Defense mechanisms are automatic psychological processes that regulate emotional conflicts and modulate adaptation to internal and external stressors. As implicit components of emotion regulation, they play a transdiagnostic role across psychological and physical domains of health. Among the available instruments, the Defense Mechanisms Rating Scales-Self-Report-30 (DMRS-SR-30) directly operationalizes the hierarchical model of defenses, widely considered the gold standard framework for their empirical assessment. This systematic review aimed to synthesize findings from all studies that had employed the DMRS-SR-30 to date, summarizing its psychometric properties, domains of application, and clinical implications. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was conducted across PubMed, Scopus, and Web of Science databases. Eligible studies were full-text peer-reviewed articles written in English employing the DMRS-SR-30. Risk of bias was assessed according to study design using an established quality appraisal tool. Twenty-six studies met the inclusion criteria. The main domains of application were medical conditions, mental health and psychopathology, personality, and stress-related adjustment. Across these research areas, mature defenses were consistently associated with adaptive functioning and resilience, whereas immature and neurotic defenses predicted higher psychological distress, maladjustment, and psychopathology. The findings from the validation studies demonstrated that the scale exhibited robust reliability, construct validity, and clinical sensitivity. The DMRS-SR-30 provides a valid, efficient, and clinically meaningful method to assess the full hierarchy of defense mechanisms through a self-report tool. Its overall defensive functioning (ODF) index may offer an integrative measure of adaptive capacity that can complement standard psychodiagnostic and medical evaluations. Incorporating the assessment of defensive functioning can enhance the holistic understanding of patients, improve compliance with treatment, and promote person-centered care within mind-body health contexts.

Growing evidence highlights the crucial role of defense mechanisms in the context of chronic diseases. However, few studies have evaluated the impact of these implicit emotion regulation strategies on the adaptation processes related to inflammatory bowel diseases (IBD). This narrative review aimed to explore the role of defense mechanisms in patients with IBD and clarify their association with related psychological and physical symptoms. A literature search was conducted using PubMed and PsycINFO databases to select studies considering defense mechanisms in patients with IBD. Inclusion criteria were English language articles, diagnosis of Crohn's disease or ulcerative colitis, and use of validated assessment instruments specifically related to defense mechanisms. Six studies, including a total of 664 patients, were deemed eligible. Immature defense mechanisms were commonly detected in IBD patients, with significant effects on psychological and physical health. Significant associations were found between defense mechanisms, perceived health-related quality of life (HR-QoL), and psychological distress. Findings suggested that immature defense mechanisms may negatively impact the management of disease, leading to lower perceived HR-QoL, decreased treatment adherence, and increased risk of psychopathological symptoms. Considering these findings, we suggest that an integrated clinical evaluation, including an in-depth investigation of defense mechanisms, may promote more effective psychological treatments and improve psychological well-being in patients suffering from IBD.

The therapist's self-disclosure (TSD) interventions are considered beneficial and often used by psychotherapists. However, their use remains controversial for several reasons, including the use of broad definitions neglecting the distinction between the TSD and the therapist's self-involving (TSI) interventions. The TSD interventions involve the revelation of personal information to the patient, while the TSI implicates the direct expressions of the therapist's reaction to the patient's statements and behaviors within the session. To compare the immediate therapeutic effects of the TSD and TSI interventions, we conducted a study on 57 total interventions (i.e., 35 TSI and 22 TSD, respectively) performed during 17 psychotherapy sessions in a sample of 6 patients, evaluating the effects of each intervention (TSD or TSI) based on two parameters: patient's cooperative attunement and patient's metacognitive functioning. Results show that, compared to the TSD, the TSI interventions were followed by a higher cooperative attitude and metacognitive functioning of the patients. The difference in the short-term effects of these two interventions suggests the usefulness of considering TSD and TSI distinctly to evaluate their psychotherapeutic effectiveness.

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The development of fidelity and quality measures for the dissemination of evidence-based practices is an often-neglected, vital step in the implementation of psychological interventions, especially within parent-infant mental health. The current study aims to address this gap by developing a competency-based measure for clinicians delivering the Group Attachment Based Intervention (GABI). GABI is an intervention aimed at supporting family preservation in parents who have experienced disparities across multiple systems of care. After observing over 100 hours of clinical video, the research team, comprised of clinicians and academic researchers, developed a competency coding system to measure clinician efficacy titled the REARING coding system (RCS). This paper outlines the development and structure of the measure, including a detailed discussion of the model of therapeutic action (i.e., REARING: reflective functioning, emotional attunement, affect regulation, reticence, intergenerational transmission of attachment, nurturance, and group therapy context), as well as provides a clinical case study to illustrate the utility, flexibility, and depth of the measure. The case study details a family session consisting of a mother, father, and two children (one infant, one toddler), and how RCS can be used in supervision to foster clinical competency and effectiveness in the GABI model. RCS seeks to address the dissemination gap in Evidence Based Practices (EBPs) by contributing to the limited number of existing fidelity and competency measures in infant mental health and psychodynamic dyadic psychotherapy. RCS is an important tool for monitoring clinical competency in the dissemination of GABI and gives supervisors the ability to provide fidelity-focused supervisions.

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