certain types of protists (Cheng et al. 2002 ). CDPK harbors four typical domains, a variable N-terminal variable domain (VNTD), a serine/threonine kinase domain, an auto-inhibitory junction domain (AID), and a C-terminal regulatory calmodulin-like domain (CaM-LD) (Yip Delormel and Boudsocq 2019 ). The VNTD is involved in identifying diverse substrates and plays a crucial role in subcellular localization owing to its myristoylation and palmitoylation sites (Martín and Busconi 2000 ). The catalytic Ser/Thr kinase domain is highly conserved, contains an ATP-binding site, and exhibits extensive homology across species (Yoo and Harmon 1996 ). The AID domain is adjacent to the Ser/Thr kinase domain and forms a helical structure that interacts with the kinase domain to block its active site (Sanders et al. 1999 ). Previous studies have shown that AID mutations (simultaneous deletion of AID and CaM-LD) produce a constitutively active kinase independent of Ca 2+ (Yoo and Harmon 1996 ; Tian et al. 2020 ). CaM-LDs are composed of one to four EF-hand motifs for Ca 2+ binding, and thus, the interaction between CaM-LD and AID induces conformational changes in CDPK, which exposes the active site of the kinase domain, leading to the phosphorylation of substrates. (Wernimont et al. 2011 ).

In plants, a rapid and transient increase in cytoplasmic Ca 2+ concentration is one of the earliest immune responses to pathogen-associated molecular pattern (PAMP) perception. By monitoring changes in cytoplasmic Ca 2+ concentrations, CDPKs translate cytoplasmic Ca 2+ levels into downstream signaling cascades through the kinase-induced phosphorylation of various substrates (Zielinski 1998 ). In Arabidopsis thaliana , AtCDPK4/5/6/11 has been identified as a Ca 2+ sensor that directly phosphorylates the NADPH oxidase AtRBOHD, as well as the specific transcription factors WRKY48 and WRKY28 to regulate the immune signaling (Dubiella et al. 2013 ). AtCDPK28 negatively regulates PAMP-induced signaling and resistance to Pseudomonas syringae pv. tomato by phosphorylating PLANT U-BOX 25 (PUB25) and PUB26, which controls BOTRYTIS-INDUCED KINASE 1(BIK1) accumulation (Kadota et al. 2014 ; Monaghan et al. 2014 ). TOUCH 3 (TCH3) relieves the auto-inhibition of AtCDPK5 to elicit PAMP-induced CBP60g phosphorylation (Sun et al. 2022a ). Similarly, a previous study showed that the rice AtBIK1 ortholog OsRLCK176 is phosphorylated by OsCDPK4, resulting in the degradation of OsRLCK176 and restricted plant defenses (Wang et al. 2018 ). Furthermore, mutual phosphorylation of OsMPK5 and OsCDPK4/18 regulates kinase activity, thereby coordinating plant growth and disease resistance (Li et al. 2022a ).

Sugarcane ( Saccharum spp.) is a prime sugar crop that accounts for 26% of global bioethanol production (Oz et al. 2021 ), whose growth and productivity are severely affected by pathogens such as Sporisorium scitamineum , Fusarium sacchari , and Pythium arrhenomanes . The vast majority of sugarcane main cultivars are susceptible to diseases (Yang and Mirkov 1997 ). Breeding disease-resistant varieties is one of the most effective measures to cope with sugarcane pathogens. However, sugarcane is a heteropolyploid crop with a complex genetic background. Therefore, breeding disease-resistant varieties using traditional crossbreeding techniques is challenging. Moreover, the diversity of pathogens and rapid evolution of pathogen virulence increase the difficulty of breeding varieties with commercial cultivation value (Bhuiyan et al. 2021 ). Due to the lag in deciphering the sugarcane genome, the identification of functional genes in sugarcane has proceeded slowly. To date, only the brown rust resistance gene ( BRU1 ) has been a target in breeding, and biotechnological tools to improve the breeding process are lacking, resulting in insufficient research on the regulatory mechanisms of sugarcane resistance and targets for editing in the sugarcane genome (Asnaghi et al. 2004 ).

With the rapid progress in sequencing technology, a growing number of major crop genome sequencing techniques have made outstanding breakthroughs. For example, genome sequencing of major food crops (wheat, corn, sorghum, millet, etc.), cash crops (cotton, soybean, etc.), and horticultural crops (main vegetables, fruit trees, etc.) has been completed, including the genome of the autopolyploid sugarcane Saccharum spontaneum , contributing to molecular breeding and germplasm resource research (Sun et al. 2022b ; Zhang et al. 2022 ). Although significant progress has been made in genome analysis, the functions of immune regulatory genes in the sugarcane genome remain largely unknown and research on targets that can be used for modification is scarce.

Identification and phylogenetic analysis of putative CDPKs in sugarcane

S. officinarum , whose genome has been deciphered, is one of the core original varieties of the major sugarcane cultivars (Jiang et al. 2023 ). Searching for CDPK genes in S. officinarum for further study of CDPKs in the cultivar, we performed a genome-wide analysis based on sugarcane genomes from NCBI and the sugarcane genome hub. We used the CDPK protein sequences of Arabidopsis and rice as queries to perform BLASTP analysis in the local sugarcane protein database. With reference to annotations from eggNOG 5.0, we eventually received a total of 229 putative CDPKs in S. officinarum .

The genomes of the major cultivars of sugarcane have not yet been decoded, and there are genomic differences and genetic diversity between S. officinarum and sugarcane cultivar. Searching for the putative CDPKs from NCBI genomic data, 12 putative CDPKs in the cultivars were identified and analyzed for their function in defense. According to the pairwise-distance between AtCDPK1 and 12 putative CDPKs, we renamed them ScCDPK1-12.

The evolutionary relationships of putative CDPKs were analyzed through a neighbor-joining (NJ) phylogenetic tree (Fig.  1 ). The phylogenetic tree was constructed with alignments of CDPKs from sugarcane cultivar, S. officinarum , Arabidopsis , and rice. Similar to Arabidopsis and rice, CDPKs in sugarcane were grouped into four subgroups, with 49, 64, 90, and 101 members in subgroup I, II, III, and IV, respectively. Among these four subgroups, subgroup IV was the largest group including 11 rice members, 10 Arabidopsis members, and 80 sugarcane members. Subgroup I was the smallest one with 49 members, of which 3 were from Arabidopsis , 2 were from rice, and 44 were from sugarcane.

Phylogenetic relationship among the calcium-dependent protein kinases (CDPK) of sugarcane cultivars, Saccharum officinarum , rice, and Arabidopsis thaliana . The phylogenetic tree was constructed based on an amino acid sequence alignment using Neighbor-Joining method with p-distance and bootstrap analysis (1000 replicates)

ScCDPK1 NT and ScCDPK8 NT enhanced the expression of ScPR1 in Nicotiana benthamiana

We analyzed the characteristics of 12 ScCDPKs. As shown in Table  1 , the coding region of CDPK family members varies from 789 to 1800 bp, among which the ScCDPK11 gene is the shortest and the ScCDPK12 gene is the longest. The amino acids encoded by the CDPK family range from 262 to 599 aa, with a minimum isoelectric point of 5.37 (ScCDPK2) and a maximum isoelectric point of 9.01 (ScCDPK12). ScCDPKs except for ScCDPK10, ScCDPK11, and ScCDPK12, feature typical auto-inhibitory junction domains, indicating their potential for auto-inhibitory activity. In addition, most ScCDPKs have four EF-hand motifs in the CaM-LD that recognize and bind Ca 2+ .

Since ScCDPK10, ScCDPK11, and ScCDPK12 are deficient in AID and CaM-LD, we analyzed and compared the protein structures of ScCDPK1, ScCDPK2, ScCDPK3, ScCDPK4, ScCDPK5, ScCDPK6, ScCDPK7, ScCDPK8, and ScCDPK9 with those of AtCDPK4/5/6/11, which have been associated with transcriptional reprogramming during disease resistance in Arabidopsis . The protein structures were predicted and annotated using UniProt and InterPro databases. As shown in Fig.  2 , the 9 ScCDPKs have high similarity with AtCDPK4/5/6/11 (Fig.  2 ). Therefore, we selected these 9 ScCDPKs for further investigation.

Structural comparisons of AtCDPK4/5/6/11 and ScCDPKs. The sequence marked in pink, blue, and yellow represents the serine/threonine kinase domain, the auto-inhibitory junction domain, and the EF-hand, respectively

After calcium influx, Ca 2+ binding causes conformational changes in CaM-LDs, releasing the auto-inhibition of CDPK, a key link in the process through which CDPK promotes plant immunity. TCH3 promotes CDPK5 phosphorylation of CBP60 by interfering with CDPK5 auto-inhibition and positively regulates plant resistance to soil-borne fungal pathogens (Sun et al. 2022a ). To obtain active ScCDPKs and elucidate their enzymatic properties, we used the major sugarcane cultivar Guitang 42 (GT42) as a template to construct genes encoding the N-terminal-truncated (NT) forms of ScCDPK1 NT , ScCDPK2 NT , ScCDPK4 NT , ScCDPK5 NT , ScCDPK6 NT , ScCDPK7 NT , ScCDPK8 NT , and ScCDPK9 NT , in which the auto-inhibitory region and CaM-LD were deleted (Fig.  3 ).

Schematic diagram of N-terminal truncated (NT) ScCDPKs. The sequence marked in pink represents the serine/threonine kinase domain

Pathogenesis-related protein 1 (PR-1) is an important defense protein that is activated by plants under stress conditions and is capable of enhancing plant defense. A previous study showed that the sugarcane ScPR1 gene significantly improves tolerance to abiotic stress in sugarcane and Arabidopsis (Chu et al. 2022 ). To determine whether putative ScCDPK could induce the expression of ScPR1 , we prepared constructs expressing each ScCDPK NT driven by the 35S promoter and employed a reporter construct in which the promoter of ScPR1 was fused to the luciferase reporter gene ( LUC ). Agrobacteria carrying Pro35s:ScCDPK NT - HA and ProScPR1:LUC were infiltrated into N. benthamiana leaves. The LUC activity was measured 48 h post infiltration. Results showed that ScCDPK1 NT and ScCDPK8 NT significantly induced ScPR1 expression, whereas ScCDPK2 NT , ScCDPK4 NT , ScCDPK5 NT , ScCDPK6 NT , ScCDPK7 NT , and ScCDPK9 NT had no obvious effect on ScPR1 expression (Fig.  4 a–f).

Truncated ScCDPK1 and ScCDPK8 significantly induced ScPR1 expression. a , c , e LUC signals generated in three sets of reporter assays by expressing ProScPR1:LUC and Pro35s:ScCDPK NT -HA ( a ScCDPK1 NT , ScCDPK2 NT , and ScCDPK5 NT ; c ScCDPK4 NT , ScCDPK6 NT , and ScCDPK9 NT ; e ScCDPK7 NT , ScCDPK8 NT , and ScCDPK12 NT ). b , d , f Quantitative analysis of LUC signals generated in the assays depicted in a , c, and e , respectively. g Protein levels of ScCDPK1 NT , ScCDPK2 NT , ScCDPK4 NT ScCDPK5 NT , ScCDPK6 NT , ScCDPK7 NT , ScCDPK8 NT , ScCDPK9 NT , and ScCDPK12 NT as indicated in Nicotiana benthamiana . As indicated, N. benthamiana leaves infiltrated with Agrobacterium strains carrying ProScPR1:LUC and Pro35s:ScCDPK . NT -HA were subjected to reporter assays . Infiltrated N. benthamiana leaves were sliced into strips 48 h post-infiltration, and relative luminescence was determined by a microplate luminometer. Error bars indicate SD of three biological repeats. Different letters indicate significant differences ( P  < 0.05, one-way ANOVA with Tukey’s multiple comparisons)

ScCDPK1 NT and ScCDPK8 NT exhibited stronger activity than ScCDPK1 FL and ScCDPK8 FL in inducing ScPR1 expression

Induction of ScPR1 expression by ScCDPK1 NT and ScCDPK8 NT led us to investigate the auto-inhibitory activity of ScCDPKs. The full-length (FL) forms of ScCDPK1 and ScCDPK8 were constructed to determine whether ScCDPK1 NT and ScCDPK8 NT exhibited stronger activity than ScCDPK1 FL and ScCDPK8 FL . Agrobacteria carrying ProScPR1:LUC reporter were infiltrated alone or together with Agrobacteria carrying Pro35s:ScCDPK1 NT -HA, Pro35s:ScCDPK8 NT -HA, Pro35s:ScCDPK1 FL -HA , or Pro35s:ScCDPK8 FL -HA into N. benthamiana leaves. Compared to the full-length forms, truncated ScCDPK1 and ScCDPK8 dramatically increased the ability to induce ScPR1 (Fig.  5 a–d). These results indicated that ScCDPK1 NT and ScCDPK8 NT constitutively activated ScPR1 expression in N. benthamiana .

Truncated ScCDPK1 and ScCDPK8 exhibited stronger activity than full-length ScCDPK1 and ScCDPK8 in inducing ScPR1 expression. a , c LUC signals generated in three sets of reporter assays by expressing ProScPR1:LUC with Pro35s:ScCDPK1 NT - HA , Pro35s:ScCDPK1 FL - HA , Pro35s:ScCDPK8 NT - HA , or Pro35s:ScCDPK8 FL - HA . b , d Quantitative analysis of LUC signals generated in the assays depicted in a and c . Agrobacteria carrying ProScPR1:LUC were infiltrated alone, or together with Agrobacteria carrying Pro35s:ScCDPK1 NT - HA, Pro35s:ScCDPK8 NT - HA, Pro35s:ScCDPK1 FL - HA, or Pro35s:ScCDPK8 FL - HA, as indicated. e Protein levels of ScCDPK1 NT , ScCDPK1 FL , ScCDPK8 NT , and ScCDPK8. FL as indicated in N. benthamiana . Infiltrated N. benthamiana leaves were sliced into strips 48 h post-infiltration, and relative luminescence was determined by a microplate luminometer. Error bars indicate SD of three biological repeats. Different letters indicate significant differences ( P  < 0.05, one-way ANOVA with Tukey’s multiple comparisons)

ScCDPK1 NT and ScCDPK8 NT activated defense-related gene expression in sugarcane protoplasts

The ability of ScCDPK1 NT and ScCDPK8 NT to transiently activate ScPR1 in N. benthamiana prompted the investigation into whether ScCDPK1 NT and ScCDPK8 NT were constitutively activated in sugarcane protoplasts. Serine Protease Inhibitor ( SPI ) encodes key enzymes involved in signaling pathways, and ScSPI is induced by S. scitamineum inoculation (Wu et al. 2022 ). Therefore, we used ScPR1 and ScSPI as disease resistance-related reporter genes to investigate the auto-inhibitory activation of ScCDPK in sugarcane protoplasts. Pro35s:ScCDPK1 FL -HA , Pro35s:ScCDPK8 FL -HA, Pro35s:ScCDPK1 NT -HA , or Pro35s:ScCDPK8 NT -HA were transfected into sugarcane protoplasts. We examined ScSPI and ScPR1 expression and found that truncated ScCDPK1 and ScCDPK8 significantly induced ScPR1 and ScSPI expression compared to those of the full-length forms, which is consistent with our finding that truncated ScCDPK1 and ScCDPK8 activate ScPR1 in N. benthamiana (Fig.  6 a, b). These results demonstrate that ScCDPK1 and ScCDPK8 possess auto-inhibitory activity.

Truncated ScCDPK1 and ScDPK8 induced higher expression of ScPR1 and ScSPI than full-length ScCDPK1 and ScDPK8 in sugarcane protoplasts. a Relative levels of ScPR1 gene transcripts in protoplasts transfected with Pro35s:ScCDPK1 N T - HA, Pro35s:ScCDPK1 FL -HA , Pro35s:ScCDPK8 NT - HA, or Pro35s:ScCDPK8 FL - HA . b Relative levels of ScSPI gene transcripts in protoplasts transfected with Pro35s:ScCDPK1 NT - HA, Pro35s:ScCDPK1 FL - HA, Pro35s:ScCDPK8 NT -HA, or Pro35s:ScCDPK8 FL - HA . c Protein levels of ScCDPK1 NT , ScCDPK1 FL , ScCDPK8 NT , and ScCDPK8 FL as indicated in sugarcane protoplasts. Protoplasts isolated from Guitang 42 were transfected with Pro35s:ScCDPK1 FL - HA , Pro35s:ScCDPK8 FL - HA , Pro35s:ScCDPK1 NT - HA , or Pro35s:ScCDPK8 . NT -HA. Total RNA was isolated from samples collected 8 h after treatments and used for cDNA synthesis followed by quantitative RT-PCR analysis of ScPR1 and ScSPI transcripts with specific primers. Error bars indicate SD of three biological repeats. Different letters indicate significant differences ( P  < 0.05, one-way ANOVA with Tukey’s multiple comparisons)

Plants are often attacked by pathogens during their growth and development, resulting in severe consequences to their yield and quality. Ca 2+ plays a vital role in many physiological processes, especially those related to environmental changes and stressors. As a large family of calcium-sensing proteins, CDPKs sense the rapid accumulation of cytoplasmic Ca 2+ upon pathogen infection, then directly phosphorylate and activate the downstream components to promote the decoding of immune-related calcium signals. CDPKs have been identified in many plants, including Arabidopsis , tobacco, rice, wheat, and potatoes (Sun et al. 2022b ). However, the abundance and function of CDPKs in sugarcane, which is the primary source of sugar, remain unknown. In this study, we found that ScCDPK1 and ScCDPK8 are involved in defense regulation. Using sugarcane genomic data, we identified 229 putative ScCDPKs in primordial specie S. officinarum . Searching for putative CDPKs in sugarcane cultivars from NCBI, we identified 12 putative ScCDPKs. Phylogenetic analysis revealed evolutionary relationships among these CDPKs in sugarcane cultivars and CDPKs in S. officinarum and Arabidopsis , as well as in rice. According to protein structure analysis and multiple sequence alignment, ScCDPKs have high similarity to AtCDPK4/5/6/11. Transient expression assays in N. benthamiana and sugarcane protoplasts showed that truncated ScCDPK1 and ScCDPK8 induce higher expression of ScPR1 than full-length ScCDPK1 and ScCDPK8.

The major cultivated sugarcane varieties are the progeny of crosses between S. officinarum and Saccharum spontaneum , which are highly polyploid and aneuploid, respectively, with chromosomes ranging from 80 to 120 (Mohan 2016 ). The sugarcane genome complexity lies in the fact that its aneuploid chromosome sets contain 8–12 homologous genes, which makes sugarcane sequencing and molecular biology research challenging (Dal-Bianco et al. 2012 ). Although high-throughput sequencing technologies have been applied in recent years, including the combination of PacBio and high-throughput chromosome conformation capture (Hi-C) technologies, which can perform sequencing at the chromosome level (Wang et al. 2023 ), the problems encountered in sugarcane sequencing cannot be completely overcome at this stage. The large number of chromosomes, similarities in morphology, and diverse modes of inheritance often lead to unbalanced increases or decreases in the number of chromosomes in sugarcane, which seriously hamper genetic research and improvement (Mohan 2016 ). As stable transformation of sugarcane is both difficult and time-consuming, we identified and screened ScCDPKs with auto-inhibitory activity using ScPR1 and ScSPI as reporter genes in a protoplast-based transient transformation, which is a simple and versatile method for in vivo analysis of gene function (Wang et al. 2021 ).

Although the genomes of S. officinarum , S. spontaneum , and the diploid complex of Erianthus rufipilus are available (Zhang et al. 2018 , 2022 ), there are genomic differences and genetic diversity between the main cultivars GT42 and S. officinarum . However, the genome assembly of GT42 is still incomplete, and the sugarcane genome has not yet been fully annotated; therefore, we may have missed genomic information in mining for the CDPKs. Furthermore, ScCDPK3 has not been cloned because of the dissimilarities between the GT42 and S. officinarum genomes. All of these factors contributed to the incomplete results of our analyses.

Transgenic technology is an important avenue for molecular biology research and germplasm improvement of sugarcane plants. However, sugarcane transgenic technology still has bottlenecks, such as low transformation efficiency and limited transformable genotypes (Budeguer et al. 2021 ). Gene editing technology can realize fixed and controllable gene modification, which avoids the uncertainty and risk of random insertion of exogenous genes and improves the precision and safety of operations (Gao 2021 ). CRISPR-Cas has become one of the most advanced systems for the genome engineering of crops; this technology has rapidly expanded and applied to crops critical for food security. The discovery and utilization of functional genes are essential for gene editing to modify crops and increase resistance resources. Editing the RESISTANCE TO BLAST1 ( RBL1 ) gene, which encodes CDP-DAG synthase in rice, and the MILDEW RESISTANCE LOCUS O ( MLO ) gene in wheat using CRISPR-Cas has resulted in high-yield and resistance-compatible crops (Li et al. 2022b ; Sha et al. 2023 ). Solanum tuberosum PLASMA MEMBRANE PROTEIN 1 ( StPM1 ) gene-edited potato plants, using CRISPR-Cas9 technology, showed significantly improved resistance to Phytophthora infestans (Bi et al. 2024 ).

The sugarcane genome contains numerous homologous genes with high ploidy and sequence similarities. Therefore, the development of an effective transformation method for gene modification in sugarcane remains a major technical challenge. A key requirement in the field of sugarcane genetic modification is the availability of sufficient functional genomic resources to comprehensively dissect the functional and regulatory networks of the sugarcane genome for precise gene editing strategies (Dal-Bianco et al. 2012 ). Genome editing is powerful in generating loss-of-function mutations of target genes and has been further developed to create gain-of-function mutations of target genes. In this study, truncated ScCDPK1 and ScCDPK8 were found to induce higher expression of the defense-related genes ScPR1 and ScSPI than the full-length ScCDPK1 and ScCDPK8, indicating that the deletion of the auto-inhibitory region in ScCDPK1 and ScCDPK8 provides access to gain-of-function mutations. Therefore, removing the auto-inhibitory region of full-length ScCDPKs by genome editing may generate active ScCDPK variants. Our study suggests new targets for genome editing in sugarcane defense regulation.

Conclusions

In this study, we conducted a genome-wide analysis using the genome of S. officinarum to identify the CDPKs in sugarcane core primordial species. We further analyzed ScCDPK in sugarcane cultivars. As confirmed by protein structure analysis and multiple sequence alignment, ScCDPKs exhibited high similarity to those of AtCDPK4/5/6/11, which have been associated with transcriptional reprogramming during disease resistance. Transient expression assays in N. benthamiana and sugarcane protoplasts showed that truncated ScCDPK1 and ScCDPK8 exhibit stronger activity than full-length ScCDPK1 and ScCDPK8 for activation of defense-related genes ScPR1 and ScSPI . These findings highlight the essential roles of ScCDPK1 and ScCDPK8 in defense regulation and provide novel targets for sugarcane gene editing.

Plant materials and constructs

The primer sequences used in this study are shown in Additional file 1 : Table S1. Strains used in this study include Escherichia coli DH5α and Agrobacterium tumefaciens GV3101. Nicotiana benthamiana was used for transient expression assay, while sugarcane Guitang 42 (GT42) was used for protoplast preparation. To conduct the reporter assay, we fused the promoter of ScPR1 with the firefly luciferase reporter gene (LUC) to construct the vector pCambia1300-ProScPR1:LUC-HA. The N-terminal truncated forms of ScCDPK1 , ScCDPK2 , ScCDPK4 , ScCDPK5 , ScCDPK6 , ScCDPK7 , ScCDPK8 , and ScCDPK9 coding sequences were amplified by RT-PCR from cDNA isolated from GT42 and cloned into the pCambia1300-HA vectors. The resulting constructs carry truncated ScCDPKs lacking the auto-inhibitory junction domain and the C-terminal regulatory calmodulin-like domain. The full-length of ScCDPK1 and ScCDPK8 were cloned into the pUC19-HA vectors to generate transient expression constructs.

Identification of CDPKs in sugarcane

Sugarcane genomes were obtained from NCBI ( https://www.ncbi.nlm.nih.gov/ ) and sugarcane genome hub ( http://sugarcane-genome.cirad.fr ) (Garsmeur et al. 2018 ; Zhang et al. 2018 , 2022 ). According to previous reports, we downloaded 29 CDPK protein sequences in rice and 34 CDPK protein sequences in Arabidopsis from NCBI and TAIR databases, respectively (Asano et al. 2005 ; Yip Delormel and Boudsocq 2019 ). The obtained sequences were subjected to a protein blast in the local protein database of sugarcane, and the results with > 70% query coverage were taken as the sugarcane CDPK gene family members. We used the eggNOG 5.0 database for protein classification and functional annotation ( http://eggnogdb.embl.de/ ) (Huerta-Cepas et al. 2019 ).

Phylogenetic analysis and multiple sequence alignment

The pairwise-distance analysis of the amino acid sequences of ScCDPKs and AtCDPK1 are shown in Additional file 2 : Table S2. Mega 7.0 software was used to perform muscle multiple sequence alignment of CDPKs in rice, Arabidopsis , and sugarcane. The phylogenetic tree was constructed by the neighbor-joining method, and the bootstrap value was set to 1000. The web-based tool iTOL ( http://itol.embl.de ) was used for the visualization, manipulation, and annotation of phylogenetic tree. Molecular weight (MW) and isoelectronic points (pI) of ScCDPKs were predicted using the ExPASY PROTPARAM tool ( http://web.expasy.org/protparam/ ).

To explore the relationship between putative ScCDPKs and AtCDPK4/5/6/11, we aligned the protein sequences with DNAMAN 9.0. To investigate the similarities between ScCDPKs and AtCDPK4/5/6/11, we clarified the structures in the protein databases UniProt ( https://www.uniprot.org/ ) and InterPro ( https://www.ebi.ac.uk/interpro/ ), followed by protein structure annotation via the software IBS 1.0.

Reporter assay in Nicotiana benthamiana

Agrobacterium strain carrying ProScPR1:LUC-HA was infiltrated alone or together with Agrobacterium carrying Pro35s:ScCDPK NT -HA or Pro35s:ScCDPK FL -HA , as indicated into 4-week-old N. benthamiana leaves. After 48 h, we sliced the infiltrated N. benthamiana leaves into 1 mm wide strips and measured relative luminescence with a microplate luminometer. Total proteins were separated by 8% SDS-PAGE, and ScCDPKs were detected by anti-HA immunoblot.

Transient expression in sugarcane protoplasts

Protoplasts were prepared from the leaf sheaths of 2-month-old GT42 seedlings. The protoplasts isolated were transfected with the indicated PUC-ScCDPK NT -HA or PUC-ScCDPK FL -HA under 40% polyethylene glycol. After 8 h of incubation, total RNA was isolated and used for cDNA synthesis, followed by quantitative RT-PCR analysis of ScPR1 and ScSPI transcripts with specific primers. Total RNA was isolated with the TRIzol reagent (Invitrogen) and used for cDNA synthesis with SuperScript III FirstStrand Synthesis System for RT-qPCR (Invitrogen) following the manufacturer’s instructions. The RT-qPCR was performed with the SYBR Premix Ex Taq kit (TaKaRa) following standard protocols. Total proteins were separated by 8% SDS-PAGE and ScCDPKs were detected by anti-HA immunoblot.

Availability of data and materials

All data generated or analyzed during this study are included in this published article and its supplementary information files.

Abbreviations

• Calcium-dependent protein kinase

Calcineurin B-like

CBL-interacting protein kinases

Luciferase reporter gene

Variable N-terminal variable domain

Auto-inhibitory junction domain

C-terminal regulatory calmodulin-like domain

Pathogen-associated molecular pattern

Neighbor-joining

High-throughput chromosome conformation capture

Sugarcane Pathogenesis-Related Protein 1

Sugarcane Serine Protease Inhibitor

National Center for Biotechnology Information

PLANT U-BOX 25

BOTRYTIS-INDUCED KINASE 1

Brown rust resistance gene 1

RESISTANCE TO BLAST 1

MILDEW RESISTANCE LOCUS O

PLASMA MEMBRANE PROTEIN 1

Molecular weight

Isoelectronic points

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Acknowledgements

The authors are grateful to Yonglun Zeng, Mingyong Zhang, and Xuan Zeng from South China Botanical Garden, Chinese Academy of Sciences, China, for providing Guitang 42.

This work was supported by grants from the CAS Projects for Young Scientists in Basic Research (YSBR-080), the Strategic Priority Research Program of the Chinese Academy of Sciences (XDA0450000), the Chinese Natural Science Foundation (32200241), and the Special Fund for Science and Technology Innovation Teams of Shanxi Province (202204051001020).

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Xiangguo Li and Jiajie Zhong contributed equally to this work.

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Hou Ji Laboratory in Shanxi Province, College of Agriculture, Shanxi Agricultural University, Taigu, 030801, China

Xiangguo Li & Lixiang Wang

Institute of Microbiology, Chinese Academy of Sciences, Beijing, 100101, China

Xiangguo Li, Jiajie Zhong, Baiyang Li, Yingfeng Luo, Kailun Wang, Yu Wang, Ziqin Ye, Lifan Sun, Jinghan Zhang & Jie Zhang

University of Chinese Academy of Sciences, Beijing, 100049, China

Jiajie Zhong, Baiyang Li, Yu Wang & Ziqin Ye

School of Life Sciences, Hebei University, Baoding, 710023, China

Jinghan Zhang

Shangluo Plant Protection and Quarantine Station, Shaanxi, 726000, China

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JZ, XL, and JZ designed the experiments. JZ, JZ, XL, and LW wrote the manuscript. BL, YL, KW, YW, ZY, LS, JZ, and LY performed the experiments and analyzed the data. All authors read and approved the final manuscript.

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Supplementary Information

Additional file 1: table s1..

Sequences of primers used in this study.

Additional file 2: Table S2.

Pairwise-distance analysis of the amino acid sequences of ScCDPKs and AtCDPK1.

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Li, X., Zhong, J., Li, B. et al. Two putative calcium-dependent protein kinases are involved in the regulation of sugarcane defense genes. Phytopathol Res 6 , 22 (2024). https://doi.org/10.1186/s42483-024-00240-1

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Mentalization, attachment, and defense mechanisms: a Psychodynamic Diagnostic Manual-2-oriented empirical investigation

Annalisa tanzilli.

1 Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, La Sapienza University of Rome, Rome

Mariagrazia Di Giuseppe

2 Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa

Guido Giovanardi

Tommaso boldrini.

3 Department of Developmental Psychology and Socialization, University of Padua, Padua

Giorgio Caviglia

4 Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy

Ciro Conversano

Vittorio lingiardi.

Contributions: AT and MDG conceived the research design. AT analyzed the data. AT wrote the first draft of the manuscript. MDG and GG contributed to the writing of the manuscript. GG, TB, MDG, and AT collected data by coding the interview transcripts. CG, CC, and VL contributed to the interpretation of the results and critically reviewed the final draft of the manuscript.

Mentalizing capacities depends on the quality of primary attachment interactions with caregivers who thinks of the child as a subject with mental states. Operationalized as reflective functioning, mentalization is crucial for regulating emotions and developing of a coherent sense of identity, for interacting with individuals making sense to own and others mental states, and for distinguishing internal and external realities without distortions. Although the clinical literature on interplay between mentalization, attachment, and emotional regulation is rich, the empirical research is limited. This study sought to explore connections between reflective functioning, attachment styles, and implicit emotion regulation, operationalized as defense mechanisms, in a group of depressive patients. Twenty-eight patients were interviewed using the adult attachment interview (AAI) and diagnosed using the Psychodynamic Chart-2 of the Psychodynamic Diagnostic Manual, Second Edition . The reflective functioning scale and the defense mechanisms rating scale Qsort were applied to AAI transcriptions to assess reflective functioning and defensive profile. Patients with secure attachment showed significantly higher levels in reflective functioning and overall defensive functioning as compared to those with insecure attachment. Good reflective functioning and secure attachment correlated with mature defenses and specific defensive mechanisms that serve in better regulating affective states. Overall, the relationship between mentalization, attachment and emotion regulation lay the foundations for the delineation of defensive profiles associated with attachment patterns and reflective functioning in depressive patients. The systematic assessment of these psychological dimensions with gold-standard tools may help in tailoring personalized therapeutic interventions and promoting more effective treatments.

Introduction

Mentalization can be defined as the individual’s imaginative capacity to understand and interpret-both implicit and explicitly-behavior in self and others as conjoined with intentional mental states, such as motives, affects, desires, beliefs, goals, and needs (Fonagy, Gergely, Jurist, & Target, 2002). It allows to symbolize human experiences, enabling individuals to use thoughts and ideas to represent, describe and express their internal life, as well as deeply understand the intersubjective nature of social relationships (Bouchard et al ., 2008 ). This form of representational mental activity is crucial for emotion regulation and development of a coherent sense of identity. Moreover, it helps in interacting with others making sense of what occurs in one’s own and others’ minds, in distinguishing between internal and external reality ( e.g ., cognitive and emotional processes), and in building connection with real-world (Bateman & Fonagy, 2016; Fonagy, Steele, Steele, Higgitt, & Target, 1994).

The construct of mentalization was founded within attachment theory and operationalized as reflective functioning (RF) (Fonagy, Target, Steele, & Steele, 1998 ). The individual develops mentalizing capacities in early infancy and their progression depends on the quality of primary attachment interactions with caregivers who thinks of the child as a subject with mental states (Bowlby, 1973 ). From this perspective, a close, warm, and affectively attuned infant-caregiver relationship allows the development of a secure attachment and provides the ideal condition for fostering an optimal mentalization. Conversely, caregivers’ failure in sensitiveness and responsiveness to the child’s need of protection and support may evolve into insecure attachment and hinder the development of mentalizing abilities (Fonagy et al ., 2002 ).

Maladaptive caregiving of parents who cannot reflect empathically on the child’s inner experience and respond accordingly may promote severe distortions in child’s mentalizing ability, such as hypermentalization ( e.g ., overinterpretive mental state reasoning), vulnerability to mentalizing capacity breakdowns, and impairments in cohesive and integrated sense of self, adaptive capacities in affective regulation, and stable and mutually satisfying interpersonal relationships (Lingiardi & Bornstein, 2017 ; Mikulincer & Shaver, 2018 ).

Child-caregiver interactions are encoded and internalized by the child in ‘ internal working models ’ (IWM), which are mental representations of the attachment figure, the self, and their relationship that predict child’s later social and emotional outcome (Bowlby, 1969 , 1980 ; Eagle, 2013 ; Fonagy, Steele, & Steele, 1991 ; Main, Kaplan, & Cassidy, 1985 ).

Research has highlighted a strong connection between attachment and mentalization. Insecure attachment is related to RF deficits (Bouchard et al ., 2008 ; Fonagy & Target, 1997, 1998 ; Nazzaro et al ., 2017 ), which together increase the risk to develop several psychopathological conditions ( e.g ., anxiety and depressive disorders) and personality syndromes ( e.g ., Antonsen, Johansen, Ro, Kvarstein, & Wilberg, 2016 ; Bouchard et al ., 2008 ; Calati, Oasi, De Ronchi, & Serretti, 2010 ; Fischer-Kern et al ., 2010 ; Katznelson, 2014 ; Levy et al ., 2006 ; Muller, Kaufhold, Overbeck, & Grabhorn, 2006 ; Taubner, White, Zimmermann, Fonagy, & Nolte, 2013 ). Moreover, parental RF appears to be involved in the intergenerational transmission of attachment (Slade, Grienenberger, Bernbach, Levy, & Locker, 2005 ; Stacks et al ., 2014 ).

In light of what above described, the link between RF, attachment, and implicit emotion regulation seems rather clear. Emotion regulation strategies serve in mitigating distress through volunteer (explicit emotion regulation) or automatic (implicit emotion regulation) modification of the intensity, duration, and type of the experienced emotion (Gross & Thompson, 2007 ; Gyurak, Gross, & Etkin, 2011 ). Research demonstrated that both explicit and implicit emotion regulation strategies are essential for psychological well-being (Di Giuseppe, Ciacchini, Piarulli, Nepa, & Conversano, 2019 ; Gyurak et al ., 2011 ), although the adequacy of implicit emotion regulation, such as mature defense mechanisms, plays a key role in the overall adaptiveness of individual psychological functioning (Di Giuseppe, Gennaro, Lingiardi, & Perry, 2019; Maffei et al ., 1995 ).

Defense mechanisms are defined as unconscious mechanisms that mediate the individual’s reaction to emotional conflicts or external situations derived from difficulties in adapting inner needs, impulses, desires and thoughts to real world (American Psychiatric Association, 2013 ; Perry, 2014 ). They serve to eliminate or attenuate negative sensations (distress, anxiety, insecurity, fear, etc .) connected to dangerous or threatening events or emotional experiences, real or imaginary (Olson, Perry, Janzen, Petraglia, & Presniak, 2011 ; Vaillant, 1992 ). According to the gold-standard classification of defense mechanisms (Di Giuseppe, Perry, Petraglia, Janzen, & Lingiardi, 2014; Di Giuseppe et al ., 2020 ; Perry, 1990), each of the thirty defense mechanism holds specific definition and function that contribute to determine the individual defense style. Defense mechanisms are hierarchically organized into seven levels of adaptiveness, ranging from least to most mature ( Table 1 ). At the more immature levels, defenses act a massive image distortions and withdrawn of charged feelings, while more adaptive defense levels allow higher awareness of feelings, ideas, thus maximize gratification and resilience (Di Giuseppe, Prout, Fabiani, & Kui, 2020 ). Immature defense mechanisms are often associated to various levels of severity of psychological functioning and different psychopathological conditions, especially personality disorders ( e.g ., Di Giuseppe, Gennaro et al ., 2019 ; Hilsenroth, Callahan, & Eudell, 2003 ; Lingiardi et al ., 1999 ; Oasi et al ., 2017 ; Perry, Presniak, & Olson, 2013 ). On the other hand, mature defense mechanisms are associated with physical and psychological health and better adjustment (Hayden et al ., 2021 ; Martino et al ., 2020 ).

The relationship between attachment, defense mechanisms and psychological distress in clinical and nonclinical populations has been neglected in empirical research. In one study, Cramer and Kelly ( 2010 ) found that levels of insecure attachment style and defenses of denial were higher among parents abusing their children. Another research revealed that anxious attachment and immature defenses were significant predictors of postnatal depression (McMahon, Barnett, Kowalenko, & Tennant, 2005 ). Moreover, defense mechanisms may mediate the significant association between insecure attachment and alexithymic traits in youth population (Besharat & Khajavi, 2013 ). Consistent with this study, Laczkovics and colleagues ( 2018 ) supported the mediating role of immature defenses on the association between insecure attachment and psychopathology, suggesting that attachment had a direct impact on defense mechanisms, which in turn conveys the effects of insecure attachment on psychopathology. A recent research pointed out that insecure attachment is related to primitive defenses of denial, splitting, and projection (Prunas, Di Pierro, Huemer, & Tagini, 2019 ). Another study highlighted that secure attachment and adaptive defenses have a crucial impact in providing individuals exposed as children to intimate partner violence (IPV) with ways to survive their traumatic environments (Bain & Durbach, 2018).

According with these findings and clinical literature (cfr., Bowlby, 1973 , 1980 ), we assume that attachment security is associated to mature psychological defenses intervening to modulate and reduce intense painful feelings and impact of negative experiences or events (Ciocca et al ., 2020 ; Kobak & Bosmans, 2019 ; Malik, Wells, & Wittkowski, 2015 ). Similarly, it is reasonable to consider a strong connection between RF and defenses taking into account that they help in regulating emotional states activated within interpersonal relationships and influenced by mental procedures and representations from past meaningful relational experiences (Eagle, 2013 ). Moreover, consistent with the framework of the M Axis of the Psychodynamic Diagnostic Manual, Second Edition (PDM-2) (Lingiardi & Bornstein, 2017), it is important to recognize that these capacities of mental functioning are interconnected and based on specific and integrated set of psychological processes (Lingiardi, McWilliams, Bornstein, Gazzillo, & Gordon, 2015 ).

Starting from these premises, the present study sought to explore the connections between all these relevant dimensions of psychological functioning in a group of depressive patients. More in detail, this research focused on two main aims:

Hypothesis 1: Identify whether attachment security was characterized by higher RF and higher overall defensive functioning (ODF) [see defense mechanisms rating scale Q-sort (DMRS-Q)’s description among ‘ Measures ’]. We hypothesized that people with secure attachment would show significantly higher RF and ODF as compared to insecure individuals.

Hypothesis 2: Investigate the associations between RF, attachment security/insecurity, and specific defense mechanisms. We hypothesized that high-adaptive defenses would be positively associated with both high RF and secure attachment, while disavowal, image-distorting defenses, and action defenses would be positively related to low RF and insecure attachment.

Participants’ sampling

The sample consisted of 28 patients recruited from two national counselling centers (Rome, Italy) between June 2019 and February 2020 (before the outbreak of the coronavirus disease 2019 pandemic). The inclusion criteria were as follows: i) being at least 18 years old; ii) not having a diagnosis of organic syndrome, psychotic disorder or any syndrome with psychotic symptoms that could complicate the assessment of any variable in the study; and ii) not being on drug therapy. Clinicians (all of psychodynamic orientation) were direct to briefly describe to their patients the rationale of the research project on psychological assessment. All the patients indicated their willingness to participate in the study on a volunteer basis and without remuneration. They provided written informed consent. The patients were taken once-a-week psychotherapy treatment and therapists provided basic demographic and diagnostic data. The study protocol received ethics approval from the Research Ethics Committee of the Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome.

Defense levels and their corresponding defenses.

The clinical sample was equally distributed among gender. Mean age was approximately 45 years [standard deviation (SD)=4.90, range=39-58]. Twenty-three patients had a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnosis of persistent depressive disorder (dysthymia) and five had a diagnosis of major depressive disorder. Moreover, according to the P Axis of the Psychodynamic Chart-2 (PDC-2) (see the description of the PDC-2 in section ‘ Measures ’) of the PDM-2, the level of patients’ personality organization was neurotic (mean score of overall personality organization=6.07, SD=1.72). Some patients (N=20) had a personality syndrome (comorbid with psychiatric diagnosis), which was distributed as follow: six depressive, four narcissistic, four borderline, two dependent, two obsessive, one anxious-avoidant and phobic, one hysteric-histrionic, while two patients showed subclinical depressive traits (rating score=3). Concerning the adult attachment interview (AAI) classifications distribution, the four-way distribution of states of mind with respect to attachment was as follows: 14 patients were Secure-Autonomous (F), 4 were Preoccupied (E) and 9 were Dismissing (Ds); the remaining 1 participant was Unresolved/ disorganized (U/d) with an additional classification as Dismissing. The length of treatment averaged 2.67 months (SD = 0.88; range=1-4).

Clinical questionnaire

We constructed an ad hoc clinician report questionnaire to obtain information about therapists, patients, and their psychotherapies. Clinicians provided basic demographic and professional data, as well as DSM-5 diagnoses assigned at the intake. Clinicians also furnished data on the therapies, such as length of treatment.

Psychodynamic Chart-2 of the Psychodynamic Diagnostic Manual

The PDC-2 (Gordon & Bornstein, 2015 ) is a clinician report tool used to guide clinicians in the PDM-2-oriented diagnostic assessment of adults. The PDC-2 starts with Section I: Level of Personality Organization calls for ratings of identity, object relations, level of defenses, and reality testing. Then, the clinician has to provide an overall rating of the personality organization as either ‘normal’ (healthy), mildly dysfunctional (neurotic), dysfunctional (borderline), or severely dysfunctional (psychotic). Section II: Personality Styles/Syndromes (P Axis) asks the clinician to determine the patient’s emerging personality patterns by checking as many relevant patterns as apply; then, the clinician notes the one or two most dominant patterns. For research purposes, each pattern can be given a rating from 1 (severe) to 5 (high functioning). Section III: Mental Functioning (M Axis), which asks the clinician to rate the patient’s level of strength or weakness on each of 12 mental functions on a scale from 1 (severe deficits) to 5 (healthy) and then to provide an overall rating for level of personality severity as the sum of these 12 ratings. Section IV: Symptom Patterns (S Axis) asks the practitioner to describe the patient’s main symptom patterns from those that are related to predominantly psychotic disorders, mood disorders, disorders primarily related to anxiety, event- and stressor-related disorders, and so forth. Moreover, the clinician may use DSM or ICD symptoms and codes here. The dominant symptoms are rated on a 5-point scale from 1 (severe) to 5 (mild). Section V: Cultural, Contextual, and Other Relevant Considerations. In the present study, we used only the first two sections of this measure on the personality assessment.

Adult attachment interview

The adult attachment interview (AAI) (George, Kaplan, & Main, 1996 ) is a semi-structured interview used to assesses the individual’s ‘state of mind’ with respect to attachment relationships. The AAI consists of 20 questions asked in a set order with standardized probes. Individuals are asked to describe the overall quality of their childhood relationship with their parents as well as any experiences of loss, rejection, early separation, and maltreatment. The interview requires participants to reflect on their parents’ styles of parenting and to consider how their childhood experiences with their parents may have influenced their personality development. The traditional AAI scoring system points to the following attachment classification: secure/autonomous (F), dismissing (Ds), enmeshed/preoccupied (E), or unresolved/disorganized (U/d). The U/d category is assigned a secondary organized classification (F, Ds or E). Previous research has shown that the AAI has remarkable stability and predictive validity (for a review, see Hesse, 2008 ). Individuals classified as F are able to cope effectively with negative feelings about past experiences and are aware of the value of attachment relationships. On the other hand, E individuals are overwhelmed by anxiety and negative emotions arising from childhood memories. Ds individuals deal with painful feelings related to attachment relationships through ‘defensive exclusion’ (Bowlby, 1973 ) of attachment-related memories, idealization of painful relationships or derogation of attachment figures. Individuals with U category show disorganization or confusion with regard to attachment-related loss or trauma.

Reflective functioning scale

The reflective functioning scale (RFS) (Fonagy et al ., 1998 ) is a quantified index of mentalization capacity applied to the transcripts of the AAI (George et al ., 1996 ). It is designed to assess whether subjects are able to understand attachment- related experiences in terms of mental states. The coding system is based on the following dimensions: i) awareness of the nature of mental states ( e.g ., the fact that mental states can be disguised); ii) explicit effort made to tease out the mental states underlying one’s own and others’ behavior ( e.g ., an awareness that different people may experience different feelings and thoughts in response to the same situation); iii) recognition of the developmental aspects of mental states ( e.g ., an understanding of age-derived changes in mental states); and iv) recognition of mental states in the interviewer ( e.g ., guessing that an interviewer may be distressed while listening to an emotionally difficult story). RF is assessed through ratings of the perceived level of reflection made by the individual on the different passages in the AAI, with questions that directly encourage the subject to employ reflective capacities (‘demand,’ as opposed to ‘permit,’ questions) carrying more weight. The scores given to subject’s statements throughout the interview are weighed together to obtain a final RF score on an 11- point scale ranging from –1 ( negative reflective capacity or antireflective ) to 5 ( ordinary reflective capacity ) to 9 ( exceptionally reflective functioning ). The RFS was validated on the coherence scale of the AAI and shows good interrater reliability when administered by trained raters (Fonagy et al ., 1998 ). Psychometric analysis confirmed the one-factor structure, which also showed good reliability and stability over time (Taubner et al ., 2013 ).

Defense mechanisms rating scale-Q sort

The DMRS-Q (Di Giuseppe et al ., 2014 ) is a computerbased observer-rated measure developed for the assessment of defense mechanisms in clinical setting and based on the gold-standard theory of defense mechanisms (Perry, 1990 ). The DMRS-Q consists of 150 statements describing 30 defense mechanisms in terms of personal mental states, relational dynamics, verbal and nonverbal expressions, self and others’ perceptions that emerge on occasions when the subject experiences internal or external stress or conflict. Raters sorted each statement utilizing a seven-point Likert scale, ranging from least characteristic to most characteristic, which described how each defense pattern contributed to the individual’s defensive functioning. After sorting all 150 statements into a seven-ranks forced distribution, the software provides a DMRS-Q report ( Figure 1 ) with: i) a qualitative description of the patient defensive profile, the so called defensive profile narratives (DPN); and ii) quantitative scores for the ODF, seven hierarchically ordered defense levels, and 30 defense mechanisms (see Table 1 for a comprehensive description of the hierarchy of defense mechanisms). The DMRS-Q rating procedure is available online at: https://webapp.dmrs-q.com/login

All patients were assessed with the DSM-5 and PDC-2 of the PDM-2 after 4 initial diagnostic interviews to collect background information, developmental history, and current concerns. In this time, they interviewed with the AAI by two member of the research group. AAI interviews were audio recorded and transcribed verbatim and was coded by two certified AAI coders who were blind to all other study variables. The interrater reliabilities (ICC) of the AAI subscales were of 0.73 and agreement of the two raters on major attachment classification (four-way classification) was 85.7% (with 100% agreement on insecure vs secure classification). RF was coded according to the RFS from verbatim transcripts of the AAI by two raters who performed the training trained by H. Steele. The ICC of RF raters was 0.84. Defense mechanisms were assessed from AAI transcripts by two raters trained in the use of the DMRS-Q. Raters’ ICC among all DMRS-Q scales was 0.82 on average.

Statistical analysis

The Mann-Whitney U tests were performed to verify differences in RF and ODF between patients with secure attachment versus patients with insecure attachment. Bivariate correlations (Pearson’s r, two-tailed) were carried out to examine the relationship between RF, attachment, and defense mechanisms. All analyses were conducted with SPSS 23 for Windows.

Differences between groups with secure versus insecure attachment in reflective functioning and overall defensive functioning

Differences in mentalization (as assessed using the RFS) and defensive functioning (as assessed using the ODF index of DMRS-Q) between patients with secure (N=15) versus insecure/disorganized (N=13) attachment were tested using the Mann-Whitney U test. Results showed significant differences between groups in RF (Mann-Whitney U= 3.50; P≤0.000, two tailed) and ODF (Mann-Whitney U =45, P=0.016, two tailed). More in detail, levels of RF and ODF were greater for secure patients ( Mdn RF = 5; Mdn ODF= 5.31) than for insecure/disorganized patients ( Mdn RF =3; Mdn ODF = 4.73).

Relationships among mentalization, attachment and defense mechanisms

Table 2 displays correlations between RF, attachment, and defensive functioning assessed among the whole hierarchy of defense mechanisms.

Results showed that RF was positively associated with the high-adaptive defense level, and negatively associated with minor image distorting, major image distorting, and acting defense levels. Moreover, RF showed positive correlations with the individual defenses suppression, self-observation, affiliation, and undoing, and negative correlations with the individual defenses omnipotence, projection, splitting of self-image, help-rejecting complaining, and acting out. Consistently, attachment security was positively associate with the high-adaptive defensive level and with the individual defenses affiliation and undoing. Secure attachment also showed negative correlations with the individual defenses displacement, projection, splitting od self-image, and acting out.

Example of a shortened defense mechanism rating scale-Q (DMRS-Q) report.

Empirical research advances have been providing deeper understanding of connections between psychodynamic constructs helped by the development of more and more effective instruments for their assessment. Applying gold-standard tools for testing attachment patterns (AAI), RF (RFS) and defense mechanisms (DMRS-Q), this pilot study demonstrated the relationship between these psychological constructs in a sample of dysthymic individuals. Taking into account the whole hierarchy of defense mechanisms, our findings lay the foundations for the delineation of defensive profiles associated with specific attachment patterns and RF capacities.

Associations among reflective functioning, attachment security/insecurity, defensive levels and mechanisms.

DMRS-Q, defense mechanism rating scale-Q sort; RF, reflective functioning. Attachment (secure coded=1, insecure/disorganized coded=0); *P≤0.05; ** P≤0.01; ***P≤0.001.

Our first hypothesis, that people with secure attachment would show significantly higher RF and more adaptive defensive functioning than insecure individuals, was fully confirmed by the findings. Consistent with literature and empirical contributions in the field (Besharat & Khajavi, 2013 ; Boldrini, Lo Buglio, Giovanardi, Lingiardi, & Salcuni, 2020 ; Malik et al ., 2015 ; Bouchard et al ., 2008 ; Fonagy & Target, 1997, 1998 ; Horz-Sagstetter, Mertens, Isphording, Buchheim, & Taubner, 2015; Nazzaro et al ., 2017 ), the results indicate the shared line of development of two very important aspects of psychological functioning, such as mentalization and emotion regulation, that take place in early relationships with sensitive and responsive caregivers as main sources of the development of secure internal working models of attachment (Bowlby, 1969 ; Carrere & Bowie, 2012 ; Fonagy &Target, 1998 ; Hershenberg et al ., 2011 ). Conversely, we confirmed Besharat and Khajavi’s idea ( 2013 ) that massive use of immature defense mechanisms in insecure attachment may be aimed to react against mental distress by blocking awareness of negative emotions.

At a deeper level of inquiry, the results fully confirmed our second hypothesis of a positive association between RF, secure attachment and adaptive defense mechanisms. This research found the use of mature defense mechanisms in people with secure attachment and good RF, such as affiliation and undoing. Looking at the functions of these defenses, we notice that affiliation enhances personal coping skills and attachment needs satisfaction by seeking support from others, while undoing minimizes the distress caused by uncomfortable feelings by expressing a series of opposite affects, impulses, or actions ( e.g ., misdeeds followed by acts of reparation) in order to camouflage the subject’s primary feeling or intention (Perry, 1990).

Conversely, the use of immature-depressive defenses, in particular projection , splitting of self-image , and acting out , were strongly related to poor RF and insecure attachment. These defensive mechanisms protect the individual from awareness of internal conflict and external stressors by attributing his or her own unacknowledged feelings, impulses, or thought to others (projection), by failing to integrate the positive and negative qualities of the self into cohesive image (splitting of self-image), and by expressing of intolerable feelings in impulsive behaviors without prior thought (acting out). These findings add empirical evidences to previously reported correlation between secure/ insecure attachment and mature/primitive defense mechanisms (Besharat & Khajavi, 2013 ; Ciocca et al ., 2020 ; Cramer & Kelly, 2010 ; Kobak & Bosmans, 2019 ; McMahon et al ., 2005 ; Prunas et al ., 2019 ).

In addition, our results showed that good levels of RF was associated with higher use of self-observation , self-assertion , and suppression , which are all mature defenses that helps the individual in dealing with internal conflicts or external stressors by recurring to introspective thinking, direct expression or feelings and ideas, or voluntarily temporarily avoiding thinking about disturbing problems, in order to maximize gratification and adjustment. In particular, selfobservation allows the person to make optimal adaptation to the demands of external reality based on having an accurate view of one’s own affects, wishes and impulses, and behavior. Moreover, we found that RF was negatively associated to image-distorting and action defense levels and to as individual defenses of omnipotence and help-rejecting complaining, supporting the relevant interplay between mentalization and emotion regulation. These results suggest that the capacity to understand and interpret self and others’ behaviors as conjoined with intentional mental states (Fonagy et al ., 2002) is strongly related to the ability to deal with one’s feelings, desires, and thoughts without recurring to self and others’ images distortion and impulsive withdrawn of intolerable feelings.

Taking together these findings, the primacy of interpersonal dimension and the relationship between attachment, RF and defense mechanisms become more evident. Attachment theory (Bartholomew & Horowitz, 1991 ; Bowlby, 1973 ; Collins & Read, 1990 ; Mikulincer, 1995) often linked attachment security to positive perceptions of the self and others, and insecure attachment patterns to low self-esteem and negative expectations about the others. In our sample the security of attachment and good mentalization skills were related to mature defenses that frame a safe and balanced relationship with the self ( selfassertion and self-observation ), but also indicate the capacity to acknowledge the trustfulness of the other and the possibility to rely on others as a resource ( affiliation ).

The present study also presented some limitations. First, the sample size was relatively small, and therefore generalization must be drawn with caution. Further research involving larger stratified samples should be pursued to confirm these associations. Second, due to the cross-sectional nature of the research, only exploratory analyses of associations between the studied variables were possible. Longitudinal studies should be designed to gain insight on how defense mechanisms, attachment patterns and RF might impact the adjustment of dysthymic patients during and after psychological interventions. Finally, RF and defensive mechanisms were evaluated using the same source of the attachment assessment (the AAI transcripts). Further studies should use mixed method ( i.e ., interviews and self-reports) to have a broader assessment of these variables.

However, to our knowledge, the present study is the first to have studied the association between defenses and mentalizing capacity (assessed with gold-standard tools), taking into account the link with the attachment. Our findings are consistent with the diagnostic framework of the PDM-2 and have significant implications from both the theoretical and clinical perspectives (Hilsenroth, Katz, & Tanzilli, 2018 ).

The strong relationship between two largely, but separately, studied constructs as mentalization and emotion regulation suggests new directions for bridging these fields of study, for example by conceptualizing mentalizing ability as peculiar high-adaptive defensive patterns ( i.e . affiliation, self-observation and self-assertion). Furthermore, the importance of a broad assessment of these constructs highlights the need of developing tailored interventions for depressed patients, informed by the use of specific defense mechanisms and their relations with insecure attachment and mentalization deficits.

In particular, psychological interventions aimed at preventing and addressing depressive problems should focus on the interrelation between attachment insecurity, low RF and the use of immature-depressive defenses. Thus, it might be useful to first establish with patients a secure and trustful relationship (Fonagy, Luyten, Allison, & Campbell, 2019) in which tackling the difficulties related to insecure internal working models of attachment ( e.g . lack of trust in others, problems in emotion regulation, low levels of self-esteem; see Bowlby, 1973 ), at the same time encouraging the patients to open up and value their resources, empowering the self-image and providing a positive relationship in which to improve the relationship with the other.

Additionally, within a good therapeutic relationship (informed on these psychological dimensions) patients can increase their mentalizing abilities and learn to better symbolize their psychic contents, moving out from the immature defensive dimensions of acting-out and helpreject complaining to a more mature capacity for self-observation and expression of one’s suffering (Hoglend & Perry, 1998 ; Conversano & Di Giuseppe, 2021).

As suggested by previous studies ( e.g ., Kobak & Bosmans, 2019 ; Mikulincer & Horesh, 1999 ), this research supports that the joint effect of high RF, secure attachment, and mature defense mechanisms may help stabilizing the mental health of patients, helping them regulating better their emotions and developing positive representations of the self and the others.

Acknowledgments

The first author thanks Anna Canale for her support and encouragement in the preparation of this work.

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Researchers unveil PI3K enzyme's dual accelerator and brake mechanisms

A group of researchers have expanded conventional knowledge on a critical enzyme that controls cell migration. In a recent publication in the journal Nature Communications, they reported that phosphoinositide 3-kinase (PI3K) not only acts as an accelerator to prompt cell motility, but it also has a built-in brake mechanism that impedes migration.

"PI3K is a major signaling enzyme that has been extensively studied for over 30 years due to its roles in fundamental cellular functions like growth, survival, movement and metabolism," points out Hideaki Matsubayashi, lead author of the study and assistant professor at Tohoku University's Frontier Research Institute for Interdisciplinary Sciences (FRIS). "It plays a critical part in cell migration and invasion, something that, when dysregulated, can cause many pathologies. Our work revealed that PI3K can also actively restrain these same migratory processes through a separate non-catalytic endocytic mechanism originating from its p85β subunit."

Using a combination of bioinformatics, molecular modeling, biochemical binding assays and live-cell imaging, Matsubayashi and his colleagues demonstrated that a disordered region within p85β's inter-SH2 domain directly binds to the endocytic protein AP2. This part of PI3K can activate a cellular process that pulls certain molecules into the cell, and it does so without needing the enzyme's typical lipid-modification function.

When the researchers disrupted the binding, the mutated p85β did not function as it should. Instead of regulating cell movement through its brake mechanism, it built up in specific sites within the cell. This leads to cells moving faster and more persistently, indicating a loss of the brake mechanism's control over cell migration.

"Remarkably, this single PI3K enzyme has opposing accelerator and brake pedals built into its molecular framework," added Matsubayashi. "The endocytic mechanism helps regulate PI3K's activity to ensure that cell movement is controlled at the right times and in the right places for important biological processes."

This braking role was found to be specific to just the p85β subunit. And since the p85β subunit of PI3K is linked to cancer-promoting properties, deeper understanding of PI3K regulation and its isoform specificity could lead to novel therapeutic strategies, such that selectively inhibit the cancerous aspect of PI3K, while preserving the normal functions of PI3K in healthy cells.

• Colon Cancer
• Lung Cancer
• Sickle Cell Anemia
• Molecular Biology
• Cell Biology
• Bioluminescence
• Lactose intolerance
• Stem cell treatments
• Lactic acid
• Cholesterol

Story Source:

Materials provided by Tohoku University . Note: Content may be edited for style and length.

Journal Reference :

• Hideaki T. Matsubayashi, Jack Mountain, Nozomi Takahashi, Abhijit Deb Roy, Tony Yao, Amy F. Peterson, Cristian Saez Gonzalez, Ibuki Kawamata, Takanari Inoue. Non-catalytic role of phosphoinositide 3-kinase in mesenchymal cell migration through non-canonical induction of p85β/AP2-mediated endocytosis . Nature Communications , 2024; 15 (1) DOI: 10.1038/s41467-024-46855-y

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Eghbal Hosseini Thesis Defense: Towards Synergistic Understanding of Language Processing in Biological and Artificial Systems

Speaker: Eghbal Hosseini

Advisor: Evelina Fedorenko

Date: Friday, April 26, 2024,

Time: 2:00pm 

In-person location: Singleton Auditorium (46-3002, Third Floor of MIT Building 46)

On Zoom:  https://mit.zoom.us/j/6779273385?omn=92198329747

Title: Towards Synergistic Understanding of Language Processing in Biological and Artificial Systems

Abstract : The faculty of language in the human brain relies on a network of frontal and temporal regions, predominantly in the left hemisphere, often defined as the “language network”. Despite decades of research aimed at uncovering the neural mechanisms underlying activity in this network, a computationally precise account has remained elusive. Over the past five years, artificial neural networks (ANNs) have achieved capabilities in the comprehension and production of language that are indistinguishable from those of humans, and their internal representations bear similarity to activity within the language network. In this thesis, I aim to build a synergistic understanding of language processing in both ANN models and the language network in the human brain by addressing three main questions: 1. When and how do human brains and ANN language models converge or diverge in their representations during language processing? 2. How does the amount of training data affect convergence between the human brain and ANN language models? 3. What computational mechanisms could underlie similarities in language processing between human brains and ANN language models?

To answer the first question, I demonstrate that representational spaces converge between successful ANNs and the human brain, presumably driven by the statistics of their inputs. I show that brain responses to stimuli (sentences) that are represented similarly across multiple successful ANNs are easier to predict from model representations; in contrast, brain responses to sentences that are represented differently across models are challenging to predict, despite high consistency among human participants. Extending these findings to the domain of vision, I suggest that the principle of representation universality may underlie information processing across various domains.

The second question addresses a common criticism of language ANNs: namely, that they are implausible as models of human language processing because they require  vastly more training data. Using two complementary approaches, I show that ANNs can build representations similar to those in the human language network even with a “developmentally realistic” amount of training data, approximately 100 million words.

Finally, to answer the third question, I draw inspiration from computational neuroscience to reveal how ANN language models learn a predictive model of linguistic input. By focusing on representational geometry, I demonstrate that ANN models progressively “untangle” the temporal trajectory of a sentence’s representation via straightening—reduction in curvature between adjacent words as the input is passed through the model’s layers. Using this straightening mechanism, the ANN model recasts next-word prediction as a smooth linear extrapolation from the current internal state to a future state. Straightening emerges as a result of model training and scales with model size. Furthermore, the average degree of sentence straightening in the deep layers of the model correlates with corpus-based estimates of sentence surprisal, which are linked to human comprehension difficulty (e.g., as reflected in reading times).

Collectively, these lines of work provide essential ingredients for building a more computationally precise model of language processing in the human brain, leveraging synergies with artificial neural network language models.

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Single-cell analysis reveals mechanisms of a common complication of Crohn's disease

by The Mount Sinai Hospital

Mount Sinai researchers have published the first study to use single-cell analysis in identifying several pathophysiological mechanisms of abnormal passageways in the digestive system known as perianal fistulae, a common complication of Crohn's disease. These findings were published in the journal Med on April 24.

Crohn's disease is an inflammatory bowel disease that causes chronic inflammation at any part of the gastrointestinal (GI) tract and impacts more than half a million people in the United States. Perianal fistulae, abnormal connections between the anal canal and perianal skin, are a common complication of Crohn's disease that often result in painful abscesses and impact patients' quality of life.

This Mount Sinai study is the first to apply single-cell transcriptomics of perianal fistulous tracts, and to recruit Black patients with the chronic condition for a diverse and comprehensive study cohort.

Patients with African ancestry have been substantially underrepresented in genome-wide association studies of Crohn's disease, and inflammatory bowel disease overall, reflecting in part the lower prevalence of Crohn's disease in African American populations compared to patients with European ancestry. However, patients of African ancestry are about twice as likely to have perianal fistulae, according to studies in adult and pediatric populations.

The researchers profiled more than 140,000 single cells from diverse Crohn's disease patients with perianal fistulae. The team identified several key pathways underlying fistulizing Crohn's disease, including cellular aging and loss of proliferation, reaction to microenvironmental stimuli, and a destructive gene signature in connective tissues that is unique to perianal fistulae.

The researchers also determined that subpopulations of fibroblasts—cells forming the connective tissues—with this destructive gene signature may originate from mononuclear cells in the immune system , a phenomenon observed in greater magnitude from patients with African ancestry. The experts found evidence for key transcription factor binding events in relevant gene promoter regions that suggests a potential epigenetic phenomenon underlying this apparent difference in cell behavior between patients of African and European ancestry.

"Circulating blood monocytes can traffic to disease tissues and form a critical first step in fighting microbes throughout the body," said corresponding author Judy H. Cho, MD, Dean and Ward-Coleman Chair in Translational Genetics at the Icahn School of Medicine at Mount Sinai.

"In this study, we have defined population-specific differences in how blood monocytes respond, which contribute to the higher rates of perianal fistulous complications in African American patients with Crohn's disease."

A range of anti-inflammatory medications can treat Crohn's disease, but they show limited efficacy for closure of perianal fistula tracts. In severe cases, patients may require surgical removal of all or part of the rectum. But researchers said their findings provide avenues to identify new therapeutic options.

The team said future studies should examine similar epigenetic patterns in white blood cells of the immune system from diverse, healthy patients and from patients with other immune-mediated inflammatory diseases to further explore the role of the transcription factor underlying race or ancestry-based disparities.

"We have leveraged transcriptomic, epigenetic, genetic, cellular, and tissue-based data from patients with a history of this devastating complication to better understand reasons for the discrepancy in prevalence between Black and white patients," said first author Rachel M. Levantovsky, Ph.D., who is working on her MD in the Mount Sinai Medical Scientist Training Program.

"Our discovery of unique fistula fibroblasts, distinct monocyte differentiation in African-ancestry individuals, and key transcription factor binding events helps us illuminate mechanistic underpinnings of perianal fistula—critical for the optimization of future treatment."

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ORIGINAL RESEARCH article

The relationship between defense mechanisms and attachment as measured by observer-rated methods in a sample of depressed patients: a pilot study.

• 1 Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, United States
• 2 Department of Clinical Psychology, Pennsylvania State University, University Park, PA, United States
• 3 Institute for Psychosocial Prevention, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
• 4 Department of Psychology, SUNY Potsdam, Potsdam, NY, United States
• 5 Department of Psychiatry, Canada Institute of Community and Family Psychiatry, Jewish General Hospital, McGill University, Montreal, QC, Canada

Despite many theoretical and clinical writings, the theorized connection between defense mechanisms and adult attachment in depressed patients has received little empirical attention. This is the first study to examine patients’ defense mechanisms in relation to their attachment in a clinical sample of depressed patients and also the first to use observer-rated measures for assessing both defense mechanisms and attachment. In this pilot study, we aimed to investigate the relationship between patients’ attachment and their use of defense mechanisms in psychotherapy sessions, as well as patterns of change over treatment. We conducted a secondary analysis of data from a randomized controlled trial of 30 patients receiving psychotherapy for major depression. Session transcripts were previously coded for defense mechanisms using the Defense Mechanisms Rating Scales, and depression severity data were collected by the clinician-rated HRSD-17 and the self-report BDI-II. Patients’ attachment was assessed in two transcripts, one in an early session and a second in a late session, using the novel observer-rated Patient Attachment Coding System. In contrast with expectations, in the early phase of therapy, preoccupied attachment-related characteristics were significantly positively related to overall defensive functioning and negatively related to Depressive immature defenses. In the late phase of treatment, preoccupied attachment-related characteristics were negatively correlated with Non-depressive immature defenses. Moreover, as expected, early-phase defense use was related to late phase attachment; specifically, early neurotic and immature Depressive and Non-depressive defenses predicted an increase in avoidant, whereas immature Non-depressive defenses predicted a decrease in preoccupied attachment-related characteristics over the course of treatment, after controlling for early attachment effects. The results imply a longitudinal relationship between defenses and change in attachment-related characteristics over the course of treatment in a depressed sample and warrant further research about the relationship between defenses and attachment during psychotherapy.

Introduction

Patients’ attachment-related differences and defense mechanisms are the two main aspects of personality functioning and are thought to be important predictors of symptom severity and psychotherapy outcome ( Blatt and Levy, 2003 ; Perry, 2014 ; Dagan et al., 2018 ; Perry et al., 2020 ). Despite increasing interest in the topic over the past few years, there is still little empirical research conducted on the associations between defense mechanisms and patient’s attachment, especially in depressed patients. In this study, we sought to address this important gap in the literature by empirically examining the relationship between patients’ attachment-related characteristics and their use of defense mechanisms in treatment sessions conducted as part of a previous RCT for depression.

Defense mechanisms can be defined as automatic reactions to internal and external stressors or conflicts aimed at warding off negative emotional experiences. They are thought to underlie a wide range of healthy and psychopathological phenomena, including depression ( Perry, 2014 ). The use of defense mechanisms in any given situation is mostly out of the individual’s awareness; however, the type of defense mechanism used can lead to considerable differences in mental health and interpersonal functioning ( Vaillant, 2020 ).

Defense mechanisms can be categorized hierarchically, based on their general level of adaptiveness ( Perry, 1990 ; Perry and Bond, 2017 ). Of the tripartite defense categories, mature defense mechanisms are deemed the most adaptive strategies to maximize gratification and allow relatively good conscious awareness of feelings, ideas, and their behavior-related consequences. Though all defense mechanisms are thought to protect the individual from anxiety, mature defenses do not threaten interpersonal relationships or distort reality in order to do so. The intermediate level of neurotic defense mechanisms functions to keep distressing thought content out of awareness, also with minimal reality distortion. In contrast, the low level, mostly maladaptive immature defenses act through strong reality distortion or detachment from reality ( Perry and Bond, 2017 ) and are associated with mental health problems and lower interpersonal functioning, characteristic of severe mood and anxiety disorders ( Trower and Chadwick, 1995 ; Calati et al., 2010 ; Perry and Bond, 2012 ; Berney et al., 2014 ; Ciocca et al., 2017 ).

Relevant to patients who suffer from depression, the immature defense category can be further subdivided into Depressive and Non-depressive Defenses. Depressive defenses have been empirically associated with depression, whereas Non-depressive defenses were negatively associated with depression ( Høglend and Perry, 1998 ). In depressed patients, the use of immature defenses has been found to decrease by the end of treatment, whereas neurotic and mature defenses remain unchanged (e.g., Mullen et al., 1999 ). Moreover, within immature defenses, the subgroup of Depressive defense mechanisms is linked to decreases in depression symptomatology specifically ( Perry et al., 2020 ).

Attachment theory ( Bowlby, 1969 ) offers a cogent framework for understanding the development and treatment of psychopathologies such as depression ( Cummings and Cicchetti, 1990 ; Williams and Riskind, 2004 ; Dykas and Cassidy, 2011 ; Lakey and Orehek, 2011 ; Hames et al., 2013 ). There appears to be an overrepresentation of patients with insecure attachment in clinical populations in general and in clinically depressed samples in particular, compared with non-clinical samples ( Bakermans-Kranenburg and van Ijzendoorn, 2009 ; for a recent meta-analysis see Dagan et al., 2018 ). Similarly, individuals with insecure attachments have been shown to experience higher levels of depression than securely attached individuals ( Fonagy et al., 1996 ; Borelli et al., 2010 ; Ivarsson et al., 2010 ).

John Bowlby developed his theory of attachment partly to explain why some of his patients appeared to eschew intimacy and defend against experiencing emotions, with calamitous consequences for their social adaptation ( Duschinsky, 2020 ). Bowlby posited that individual differences in early relationships with one’s primary caregivers are carried forward and shape relationships with others (e.g., peers and romantic partners; Bowlby, 1988 ; Roisman, 2006 ; Feeney, 2008 ; Holland and Roisman, 2010 ; Groh et al., 2014 ).

Following Bowlby’s innovative theorizing, a host of studies have confirmed that early differences in attachment relationships later impact cognitive and affective processing of expectations about closeness and support from others. Beginning in the sixties, attachment researchers established that differences in parental sensitivity and responsiveness give rise to distinct infant tendencies to establish proximity with the caregiver, which in turn seem to be underpinned by differing expectations concerning caregiver availability ( Ainsworth et al., 1978 ). In particular, Ainsworth and colleagues proposed that infants seek proximity with their caregiver in one of three ways: secure , involving actively seeking proximity if they generally expect the caregiver to be available when they are distressed; avoidant , if they do not hold such an expectation, they seem to defensively inhibit their search for physical proximity; and resistant (or ambivalent), if they expect the caregiver to be unpredictable or inconsistent leading to constantly monitoring their proximity to the caregiver even when he or she is within reach.

Later work showed that these infant differences are robustly predicted by parent’s attachment representations, as assessed in a semi-structured interview, the Adult Attachment Interview (AAI; Main et al., 1985 ). Namely, parents of secure infants in the AAI appear to openly access their own representations and memories of their relationships with their parents and are termed “secure-autonomous.” Parents of avoidant infants seem to shift their attention away from discussing attachment relationships and stressful episodes and are termed “dismissing,” while parents of resistant infants appear to focus excessively on such topics and are termed “preoccupied.”

According to one popular view, whereas secure attachment is related to an unbiased way of processing affectively laden information, with little need to use reality-distorting defense mechanisms ( Cramer and Kelly, 2010 ; Dykas and Cassidy, 2011 ), insecure attachment reflects defensive responses to negative emotions, threats to separation, or distress more generally ( Ein-Dor et al., 2016 ). In this view, attachment is seen as an adaptation strategy to a given environment ( Luyten et al., 2021 ).

Certain defense mechanisms are prominent in the interpersonal patterns that convey the effect of attachment insecurity on psychological distress, such as depression. For example, dismissing attachment classifications seem to be associated with denying one’s own weaknesses and those of one’s attachment figures ( Main et al., 2002 ). Conversely, preoccupied attachment may be associated with hyperactivating the expression of distress and maintaining a consistent focus on negative emotions, which may work to gain and maintain others’ proximity – at least in the short term.

Indeed, attachment theory can be understood as a two-person theory of conflict and defense. It emphasizes the coping or defensive processes required to deal with fearful arousal within the context of attachment relationships. In Bowlby’s view, defensive exclusion occurs when attachment-related information is kept out of awareness to prevent the painful effect associated with attachment system activation when no perceived comfort from attachment figures (real or representational) is available ( Bowlby, 1980 ). In contrast to an intrapsychic theory of defense, attachment theory locates the ontogeny of defenses in an intersubjective field. The development of defensive styles is theorized to occur at the interface between a child’s fearful arousal and the subsequent responses of important attachment figures. More specifically, the infant-caregiver interactions that occur around distress and comfort result in defensive adaptations, in the form of defense mechanisms ( Lyons-Ruth, 2003 ). In other words, in relation to adult attachment patterns, defenses are conceptualized as the mechanism that modulates the attachment system in order to reduce distressing feelings associated with negative expectancies, both at the intrapersonal and interpersonal levels ( Kobak and Bosmans, 2019 ), and as such are directly related to emotion dysregulation ( Malik et al., 2015 ).

Despite many theoretical and clinical writings, this hypothesized connection between attachment and defense mechanisms has received little empirical attention. The few existing empirical studies generally suggest that insecure attachment is typically associated with an increased use of immature defense mechanisms (e.g., Prunas et al., 2019 ) and that this overreliance on immature defenses leaves insecurely attached individuals particularly vulnerable to psychopathology, such as depression (e.g., Laczkovics et al., 2018 ; Ciocca et al., 2020 ). Up until now, however, empirical studies investigating the association between attachment and defenses have been conducted in non-clinical samples ( Ciocca et al., 2020 ) rather than clinical or treatment samples.

Previous studies on the relationship between attachment and defense mechanisms have been further limited by their reliance on self-report questionnaires. Self-report measures may be more biased (when compared to observer-based measures) when aiming to identify processes that are predominantly unconscious, such as attachment and defenses. Whereas preliminary evidence shows that self-report and observer-rated defense ratings may align ( Di Giuseppe et al., 2020 ), it is increasingly well-agreed that self-report measures of attachment (for example, the Experience of Close Relationships Scale; Brennan et al., 1998 ) and observer-rated measures of attachment (such as the AAI) do not cohere empirically and may in fact capture different constructs ( Roisman, 2006 ; Strauss et al., 2015 ).

In the current study, we sought to address this gap in the literature by examining the association between attachment and defense mechanisms in patients undergoing psychotherapy for depression, using a novel observer-rated method for assessing attachment, the Patient Attachment Coding System (PACS; Talia et al., 2017 ), in addition to the well-established observer-rated DMRS for defenses. The PACS was initially developed in an effort to find verbal markers that would distinguish the discourse of patients who had been independently classified as secure, dismissing, or preoccupied on the AAI ( Talia et al., 2014 , 2017 , 2019b ). This work led to distinct identifying markers that can be reliably scored in any session of psychotherapy transcribed verbatim, regardless of the therapeutic orientation ( Talia et al., 2014 ). Because the PACS markers occur regardless of whether patients speak about attachments or other topics that they find distressful, Talia and his colleagues have described them first and foremost as capturing differing ways in which patients collaborate with the therapist, rather than defenses ( Talia et al., 2019a ).

Given the importance of attachment security and defense mechanisms in the development of psychopathology, such as depression ( Høglend and Perry, 1998 ; Martin-Joy et al., 2017 ) and their general importance in treatment formulations (e.g., Fonagy, 2001 ; Eagle, 2013 ), it is important to better understand the relationship between these two processes. Thus, the overall aim of our study was to investigate the relationship between patients’ attachment and their use of defense mechanisms in psychotherapy for depression, as well as any patterns of change over time. Of note, in contrast with previous studies, where attachment style was assessed as a predictor of defense use, in this present pilot study, we aimed to explore the role of defense mechanism in predicting changes in in-session attachment-related characteristics over treatment. Specifically, we explored the following two research questions:

1. What is the relationship between depressed patients’ in-session attachment-related characteristics and their defense mechanisms? We hypothesized that patients with secure attachment would exhibit higher overall defensive functioning, would use more mature defenses, and less immature defenses, in both the early and late sessions. Conversely, we also expected that patients with insecure attachment, specifically avoidant and preoccupied patterns, would use more immature defenses, in particular more Depressive defenses.

2. Does patients’ defensive functioning in the early session predict their attachment security in the late phase of treatment? We expected that patients’ overall defensive functioning, and amount of mature or immature defense use, early in treatment would predict attachment-related characteristics in the late phase of treatment. More specifically, within this clinically depressed sample, we expected that lower-level defenses, such as Immature, and especially, early Depressive Immature defense use would predict insecure (avoidant and preoccupied) attachment-related characteristics in the late phase of treatment.

Materials and Methods

Treatment trial.

This study reports on secondary analyses of existing treatment data collected as part of a previously conducted randomized controlled treatment trial (RCT) of 30 patients undergoing treatment for major depression (see Perry et al., 2021 for a detailed description of the RCT). Inclusion criteria in the study were having acute recurrent major depression and a 17 or higher score on the Hamilton Depression Rating Scale; exclusion criteria included psychotic or bipolar type I disorders, substance use or dependence serious enough to interfere with therapy, and an effective response to antidepressant medications, if tried, in the past 4weeks.

Nineteen patients (63%) were female, and mean age was 41years ( SD =12.43). As part of the RCT, patients were randomly assigned to either cognitive behavior psychotherapy (CBT; n =13), supportive psychotherapy (ST; n =7), or psychodynamic psychotherapy (PDT; n =10). On average, the CBT treatments consisted of 21.00 ( SD =10.44) sessions over 14months (range=2.75–21.75) and the ST consisted of 17.00 ( SD =9.04) sessions over 14months (6.5–27.5), whereas the PDT treatments were longer and consisted of an average of 62.7 ( SD =23.43) sessions over 21months (range=7.5–24.5). Depressive symptoms were assessed at baseline and at the end of treatment. Baseline depression scores on the BDI-II ( M =23.34, SD =6.97) and HRSD-17 ( M =17.48, SD =6.10) significantly correlated ( r =0.48, p <0.01), and both significantly decreased by termination [ t (27)=5.63, p <0.001 and t (27)=4.22, p <0.001, respectively]. As a part of the original RCT, the treatment sessions were audio-recorded and transcribed and coded for individual defense mechanisms, hierarchically organized into subsequent defense categories. For further details on the trial and the participants, please see Perry et al. (2021) .

Existing Measurements

The clinician-rated Hamilton Depression Rating Scale (HRSD-17; Hamilton, 1960 ) was used to assess depression levels pre-and post-treatment. The HRSD-17 is a 17-item semi-structured interview, which assesses depression on a 5-point Likert scale, ranging from 0 to 4. The HRSD-17 has demonstrated good internal consistency in previous studies with a mean alpha of 0.79 across studies, in our report Cronbach’s alpha=0.83.

The self-report Beck Depression Inventory II (BDI-II; Beck, et al., 1996 ) was also administered pre-and post-treatment. The BDI-II is a widely used 21-item measure of Depressive symptoms experienced during the previous week, using a four-point Likert scale. Internal consistency of the BDI-II has been reported to be good in several studies, for example, a Cronbach alpha of 0.90 has been reported ( Storch et al., 2004 ). Cronbach’s alpha for BDI-II was 0.96 in the present report.

Defense Mechanisms

The observer-rated Defense Mechanism Rating Scales (DMRS; Perry, 1990 ) was used to assess defense mechanisms in session transcripts in the early and late treatment phases. The DMRS identifies 30 individual defenses ( Perry, 1990 ) as they occur in the text. The individual defense mechanisms are hierarchically arranged into three categories: Mature, Neurotic, and Immature defenses, and the Immature category can be further subdivided into Depressive and Non-depressive immature defenses. In addition to the tripartite categories, a score for overall defensive functioning (ODF) is calculated by summing the weighted average of each defense based on its defense level. The ODF can range between 1 and 7, with higher scores indicating more adaptive defensive functioning. Inter-rater reliability of the three defense categories, the Depressive and Non-depressive defenses, and the ODF have been shown to be satisfactory ( Perry, 2014 ).

Novel Observer-Rated Method

For this secondary analysis, the Patient Attachment Coding System (PACS; Talia et al., 2014 ) was used to assess patients’ attachment. The PACS is a transcript-based measure that yields classifications of patients’ attachment based on a single therapy session transcribed verbatim in any treatment modality, regardless of the stage of treatment and of therapist’s activity. Recent work in attachment-informed psychotherapy research ( Talia et al., 2017 ) has shown that patients’ discourse style during psychotherapy reliably predicts their independently obtained attachment classification on the AAI. PACS attachment security has been found to predict greater in-session mentalizing ( Talia et al., 2017 ), greater resolution of relational ruptures in psychotherapy ( Miller-Bottome et al., 2018 ), and patient-therapist physiological synchrony ( Kleinbub et al., 2020 ). The PACS has also been shown to predict patients’ AAI classification even when applied to post-treatment interviews rather than therapy sessions ( Talia et al., 2019b ).

When coding with the PACS, the coder assesses the frequency and intensity of 40 different discourse markers as they occur in a transcript, which are grouped into five main scales used to assign a final main attachment classification to the patient: Proximity seeking, Exploring, and Contact maintaining which are associated with Secure attachment; Avoidance which is associated with Avoidant attachment; and Resistance which is associated with Preoccupied attachment. A sixth scale, Balance, is used as a global score of security which encompasses the five main PACS scales. As such, although a person may exhibit predominantly secure attachment characteristics, they may also exhibit some avoidant and resistant markers.

In this study, we report on the scores on the three PACS scales reflecting attachment-related characteristics, including secure attachment (Balance scale), avoidant attachment (Avoidance scale), and preoccupied attachment (Resistance scale). In order to avoid multiple testing of related variables, we used Balance as a proxy for attachment security (and did not include the three secure scales). The rater assigns a rating from 1 to 7 in 0.5 increments based on both the frequency and intensity of the markers of each subscale identified in the transcript. More specifically, the Balance score reflects the degree of attachment security exhibited by the patient including the open expression of emotions in the present, communication of feeling and needs in the therapeutic relationship, autonomous reflections, and positive emotions. The Avoidance scale assesses the level of evasion of inquiries into the patient’s positive and negative experience and the level of minimization or deferment of any mental state previously conveyed (e.g., the patient affirms that he or she has no right to complain; chuckles about his or her own distress). The Resistance scale captures discourse markers that enlist the therapist’s agreement with the patient’s views or otherwise restrict the therapist’s capacity to disagree, for example, by being vague or excessively detailed. In order to assign an overall attachment classification (Secure, Avoidant, or Preoccupied) for the patient, a proportional index of balance, avoidant, and resistant characteristics is calculated (for a more detailed description of the PACS, see Talia et al., 2017 ).

In order to become reliable PACS coders, four clinical psychology doctoral students completed a one-week comprehensive training workshop in the use of the PACS taught by the developer (A.T.) and attended weekly reliability consensus meetings on practice transcripts for 3months following the training workshop. When their ICC with the developer of the PACS reached 0.80 or above, the students started coding the session transcripts for the study. Session transcripts were randomly assigned across the four raters. Throughout the coding, the raters received ongoing intensive supervision from the developer of the PACS. Inter-rater reliability was calculated on 29 (50%) out of 58 coded sessions, and the ICC between the developer and the coders was 0.85. From the available session transcripts already coded on the DMRS, two sessions per treatment were coded with the PACS, one session from the early phase of treatment (the second session) and a session at the late phase of treatment (the penultimate session), altogether resulting in a sample of 60 PACS coded sessions, reflecting 30 treatments.

Data Analysis

In the reported analyses, the total sample of 30 treatments was used. Two patients were dropped out during treatment; therefore, the cross-sectional analysis at the early phase was based on n =30, whereas the analyses at the late phase of treatment and the change across treatment included n =28. The use of an existing data set and observer ratings meant that there were no missing attachment or defense scores. To compare initial attachment and defense scores across the three treatment arms, we conducted one-way ANOVA. The small number of patients in each treatment modality only allowed us to conduct pilot comparisons and to report effect sizes and not values of p .

The attachment and defense variables were not normally distributed (skewness and kurtosis more than twice the standard error). Both at the early and late phases, attachment scores on the Balance scale were significantly positively skewed, due to the high prevalence of insecure patients in the sample ( n =21). Therefore, non-parametric tests of defenses and attachment were used in subsequent analyses. Wilcoxon signed-rank test was used to compare attachment and defenses in the early and late phases of the treatments. A paired samples t test was used to compare self-rated and observer-rated depression scores at pre-and post-treatment. Spearman’s rho correlations were used to analyze the relationship between variables on the DMRS and the PACS. Linear regression analysis was used to examine whether early-phase defensive functioning predicted late-phase attachment. For checking the assumptions for the regression models, we confirmed that the data contained approximately normally distributed errors with equal variance and met the assumptions of homogeneity of variance and linearity. Two-tailed tests of significance were applied throughout. Given the exploratory nature of the examinations and the relatively low power, we did not apply a correction for multiple correlations. All statistical analyses were conducted using SPSS 24.0.

Patient Attachment and Defenses Early in Treatment

In the early sessions, the majority of the 30 patients were classified on the PACS as Preoccupied ( n =15). Nine patients were classified as Secure and six as Avoidant. Regarding the scales, the average rating on the PACS Balance scale suggested that overall the patients in this sample were relatively insecurely attached ( M =2.93; SD =1.4) at baseline, a score which is significantly lower than in other mixed outpatients’ samples [ M =3.7, SD =1.3, t (188)=2.79, p <0.01; Talia et al., 2017 ]. Moreover, these depressed patients also scored higher on the PACS Resistance scale ( M =4.20; SD =2.47), indicating that their attachment was significantly more preoccupied than is generally seen in outpatient samples [ M =3.3, SD =2.00, t (188)=2.18, p <0.05], whereas the PACS Avoidance scale ( M =2.79; SD =1.77) was in line with previous findings [ M =2.8, SD =1.60, t (188)=0.00, p =ns; Talia et al., 2017 ].

Average overall defensive functioning ( M =4.88; SD=0.57) early in treatment fell into the level usually associated with acute depression or personality disorders and was comparable to other mixed outpatient groups reported in the literature [ M =4.62, SD =0.27, t(49) =1.93, p =ns.; Perry and Henry, 2004 ]. Table 1 shows the means, standard deviations, and significant changes in the relevant variables.

Table 1 . Wilcoxon signed-rank tests comparing Beginning and Late-Phase Defense and Attachment Variables ( N =28).

Early-phase PACS and defense variables differed in the three treatment arms. Pilot comparison using Eta-squared showed that variance in early treatment PACS variables across the three treatment arms was Balance η 2 =0.010, Avoidance η 2 =0.158, and Resistance η 2 =0.154; and variance based on the treatment arms in early-phase defense variables ranged between Neurotic defenses η 2 =0.035 and ODF η 2 =0.108.

Research Question 1: Relationship Between the Patients’ Attachment-Related Characteristics and Their Use of Defense Mechanisms

Spearman’s rho correlations were used to test the relationship between in-session attachment-related characteristics (PACS Balance, PACS Avoidance, and PACS Resistance) at both early and late phases of treatment and patients’ use of defense mechanisms (DMRS variables: ODF, Mature, Neurotic, Immature including Depressive and Non-depressive Immature defenses). No significant correlations between attachment security (PACS Balance scale) or avoidance (PACS Avoidance scale) and the DMRS variables were found in the early or late sessions. In the early sessions, the PACS Resistance scale was significantly related to ODF ( r s = 0.37, p =0.043) and negatively associated with the DMRS Depressive Immature defenses ( r s =−0.45, p =0.012; see Table 2 ). At the late phase of treatment, the PACS Resistance scale negatively correlated with the DMRS Non-depressive immature defenses ( r s =−0.42, p =0.027; see Supplementary Material ).

Table 2 . Spearman correlations between early PACS attachment-related characteristics and early DMRS defense mechanisms.

Research Question 2: Patients’ Use of Defense Mechanisms Early in Treatment and Attachment-Related Characteristics Late in Treatment

In order to establish whether there was any relationship between patients’ use of defense mechanisms early in treatment and improvement in their attachment-related characteristics during treatment, we used Spearman’s rho correlations between the defense variables (DMRS scales: ODF, Mature, Neurotic, Immature) at the early phase of the treatment and attachment variables (PACS scales: Balance, Avoidance, Resistance) at the late phase of the treatment. Results showed a significant negative correlation between early DMRS Neurotic defenses and late-phase PACS Avoidance scale ( r s =−0.44, p =0.020) and a significant negative correlation with the PACS Resistance scale at the end phase of treatment ( r s =−0.42, p =0.030). Early DMRS Immature defenses were significantly and positively correlated with late-phase PACS Avoidance scale ( r s =0 .51, p =0.005) and negatively with late-phase PACS Resistance scale ( r s =−0.48, p =0.009; see Supplementary Material ).

Based on these significant relationships between DMRS defenses early in treatment and PACS scales in the late phase of treatment, we conducted linear regressions to establish whether defense use (DMRS Immature, Neurotic defenses) in the early phase predicts attachment-related characteristics (PACS Avoidance, Resistance scales) in the late phase of treatment, after controlling for early levels of attachment-related characteristics. Since the DMRS Immature defenses category can be divided into the two mutually exclusive subcategories of Depressive immature defenses and Non-depressive immature defenses, we substituted these subcategories in the regression model, rather than the less specific DMRS Immature defense category. We used stepwise regression to assess the unique contribution of Depressive and Non-depressive defenses in predicting the change in attachment-related characteristics.

As Table 3 shows, both early Depressive and Non-depressive immature defenses significantly predicted late-phase PACS Avoidance after controlling for baseline PACS Avoidance ( B =6.47, SE =2.20, t =2.95, p <0.05, Δ R 2 =0.14; B =8.43, SE =3.70, t =2.38, p <0.05, Δ R 2 =0.11; respectively). Moreover, early Non-depressive immature defenses (but not Depressive immature defenses) negatively predicted PACS Resistance at the late phase of treatment, after controlling for early PACS Resistance ( B =−18.56, SE =5.48, t =−3.38, p <0.01, Δ R 2 =0.23). Finally, early DMRS Neurotic defenses significantly predicted late-phase PACS Avoidance after controlling for early PACS Avoidance ( B =−0.3.84, SE =1.81, t =−2.13, p <0.05, Δ R 2 =0.06). Early-phase DMRS Neurotic defenses did not predict late-phase PACS Resistance significantly after controlling for early Resistance ( B =5.16, SE =2.69, t =1.92, p =ns, Δ R 2 =0.10).

Table 3 . Regression models for early DMRS defense mechanisms predicting late PACS attachment-related characteristics.

This pilot study is the first to examine patients’ defense mechanisms in relation to their attachment in a clinical sample of depressed patients and also the first to use observer-rated measures for assessing both defense mechanisms and attachment. Specifically, the present study explored the role of early-phase defense mechanisms in predicting changes in attachment-related characteristics over the course of psychotherapy.

We first hypothesized that patients with higher overall defensive functioning, more Mature defenses, and less Immature defenses would be associated with more attachment security across all sessions. This first hypothesis was not supported. We found that attachment security (PACS Balance) and PACS Avoidance were not related to defenses, but PACS Resistance was positively associated with overall defensive functioning at the early phase of treatment and negatively associated with Depressive Immature defenses in the early phase. PACS Resistance was also negatively associated with Non-depressive immature defenses at the late phase of treatment.

Our second hypothesis was partly supported, in that early-phase Immature and Neurotic defense use was related to late-phase attachment-related characteristics. We found that Immature defenses, and specifically, both Depressive and Non-depressive immature defense use and Neurotic defense use, were associated with more late-phase PACS Avoidance, even after controlling for early-phase PACS Avoidance levels. Moreover, more Non-depressive defense use during the early phase of therapy predicted less PACS Resistance at the late phase, after controlling for the effect of early PACS Resistance levels.

The positive relationship between overall defensive functioning and preoccupied attachment-related characteristics at the early phase of treatment may be explained by the fact that defensive functioning is usually at its lowest, not at the beginning of psychotherapy but somewhat later in treatment, when the patient is more deeply engaged in working on difficult topics in therapy. Thus, even though attachment-related characteristics may be detected already in early sessions, defense style of the patient when dealing with stressful conditions (or topics) may only be displayed later in therapy or across several sessions. Moreover, we assessed defenses and attachment in only one session transcript from each time point. The last sessions before termination often trigger attachment-related issues and may bring up relational insecurities, which might result in bias toward lower defensive functioning and more insecure attachment characteristics than what the patient would typically display. Although this treatment trial allowed for a pilot comparison between three different psychological treatments, the variability in the number of sessions and length of therapy across the three treatment arms (an average of 21 sessions in CBT, 17 in ST, and 62 in PDT) limited the ability to interpret the temporal relationship between defenses and attachment in our study. Future studies using more sessions per treatment may more reliably assess change processes during the course of treatment.

Another explanation for the relative lack of a cross-sectional relationship between defenses and attachment-related characteristics might also be methodological. Both defense mechanisms and attachment were coded across whole therapy sessions, as they occurred, and summary scores for both constructs were used in the subsequent analyses. It is thus possible that unrelated segments were coded as defense and as attachment episodes, with relatively little overlap, manifesting in divergent results. As such, future studies implementing a more fine-grained approach focusing on identifying episodes when defense and attachment events overlap in the transcripts may more accurately reflect the association between specific defense mechanisms and attachment-related characteristics.

When interpreting the cross-sectional associations between defense use and patient attachment, it is important to also consider that our depressed sample included patients with relatively low defensive functioning and mostly insecure attachment classification ( n =21, 70%), with half of the patients ( n =15, 50%) classified as preoccupied. A predominance of insecure and especially preoccupied attachment in a depressed sample is to be expected, as these have been proposed to relate to psychopathology, and specifically, depression (e.g., Laczkovics et al., 2018 ; Ciocca et al., 2020 ); however, the widely varying prevalence of the three attachment styles in our sample limited a fair comparison of patients with different attachment classifications.

It is important to also note that the comparison of the results based on self-report and observer-rated methods is limited, due to the inherent differences occurring when studying phenomena at least partly outside of awareness, such as defense mechanisms and attachment. Findings obtained by self-report measures may not be directly translatable to results with observer-rated methods, such as the AAI interview and the PACS, and vice versa.

Our results imply a longitudinal relationship between immature and neurotic defense use and attachment security, in which patients who used more immature (both Depressive and Non-depressive) or neurotic defenses early in treatment displayed an increase in PACS Avoidance late in treatment, whereas patients who used more Non-depressive immature defenses early in treatment displayed a decrease in PACS Resistance by the late phase of treatment, independently of their early attachment-related characteristics. That is, in this depressed sample, which had a high prevalence of neurotic and immature defenses at the beginning of treatment, the use of these defenses was related to a reduction in characteristics related to preoccupied attachment and an increase in avoidant attachment-related characteristics over the course of treatment. Previous studies showed that insecure attachment, and especially preoccupied attachment, is associated with more vulnerability to psychopathology and especially depressive symptoms, compared to not only secure but also avoidant attachment ( Cole-Detke and Kobak, 1996 ; Fonagy et al., 1996 ; Rosenstein and Horowitz, 1996 ; Borelli et al., 2010 ; Laczkovics et al., 2018 ). In our study, increase in avoidance and decrease in preoccupied characteristics thus might be considered as a possible proxy for improvement in attachment-related problems within insecure attachment.

The longitudinal (but not cross-sectional) findings of our pilot study support the theorized connection between defense mechanisms and adult attachment in depressed patients, as well as the few empirical findings that examined this association in non-clinical samples. These studies found that insecure attachment is typically associated with the less adaptive defense mechanisms (e.g., Prunas et al., 2019 ). Whereas our study did not find the expected relationship between attachment and defense variables in the same session, our findings showed that neurotic and immature defenses are related to change and possibly, improvement in insecure attachment over the course of treatment.

Limitations

Observer-rated codings are a strength but may also limit generalizability outside the session. As mentioned earlier, even though observer ratings may be less biased and better able to assess processes outside of the patient’s awareness, observer ratings are limited in that they assess patient functioning in a specific context, that is, a session, which might be affected by various circumstances, including the topic of the session or the level of alliance with the therapist. In a recent meta-analysis by Spruit et al. (2020) , the type of instrument used to assess attachment uniquely contributed to the explanation of variance in depression symptoms among adolescents, and studies including self-report tools reported bigger effect sizes compared to those based on interviews and observations. Although beyond the scope of the current investigation, it would be interesting to examine whether similar patterns between attachment and defenses would emerge if self-report assessments of attachment were used.

Furthermore, the PACS observer-rated coding system at the moment does not include the fourth attachment category Unresolved/disorganized (insecure) attachment. The inclusion of an additional attachment category may differentiate within the large proportion of patients currently classified as Preoccupied in our study.

Another limitation of this study is the relatively small sample size, which allowed for running correlations on the higher order defense and attachment categories, but did not allow for testing regression or mediation models on defense levels or individual defenses. The considerable differences in treatment length, especially the significantly longer psychodynamic therapies, also limit the generalizability of our results regarding temporal changes. Furthermore, we could only report initial comparisons across treatment arms. Given that some of the effect sizes across treatment modalities were large (Avoidance η 2 =0.158, and Resistance η 2 =0.154), further studies with larger sample sizes (powered to assess between-treatment effects) are warranted. Thus, this study can be seen as an exploratory pilot study, and larger-scale studies should examine the exact nature of the relationship between defense mechanisms and attachment security, testing mediation models of attachment, defenses, and psychopathology. A better understanding of the connections between insecure attachment and immature defenses with specific symptom clusters might induce clinicians to assess and intervene both on manifest symptoms and on defensive and relational styles, to help improve severe symptoms in depressed patients during the course of treatment.

Future research examining the association between adult attachment patterns and depressive symptoms should also examine further mediators and moderators. Attachment is likely best conceptualized as one etiological factor that interacts with many contextual and individual factors influencing risk for depression later in life ( Cummings and Cicchetti, 1990 ; Rosen and Rothbaum, 1993 ; Belsky, 1997 ; De Wolff and Van Ijzendoorn, 1997 ; Sroufe, 2005 ;). As such, the association between adult attachment and depressive symptoms may be mediated by cognitive, behavioral, relational, physiological, and affective processes (e.g., emotion regulation; Malik et al., 2015 ). Identifying these mechanisms may offer novel targets for the treatment of depression.

Using the PACS system to study patients’ attachment in session transcripts illustrates the potential clinical relevance of applying post hoc observer-rated measurements within the context of a highly controlled research design, such as an RCT. These observer codings are not only relevant with regard to the research insights they provide, but also might provide a useful clinical training tool to graduate students, who are interested in learning more about the psychotherapy process and how to attune their interventions to different types of patients. Furthermore, developing simple observer-rated methods that require minimal or no training to use are warranted. These methods could provide tools for clinicians to assess their patients’ defensive and attachment-related patterns in situ , at any time point during treatment, which has the potential to significantly enhance case formulation and tracking treatment-related changes over time.

Data Availability Statement

The data analyzed in this study is subject to the following licenses/restrictions: The IRB decision did not allow publishing the dataset. Requests to access these datasets should be directed to [email protected] .

Ethics Statement

The studies involving human participants were reviewed and approved by the Research Ethics Committee of the Jewish General Hospital in Montreal, Quebec, Canada (original RCT) and Yeshiva University’s IRB (WIRB), New York, NY (secondary data analysis). The patients/participants provided their written informed consent to participate in this study.

Author Contributions

VB: original idea, study coordination, data analysis, and manuscript write-up. KD: conceptual contribution, study coordination, and manuscript write-up. DS: conceptual contribution, data analysis, and manuscript write-up. AT: conceptual contribution, coding supervision, and manuscript write-up. CS: manuscript write-up. JP: providing data from the original RCT and conceptual contribution. All authors contributed to the article and approved the submitted version.

Conflict 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.

Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2021.648503/full#supplementary-material

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Keywords: defense mechanisms, attachment, depression, observer-rated, patient attachment coding system

Citation: Békés V, Aafjes-van Doorn K, Spina D, Talia A, Starrs CJ and Perry JC (2021) The Relationship Between Defense Mechanisms and Attachment as Measured by Observer-Rated Methods in a Sample of Depressed Patients: A Pilot Study. Front. Psychol . 12:648503. doi: 10.3389/fpsyg.2021.648503

Received: 31 December 2020; Accepted: 26 August 2021; Published: 27 September 2021.

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Copyright © 2021 Békés, Aafjes-van Doorn, Spina, Talia, Starrs and Perry. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Vera Békés, [email protected]

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