Skip to main content
SpringerLink
Log in
Book cover

Neurobiological and Psychological Aspects of Brain Recovery pp 285–302Cite as

Psychodynamic Factors of Recovery After Brain Injury: A Role for Defence Mechanisms?

  • Chapter
  • First Online:

  • 1147 Accesses

Part of the book series: Contemporary Clinical Neuroscience ((CCNE))

Abstract

Brain injury may cause serious motor, cognitive, and affective sequelae that significantly affect individual’s functioning, interfering with his/her autonomous living. Psychopathology and maladaptive coping styles are frequently observed in these patients and are associated with poorer physical, occupational, and social outcomes. Psychological reactive mechanisms and premorbid cognitive–affective coping style are reported to play a significant role in the patient’s recovery processes. Among these, mechanisms of psychological defence such as repression/denial may be active in patients that, after brain injury, show emotion/affective dysregulation and tend to use less efficient coping strategies. Moreover, repression/denial could influence the patient’s ability to correctly acknowledge the illness and its consequences, in so way hampering his/her productive participation to the rehabilitative programme and social reintegration. In this paper, we discuss the possible role of psychodynamic mechanisms in the recovery after brain injury, with the aim to provide some clues for the purpose of the clinical intervention.

This is a preview of subscription content, log in via an institution.

References

  • American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

    Google Scholar 

  • Antonovsky A. The structure and properties of the sense of coherence scale. Soc Scie Med. 1993;36:725–33.

    Article  CAS  Google Scholar 

  • Babinski J. Contribution a l’etude des troubles mentaux dans l’hemiplegie organique cerebrale (anosognosie). Revue Neurologique. 1914;27:845–8.

    Google Scholar 

  • Bagby RM, Parker JDA, Taylor GJ. The twenty-item Toronto Alexithymia scale-I. Item selection and cross-validation of the factor structure. J Psychosom Res. 1994;38:23–32.

    Article  CAS  PubMed  Google Scholar 

  • Bisiach E, Berti A. Consciousness in Dyschiria. In: Gazzaniga MS, editor. The cognitive neurosciences. Cambridge: MIT Press; 1995. p. 1331–40.

    Google Scholar 

  • Bisiach E, Geminiani G. Anosognosia related to hemiplegia and hemianopia. In: Prigatano GP, Schacter DL, editors. Awareness of deficit after brain injury. Clinical and theoretical issues. Oxford: Oxford University Press; 1991. p. 17–39.

    Google Scholar 

  • Cooper CL, Phillips LH, Johnston M, Whyte M, MacLeod MJ. The role of emotion regulation on social participation following stroke. Br J Clin Psychol. 2015;54:181–99. doi:10.1111/bjc.12068.

    Article  PubMed  Google Scholar 

  • Crosson B, Barco P, Velozo CA, Bolesta MM, Cooper PV, Werts D, Brobeck T. Awareness and compensation in postacute head injury rehabilitation. J Head Trauma Rehabil. 1989;4:46–54.

    Article  Google Scholar 

  • Crowne DP, Marlowe D. A new scale for social desirability independent of psychopathology. J Consult Psychol. 1960;24:349–54.

    Article  CAS  PubMed  Google Scholar 

  • Di Giuseppe MJ, Perry JC, Petraglia J, Janzen J, Lingiardi V. Development of a Q-sort version of the defense mechanism rating scales (DMRS-Q) for clinical use. J Clin Psychol. 2014;70:452–65.

    Article  PubMed  Google Scholar 

  • Dou J, Tang J, Lu CH, Jiang ES, Wang PX. A study of suicidal ideation in acute ischemic stroke patients. Health Qual Life Outcomes. 2015;13:7. doi:10.1186/s12955-014-0198-9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Engel GL. The need for a new medical model. A challenge for biomedicine. Science. 1977;196:129–36.

    Article  Google Scholar 

  • Fang J, Cheng Q. Etiological mechanisms of post-stroke depression: a review. Neurol Res. 2009;31:904–9. doi:10.1179/174313209X385752.

    Article  PubMed  Google Scholar 

  • Fleming JM, Ownsworth T. A review of awareness interventions in brain injury rehabilitation. Neuropsychol Rehabil. 2006;16:474–500. doi:10.1080/09602010500505518.

    Article  CAS  PubMed  Google Scholar 

  • Fleming JM, Strong J, Ashton R. Cluster analysis of self-awareness levels in adults with traumatic brain injury and relationship to outcome. J Head Trauma Rehabil. 1998;13:39–51.

    Article  CAS  PubMed  Google Scholar 

  • Gainotti G. Emotional and psychological problems after brain injury. Neuropsychol Rehabil. 1993;3:259–77.

    Article  Google Scholar 

  • Gerstmann J. Problem of imperceptions of disease and of impaired body territories with organic lesions. Arch Neurol Psychiatry. 1942;48:890–913.

    Article  Google Scholar 

  • Ghika-Schmid F, van Melle G, Guex P, Bogousslavsky J. Subjective experience and behavior in acute stroke: the Lausanne emotion in acute stroke study. Neurology. 1999;52:22–8.

    Article  CAS  PubMed  Google Scholar 

  • Giacino JT, Cicerone KD. Varieties of deficit unawareness after brain injury. J Head Trauma Rehabil. 1998;13:1–15.

    Article  CAS  PubMed  Google Scholar 

  • Gill IJ, Mullin S, Simpson J. Are metacognitive processes associated with posttraumatic stress symptom severity following acquired brain injury? Disabil Rehabil. 2015;37:692–700.

    Article  PubMed  Google Scholar 

  • Gleser GC, Ihilevich D. An objective instrument for measuring defense mechanisms. J Consult Clin Psychol. 1969;33:51–60.

    Article  CAS  PubMed  Google Scholar 

  • Gregório GW, Gould KR, Spitz G, van Heugten CM, Ponsford JL. Changes in self-reported pre- to postinjury coping styles in the first 3 years after traumatic brain injury and the effects on psychosocial and emotional functioning and quality of life. J Head Trauma Rehabil. 2014;29:E43–53. doi:10.1097/HTR.0b013e318292fb00.

    Article  PubMed  Google Scholar 

  • Hagger MS, Orbell S. A meta-analytic review of the common-sense model of illness representations. Psychol Health. 2003;18:141–84. doi:10.1080/088704403100081321.

    Article  Google Scholar 

  • Hepp U, Moergeli H, Büchi S, Wittmann L, Schnyder U. Coping with serious accidental injury: a one-year follow-up study. Psychother Psychosom. 2005;74:379–86.

    Article  PubMed  Google Scholar 

  • Kaplan-Solms K, Solms M. Clinical studies in neuro-psychoanalysis. Introduction to a depth neuropsychology. London and New York: Karnac H. Books, Ltd. and Other Press LLC; 2000.

    Google Scholar 

  • Katz N, Fleming J, Keren N, Lightbody S, Hartman-Maeir A. Unawareness and/or denial of disability: implications for occupational therapy intervention. Can J Occup Ther. 2002;69:281–92.

    Article  PubMed  Google Scholar 

  • Klonoff PS. Psychotherapy after brain injury: principles and techniques. New York: The Guildford Press; 2010.

    Google Scholar 

  • Kneebone II, Lincoln NB. Psychological problems after stroke and their management: state of knowledge. Neurosci Med. 2012;3:83–9. doi:10.4236/nm.2012.31013.

    Article  Google Scholar 

  • Kouwenhoven SE, Kirkevold M, Engedal K, Kim HS. Depression in acute stroke: prevalence, dominant symptoms and associated factors. A systematic literature review. Disabil Rehabil. 2011;33:539–56. doi:10.3109/09638288.2010.505997.

    Article  PubMed  Google Scholar 

  • Lazarus RS, Folkman S. Stress, appraisal and coping. New York: Springer Publishing Company; 1984.

    Google Scholar 

  • Levenhal H, Leventhal EA, Contrada RJ. Self regulation, health and behaviour: a perceptual-cognitive approach. Psychol Health. 1998;13:717–33.

    Article  Google Scholar 

  • Levine DN. Unawareness of visual and sensorimotor defects: a hypothesys. Brain Cogn. 1990;13:233–81.

    Article  CAS  PubMed  Google Scholar 

  • Levine DN, Calvanio R, Rinn WE. The pathogenesis of anosognosia for hemiplegia. Neurology. 1991;41:1770–81.

    Article  CAS  PubMed  Google Scholar 

  • Lieberman D, Friger M, Fried V, Grinshpun Y, Mytlis N, Tylis R, et al. Characterization of elderly patients in rehabilitation: stroke versus hip fracture. Disabil Rehabil. 1999;21:542–7.

    Article  CAS  PubMed  Google Scholar 

  • Lumley MA, Neely LC, Burger AJ. The assessment of alexithymia in medical settings: implications for understanding and treating health problems. J Pers Asses. 2007;89:230–46.

    Article  Google Scholar 

  • Marcel AJ, Tegnér R, Nimmo-Smith I. Anosognosia for plegia: specificity, extension, partiality and disunity of bodily unawareness. Cortex. 2004;40:19–40.

    Article  PubMed  Google Scholar 

  • Matsuzaki S, Hashimoto M, Yuki S, Koyama A, Hirata Y, Ikeda M. The relationship between post-stroke depression and physical recovery. J Affect Disord. 2015;1:56–60. doi:10.1016/j.jad.2015.01.020.

    Article  Google Scholar 

  • McGlynn SM, Schacter DL. Unawareness of deficits in neuropsychological syndromes. J Clin Exp Neuropsychol. 1989;11:143–205.

    Article  CAS  PubMed  Google Scholar 

  • Mukherjee D, Levin RL, Heller W. The cognitive, emotional, and social sequelae of stroke: psychological and ethical concerns in post-stroke adaptation. Top Stroke Rehabil. 2006;13:26–35.

    Article  PubMed  Google Scholar 

  • Nilsson I, Axelsson K, Gustafson Y, Lundman B, Norberg A. Well-being, sense of coherence, and burnout in stroke victims and spouses during the firstfew months after stroke. Scand J Caring Sci. 2001;15:203–14.

    Article  CAS  PubMed  Google Scholar 

  • Nurmi Laihosalo ME, Jehkonen M. Assessing anosognosias after stroke: a review of the methods used and developed over the past 35 years. Cortex. 2014;61:43–63. doi:10.1016/j.cortex.2014.04.008.

    Article  PubMed  Google Scholar 

  • Ownsworth T. The impact of defensive denial upon adjustment following traumatic brain injury. Neuropsychoanalysis. 2005;7:83–94.

    Article  Google Scholar 

  • Ownsworth TL, McFarland K, Young RM. The investigation of factors underlying deficits in self-awareness and self-regulation. Brain Inj. 2002;16:291–309.

    Article  PubMed  Google Scholar 

  • Paykel ES, Prusoff BA, Uhlenhuth EH. Scaling of life events. Arch Gen Psychiatry. 1971;25:340–7.

    Article  CAS  PubMed  Google Scholar 

  • Perry JC. Defense mechanism rating scales. 5th ed. Boston: The Cambridge Hospital; 1990.

    Google Scholar 

  • Peter C, Müller R, Cieza A, Post MW, van Leeuwen CM, Werner CS, et al. Modeling life satisfaction in spinal cord injury: the role of psychological resources. Qual Life Res. 2014;23:2693–705. doi:10.1007/s11136-014-0721-9.

    Article  PubMed  Google Scholar 

  • Pilowsky I. Abnormal illness behaviour. Chichester, UK: John Wiley and Sons; 1997.

    Google Scholar 

  • Ponsford J. Factors contributing to outcome following traumatic brain injury. NeuroRehabilitation. 2013;32:803–15. doi:10.3233/NRE-130904.

    Article  PubMed  Google Scholar 

  • Prigatano GP. Principles of neuropsychological rehabilitation. New York: Oxford University Press; 1999.

    Google Scholar 

  • Prigatano GP. Anosognosia and patterns of impaired self-awareness observed in clinical practice. Cortex. 2014;61:81–92.

    Article  PubMed  Google Scholar 

  • Prigatano GP, Klonoff PS. A clinician’s rating scale for evaluating impaired self-awareness and denial of disability after brain injury. Clin Neuropsychol. 1998;12:56–67.

    Article  Google Scholar 

  • Prigatano GP, Schacter DL. Awareness of deficit after brain injury: clinical and theoretical issues. New York: Oxford University Press; 1991.

    Google Scholar 

  • Ramachandran VS. Phantom limbs, neglect syndromes, repressed memories, and Freudian psychology. Int Rev Neurobiol. 1994;37:291–333.

    Article  CAS  PubMed  Google Scholar 

  • Ristkari T, Sourander A, Ronning J, Helenius H. Self-reported psychopathology, adaptive functioning and sense of coherence, and psychiatric diagnosis among young men–a population-based study. Soc Psychiatry Psychiatr Epidemiol. 2006;4:523–31.

    Article  Google Scholar 

  • Rosenthal M. Behavioral sequelae. In: Rosenthal M, Griffith ER, Bond MR, Miller JD, editors. Rehabilitation of the head injured adult. Philadelphia: F. A. Davis Co.; 1983. p. 197–207.

    Google Scholar 

  • Rueckriegel SM, Baron M, Domschke K, Neuderth S, Kunze E, Kessler AF, et al. Trauma- and distress-associated mental illness symptoms in close relatives of patients with severe traumatic brain injury and high-grade subarachnoid hemorrhage. Acta Neurochir (Wien). 2015 Sept;157(8):1329–36; discussion 1336. doi:10.1007/s00701-015-2470-0.

  • Sela-Kaufman M, Rassovsky Y, Agranov E, Levi Y, Vakil E. Premorbid personality characteristics and attachment style moderate the effect of injury severity on occupational outcome in traumatic brain injury: another aspect of reserve. J Clin Exp Neuropsychol. 2013;35:584–95. doi:10.1080/13803395.2013.799123 (Epub 2013 May 23).

    Article  PubMed  Google Scholar 

  • Shi YZ, Xiang YT, Yang Y, Zhang N, Wang S, Ungvari GS, et al. Depression after minor stroke: the association with disability and quality of life—a 1-year follow-up study. Int J Geriatr Psychiatry. 2015;. doi:10.1002/gps.4353.

    Article  PubMed  Google Scholar 

  • Singh A, Black SE, Herrmann N, Leibovitch FS, Ebert PL, Lawrence J, et al. Functional and neuroanatomic correlations in poststroke depression: the Sunnybrook stroke study. Stroke. 2000;31:637–44.

    Article  CAS  PubMed  Google Scholar 

  • Snell D, Hay-Smith E, Surgenor L, Siegert R. Predicting long-term outcome after mild traumatic brain injury: the contribution of outcome after mild traumatic brain injury: the contribution of injury beliefs and Leventhal’s common sense model. Neuropsychol Rehabil. 2013;23:333–62.

    Article  PubMed  Google Scholar 

  • Snell DL, Surgenor LJ, Hay-Smith EJ, Williman J, Siegert RJ. The contribution of psychological factors to recovery after mild traumatic brain injury: is cluster analysis a useful approach? Brain Inj. 2015;29:291–9. doi:10.3109/02699052.2014.976594.

    Article  PubMed  Google Scholar 

  • Surtees P, Wainwright N, Luben R, Khaw KT, Day N. Sense of coherence and mortality in men and women in the EPIC-Norfolk United Kingdom prospective cohort study. Am J Epidemiol. 2003;158:1202–9.

    Article  PubMed  Google Scholar 

  • Taylor GJ, Bagby RM, Parker JDA. Disorders of affect regulation: alexithymia in medical and psychiatric illness. Cambridge: Cambridge University Press; 1997.

    Book  Google Scholar 

  • Turnbull OH, Fotopoulou A, Solms M. Anosognosia as motivated unawareness: the ‘defence’ hypothesis revisited. Cortex. 2014;61:18–29. doi:10.1016/j.cortex.2014.10.008.

    Article  PubMed  Google Scholar 

  • Vallar G, Ronchi R. Anosognosia for motor and sensory deficits after unilateral brain damage: a review. Restor Neurol Neurosci. 2006;24:247–57.

    PubMed  Google Scholar 

  • van Mierlo ML, van Heugten CM, Post MW, de Kort PL, Visser-Meily JM. Psychological factors determine depressive symptomatology after stroke. Arch Phys Med Rehabil. 2015;96:1064–70. doi:10.1016/j.apmr.2015.01.022.

    Article  PubMed  Google Scholar 

  • Visser MM, Heijenbrok-Kal MH, Spijker AV, Oostra KM, Busschbach JJ, Ribbers GM. Coping, problem solving, depression, and health-related quality of life in patients receiving outpatient stroke rehabilitation. Arch Phys Med Rehabil. 2015;96:1492–8. doi:10.1016/j.apmr.2015.04.007.

    Article  PubMed  Google Scholar 

  • Vuilleumier P. Anosognosia: the neurology of beliefs and uncertainties. Cortex. 2004;40:9–17.

    Article  PubMed  Google Scholar 

  • Wolters Gregório G, Ponds RW, Smeets SM, Jonker F, Pouwels CG, Verhey FR, et al. Associations between executive functioning, coping, and psychosocial functioning after acquired brain injury. Br J Clin Psychol. 2015;54:291–306. doi:10.1111/bjc.12074.

    Article  PubMed  Google Scholar 

  • Wolters G, Stapert S, Brands I, Van Heugten C. Coping styles in relation to cognitive rehabilitation and quality of life after brain injury. Neuropsychol Rehabil. 2010;20:587–600. doi:10.1080/09602011003683836.

    Article  PubMed  Google Scholar 

  • Wood RL, Doughty C. Alexithymia and avoidance coping following traumatic brain injury. J Head Trauma Rehabil. 2013;28:98–105. doi:10.1097/HTR.0b013e3182426029.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Università degli studi di Roma “Niccolò Cusano”, Via Don Carlo Gnocchi, 3, 00166, Rome, Italy

    Alberto Costa & Salvatore Gullo

  2. IRCCS Fondazione Santa Lucia, Rome, Italy

    Alberto Costa & Carlo Caltagirone

  3. Dipartimento di Medicina dei Sistemi, Tor Vergata University, Rome, Italy

    Carlo Caltagirone

Authors
  1. Alberto Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Salvatore Gullo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carlo Caltagirone
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alberto Costa .

Editor information

Editors and Affiliations

  1. Department of Psychology, Sapienza University of Rome, Rome, Italy

    Laura Petrosini

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Costa, A., Gullo, S., Caltagirone, C. (2017). Psychodynamic Factors of Recovery After Brain Injury: A Role for Defence Mechanisms?. In: Petrosini, L. (eds) Neurobiological and Psychological Aspects of Brain Recovery. Contemporary Clinical Neuroscience. Springer, Cham. https://doi.org/10.1007/978-3-319-52067-4_15

Download citation

Publish with us

Policies and ethics

Search

Navigation