|Year : 2017 | Volume
| Issue : 1 | Page : 3-8
Relationship between emotional regulation strategies and self –reported ego defense styles among nursing interns at Alexandria Main University Hospital
Amal Mohamed Gamal Hussein Shehata1, Fatma Ramadan2
1 Assistant Professor, Psychiatric Mental Health Nursing
2 Faculty of nursing Alexandria University
|Date of Web Publication||9-Jul-2019|
Amal Mohamed Gamal Hussein Shehata
Assistant Professor, Psychiatric Mental Health Nursing
Source of Support: None, Conflict of Interest: None
Internship year represents the first independent practice nurse graduates with the real work environment with all its challenges. The transition from student nurse to qualified staff nurse is often filled with overwhelming stress. Many nurse interns reported being distressed and emotionally overwhelmed in dealing with new or traumatic experiences when rotating various critical clinical settings. The experienced stress is likely to be exacerbated by lack of emotional regulation and adopting immature defenses that cause many forms of defensive behaviors. This study aimed to identify the relationship between emotional regulation strategies and self –reported ego defense styles among nursing interns at Alexandria Main University Hospital. Subjects of this study included 100 nursing interns in the internship year 2014 -2015. Data was collected by using Defense Style Questionnaire 40’' (DSQ-40) and Emotion Regulation Questionnaire (ERQ). The finding showed that, mature defense style is positively correlated to cognitive reappraisal of emotional regulation, whereas, immature defense style was positively correlated to emotional suppression. A significant difference was noted between gender and emotional regulation strategies, female interns tend to use more cognitive reappraisal, whereas, male tend to use more emotional suppression.
Keywords: Emotional Regulation, Ego Defense Styles, Nursing Interns
|How to cite this article:|
Hussein Shehata AM, Ramadan F. Relationship between emotional regulation strategies and self –reported ego defense styles among nursing interns at Alexandria Main University Hospital. Indian J Psy Nsg 2017;14:3-8
|How to cite this URL:|
Hussein Shehata AM, Ramadan F. Relationship between emotional regulation strategies and self –reported ego defense styles among nursing interns at Alexandria Main University Hospital. Indian J Psy Nsg [serial online] 2017 [cited 2023 Jun 1];14:3-8. Available from: https://www.ijpn.in/text.asp?2017/14/1/3/262419
| Introduction|| |
Internship year represents the first actual contact of the nurse graduates with the real work environment with all its challenges. The transition from student nurse to qualified staff nurse is often filled with overwhelming stress. Research findings suggest that the conflicting demands of being a student and an emerging professional can be particularly distressing,. Despite the negative consequences of stress on psychological growth and quality of patient care, nurse intern’s psychological reaction has not been yet studied in nursing research.
Many nurse interns reported being distressed and emotionally overwhelmed in dealing with new or traumatic experiences when rotating various critical clinical settings at Alexandria Main University Hospital. Some of them stated, “When I wanted to examine a patient, I was afraid of doing something that causes harm to the patient. I was hoping for my internship to be just finished as soon as possible”. Also, nurse interns feel sympathy with patients and talked about fears and worried that the patient might die; one of nurse interns said, “If any case die, it will be so hard, it really affected me, so I stay away and avoid managing hopeless case as possible”.
The experienced stress is likely to be exacerbated by lack of emotional regulation and adopting immature defenses that cause many forms of defensive behaviors.
Emotion regulation is a key element of most theories of emotion. It refers to a person’s ability to understand and accept his or her emotional experience, to engage in healthy strategies to manage uncomfortable emotions when necessary, and to engage in appropriate behavior when distressed.Two commonly used strategies for regulating emotions are cognitive reappraisal which involves changing how one thinks about a situation to decrease its emotional impact and the second, emotional suppression, involves inhibiting ongoing emotion-expressive behavior,,.
Despite the assessment of defensive styles in research, neither appears to have a structure that accurately describes the defensive styles or factors of separate sample of men and women. Men and women differ in their use,,,, of psychological defense mechanisms without them the conscious mind would be much more vulnerable to negatively charged emotional input.
Raising awareness among nurse interns and staff involved in nurse education and clinical practice during internship year, with the relationship between ego defense styles and emotional regulation could prompt the development of strategies to potentially prevent or at least reduce stress in the work environment and hopefully identify areas where contingency plans need to be put in place to support nurse interns in the clinical environment. Therefore, the current study was intended to identify the relationship between defense mechanism styles and emotional regulation strategies among nursing interns.
| Material and Methods|| |
This study aimed to identify the relationship between emotional regulation strategies and self-reported ego defense styles among nursing interns at Alexandria Main University Hospital. This study followed a descriptive correlational design. The study was conducted at Alexandria Main University Hospital at the departments in which student interns are enrolled.Subjects of this study included 100 nursing interns in the internship year 2014-2015. The tools used were: Tool I: Defense Style Questionnaire 40’' (DSQ-40), the scale was self-administered it is a measure of 20 defense mechanisms which grouped as mature (sublimation, suppression, anticipation, altruism, and humor), immature (projection, passive aggression, acting out, fantasy, hypochondriasis, and dissociation), and neurotic (displacement, repression, isolation, and reaction formation). Items are rated on a Likert scale ranging from 1 (“strongly disagree”) to 9 (“strongly agree”) based on personal agreement with the statement. Defenses are scored by taking a mean score of the representative items. Cronbach’s alphas of 0.65, 0.63 and 0.82 were reported for the three defense styles of mature, neurotic and immature respectively. Tool II: Emotion Regulation Questionnaire (ERQ). It is a 10-item scale designed to assess respondents’ tendency to regulate their emotions in the habitual use of two emotion regulation strategies: cognitive reappraisal and expressive suppression. Respondents answer each item on a 7-point Likert-type scale ranging from 1 (strongly disagree) to 7 (strongly agree). It is scored by taking a mean score of the representative items. Internal consistency obtained by Cronbach’s alpha coefficient for the factors of cognitive reappraisal and emotional suppression were 0.73 and 0.75, respectively.
In addition, socio-demographic data was obtained by the researchers to elicit data about the general socio-demographic characteristics of the student
Written approval was obtained from the faculty dean and the vice dean for student affairs to send it to the manager of the Main University Hospital to collect the necessary data. Data was collected by the researchers after the first month of the beginning of internship year from 100 subjects. The questionnaire was hand delivered to each study subject at the identified study setting.
| Results|| |
[Table 1] reveals that the age of the studied interns ranged from 21 to 24 years, with a mean age 22.50 ± 1.24 years. More than two thirds of them (69%) were females. Almost two thirds (64%) lived int rural areas. Regarding their academic achievement, 23% of them obtained C+, 22% obtained C- and 21% obtained B.
|Table 1: Socio-demographic characteristics among the studied nurse interns|
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[Table 2] shows the distribution of the studied nurse interns according to their total percent mean score of ego defense mechanisms. The highest percent mean score was for mature ego defense mechanisms (59.47 ± 9.54), Anticipation has the highest mean score among nurse interns among the mature defenses. Whereas immature defense mechanism had the lowest percent score among the studied interns (49.31 ± 12.18), the highest mean score among this group was for rationalization and somatization (11.40 ± 3.42 & 11.25 ± 4.07 respectively). As regard, neurotic ego defense mechanisms, the total percent mean score was 55.84 ± 14.95, Pseudo-altruism has the highest mean score among the studied interns in neurotic defenses (12.52±3.36).
|Table 2: Self-reported ego defense styles among the studied nurse interns|
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As given in [Table 3] that the distribution of the studied nurse interns according to their mean score of emotional regulation strategies. It was noted that cognitive reappraisal strategy had a higher mean score (30.23 ± 7.42) than emotional suppression strategy (17.17 ± 5.58) among nurse interns.
|Table 3: Emotional regulation strategies among the studied nurse interns (n = 100)|
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[Table 4] shows that total mature defense mechanism was significantly correlated with cognitive reappraisal emotional regulation strategy (r=0.355, p=<0.001), suppression and sublimation as mature defenses were significantly correlated with cognitive reappraisal emotional regulation strategy (r =0.240, p=0.016 & r = 0.346, p= <0.001 respectively). Furthermore, neurotic defense mechanisms were significantly correlated with cognitive reappraisal (r=0.365, p=<0.001), pseudo-altruism and reaction formation were also positively correlated with cognitive reappraisal (r= 0.270, p=0.007 & r=0.347, p=<0.001 respectively). Whereas, the total immature defense mechanisms were positively correlated with emotional suppression emotional regulation strategy (r=0.322, p=<0.001).
|Table 4: Relationship between self-reported ego defense styles and emotional regulation strategies among the studied nurse interns (n = 100)|
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As given in [Table 5] it was noted that male interns had higher mature mean score (64.67 ± 12.75) than female interns (57.13 ± 15.30) with significant difference between them (t=.2.39 p=0.019*). Whereas, female interns had higher neurotic mean score (56.73 ± 14.96) than male interns (53.88 ± 14.98) with no significant difference (t=0.879, p= 0.381). The total mean score of immature defenses among male interns (51.31 ± 11.76) was higher than females (48.41 ± 12.34) with no significant difference was found (t= 1.103, p=0.273). It also observed that passive aggressive defense mechanism was significantly different between male and female interns (t=2.286 , p=0.024) , male interns had higher mean score than female interns in passive aggressive defense mechanism(47.98 ± 20.63 & 37.23 ± 22.24 respectively).In relation to gender difference in emotional regulation, a significant difference was found between male and female interns in relation to emotional suppression ( t=4.029*, p=<0.001*) , male interns had higher mean score(67.88 ± 22.83) than female interns(49.03 ± 21.08). In addition, denial, isolation and acting out defenses were higher in male interns than in females. While somatization defense mechanism was higher in females as compared to males.
|Table 5: Emotional regulation strategies and self-reported ego defense styles among male and female nurse interns|
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| Discussion|| |
Defense style and emotional regulation are crucial to healthy mental functioning, and that disturbances in them play an important role in psychopathology. Hence, the current study would shed light on individual differences in defense use in relation to emotional regulation among nursing interns. According to the results of the present study, mature defense style has positive and significant correlation with cognitive reappraisal of emotional regulation. An explanation to this results, as coping is a situational based, successful coping with a situation seems to require the thinking ability to do when the problems are within his/ or her control to cope and function as a self-reliant through using mature defenses and cognitive reappraisal.
In addition, Suppression and sublimation were significantly and positively correlated with cognitive reappraisal. Consistent with these results, Waqas et al. (2015) reported that the use of mature defenses such as sublimation enhances pleasure and feelings of control and suppression helps in integrating conflicting emotions and thoughts. This result was in concordance with a study in Iran which found that nurses who use mature defense style in stress and anxiety situations have better psychological well-being than nurses who use of neurotic and immature defense styles.
Furthermore, Viallant (2000) found that mature defenses are correlated with better adaptability and compatibility in life on some college students. Moreover, Sepidehdam et al. (2012) showed that the more mature mechanisms people have the less emotionally fatigued they feel. It was also found a negative significant relation between mature defenses and the symptoms of depression, fatigue and the poor life quality thus adaptive coping and renders them not vulnerable to various forms of psychological distress.
In the current study, immature defenses style was positively and significantly correlated with suppressive emotional regulation. This may be related to the fact that immature defenses styles are non-adaptive and inefficient confrontation methods. According to the present finding, rationalization and somatization had the highest mean scores among nursing interns. This finding may be attributed to the fact that immature defenses style was adopted by individuals to prevent them from the awareness of their own unacceptable thoughts, impulses or wishes resulting into anxiety. These defense mechanisms regulate the individual’s inner psychological state through self-deception and emotional suppression. Thus emotional disorder is positively correlated with immature defenses and negatively correlated with mature defense styles and not correlated with neurotic defense styles Malone et.al. (2013).
Consistent with the current results, a study done by Javaheri et al. (2011) found that immature defenses have a positive correlation with anger expression and emergence of anger, angry mood and reactions. Furthermore, those who use immature and neurotic defense mechanisms avoid experiencing their feelings which does not mean eliminating it, but the feeling is being suppressed and projects through behaviors which are sometimes out of control.
As regard gender differences in defensive style, the results of the present study showed that, men are significantly more likely to adopt mature defenses than females, this finding may be related to the gender differences in behavior between males and females. Males often seek straight forward solutions to problems, while females have emotional approach to problems. Zeigler-Hill and Pratt, (2007) found that the use of mature defenses is associated with dominance among men but with nurturance among women. Studies have shown that men and women differ in their use of defense mechanisms,. Men use internalizing defenses and projection more than females, and women use externalizing defenses, denial, and reaction formation more than males,. In addition, the current study showed that, the mean score of neurotic mechanisms was higher in females than males. Most studies using the DSQ have found no gender differences. In study using adolescent sample, females were found to score higher on neurotic defenses than males. First, females constituted more than two third of the study subjects. Also, it was noted that males scored high immature defenses than females, Luxen (2005) revealed that males reported greater use of immature defense mechanisms: isolation, dissociation, devaluation, denial, and passive aggression. The only immature defense mechanism that women relied upon more heavily than men was somatization, that observed in the current study. This can be explained by the fact that male and female may differ in promoting or overcoming their feelings or in their using emotional regulation strategies. therefore, nurse interns who are use somatization may withdraw or escape from situations which cause discomfort.
In addition, the present results showed significant difference between gender and emotional regulation strategies, female’s interns tend to use more cognitive reappraisal, whereas, male tend to use more emotional suppression. This finding may be attributed to the common belief is that women are more in touch with their feelings than men are that they react more emotionally and experience emotions more intensely; in contrast to men, women also report more comfort in expressing emotions.
Researchers have suggested three possible explanations for these differences. One explanation is the different ways men and women have been socialized. Men are taught to be tough and brave. For instance, women are expected to express more positive emotions on the job (shown by smiling) than men, and they do. A second explanation is that women may have more innate ability to read others and present their emotions than do men. Third, women may have a greater need for social approval and, so, a higher propensity to show positive emotions, such as happiness,.
| Conclusion|| |
It can be concluded from the present study that defense styles may be at least distinguishable with regard to nurse interns’ emotional regulation strategies. The finding showed that, mature defense style is positively correlated to cognitive reappraisal of emotional regulation, whereas, immature defense style was positively correlated to emotional suppression. Therefore, emotional regulation might be improved through utilizing adapted or mature defense styles in order to prepare nurse interns to fulfill their experiences more effectively.
| References|| |
Pearcey PA, Elliott BE. Student impressions of clinical nursing. Nurse Educ Today. 2004 Jul;24(5):382-7.
Cosimano A. The Experience of New Nursing Graduates on Labor and Delivery Units: A Phenomenological Approach. in partial fulfillment of the requirement for the degree of Doctor in Education 2 0 1 0 p a g e . 2 1 - 2 4 A v a i l a b l e a t : http://www.csm.edu/sites/default/files/Cosimano.pdf
Shiferaw H, Anand N, Nemera, N. Stress and coping strategies among genetic B.Sc. nursing students of jimma university, south west Ethiopia International Journal of Recent Advances in Multidisciplinary Research 2015;2(7):511
Lewis M, Haviland-Jones J, Barrrett L. Handbook of Emotions.3rd edition .Guilford Press. New York, London 2008.
Seiffge-Krenke, I., Aunola, K., & Nurmi, J.-E. Changes in stress perception and coping during adolescence: The role of situational and personal factors. Child Development,2009; 80:259-279.
Wolgast M, Lundh l, Viborg G.Anonymous. American Psychiatric Association Committee on Nomenclature and Statistics. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Press 1994. Kaplan-and-Sadocks-Study-Guide Available: https://www.scribd.com/document/321151792
Sherman, D. K., & Cohen, G. L. The psychology of self-defense: Self-affirmation theory. In M. P. Zanna (Ed.) Advances in Experimental Social Psychology2006, Vol. 38:183-242.
Kraustrom K. personality and depression. Department of Psychiatry University of Turku, Finland Graduate School of Psychiatry, Finland (2011).
Colman, A. M. A Dictionary of Psychology. 3rd edn. Oxford University Press, Oxford (2009).
Cramer, P., & Tracy, A. The pathway from child personality to adult adjustment: The road is not straight. Journal of Research in Personality 2005, 39, 369 - 39.
Vaillant, GE. Ego mechanisms of defense: A guide for clinicians and researchers. Washington DC: American Psychiatric Association 1992.
Steiner H., Araujo K. B. Koopman C. The Response Evaluation Measure (REM- 71): A new instrument for the measurement of defenses in adults and adolescents. American Journal of Psychiatry 2001, 158, 467-473.
Cour P. Psychological Defenses of Danish Medical Students Journal of Nervous & Mental Disease 2002 190(1):22-6·
Malone J, Cohen S, Liu S, Vaillant G, Waldinger R.Adaptive midlife defense mechanisms and late-life health Personality a n d I n d i v i d u a l differences2013 /256541723_Adaptive_midlife_defense_mechanisms and late-life health.vailable at: https://www.researchgate.net/publication
Mahalik J, Cournoyer R, DeFranc W, Cherry M, Napolitano J. Men’s gender role conflict and use of psychological defenses. Journal of Counseling Psychology 1998; 45: 247-55.
Watson C, Sinha B. Gender, age, and cultural differences in the Defense Style Questionnaire-40. Journal of Clinical Psychology 1998; Volume 54 (1):67-75.
Petraglia, J., Thygesen, K. L., Lecours, S., & Drapeau, M. Gender differences in self-reported defense mechanisms: a study using the new defense style questionnaire - 60. American Journal of Psychotherapy, 2009; 63(1), 87-99.
Drapeau M, Thompson K, PetragliaJ, Thygesen K, Lecours S. Defense Mechanisms and Gender: An Examination of Two Models of Defensive Functioning Derived from the Defense Style Questionnaire. International Journal of Psychology and Psychological Therapy 2011; 11 (1): pp. 149-55.
Luhmann, M., Hofmann, W., Eid, M., & Lucas, R. E. Subjective well-being and adaptation to life events: A meta-analysis. Journal of Personality and Social Psychology, 2012; 102(3), 592-615.
Eren N, Sahin S. An evaluation of the difficulties and attitudes mental health professionals experience with people with personality disorders. Journal of mental health nursing.2016; Volume23,1(2): 22-36.
Atiken L, Clarke S, Sloane D, Lake E, Cheney T. Effects of hospital care environment on patient mortality and nurse outcomes. Journal of Nursing Administration 20008; 38(5): 223-9.
Blaya C. Dornelles M, Blaya R. Kipper L, Heldt E, Isolan L. Bond M, Manfro G. Does defense mechanism vary according to the psychiatric disorder? Brazil Journal of Psychiatry 2006; 28 (3):1-5.
Andrews G, Singh M, Bond M. The Defense Style Questionnaire. Journal of Nervous and Mental Disease 1993, 181, 246-256.
Gross, J. John, O. Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology2003, 85, 348-362.
Ghadimianfar M, Dadkhah A. Prediction of Rehabilitation Nurses’ Psychological Well-Being Through Personality Traits and Defense Mechanisms Iranian Rehabilitation Journal 2015, Vol. 13, Issue 4 :40-45.
Vaillant GE. Adaptive mental mechanisms: their role in a positive psychology. Am Psychologist. 2000;55(1):89-98.
Sepidehdam F, Karimi Y, and Besharat M. The Relation between Defense Mechanisms and Job Burnout among Iran AIR Staff. International Journal of Social Science and Humanity 2012; 2(3) :1-5.
Malone, J. C., Cohen, S., Liu, S. R., Vaillant, G. E., & Waldinger, R. J. Adaptive midlife defense mechanisms and late-life health. Personality and Individual Differences, 2013; 55(2), 85-89.
Javaheri A, Ghanbari S, Zarandi AR. Relationship between defense mechanisms with experience and express of anger in female university student’s J Appl Psychol.2011;5(18):97-100?
Zeigler-Hill V, Pratt D. Defense. Defense Styles and the Interpersonal Circumflex: The Interpersonal Nature of Psychological Defense. Journal of Humanities and Social Sciences 2007; 1 (2):1-14.
Cramer, P., & Tracy, A. The pathway from child personality to adult adjustment: The road is not straight. Journal of Research in Personality 2005, 39, 369 - 39.
Luxen FM. Gender Differences in Dominance and Affiliation During a Demanding Interaction. The Journal of Psychology Interdisciplinary and Applied 2005, 139(4):331-47.
Marth C. Cultivating Humanity: A Classical Defense of Reform in Liberal Education. Cambridge, MA: Cambridge University Press, 1997. pp. 6-7.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]