Study of Motivational and Temperamental Indicators and Mechanisms of Psychological Defense of Patients with Inflammatory Bowel Diseases

Kukso Ol'ga Gennad'evna Senior Lecturer, Department of Management and Informatics and General Scientific Disciplines, Eastern Academy of Economics and Law for the Humanities 450022, Russia, Republic of Bashkortostan, Ufa, Mendeleev str., 215/4 olgagen555@gmail.com

Kukso Polina Aleksandrovna ORCID: 0000-0003-1529-4809 PhD in Biology Associate Professor, Department of Biological Chemistry, Bashkir State Medical University 450077, Russia, respublika Bashkortostan, g. Ufa, ul. Kommunisticheskaya, 86, kv. 1 polinalex.ks555@gmail.com Other publications by this author

Constant exposure to stress for a long time can lead to a gradual depletion of internal adaptation mechanisms and personal resources, which, in turn, can disrupt her mental adaptation. Therefore, it is important to identify the main characteristics and diagnostic indicators of a person's "psychological vulnerability", which is a pathological ground for the development of various forms of adaptation disorders (1). These can also be neurotic, stress-related somatoform disorders (2). Most ovarian cancer patients experience clinically significant distress (3).

Our research is based on the views of Russian scientists on psychosomatic diseases and the study of their characteristic features of the psyche in a personal aspect, where personality is the highest step in the hierarchy of activity of the central nervous system. V.N. Myasishchev wrote about personogenic somatic diseases, the origin of which is associated with the characteristics of the patient's personality and the presence of a pathogenic situation (4).

There are a large number of medical and psychological studies that successfully solve the problem of a comprehensive study of the psychological characteristics of patients with psychosomatic diseases using a large number of psychodiagnostic methods. An urgent task of modern research is the psychological justification of a multidimensional study of coping with the stress of the disease and assessing the personal resources of patients to overcome the frustrating influence of the disease (5; 6; 7).

Many works present clinical, psychological and methodological studies of personality profiles specific to individual psychosomatic diseases (2). The cause of various somatic diseases may be mental factors. Negative emotions, especially in uncontrolled situations, are considered one of the causes of stomach and duodenal ulcers.

A.I. Chizhova noted certain emotional-personal, cognitive characteristics and types of attitude to the disease in patients with somatoform disorders (8). The author identified three groups of patients. Personality traits were important for the first group, somatic and anxiety-depressive symptoms were important for the second, and maladaptive relationships in the social sphere were characteristic for the third group. The author has shown that patients with somatoform disorders are characterized by comorbidity of somatoform and affective disorders.

A.S. Khazova et al. The quality of life of people with disabilities was analyzed (9). The authors showed that regardless of the type of disorders, people with disabilities have a fairly high quality of life. Coping strategies were associated with indicators of quality of life and subjective well-being. Strategies such as distancing, avoidance, and positive reassessment affect the quality of life.

Inflammatory bowel diseases (Functional diseases of the gastrointestinal tract) occupy a leading place in the structure of pathology of the digestive organs. In recent decades, there has been great interest in the study of inflammatory bowel diseases (10; 11; 12;13).

Yakhin K.K., Abdulganieva D.I., Bodryagina E.S. conducted a study of the quality of life and psychological characteristics of patients with inflammatory bowel diseases depending on clinical parameters, social characteristics and demographic characteristics of patients (11). The authors showed a multidirectional decrease in the components of quality of life in patients with ulcerative colitis and Crohn's disease and assessed the spectrum of mental disorders of patients.

O.Z. Okhlobystina, S.V. Ivanov studied the psychopathological structure of mental disorders in patients with various variants of inflammatory bowel diseases – nonspecific ulcerative colitis and Crohn's disease in comparison with patients with clinically similar functional disorders of the gastrointestinal tract - functional abdominalgia with or without signs of irritable bowel syndrome (14). The authors found that mental disorders in the studied sample are mainly represented by sluggish schizophrenia and hypochondriacal development.

R.V. Bryant et al. inflammatory bowel diseases and concomitant functional disorders of the gastrointestinal tract were studied (15). They revealed the relationship between functional disorder of the gastrointestinal tract, symptoms of functional disorders, quality of life related to health and psychological comorbidity. The authors confirmed that functional disorders of the gastrointestinal tract, symptoms of functional disorders are associated with an increase in psychological comorbidity and a decrease in the quality of life associated with health.

T. Van de star, A. Banana (2015) note the role of psychosocial factors such as stress, anxiety and depression in the development of inflammatory bowel diseases (16). The authors noted that patients with inflammatory bowel diseases are characterized by depression and anxiety. These characteristics negatively affect patients through activation of the brain-gut axis. Pharmacological and non-pharmacological psychotherapeutic interventions reduce the symptoms of inflammatory bowel diseases, many of them also reduce depression, anxiety, stress symptoms, fatigue, recurrence rate and improve quality of life.

Stress affects the course of the disease through its effect on the brain-intestine axis, consisting of nervous and humoral connections between the brain and intestines. Stress activates the sympathetic nervous system and the hypothalamic-pituitary-adrenal system, and suppresses the efferent pathways of the vagus nerve. After that, the hypothalamus produces a corticotropin-releasing factor that modulates intestinal inflammation.

Isaeva E.R. studied the personal resources of patients with peptic ulcer disease (17). The author noted the powerful filtering barriers of denial and repression defenses in patients. They suppressed negative emotions and ignored intrapersonal contradictions. Stress-coping behavior corresponded to the norm with the dominance of emotionally focused coping strategies.

E.N. Ashanina, E.E. Kriit, E.L. Pozharskaya studied the protective and coping behavior of higher education managers with different teaching experience (18). The authors noted that managers with different teaching experience use different coping behavior strategies in a stressful situation. Significant differences were also revealed in the use of unconscious psychological defense mechanisms. The components of the protective and coping behavior of higher education managers, taking into account coping resources, are described. The authors have established the dependence of the choice of coping behavior strategies and psychological protection mechanisms on work experience.

E.B. Fantalova examined patients with arterial hypertension for intrapersonal conflicts, internal vacuums and neutral zones, and indices of divergence of value and accessibility. The author noted that the discrepancy index prevails in psychosomatic patients (19).

Modern ideas about the essence of the concept of the disease presuppose taking into account the totality of changes affecting both the biological level of disorders and the social level of functioning of the patient. The biological level of disorders is represented by somatic symptoms and syndromes. The social level of the patient's functioning implies a change of role positions and a transition to various new social situations.

In our work, an attempt is made to reveal the semantic features of self-awareness, mechanisms of psychological protection, features of intrapersonal conflict and temperamental indicators in patients with inflammatory bowel diseases and in healthy people. Inflammatory bowel diseases (IBD) are a serious stress factor that further affects the protective and stress-coping behavior of the patient.

The purpose of this work is to identify diagnostic indicators of the "psychological vulnerability" of the personality of sick and healthy individuals. Therefore, the comparison of average indicators was carried out, as well as the identification of the relationship between the mechanisms of psychological protection, motivational sphere and temperamental indicators, which are of paramount importance for the process of adaptation and self-regulation in patients with gastrointestinal diseases and healthy individuals resistant to this disease.

To achieve this goal, the following methods were evaluated:

Material and methods.

To determine the motivation of patients and healthy people, we used the technique "Diagnosis of polymotivational tendencies in the "I-concept" of personality" by S.M. Petrova. According to the methodology, the subjects are offered two lists (options A and B) containing 32 proverbs each. There are 16 pairs of proverbs in the methodology, which correspond to 16 pairs of alternative motivation trends: akisitive (material), hedonistic, optimistic, communicative, cognitive, labor, normative, moral, heuristic, scaremongering motivation, striving for superiority, motivation of positive attitude towards people, motivation to avoid trouble, motivation of individualization, egocentric and altruistic motivation (20); mechanisms of psychological protection of the Life Style Index questionnaire (according to Plutchik, Kellerman, Conte) (21), the level of disintegration in the motivational and personal sphere according to the method "The level of value and accessibility in various spheres of life" (USCD) (according to E.B. Fantalova) (22), extraversion, introversion and neuroticism according to the EPI personality questionnaire (according to G. Eysenck) (23).

For data processing, ANOVA single-factor analysis of variance using the LSD criterion for comparing averages, correlation analysis using Spearman's rank correlation coefficient using Statistica 12.0 were used.

The study involved 200 people (100 patients with IBD and 100 healthy) aged 20 to 30 years.

Discussion of the results

The motivations of the experimental and control groups for the "Diagnosis of polymotivational tendencies in the "I-concept of personality" were distributed as follows (Fig. 1).

Fig. 1. Distribution of average values of motivations in the experimental group (patients with IBD) and in the control group (healthy individuals) according to the method of Polymotivation tendencies in the "I-concept" of personality (S.M.Petrova).

Note – 1– akistive (material) motivation; 2 – hedonistic motivation; 3 – optimistic motivation; 4 – communicative motivation; 5 – cognitive motivation; 6 – work motivation; 7 – normative motivation; 8 – moral motivation; 9 – heuristic motivation as a pursuit of perfection; 10 – scaremongering motivation; 11 – heuristic motivation as the pursuit of excellence; 12 – motivation of a positive attitude towards people; 13 – motivation to avoid trouble; 14 – motivation of individualization; 15 – egocentric motivation; 16 – altruistic motivation according to the method of "Diagnosis of polymotivational tendencies" of the Self concept of "personality".

A comparison of the motivational sphere of groups using the t-criterion for independent samples with the grouping variable for IBD disease showed differences only in the third and sixth indicators of motivation (Table 1).

Table 1.

Comparative analysis of the motivational sphere of the experimental group with IBD (1) and the control group (2) using the method of Polymotivation tendencies in the "I-concept" of personality (S.M.Petrova) using ANOVA.

Note – 1– akistive (material) motivation; 2 – hedonistic motivation; 3 – optimistic motivation; 4 – communicative motivation; 5 – cognitive motivation; 6 – work motivation; 7 – normative motivation; 8 – moral motivation; 9 – heuristic motivation as a pursuit of perfection; 10 – scaremongering motivation; 11 – heuristic motivation as a desire for excellence; 12 – motivation of a positive attitude towards people; 13 – motivation to avoid trouble; 14 – motivation of individualization; 15 – egocentric motivation; 16 – altruistic motivation according to the method of "Diagnosis of polymotivational tendencies" of the Self of the concept of "personality" (according to: S.M. Petrova).

The significant level of differences using the t-criterion for independent samples with a grouping variable is highlighted in red; M1 is the average value of the motivations of the experimental group; M2 is the average value of the motivations of the control group; m is the standard error of the mean (standard deviation); p is the significance levels, %.

According to Table 1, this is an optimistic motivation, the average value of the third indicator of the experimental group was 1.56 ± 0.06, whereas the control group 1.28 ± 0.08 had the highest level of significance at p = 0.004 and the sixth indicator was work motivation 1.54 ± 0.06 and 1.28 ± 0.08 with a sufficient level of significance p= 0.01.

Next, a comparative analysis of the protection mechanisms was carried out (Fig. 2).

Fig. 2. Distribution of the average values of protective mechanisms in the experimental group (patients with IBD) and in the control group (healthy individuals) according to the "Lifestyle Index" method (according to Plutchik, Kellerman, Conte).

Note – From – denial, From – displacement, Reg – regression, Com – compensation, Pro – projection, Substitution, Int – intellectualization, RO – reactivity – the indicators of the test questionnaire.

A comparative analysis of the indicators of extraversion and neuroticism showed the following (Table 2).

Table 2.

Comparative analysis of indicators of extroversion and neuroticism according to the EPI personality questionnaire (according to G. Eysenck)

Note Ex – extraversion, Ney – neuroticism.

There were no differences in the indicators of extraversion and neuroticism between the experimental group and the control group. According to the median, which divides the data set in half (13.00 ± 0.36) and mode, the numerical value that is more common in the sample (10.00 ± 0.31), we can say that in patients with IBD, the values of the extraversion scale are shifted towards extraversion.

Further, a correlation analysis of the motivational sphere, the level of disintegration of the motivational and personal, mechanisms of psychological protection and temperament indicators was carried out (Tables 3, 4).

Table 3.

The results of the correlation analysis of the motivational sphere, the level of disintegration of the motivational-personal, mechanisms of psychological protection and some temperament indicators of the experimental IBD group

Note – 1– akistive (material) motivation; 2 – hedonistic motivation; 3 – optimistic motivation; 4 – communicative motivation; 5 – cognitive motivation; 6 – work motivation; 7 – normative motivation; 8 – moral motivation; 9 – heuristic motivation as a pursuit of perfection; 10 – scaremongering motivation; 11 – heuristic motivation as a desire for superiority; 12 – motivation of a positive attitude towards people; 13 – motivation to avoid trouble; 14 – motivation of individualization; 15 – egocentric motivation; 16 – altruistic motivation according to the method of "Diagnosis of polymotivational tendencies" of the Self of the concept of "personality" (according to S.M. Petrova); Ur – the level of disintegration of motivational- personal sphere (according to E.B. Fantalova); From – denial, From – displacement, Reg – regression, Com – compensation, Pro – projection, Substitution, Int – intellectualization, RO – reactivity – indicators of the Life Style Index test questionnaire (according to Plutchik, Kellerman, Conte); Ex – extraversion, Neuro – neuroticism – indicators according to the EPI personality questionnaire (according to G. Eysenck). A significant level of communication is shown in red.

The results of the correlation analysis of the experimental IBD group showed that akisitive (material) motivation has an inverse relationship with the level of disintegration of the motivational and personal sphere according to E.B. Fantalova and a direct connection with denial according to Plutchik, Kellerman, Conte (r = -0.25; r = 0.28). Cognitive motivation is directly related to extroversion according to G. Aizenk, and optimistic and heuristic motivation according to S.M. Petrova is inversely related (r = 0.29; r = -0.27; r = -0.22). According to Plutchik, Kellerman, and Conte, intellectualization is directly related to heuristic motivation, as the pursuit of perfection, and has a feedback relationship with the motivation of avoiding trouble according to S.M. Petrova (r = 0.26; r = -0.31).

The results of the correlation analysis of the control group with the gastrointestinal tract showed the following (Table 4).

Table 4.

The results of the correlation analysis of the motivational sphere, the level of disintegration of the motivational and personal, the mechanisms of psychological protection and some temperament indicators of the control group (healthy individuals)

Note – 1– akistive (material) motivation; 2 – hedonistic motivation; 3 – optimistic motivation; 4 – communicative motivation; 5 – cognitive motivation; 6 – work motivation; 7 – normative motivation; 8 – moral motivation; 9 – heuristic motivation as a pursuit of perfection; 10 – scaremongering motivation; 11 – heuristic motivation as a desire for superiority; 12 – motivation of a positive attitude towards people; 13 – motivation to avoid trouble; 14 – motivation of individualization; 15 – egocentric motivation; 16 – altruistic motivation according to the method of "Diagnosis of polymotivational tendencies" of the Self of the concept of "personality" (according to S.M. Petrova); Ur – the level of disintegration of motivational- personal sphere (according to E.B. Fantalova); From – denial, From – displacement, Reg – regression, Com – compensation, Pro – projection, Substitution, Int – intellectualization, RO – reactivity – indicators of the Life Style Index test questionnaire (according to Plutchik, Kellerman, Conte); neuro – neuroticism, ex – extraversion – indicators according to the EPI personality questionnaire (according to G. Eysenck). A significant level of communication is shown in red.

In the control group, akisive motivation is inversely related to displacement and is directly related to regression according to Plutchik, Kellerman, Conte (r = -0.46; r = 0.37). Optimistic motivation is directly related to repression (r = 0.39). Heuristic motivation is inversely related to projection and directly to intellectualization (r = -0.51; r = 0.39). Motivation for a positive attitude towards people is directly related to displacement and compensation and inversely related to projection and regression, (r = 0.47; r = 0.49; r = -0.34; r = -0.36).

Discussion

Using ANOVA analysis using the LSD criterion for comparing the average high level of motivation for optimism and work in patients with IBD using the method of Polymotivation tendencies in the "I-concept" of personality (S.M.Petrova) (Fig. 1). The subjects are characterized by a passive expectation of well-being in life and orientation towards completing the task through overcoming difficulties.

The tendency to develop diseases of the gastrointestinal tract is associated with the motivational sphere of personality due to their proximity to archetypal formations of the psyche and mental forms of consciousness for optimistic and work motivation. All this reflects the motivational conditioning of the personality.

The results of the correlation analysis of the experimental IBD group showed that akisitive (material) motivation has an inverse relationship with the level of disintegration of the motivational and personal sphere according to E.B. Fantalova and a direct connection with denial according to Plutchik, Kellerman, Conte (r = -0.25; r = 0.28).

The results of the correlation analysis of the experimental IBD group showed that material motivation has an inverse relationship with the level of disintegration of the motivational and personal sphere according to E.B. Fantalova and a direct connection with denial according to Plutchik, Kellerman, Conte (Table 1). Internal conflicts arise against the background of illness with the inclusion of such a mechanism of psychological protection as a denial of external reality, which does not perceive the personality of the patient.

In the experimental group of IBD, extraversion according to G. Eysenck is directly related to cognitive motivation and inversely related to optimistic and heuristic motivation, the desire for excellence.Orientation of the personality or to the world of external objects.

In the experimental group of IBD intellectualization according to Plutchik, Kellerman, Conte, heuristic motivation is directly related, as the pursuit of perfection and has a feedback relationship with the motivation of avoiding trouble according to S.M. Petrova (r = 0.26; -0.31). The orientation of the patient's personality to the outside world and cognition, the pursuit of excellence, as well as the pursuit of perfection and the inclusion of logical attitudes and manipulations, a protective mechanism. The inclusion of a protective mechanism - intellectualization, experiences caused by an unpleasant situation are suppressed with the help of logical attitudes and manipulations.

In healthy individuals, akistive motivation, an attitude to material well-being, is inversely related to repression and is directly related to regression according to Plutchik, Kellerman, Conte (Table 2). Optimistic motivation is directly related to the mechanism of protection by repression associated with mnestic processes, through which thoughts unacceptable to a person that cause anxiety become unconscious.

Heuristic motivation, the pursuit of perfection, is inversely related to projection and directly to intellectualization. The inclusion of a protective mechanism - intellectualization, which suppresses experiences caused by an unpleasant situation with the help of logical attitudes and manipulations. Motivation for a positive attitude towards people is directly related to displacement and compensation, and inversely related to projection and regression. With an increase in the orientation of a positive attitude towards people, the projection protection mechanisms are activated, attributing their own unconscious thoughts to other people. A protective mechanism is also activated – regression, which reduces anxiety by moving to earlier stages of libido development. Reduction of the mechanism of protection by compensation, manifested in the replacement of a disadvantage with dignity by fantasizing with the appropriation of other behavioral characteristics. A decrease in the mechanism of protection - repression associated with mnestic processes, through which thoughts unacceptable to the individual, causing anxiety, become unconscious.

Thus, diagnostic indicators of the "psychological vulnerability" of the personality of patients and the psychological stability of healthy individuals were identified.

The personality profile of healthy people resistant to IBD presents different types of psychological defenses and motivations. These are protection mechanisms from the simplest to the most complex and mature, related to the processing and reassessment of information in a changing external environment. These are such protection mechanisms as displacement, compensation and substitution, intellectualization and projection. The profile includes semantic features of self-awareness (motivation)such as a positive attitude and focus on development, striving for excellence, etc.

In patients with inflammatory bowel disease, the mechanisms of psychological defense are less diverse and limited to two – denial and intellectualization. The personal profile presents an intrapersonal conflict that occurs against the background of the disease.

Conclusions

The data obtained in the study make it possible to identify diagnostic indicators of the "psychological vulnerability" of the personality of patients affecting the pathogenesis of inflammatory bowel diseases:

1. A comparative analysis of the average motivational sphere showed that patients with inflammatory bowel diseases have a high level of motivation for optimism and work.

2. In patients with inflammatory bowel diseases, the mechanisms of psychological defense are less diverse and limited to two – denial and intellectualization.

3. In healthy individuals, motivation for material well-being is inversely related to repression and is directly related to the protective mechanism of regression. Optimistic motivation is directly related to displacement.

4. In healthy individuals resistant to inflammatory bowel diseases, the mechanism of psychological protection plays the role of a regulator of intrapersonal balance. An increase in resistance to the disease is associated with such defense mechanisms as displacement, compensation, projection, regression, intellectualization and projection.

The results obtained in this work expand and complement the scientific understanding of diagnostic indicators of the "psychological vulnerability" of the personality of patients with inflammatory bowel diseases.