Psychological defence mechanisms during the COVID-19 pandemic: A case series

Abstract

Background and objectives COVID-19 has had a negative effect on mental health across the world's population. Healthcare workers in particular have experienced increased levels of psychological distress, depression and anxiety. Any perceived stress to an individual can provoke psychological defence mechanisms. Using psychoanalytic theory, a defence mechanism is described as an unconscious psychological strategy, with or without resulting behaviour, which aims to reduce or eliminate anxiety arising from unacceptable or potentially harmful stimuli. This paper aims to describe a range of psychological defence mechanisms encountered within colleagues in relation to the COVID-19 pandemic. Methods Using the methodology of a case series, specific defence mechanisms are explored with reference to further literature in the field. Results The author has encountered varying psychological defence mechanisms, both within himself and in other members of the multidisciplinary team. These have been illustrated in the attached clinical vignettes, relating to the specific psychological coping mechanisms of; denial, hypochondriasis, altruism, sublimation and humour. Conclusion We encourage acknowledgement of psychological defence mechanisms and their implications on day to day practice. Whilst defence mechanisms can have a number of negative consequences as described in this article, they also have an important role, particularly in the case of mature defence mechanisms, as protective factors against psychological distress and symptom formation. Deeper understanding of the gold-standard hierarchical organization of defence mechanisms could help increase utilisation of specific therapeutic interventions for enhancing changes from immature to mature defensive responses to stressful experiences as the COVID-19 pandemic progresses.

Stress, Burnout, and Resilience among Healthcare Workers during the COVID-19 Emergency: The Role of Defense Mechanisms

“…The association of defensive functioning with perceived stress, burnout, and resilience was also confirmed by our findings [ 62 ]. Higher overall defensive functioning and higher use of mature defenses were related to a greater sense of personal accomplishment and ability to withstand or adaptively recover from stress and, conversely, to lower perceived stress, emotional exhaustion and depersonalization.…”

Which personality traits can mitigate the impact of the pandemic? Assessment of the relationship between personality traits and traumatic events in the COVID-19 pandemic as mediated by defense mechanisms

“…This study can contribute by proposing differentiated interventions and treatments, starting from a better understanding of the defensive strategies used in relation to dispositional aspects. In this regard, these data suggest the usefulness of intervening to increase and support the use of mature defensive styles for dealing with the stressful experiences related to COVID-19 [ 69 ]. Treatments could focus, for example, on favoring increases in mentalizing or insight levels, which were positively associated with functional defenses and inversely with maladaptive defensive mechanisms [ 70 , 71 ], as well as related to higher levels of mental health, meaningfulness, and satisfaction [ 72 – 74 ].…”

A qualitative study to explore primary health care practitioners’ perceptions and understanding regarding the COVID-19 pandemic in KwaZulu-Natal, South Africa

“…Denial as a coping mechanism was widespread in the initial stages of the outbreak in Wuhan, China. 57 The use of denial as a coping mechanism highlights the deep-rooted psychological effects of the COVID-19 pandemic. Interventions are, therefore, necessary to assist healthcare workers and the general public to inculcate positive coping mechanisms in order to prevent negative mental health outcomes.…”