Time in the Mental Health Context: Neurotic Symptomatology,Defense Mechanisms and the Perception of Time Perspective Among Patients Diagnosed With Neurotic and Personality Disorders

Abstract

Aim

The main objective of the study is to explore relations between the time perspective, neurotic symptoms, anxiety, and defense mechanisms in the group of patients diagnosed with neurotic and personality disorders (ICD-10 groups: F4x, F60.x and F61) treated with group psychotherapy. The research is conducted on the theoretical basis of the Zimbardo and Boyd’s Time Perspective Theory.

Methods

The study included 49 patients treated in the day ward for the Treatment of Neurotic Disorders and Behavioral Syndromes at the University Hospital. The measurement of the TP was performed with the Zimbardo Time Perspective Inventory. Patients also completed the State-Trait Anxiety Inventory and the Defense Style Questionnaire 40. The diagnosis was done by licensed psychiatrists and supported with the measures: Symptom Checklist KO“O”, Neurotic Personality Questionnaire KON-2006.

Results

Multiple regression analysis models showed that the four time perspectives (past negative, present fatalistic, present hedonistic, and future) are predicted in different variations by the level of anxiety state or trait and repertoire of used defense mechanisms (immature or mature).

Conclusions

Considering the established bilateral correlations, change in the time perspective may constitute an important factor in the reduction of neurotic symptoms, possibly through changes in the repertoire of utilized defense mechanisms. However, there is also possible that altering neurotic symptomatology would alter time perspective. The assessment of the time perspective in patients with neurotic and personality disorders may provide useful data for the diagnosis and the monitoring of psychotherapy effectiveness. Based on the results of this study conducting further research on the role of the changes in the time perspective in the course of psychotherapy is recommended and necessary to expand the understanding of the relations observed in this study.

Keywords

time perspective anxiety defense mechanisms neurotic disorders personality disorders

Introduction

Variables related to the functioning of psychiatric patients are of primary interest to mental health professionals. One of the aspects that present how patients from various clinical groups experience and perceive their lives may be the perception of time. It is de facto how people organize their life into time frame categories – past, present, and future. Our previous investigation showed the differences in the time perspective between patients diagnosed with neurotic and personality disorders and the general population (Mostowik et al., 2018). In the presented paper we explore factors associated with the perception of time among patients with neurotic and personality disorders treated in the group psychotherapy. Successful identification of the potential factors would allow for a better understanding of one of the most common mental health problems.

Time as a phenomenon has not only a physical aspect but also a psychological one. From the subjective, psychological perspective, time can be described in different terms. One of them is a time perspective or time orientation which is structured by life experiences. According to Frank Zaleski (1991) – the time perspective is “the whole subjective perception of one’s future and past existing in a particular moment of time”. Therefore, the actual perception of the present time and actions taken by persons are based on their perspective of the past and the future. Behavior is not dependent only on individuals’ thoughts about the present but is also affected by their reflections on the past and expectations for the future (Lewin, 1935). The present paper is focused on the concept of time perspective described by Zimbardo and Boyd (1999). Authors define time perspective as a personal, frequently unconscious attitude towards time. Within the scope of time perspective, life experiences are divided into time categories which allow to add order and meaning to life. In the concept, five time perspectives are differentiated: past negative, past positive, present fatalistic, present hedonistic, and future (Zimbardo & Boyd, 2008). People use various perspectives to various degrees; this is related to various ways of perception, interpretation, and reacting towards events in everyday life. People-oriented towards the past negative, in their experience, concentrate on everything that went wrong – “No matter what I do, my life will never change”, whereas people-oriented towards the past positive concentrate on good memories in their everyday life experiences. People focused on present fatalistic are convinced of their lack of influence, their dependence on fate, destiny – “Whatever will be, will be”. The people who are present hedonistic oriented, in turn, are those who live concentrating on the current moment, they assess life through the prism of experiencing temporary pleasures and satisfying current needs. People with an attitude towards the future concentrate on long-term goals, plans, they believe that they will bring good results (Zimbardo et al., 2012).

The studies carried out until now demonstrated typical patterns of time perspective among various clinical groups. Wallace (1956) and Israeli (1936) indicated the dysfunctions related to thinking through goals, plans among patients with schizophrenia. Similarly, difficulties in directing thinking about the future were demonstrated among patients with depression (Breier-Williford & Bramlett, 1995) and PTSD (Zimbardo et al., 2012). Studies demonstrated also a higher level of concentration on negatively interpreted past among patients with depression (Melges, 1982; Nolen-Hoeksema, 1991) with bipolar affective disorder, schizophrenia, and among persons with personality disorders (Oyanadel & Buela-Casal, 2014). Moreover, studies indicate that particular temporal orientation co-occurs with many variables associated with the frame of mind and the general everyday functioning of an individual, i.e. with experienced emotions – sadness, anxiety, anger (Stolarski et al., 2014), with the level of happiness, depressiveness, aggressiveness, as well as with compulsivity, self-confidence, and self-esteem (Van Beek et al., 2011; Zimbardo & Boyd, 1999). Zimbardo and Boyd (2008) also mention the connection between the present hedonistic and lower control of the ego and impulses. Boniwell and Zimbardo (2015) as well as Anagnostopoulos and Griva (2012) highlight that for emotional states such as anxiety, depression, anger, aggression, a typical element is a high level of the past negative perspective and of the present fatalistic perspective. The preoccupation with the negative past, fatalistic present, and lack of a positive future leads to hopelessness and may relate to suicide ideation (Laghi et al., 2009; MacLeod et al., 1998). Sticking in the negative past is an inability to see different aspects of one’s life. Patients treated with psychotherapy experienced stressful, harmful events in their histories. However, the level of psychopathology is not a direct result of an objective assessment of how stressful and traumatic were life experiences. It is rather dependent on how one’s subjectively experienced past events and how they experience and perceive these events from the present (Vaillant, 1994). Different histories are very often a source of anxiety, angry, feeling guilty, feeling of harm, and relates to inner psychological conflicts. Defense mechanisms have an important role to cope with anxiety and inner conflicts (Cramer, 2006; Thobaben, 2005). According to DSM-IV-TR, defense mechanisms are defined as automatic psychological processes that mediate individuals’ reactions to emotional conflicts and internal and external stressors (American Psychiatric Association, 2000). Defense mechanisms, however, when used in excess, “may” lead to distortion of reality, usually “are” adaptive and lead to a “comfortable level of functioning” (Cramer, 1987). Therefore, the tendency to returning to traumas is associate with a repertoire of used defense mechanisms, which is an indicator of the general state of the patient’s mental health and ability to adapt and cope (Gabbard, 2005). More mature ego mechanisms are associated with better physical and mental health, while more immature ones are associated with the rise of one’s psychopathological level (Andrews et al., 1989; Blaya et al., 2006; Muris & Merckelbach, 1996). It would thus be interesting to find out factors that are associated with the way how patients with a history of harmful, painful events perceive their life in terms of the focus on emotional dimensions of past, present, and future.

Studies, therefore, illustrate the characteristics of the structure of time perspective in various clinical groups, as well as its association with various variables – emotions, beliefs, or behaviors. The issue of dependence and relationship between the time perspective and specific features and disease mechanisms has not been investigated sufficiently, which has been confirmed by the performed literature review. There are few studies which, at the same time, explain the intensity of particular time perspectives in a given clinical group in reference to features and disease mechanisms, not only to the medical diagnosis.

Aim of the study

The research is conducted on the theoretical basis of the Zimbardo and Boyd’s Time Perspective Theory. The main objective of the study is to explore how people with neurotic symptoms organize their life experiences in temporal and emotional frames of the past, the present, and the future, depending on the intensity of neurotic symptoms, the intensity of trait or state anxiety, and the defense mechanisms involved. Assuming that the level of symptoms and anxiety is higher than average, authors are of particular interest in the role of defense mechanisms. The study was based on the assumption that there is a relation between the listed variables. It was hypothesized that the higher the intensity of neurotic symptoms and anxiety, the higher the concentration on negatively experienced past and fatalistically experienced present, along with decreased importance of the future.

It was also hypothesized that defense mechanisms play a role in the way that different experienced aspects of life are perceived in its emotional and horizontal time frame categories – past, present, and future. Time perspective is like a lens through that life events are seen. Some people focus more on what was negative in their past, whereas others try to concentrate more on aspects that are good, pleasure, and satisfying in the present life situation and experiences. Using mature defense mechanisms allows to cope with daily life challenges, difficult or stressful situations in the present, as well as past experiences. Adaptive coping may facilitate the process of looking at one’s life from a more balanced perspective. Instead of being stuck in the negative past or fatalistic present, the ability to cope with present difficulties, and to set future short-term and long-term goals is essential in maintaining the sense of life. A healthy balanced time perspective facilitates the process of learning from the past, adapting to the present, and shaping the future following achievable and satisfying goals.

The functions of the defense mechanisms are (1) to protect the individual from experiencing excessive anxiety and (2) to protect the integration of the self (Cramer, 2006). Since the time perspective represents how individuals perceive their life it may be regarded as a result of adaptive or maladaptive defense mechanisms functioning.

Material and methods

Participants and procedure

The study was carried out in the day ward for the Treatment of Neurotic Disorders and Behavioral Syndromes at the University Hospital. All patients included in the study have granted researchers with their freely-given and informed written consent. Each patient has been informed about the right to resign without any negative influence on his or her treatment. This research was approved by the Bioethics Committee of the Jagiellonian University Medical College, no. 122.6120.251.2015.

The study was carried out on a sample of 49 patients (32 women – 65.3% and 17 men – 34.7%) diagnosed with neurotic or personality disorders according to ICD-10 (F4x, F60.x and F61) (World Health Organization, 1992), treated with group psychotherapy. Patients were qualified for the treatment by a licensed psychologist and psychiatrist, including the use of psychological tests (Sobański et al., 2011), a few months before entering the treatment. The research was conducted during the treatment. The exclusion criteria were: a lack of qualification for treatment due to the recognition of a somatic background for patient’s symptoms, CNS organic changes, psychosis, ongoing substance addiction, mental retardation, and a lack of consent to participate in the study.

The median age was 31 years (min. 22; max. 46). Due to age diversity within the sample and sample size, two age groups were created: 22–30 and 31–46 years old. 16 patients (32.6%) were diagnosed with neurotic disorders (F40-F48) only, 19 patients (38.8%) with personality disorders (F60-F61) only, and 14 patients (28.6%) received mixed diagnoses – co-occurrence of neurotic and personality disorders.

Each patient was diagnosed with a clinically significant intensity of neurotic symptoms. The average measured with the Symptoms Checklist KO “O” scored during qualification procedure to psychotherapy 340.14 points (W = 325.47; M = 367.76), (min. 64; max. 617) and during the treatment 224 points (W = 216; M = 239), (min. 52; max. 490). The standard average is 200 points for women and 165 points for men (Aleksandrowicz et al., 1981). The average for Neurotic Personality Questionnaire measured during qualification to treatment reached 40.87 (W = 37.88; M = 46.85), (min. 8; max. 101). A maximum value among healthy persons is 8 points, the score typical for a person with a mental disorder is above 18 points. A score between 8 and 18 points is recognized as “uncertain” (Aleksandrowicz et al., 2009). The majority of patients (66.2%) were single, lived in a single-person household (46.9%), had received higher education (81.6%), worked full-time (64.6%), and lived in a city of over 500,000 inhabitants (83.7%).

Treatment

The treatment in the day ward for the Treatment of Neurotic Disorders and Behavioral Syndromes at the University Hospital is based on the integration of group psychotherapy with individual psychotherapy. The groups are semi-open. The length of treatment is 60 days (most frequently means 12 weeks). Psychotherapy is carried out in the stream which integrates the elements of psychodynamic, cognitive, and behavioral theories. The therapeutic program for patients involved six 60-minutes sessions of a group psychotherapy weekly (2x60 minutes daily three times a week), two optional inter-group psychotherapy sessions (2x120 minutes twice a week), which involved various techniques such as psychodrama, pantomime, guided imagery, music therapy, relaxation, drawing, collage, and one session of individual psychotherapy weekly.

Measures

Symptom Checklist KO “O” developed by Aleksandrowicz et al. (Aleksandrowicz, et al., 1981; Aleksandrowicz & Sobański, 2011). The questionnaire allows for the assessment of neurotic symptoms’ intensity. It consists of 14 scales: phobic disorders, other anxiety disorders, obsessive-compulsive disorders, conversions, autonomic nervous system disorders – heart and cardiovascular system, somatization disorders, hypochondriacal disorders, neurasthenia, depersonalization-derealization syndrome, mixed and other personality disorders F60.6 and F60.7 – and avoidance and dependence, mixed personality disorders F60.3 and F60.4 – impulsive and histrionic, sexual dysfunctions, dysthymia. The overall value is the information that allows for the diagnosis of neurotic disorders. The score above standard for women is 200 points and for men is 165 points. The results achieved during a psychotherapy qualification procedure (a few months before entering the treatment) and from the week in which the procedure was conducted were included in the study.

The KON-2006 Neurotic Personality Questionnaire developed by Aleksandrowicz et al. (2009). The questionnaire allows to identify personality features that are characteristic for people suffering from neurotic disorders. The intensity of these traits is significantly higher among people with neurotic disorders than healthy ones. It consists of 24 scales: a feeling of being dependent on the environment, asthenia, negative self-esteem, impulsivity, difficulties with decision making, sense of alienation, demobilization, tendency to take risks, difficulties in emotional relations, lack of vitality, a conviction of own resourcefulness in life, sense of lack of control, a deficit in an internal locus of control, imagination and indulging in fiction, sense of guilt, difficulties in interpersonal relationships, envy, narcissistic attitude, sense of being in danger, exaltation, irrationality, meticulousness, ponderings, sense of being overloaded. The global score which is typical for a person with mental disorders is above 18 points, while the one for a healthy person is below 8 points. A score between 8–18 points is recognized as “uncertain”. The study considered the score achieved during a psychotherapy qualification procedure (a few months before entering the treatment).

State-Trait Anxiety Inventory (STAI) developed by Spielberger et al. (1983), translated to polish by Sosnowski et al. (2011). The tool allows to measure anxiety understood as a temporary and situational state of the individual and anxiety understood as a relatively constant personality trait. Both tests – American and polish one have been designed for the examination of healthy and ill people of over 15. The tool consists of 40 items grouped into two scales – state anxiety and trait anxiety.

Defense Style Questionnaire 40 (DSQ-40) developed by Andrews et al. (1993), translated to polish by Kokoszka et al. (1999). The questionnaire is used to assess defense mechanisms. It is based on Bond’s division of defense mechanisms. The tool includes 40 coping styles aggregating in 20 defense mechanisms divided into 3 groups: mature, neurotic, and immature. Among mature mechanisms are humor, sublimation, anticipation, suppression. Among neurotic mechanisms are undoing, pseudo altruism, idealization and reaction formation, and among immature ones are projection, passive aggression, acting-out, isolation, devaluation, schizoid fantasy, denial, displacement, dissociation, splitting, rationalization and somatization.

It is the most widely used tool to assess defense mechanisms. However, there are some doubts concerning its reliability. The original questionnaire was reported to have moderate to high Cronbach’s alpha coefficient for all three factors (immature mechanisms α = 0.80; neurotic α = 0.58; mature α = 0.68). The Polish version of DSQ-40 was reported lower Cronbach’s alpha levels for the immature (α = 0.73), neurotic (α = 0.39), and mature (α = 0.56) factors. Therefore, internal consistency (Cronbach’s alpha coefficient) of the applied instrument was assessed in the study group. The results were as follows: immature mechanisms α = 0.78, neurotic α = 0.47, and mature mechanisms α = 0.63.

4. Time Perspective Inventory developed by Zimbardo and Boyd, adapted to polish by Mażewski (2005). The tool consists of 56 items grouped into 5 scales: past positive, past negative, present hedonistic, present fatalistic, and future.

Statistical analysis

The statistical analysis was conducted using StatSoft Statistica 12. The results were considered statistically significant at p < 0.05. The normality of distributions was verified using the Shapiro-Wilk test. The distributions of all variables, except for the intensity of the features of neurotic personality, met the normality of distribution criterion. The following statistical methods were applied - parametric ones: Student’s t-test and the ANOVA analysis of variance, non-parametric ones: Spearman's rank correlation coefficient, the Mann–Whitney U test, following the characteristics of the distribution of analyzed variables. The dependence between selected factors was examined using the Pearson r parametric correlation coefficient and the Spearman r non-parametric correlation coefficient, respectively. The multivariate regression model was also used in the analysis.

It was verified whether variables differ depending on the demographic features of the analyzed subjects, such as gender, marital status, and the run household. The differences referring to education and the professional status were not verified due to the insufficient number of particular subgroups. Student’s t-test was used to find a significant difference between genders for the Future Scale TS: Please replace the highlighted data with (W: M = 3.56 SD = 0.58; M: M = 3.14 SD 0.61; p = 0.0238). The variant analysis did not show any significant differences in the intensity of neurotic symptoms and anxiety based on a medical diagnosis of neurotic disorders, personality disorders, or dual diagnosis.

Results

Associations between the severity of neurotic psychopathology and time perspective

Tables 1 and 2 show the results of the correlation analysis for the relationship between the severity of neurotic psychopathology and the time perspective. The intensity of symptoms as measured by the Symptom Checklist “O” (M = 224 points) during the week in which the procedure was conducted correlated with a more intense focus on past negative and less on the future. The intensity of symptoms measured during the qualification process (M = 340.14 points), which was higher than during the treatment, was not related to time perspective – the past negative and the future. However, the analysis revealed a trend for a positive correlation between the symptoms intensity score determined during the psychotherapy qualification procedure and the past-positive orientation. A correlation analysis including patient age revealed some differences between age-based relations. The link between the current level of neurotic symptoms and a high level of concentration on the negative past is significant in the group of 31–46 years old patients (r = 0.51, p < 0.01). In the 22–30 years, age group these links turned out to be insignificant (p = 0.998). On the contrary, the relation between neurotic symptoms and high focus on the future is significant among 22–30 years old patients (r = −0.49, p < 0.05) while being insignificant among 31–46 years old group (p = 0.081). Besides, a relation between symptoms’ intensity and level of concentration on a fatalistically perceived present (r = 0.45, p < 0.05) was revealed only in the 31–46 years old age group (22–30: p = 0.596).

Table 1.

The intensity of neurotic symptoms and time perspective (r-Pearson).

	Global symptom levels (OWK) before psychotherapy (during qualification process)		Global symptom levels (OWK) during psychotherapy treatment
	r	p	r	p
Past Negative	0.02	0.887	0.29	0.037
Past Positive	0.26	0.076	–0.07	0.630
Present Fatalistic	0.07	0.259	0.22	0.130
Present Hedonistic	−0.05	0.752	–0.14	0.344
Future	0.04	0.772	–0.43	0.002

The intensity of symptoms as measured by the Symptom Checklist “O” (M = 224 points) during the week in which the procedure was conducted correlated with a more intense focus on past negative (r = 0.29, p = 0.037)) and less presence of thoughts referring to the future (r = −0.43, p = 0.002).

Table 2.

The intensity of neurotic personality psychopathology and time perspective (r-Spearman).

	Level of neurotic personality disintegration before psychotherapy (during qualification process)
	r	p
Past Negative	0.54	0.000
Past Positive	0.05	0.729
Present Fatalistic	0.52	0.000
Present Hedonistic	0.05	0.734
Future	–0.24	0.106

The intensity of neurotic personality features measured by KON during the qualification process was associated with a stronger focus on the past perceived as negative (r = 0.54, p < 0.01) and the present perceived as fatalistic (r = 0.52, p < 0.01). Described relations were revealed in both age group samples. The correlations between scales were moderate (r = 0.3 – 0.49).

The analysis revealed a trend for a negative correlation between the intensity of neurotic personality features measured by XKON and focusing on the future, and a positive correlation between the symptoms intensity score determined during the psychotherapy qualification procedure and the past-positive orientation. The correlations found were weak; however, they would be probably significant for a larger sample.

Associations between anxiety intensity and time perspective

Table 3 presents the results of the correlation analysis for the link between anxiety intensity and time perspective. More pronounced trait anxiety co-occurs with stronger past-negative (r = 0.69, p < 0.01) and present-fatalistic orientations (r = 0.38, p < 0.01). The analysis including patients’ age revealed that the relation between anxiety and fatalistically perceived present is significant in the group of 22–30 years old patients (r = 0.47, p < 0.05), not in the one including patients aged 31–46 (p = 0.096). The age does not distinguish significantly between anxiety and negative perception of the past. The relation is important in both samples (22–30: r = 0.65, p < 0.01; 31–46: r = 0.71, p < 0.01). The analysis revealed a tendency towards a negative correlation between anxiety and the Future Scale in the 22–30 old group (r = −0.40, p = 0.063). The correlations found were weak; however, they would be probably significant for a larger sample. State anxiety was found not to be significantly related to how life experiences are perceived in terms of the time perspective. The obtained results support the understanding of state anxiety as a temporary state and the time perspective’s construct as a relatively permanent attitude.

Table 3.

The intensity of an anxiety and time perspective (r-Pearson).

	Anxiety-state			Anxiety-trait
	r	r²	p	r	r²	p
Past Negative	0.15	0.02	0.323	0.69	0.48	0.000
Past Positive	–0.11	0.01	0.472	0.01	0.00	0.961
Present Fatalistic	0.13	0.02	0.376	0.38	0.14	0.008
Present Hedonistic	–0.04	0.00	0.766	0.09	0.01	0.533
Future	0.16	0.03	0.273	–0.24	0.06	0.094

The role of defense mechanisms in understanding time perspective

Table 4 shows the results of the correlation analysis for the relationship between defense mechanisms and time perspective. The correlations between time perspectives and mature and immature defense mechanisms were relatively high (0.32 – 0.56). The study did not reveal a relationship between the time perspective and neurotic mechanisms; this may be explained by the low reliability of the mentioned scale. More immature mechanisms are associated with stronger focus on present-fatalistic (r = 0.52, p < 0.01), present-hedonistic (r = 0.32, p < 0.05) and past-negative (r = 0.48, p < 0.01) approaches, and with weaker focus on the future (r = −0.43, p < 0.01). Similarly, a high level of mature mechanisms is associated more often with the presence of thoughts referring to the future (r = 0.56, p < 0.01), decreased perception of present events referring to fatalistic (r = −0.53, p < 0.01), and hedonistic (r = −0.28, p < 0.05) time perspective, as well as decreased concentration on the past experienced negatively (r = −0.34, p < 0.05). The past negative perspective correlates more with trait anxiety than with defense mechanisms, whereas focusing on the fatalistic present correlates more with defense mechanisms than with anxiety. Trait anxiety and defense mechanisms correlate positively with the above-mentioned variables. Likewise, mature defense mechanisms correlate negatively with those variables.

Table 4.

Level of defense mechanism and time perspective (r-Pearson).

	Immature mechanisms			Neurotic mechanisms			Mature mechanisms
	r	r²	p	r	r²	p	r	r²	p
Past Negative	0.48	0.23	0.001	0.09	0.01	0.5275	–0.34	0.13	0.012
Past Positive	0.03	0.00	0.843	–0.07	0.00	0.6399	–0.05	0.00	0.730
Present Fatalistic	0.52	0.28	0.000	–0.01	0.00	0.9616	–0.53	0.29	0.000
Present Hedonistic	0.32	0.11	0.021	0.12	0.01	0.4311	–0.28	0.09	0.041
Future	–0.43	0.19	0.002	0.10	0.01	0.4903	0.56	0.32	0.000

The study showed a tendency for a significant correlation between the present-hedonistic orientation and mature defense mechanisms.

To evaluate the overall contribution of the analyzed factors in explaining the variability of intensity of particular time perspectives, multiple regression analyses were applied which were carried out applying the stepwise regression technique. The adopted criterion of acceptance of a model was the significance of the multiple correlation coefficient in association with the significance of all the regression coefficients in an equation adjusted to empirical data using the least-squares method. The results of the obtained multiple regression models have been presented in Table 5. The results are four equations. The first model presents a dependence of the intensity of the past negative perspective on anxiety understood as a feature and on using immature defense mechanisms. The model explains 56% of the variance of the past negative perspective (adjusted R² = 0.563). This means that among the patients, the tendency to go back and reconstruct earlier traumas and failures in one’s experiences intensifies together with the increase of anxiety understood as a feature and of the applied immature defense mechanisms. The model has not included potential predictors such as the current intensity of neurotic symptoms, the intensity of the neurotic personality, and mature defense mechanisms. It should be highlighted that it was not possible to create a model explaining the level of the past positive including the variables. None of the possible predictors was included in the developed regression models. The second model presents the dependence of the intensity of the present fatalistic perspective on applied mature and immature defense mechanisms and the intensity of the neurotic personality. The model explains 51% of the variance of the analyzed variable (adjusted R² = 0.512). The level of experiencing the present in a fatalistic way, in the feeling of hopelessness, helplessness, and a lack of influence on one’s everyday life increases together with a smaller participation of applying mature defense mechanisms and simultaneously more frequent use of immature mechanisms as well as the higher intensity of the features of neurotic personality. Another variable – the present hedonistic, has been explained only by applying immature defense mechanisms. The higher the number of applied immature defense mechanisms, the higher the level of experiencing the present in a hedonistic way, i.e. making decisions based on the current moment, an attitude aimed at seeking experiences, pleasures and achieving quick gratification. In the model, a significant association of mature defense mechanisms has not been demonstrated. The developed model explains only 9% of the variance of the variable (adjusted R² = 0.091). The last model describes the dependence of the future perspective on the degree of applied mature and immature defense mechanisms. A higher level of focusing on the future, i.e. the assessment of experiences, events through a prism of plans and goals, not ad hoc gratifications, is associated with more frequent application of mature defense mechanisms and less frequent use of immature mechanisms. It is also explained by a more intensity of anxiety-state and less severity of actual neurotic symptoms. The presented model explains about 54% of the variance of the variable (adjusted R² = 0.543).

Table 5.

Multiple regression models explaining each time perspective.

Independent variable	Regression coefficient			Significance test of the regression coefficient
Independent variable	Parameter b	Standard error	Beta	t	p
Model 1 explaining the intensity of the past negative time perspective
R = 0.763; R² = 0.582; adjusted R² = 0.563; p = 0.000
Anxiety–trait	0.042	0.007	0.611	6.123	0.000
Immature defense mechanisms	0.218	0.067	0.326	3.265	0.002

Model 2 explaining the intensity of the fatalistic present time perspective
R = 0.737; R² = 0.543; adjusted R² = 0.512; p = 0.000
Mature defense mechanisms	–0.197	0.054	–0.390	–3.648	0.001
Intensity of neurotic personality disintegration	0.009	0.003	0.300	2.649	0.011
Immature defense mechanisms	0.212	0.073	0.325	2.912	0.006

Model 3 explaining the intensity of the hedonistic present time perspective
R = 0.332; R² = 0.110; adjusted R² = 0.091; p = 0.021
Immature defense mechanisms	0.173	0.073	0.332	2.385	0.021

Model 4 explaining the intensity of the future time perspective
R = 0.763; R² = 0.582; adjusted R² = 0.543; p = 0.000
Mature defense mechanisms	0.249	0.055	0.499	4.534	0.000
Anxiety–state	0.018	0.006	0.331	3.205	0.003
Immature defense mechanisms	–0.179	0.065	–0.279	–2.742	0.009
Global symptom levels (OWK) during psychotherapy treatment	–0.002	0.001	–0.288	–2.734	0.009

Discussion

Research so far shows that various mental health issues result in problems with understanding and experiencing time (Zimbardo & Boyd, 2008). Compared to non-clinical sample Patients with different medical disorders are more focused on the negative past, fatalistic present, and less on the future understood as an ability to set goals. This relates to emotional states such as anger, anxiety, sadness. The results of our analysis contribute to a broader understanding of the time perspective among patients with neurotic and personality disorders regarding underlying the relations between defense mechanisms and the perception of time.

In the sample, a high level of neurotic symptoms, neurotic personality traits, and trait anxiety were observed. They constitute the factors whose high intensity is associated with frequent recollection of the past perceived negatively and to the fatalistic perception of the present time, seeing life as hopeless and unlikely to change. The conducted study helps to expand our understanding of the studied phenomenon and to indicate not only the connection between the way of time perception and particular clinic sample, as it was mentioned in the research cited at the beginning of the article, but also some traits and mechanisms associated with the way of experiencing time in the discussed patients’ group.

It is observed that along with a raise in psychopathological level – neurotic symptoms and neurotic traits, the ability to experience, remind and interpret past events and memories adaptively and favorably weakens. Instead, patients tend to come back to negative experiences and to see life as hopeless and unlikely to change. As the results present, the intensity of neurotic symptoms measured by KO, which are temporary, prone to change even weekly during the treatment, is related to the negative past and present time perspectives.

The results show the positive relationship between the severity of symptoms measured at the stage of qualifying for psychotherapy and focusing on positive experiences in the past, at the level of statistical tendency. The relationship is weaker during the treatment, while a relationship between the strength of symptoms and a focus on negative experiences in the past and present emerges. At the same time, comparing the state before and during psychotherapy treatment, a decrease in the intensity of symptoms is observed. Patients use various defense mechanisms, such as denial, repression, rationalization, emotional isolation, thus they do not experience the impact of the painful life experiences present in their biographies on their actual intra- and interpersonal functioning. Repression, denial, or emotional isolation allow not to experience the source of inner conflicts and anxiety (Cramer, 2000). The blocked feelings often coexist with an intensification of neurotic symptoms. This mechanism may be the possible interpretation of the relation observed before and during the treatment in terms of concentration on the positive versus negative past and level of symptoms. In psychotherapy, a process crucial for successful treatment is the development of an understanding of the meaning of life experiences and one’s history in the present. The possible explanation is that stronger correlations of symptoms with past negative during psychotherapy may present a particular moment of the treatment. It may be only a moment during the whole process of the treatment when defenses such as denial, repression weakens. Patients become more conscious. Therefore, we observed stronger correlations with the negative past and the fatalistic present. This hypothetical explanation of the dynamic of symptoms and the perception of time would require further exploration by using multiple simultaneous measurements of both - the severity of symptoms, neurotic personality traits, and time perspective. It would also be recommended to include the whole process of the treatment, which is very often not limited to one 12-week program, but several 12-week stays in the ward.

Clinging to the negative past is associated with a high level of anxiety understood as a trait, an intensity of neurotic personality traits, and immature defense mechanisms involved. The findings are congruent with studies showing that for an emotional state of anxiety, which is an important predictor for existing neurotic disorders (Mielimąka et al., 2017), a high level of negative past and fatalistic present perspectives are characteristic (Boniwell & Zimbardo, 2015). The study also emphasizes the significant role of the mentioned factors in thinking about the future. For the future, the described interdependencies are opposite to those associated with past-negative and fatalistic-present. The existence of the correlation means that specific factors may be influenced through the perspective of the future.

It shall be highlighted that controlling possible moderators of explained relations, including medical diagnosis, resulted in the observation of differences in the level of focusing on the future between patients suffering from neurotic disorders and the ones suffering from personality disorders, what was described in another article (Mostowik et al., 2018). The analysis indicated that a higher level of concentration on the future is presented by patients with neurotic disorders. The authors decided to explain the obtained results by referring them to a spectrum of personality traits rather than a medical diagnosis. The material renders such references possible. The results show that stronger concentration on the future is associated with less pronounced personality traits responsible for neurotic disorders, and probably with a lower level of trait anxiety and less mature defense mechanisms. However, it requires verification in further research. It means that in the case of more persistent current neurotic symptoms and less frequently used mature defense mechanisms, it is more difficult to concentrate on future, upcoming events, to interpret surrounding reality and make decisions based on referring to these upcoming events. At that time, whether the perception of the surrounding reality is seen either through past harmful events and failures or as a present state of hopelessness and helplessness depends on the intensity of either of time perspectives.

The results of the regression analysis lead to interesting possible conclusions helping to understand better the mechanisms related to the perception of surrounding reality – own past, present, and the future. Besides, the important role of the defensive functioning, we observed an important role of the anxiety-trait for clinging in the negative past and of the anxiety-state for the focusing thoughts towards the future. For the understanding of higher focusing on the future, the patients' perception of actual state – the intensity of neurotic symptoms - is important. Understanding relations between the time perspective and anxiety should be related to the knowledge about the operationalization of concepts anxiety-state and anxiety-trait in Spielberger’s (1966) theory. The results present that the past negative is not related to the anxiety-state understood as a subjective, conscious perception of feeling anxiety and tension, but with the anxiety-trait understood as a behavioral disposition, tendency to perceive different objectively non-threatening situations as a threatening one and reacting with a state of anxiety. Previous research (Bados et al., 2010) indicate that trait-anxiety does not strictly mean anxiety “per se” but, rather, it relates to negative affect and tendencies to worry, fatigue and avoidance (Kelly, 2004). It means that trait-anxiety is rather a neuroticism-like trait (Bieling et al., 1998). This corresponds with understanding the past negative as a tendency to ruminations, returning to worrying memories, failures, traumas, and making one’s reactions dependent on painful past events. Anxiety “per se” which is anxiety-state, that is an expectation of something threatening in the future is observed among patients with a high level of neurotic symptoms, having neurotic and personality disorders. Such an understanding of findings is now coherent with previous research showing that depression is associated more with a past orientation and anxiety is associated more with a future orientation (Eysenck & Fajkowska, 2018; Finlay-Jones & Brown, 1981). The mental health symptomatology could be explained by the tendency to dwelling in the past and also about an expectation of something treat in the future, without the possibility of setting realistic goals. Coping with it may be highly explained by the use of defense mechanisms.

Considering the established bilateral correlations, two hypothetical effects emerge. One is that change in the time perspective may constitute an important factor in the reduction of neurotic symptoms and trait-anxiety, concerning neurotic personality traits, possibly through changes in the repertoire of utilized defense mechanisms. On the other hand, it is also possible that altering neurotic symptomatology would alter time perspective. There is no research exploring possible changes in the time perspective as a result of psychotherapy treatment in the studied group of patients with neurotic symptoms. However, research among military veterans suffering from PTSD by Zimbardo et al. (2012) has revealed changes in developing a more balanced time perspective accompanied by reduction of depression and anxiety as a result of narrative therapy treatment. Davies and Filippopoulos (2015) have found that therapeutic interventions resulted in a lower concentration on thoughts of negative past and present hedonistic, but higher focus on possible future goals and plans among addicted patients.

It would be, thus, recommended to conduct further research on the role of the changes in the neurotic symptomatology and time perspective in the course of psychotherapy, which is expected to expand the understanding of the relations observed in the studied group of patients.

Limitations

There are notable limitations of the present study. First, among the limitations of the study, a small number of studied subjects has to be mentioned. It was observed that some of the connections had only a tendency of a significant level. We may assume that they would be significant if the studied group was larger. However, it is only a hypothetical assumption and requires verification in further research.

Another limitation is an inability to indicate a direction of revealed relations. It is not possible to establish whether life experiences contribute to specific orientations or whether concentration on the past is a neurotic symptom. However, in practice, it seems that traumatic experiences may affect a way of experiencing the past and a way in which the future is experienced as threatening, impossible to plan, and then sustain psychological symptoms through defense mechanisms. This inability to set the direction of the relationship is one of the core methodological limitations typical for the naturalistic research paradigm which is represented in the presented study.

Moreover, the measure of time perspective was administered only once during psychotherapy. As a result, it is shown how neurotic symptoms, anxiety – state and traits, and defense mechanisms relate to the perception of one’s past, present, and future among patients with neurotic and personality disorders. Though, it remains unclear how it may change during psychotherapy treatment. It would be interesting to investigate if and how time perspective changes during the treatment. Repeated measures during the psychotherapy would be needed.

Finally, very low reliability of the Neurotic Defense Mechanisms Scale from the DSQ-40 should be emphasized. In consequence, it is difficult to draw unambiguous conclusions regarding the role of neurotic mechanisms in one’s perception of the past, present, and future. It needs to be noted that the reliability of the polish version of DSQ-40 is questionable. This is coherent with data from other studies among normal and clinic populations (Mrozowicz-Wrońska, 2019; Treger et al., 2015). It requires further research on a larger population to improve it.

Conclusions

The presented results apply to patients suffering from neurotic symptoms and diagnosed with neurotic disorders (F40-F48) and personality disorders (F60, F61) according to ICD-10 criteria.

Results confirm the relations between variables included in the proposed theoretical model relating to patients with neurotic symptoms – the time perspective and severity of neurotic symptoms, anxiety understood as a trait, and defense mechanisms involved. Most correlations observed concerned the past-negative dimension.

The increase in severity of neurotic psychopathology is accompanied by an increase in focusing on negatively experienced past and present and a decrease in focusing on the future. Likewise, with the higher concentration on the emotionally negative past and fatalistic present, and less concentration on the future, more personality traits associated with the occurrence and persistence of neurotic disorders, observed trait anxiety and neurotic symptoms are more severe. State anxiety was found not to be significantly related to how life experiences are perceived in terms of the time perspective.

The severity of symptoms, state, and trait anxiety is not related to a degree in which patients focus on positively interpreted past and present.

The neurotic symptomatology among patients with neurotic and personality disorders could be explained by a tendency to dwelling in the past and also about an expectation of something treat in the future, without the possibility of setting realistic goals. Coping with it may be highly explained by the use of defense mechanisms.

The obtained results emphasize the important role of defense mechanisms in a way time is experienced by patients. Both, immature and mature mechanisms participate in the process of interpretation of one’s life in terms of positive and negative seeing past, present, and future experiences.

The past-negative orientation, meaning dwelling on and recalling unhappy things, is more strongly associated with trait anxiety than defense mechanisms. However, when the present time is perceived as worrisome, harmful, lacking good perspectives, stronger defense mechanisms are required. Also in the case of the future orientation, defense mechanisms are of great significance.

The results present that the past negative is not related to the anxiety-state which is anxiety ‘per se’ understood as a subjective, conscious perception of feeling anxiety and tension, but with the anxiety-trait which is rather a neuroticism-like trait, tendency to worry, fatigue and avoidance. Anxiety “per se” explains more focusing on the future, an expectation of something treat, without the possibility of setting realistic goals.

Among limitations of the study are: (1) an inability to indicate a direction of revealed relations. The results of the study do not show whether neurotic symptoms, anxiety and defense mechanisms contribute to specific time orientations or whether particular concentration on the past, present, or future is a result of the intensity of neurotic symptoms and used defenses, (2) It is impossible to draw unambiguous conclusions regarding the role of neurotic mechanisms in one’s perception of the past, present, and future because of the very low reliability of the Neurotic Defense Mechanisms Scale from the DSQ-40.

It would be recommended to conduct further research on the role of the changes in the time perspective in the course of psychotherapy.

Clinical implications for practitioners

Despite the presented limitations, the study confirms the applicability and clinical relevance of the Time Perspective Theory in psychotherapy of patients diagnosed with anxiety and personality disorders. The findings could be inspiring for clinicians to take into regard the time perception of patients in both the diagnostic process and the treatment of those common disorders.

Psychotherapy, usually leads patients to see their past, present, and future more holistically, acknowledging positive and negative aspects of different situations and experiences. It bolsters the development of versatile strategies of coping with challenges in everyday life. The time perspective observed amid patients with neurotic and personality disorders suffering from neurotic symptoms could be an adequate tool to assess the general mental health of patients. The optimal time perspective, which means a balance between a strong past positive orientation, moderate present hedonistic and future orientations and weak past negative and present fatalistic orientations (Zimbardo & Boyd, 2008), may constitute a metaphoric description of the ideal state towards which psychotherapy should be directed (Mostowik & Cyranka, 2018). Moreover, the assessment of the time perspective in patients with neurotic and personality disorders may provide essential data for the diagnosis and the monitoring of psychotherapy effectiveness. It would be recommended to conduct further research on the role of the changes in the time perspective in the course of psychotherapy, which is expected to expand the understanding of the relations observed in the studied group of patients.”

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Joanna Mostowik

Author Biographies

Joanna Mostowik: psychologist, psychotherapist working in the University Hospital in Kraków. Interested in psychotherapy effectiveness of patients suffering from mood, neurotic and personality disorders and factors associated with treatment outcomes, especially therapeutic alliance. Currently involved in research exploring relations between attachment style, mentalization, therapeutic alliance, and treatment outcomes in group psychotherapy. The research interests also include personality functioning and time perspective.

Michał Mielimąka: MD, PhD, Medical doctor, psychiatrist, and assistant professor working in the Department of Psychotherapy Jagiellonian University Medical College and in the University Hospital in Kraków. Engaged in research and clinical work with patients treated with psychotherapy for personality, neurotic and stress-related disorders. Currently involved in research projects focused on exploring the associations between personality functioning and the function of the endocrine system. Research interests include factors influencing psychotherapy treatment, the process of change in psychotherapy, time perspective and personality disorders, hypnosis. Author and co-author of numerous publications in the fields.

Krzysztof Rutkowski: professor of medicine, senior psychiatrist, Jungian analyst, psychotherapist and supervisor. Head of the Department of Psychotherapy Jagiellonian University Medical College.

Tadeusz Ostrowski: PhD, Professor of the Andrzej Frycz-Modrzewski Krakow University in Poland, Faculty of Psychology, Education and Humanities. The holder of a 2nd degree of specialization in adults clinical psychology. The research area: theory of motivation, clinical health psychology, organizational psychology and existential psychology. The author of the libertial-value-grounded theory of the meaning of life.

References

Aleksandrowicz

J. W.

Sobański

J. A.

(2011). Symptom checklist S-III. Psychiatria Polska, 4, 515–526.

Aleksandrowicz

J. W.

Bierzyński

Filipiak

Kowalczyk

Martyniak

Mazoń

(1981). Kwestionariusze objawowe „S. i „O. — narzędzia służące do diagnozy i opisu zaburzeń nerwicowych [The symptoms questionnaires “S” & “O” – Tools for diagnosis and description of neurotic disorders]. Psychoterapia, 37, 11–27.

Aleksandrowicz

J. W.

Klasa

Sobański

J. A.

Stolarska

(2009). KON-2006 – Neurotic personality questionnaire. Archives of Psychiatry and Psychotherapy, 1, 21–29.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. 4th ed. American Psychiatric Association.

Anagnostopoulos

Griva

(2012). Exploring time perspective in Greek young adults: Validation of the Zimbardo time perspective inventory and relationships with mental health indicators. Social Indicators Research, 106(1), 41–59. https://doi.org/10.1007/s11205-011-9792-y

Andrews

Pollock

Stewart

(1989). The determination of defense style by questionnaire. Archives of General Psychiatry, 46(5), 455–460. https://doi.org/10.1001/archpsyc.1989.01810050069011

Andrews

Singh

Bond

(1993). The defense style questionnaire. The Journal of Nervous and Mental Disease, 181(4), 246–256. https://doi.org/10.1097/00005053-199304000-00006

Bados

Gómez-Benito

Balaguer

(2010). The state-trait anxiety inventory, trait version: Does it really measure anxiety? Journal of Personality Assessment, 92(6), 560–567. https://doi.org/10.1080/00223891.2010.513295

Bieling

P. J.

Antony

M. M.

Swinson

R. P.

(1998). The State-Trait anxiety inventory, trait version: Structure and content re-examined. Behaviour Research and Therapy, 36(7–8), 777–788. https://doi.org/10.1016/S0005-7967(98)00023-0

10.

Blaya

Dornelles

Blaya

Kipper

Heldt

Isolan

Bond

Manfro

G. G.

(2006). Do defense mechanisms vary according to the psychiatric disorder? Revista Brasileira de Psiquiatria (Sao Paulo, Brazil: 1999), 28(3), 179–183. https://dx-doi-org.web.bisu.edu.cn/10.1590/S1516-44462006000300007

11.

Bogutyn

Kokoszka

Pałczyński

Holas

(1999). Defense mechanism in alexithymia. Psychological Reports, 84(1), 183–187. https://doi.org/10.2466/pr0.1999.84.1.183

12.

Boniwell

Zimbardo

P. G.

(2015). Balancing time perspective in pursuit of optimal functioning. In Joseph

(Eds.), Positive psychology in practice: Promoting human flourishing in work, health, education, and everyday life (2nd ed., pp. 223–236). John Wiley.

13.

Breier-Williford

Bramlett

R. K.

(1995). Time perspective of substance abuse patients: Comparison of the scales in Stanford Time Perspective Inventory, Beck Depression Inventory, and Beck Hopelessness Scale. Psychological Reports, 77(3 Pt 1), 899–905. https://doi.org/10.2466/pr0.1995.77.3.899

14.

Cramer

(1987). The development of defense mechanisms. Journal of Personality, 55(4), 597–614. https://doi.org/10.1111/j.1467-6494.1987.tb00454.x

15.

Cramer

(2000). Defense mechanisms in psychology today: Further processes for adaptation. The American Psychologist, 55(6), 637–646. https://doi.org/10.1037/0003-066X.55.6.637

16.

Cramer

(2006). Protecting the self: Defense mechanisms in action. Guilford Press.

17.

Davies

Filippopoulos

(2015). Changes in psychological time perspective during residential addiction treatment: A mixed-methods study. Journal of Groups in Addiction & Recovery, 10(3), 249–270. https://doi.org/10.1080/1556035X.2015.1066728

18.

Eysenck

M. W.

Fajkowska

(2018). Anxiety and depression: Toward overlapping and distinctive features. Cognition & Emotion, 32(7), 1391–1400. https://doi.org/10.1080/02699931.2017.1330255

19.

Finlay-Jones

Brown

G. W.

(1981). Types of stressful life event and the onset of anxiety and depressive disorders. Psychological Medicine, 11(4), 803–815. https://doi.org/10.1017/S0033291700041301

20.

Gabbard

G. O.

(2005). Psychodynamic psychiatry in clinical practice (4th ed.). American Psychiatric Publishing.

21.

Israeli

(1936). Abnormal personality and time. Science Press Printing Company.

22.

Kelly

W. E.

(2004). Examining the relationship between worry and trait anxiety. College Student Journal, 38(3), 370–374.

23.

Laghi

Baiocco

D'Alessio

Gurrieri

(2009). Suicidal ideation and time perspective in high school students. European Psychiatry: The Journal of the Association of European Psychiatrists, 24(1), 41–46. https://doi.org/10.1016/j.eurpsy.2008.08.006

24.

Lewin

(1935). A dynamic theory of personality. McGraw Hill Book Company.

25.

MacLeod

A. K.

Tata

Evans

Tyrer

Schmidt

Davidson

Thornton

Catalan

(1998). Recovery of positive future thinking within a high‐risk parasuicide group: Results from a pilot randomized controlled trial. The British Journal of Clinical Psychology, 37(4), 371–379. https://doi.org/10.1111/j.2044-8260.1998.tb01394.x

26.

Mażewski

(2005). Adaptacja kwestionariusza ZTPI zimbardo [Polish adaptation of zimbardo ZTPI questionnaire]. University of Silesia.

27.

Melges

F. T.

(1982). Time and the inner future: A temporal approach do psychiatric disorders. John Wiley.

28.

Mielimąka

Rutkowski

Cyranka

Sobański

J. A.

Dembińska

Müldner-Nieckowski

Ł.

(2017). Trait and state anxiety in patients treated with intensive short-term group psychotherapy for neurotic and personality disorders. Psychiatria Polska, 51(6), 1165–1120. https://dx-doi-org.web.bisu.edu.cn/10.12740/PP/OnlineFirst/60537

29.

Mostowik

Cyranka

(2018). New trends in psychotherapy: The role of time perspective in mental health and practiced therapeutic interventions. Psychoterapia, 1(184), 17–29.

30.

Mostowik

Mielimąka

Rutkowski

Ostrowski

(2018). Time perspective among patients diagnosed with neurotic and personality disorders – An exploratory, clinical study. Unpublished manuscript, Jagiellonian University.

31.

Mrozowicz-Wrońska

(2019). A psychometric analysis of the polish version of the defense style questionnaire (DSQ-40) in a nonclinical sample of young adults. Psychiatria i Psychologia Kliniczna, 19(1), 13–18. https://dx-doi-org.web.bisu.edu.cn/10.15557/PiPK.2019.0002

32.

Muris

Merckelbach

(1996). The short version of the defense style questionnaire: Factor structure and psychopathological correlates. Personality and Individual Differences, 20(1), 123–126. https://doi.org/10.1016/0191-8869(95)00153-W

33.

Nolen-Hoeksema

(1991). Responses to depression and their effects on the duration of the depressive episodes. Journal of Abnormal Psychology, 100(4), 569–582.

34.

Oyanadel

Buela-Casal

(2014). Time perception and psychopathology: Influence of time perspective on quality of life of severe mental illness. Actas Españolas de Psiquiatría, 42(3), 99–107.

35.

Sobański

J. A.

Klasa

Rutkowski

Dembińska

Müldner-Nieckowski

Ł.

(2011). Kwalifikacja do intensywnej psychoterapii w dziennym oddziale leczenia nerwic [Qualification for admission to intensive psychotherapy in a day hospital for neurotic disorders. Psychiatria i Psychoterapia, 7(4), 20–34.

36.

Sosnowski

Wrześniewski

Jaworowska

Fecenec

(2011). STAI – inwentarz stanu i cechy lęku [STAI – The inventory of anxiety – State and trait]. Pracownia Testów Psychologicznych PTP.

37.

Spielberger

C. D.

(1966). Theory and research on anxiety. In: C. D. Spielberger (Ed.), Anxiety and behavior (pp.3–20). Academic Press.

38.

Spielberger

C. D.

Gorsuch

Lushene

Vagg

Jacobs

(1983). Manual for the State-Trait anxiety inventory. Consulting Psychologists Press.

39.

Stolarski

Matthews

Postek

Zimbardo

Bitner

(2014). How we feel is a matter of time: Relationships between time perspective and mood. Journal of Happiness Studies, 15(4), 809–827. https://doi.org/10.1007/s10902-013-9450-y

40.

Thobaben

(2005). Defense mechanisms and defense levels. Home Health Care Management & Practice, 17(4), 330–332. https://doi.org/10.1177/1084822304274097

41.

Treger

Matusiak

Pilecki

Rogoż

(2015). The association between self-image and defence mechanisms in a group of adolescent patients receiving psychiatric treatment. Psychiatria Polska, 49(4), 747–756. https://doi.org/10.12740/PP/30017

42.

Vaillant

G. E.

(1994). Ego mechanisms of defense and personality psychopathology. Journal of Abnormal Psychology, 103(1), 44–50.

43.

Van Beek

Berghuis

Kerkhof

Beekman

(2011). Time perspective, personality and psychopathology: Zimbardo’s time perspective inventory in psychiatry. Time & Society, 20(3), 364–374. https://doi.org/10.1177/0961463X10373960

44.

Wallace

(1956). Future time perspective in schizophrenia. Journal of Abnormal Psychology, 52(2), 240–245. https://doi.org/10.1037/h0039899

45.

World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical description and diagnostic guidelines.

46.

Zaleski, Z. (1991). Psychologia zachowań celowych [Psychology of purposeful behavior]. Warsaw: Wyd. PWN.

47.

Zimbardo

Boyd

(1999). Putting time in perspective: A valid, reliable individual-differences metric. Journal of Personality and Social Psychology, 77(6), 1271–1288. https://doi.org/10.1007/978-3-319-07368-2_2

48.

Zimbardo

Boyd

(2008). The time paradox: The new psychology of time that can change your life. Free Press.

49.

Zimbardo

Sword

(2012). The time cure: Overcoming PTSD with the new psychology of time perspective therapy. John Wiley.

Time in the Mental Health Context: Neurotic Symptomatology,Defense Mechanisms and the Perception of Time Perspective Among Patients Diagnosed With Neurotic and Personality Disorders – A Clinical Study

Abstract

Aim

Methods

Results

Conclusions

Keywords

Introduction

Aim of the study

Material and methods

Participants and procedure

Treatment

Measures

Statistical analysis

Results

Associations between the severity of neurotic psychopathology and time perspective

Associations between anxiety intensity and time perspective

The role of defense mechanisms in understanding time perspective

Discussion

Limitations

Conclusions

Clinical implications for practitioners

Footnotes

Declaration of Conflicting Interests

Funding

ORCID iD

Author Biographies

References