Reflective functioning: a review

Minding the Baby®: Enhancing parental reflective functioning and infant attachment in an attachment-based, interdisciplinary home visiting program

In this article, we describe the results of the second phase of a randomized controlled trial of Minding the Baby (MTB), an interdisciplinary reflective parenting intervention for infants and their families. Young first-time mothers living in underserved, poor, urban communities received intensive home visiting services from a nurse and social worker team for 27 months, from pregnancy to the child's second birthday. Results indicate that MTB mothers' levels of reflective functioning was more likely to increase over the course of the intervention than were those of control group mothers. Likewise, infants in the MTB group were significantly more likely to be securely attached, and significantly less likely to be disorganized, than infants in the control group. We discuss our findings in terms of their contribution to understanding the impacts and import of intensive intervention with vulnerable families during the earliest stages of parenthood in preventing the intergenerational transmission of disrupted relationships and insecure attachment.

An attachment perspective on the risk for psychosis: Clinical correlates and the predictive value of attachment patterns and mentalization

BACKGROUND

In a longitudinal design, the present study examined: (a) the nature of attachment patterns and reflective functioning (RF) in individuals at ultra-high risk for psychosis (UHR); (b) the association between RF and subclinical psychotic symtoms; and (c) the psychosis-predictive value of attachment patterns, RF, and the interaction between these factors.

METHOD

The sample comprised 57 UHR subjects and 53 clinical controls (non-UHR). UHR subjects were followed over a mean period of 14 months (SD = 2.7; range 11-19), during which time 11.5% developed psychosis. Attachment patterns and RF were measured. Hierarchical logistic regression was used to examine the predictive value of variables in the transition to psychosis.

RESULTS

At baseline, significant differences were found between groups in secure attachment patterns and RF. RF was negatively associated with the attenuated psychotic symptoms described by the Unusual Thought Content/Delusional Ideas, Suspiciousness/Persecutory Ideas, and Disorganized Communication subscales. Moreover, poor mentalization was related to an increased likelihood of developing a psychotic disorder (OR = 0.427, 95% CI [0.188, 0.970]); conversely, no predictive effects of the attachment variables and their interaction with RF on the transition to psychosis were found. Notably, an optimal threshold value of RF = 1.25 was found to distinguish UHR subjects who made the transition to psychosis from those who did not develop this pathology.

CONCLUSION

The results suggest that aberrant mentalizing patterns can predict the development of psychosis. Clinical implications of these results for the development of preventive treatments are discussed.

Brain Responses to Emotional Infant Faces in New Mothers and Nulliparous Women

The experience of motherhood is one of the most salient events in a woman’s life. Motherhood is associated with a series of neurophysiological, psychological, and behavioral changes that allow women to better adapt to their new role as mothers. Infants communicate their needs and physiological states mainly through salient emotional expressions, and maternal responses to infant signals are critical for infant survival and development. In this study, we investigated the whole brain functional response to emotional infant faces in 20 new mothers and 22 nulliparous women during functional magnetic resonance imaging scans. New mothers showed higher brain activation in regions involved in infant facial expression processing and empathic and mentalizing networks than nulliparous women. Furthermore, magnitudes of the activation of the left parahippocampal gyrus and the left fusiform gyrus, recruited during facial expression processing, were positively correlated with empathic concern (EC) scores in new mothers when viewing emotional (happy-sad) faces contrasted to neutral faces. Taken together, these results indicate that the experience of being a mother affects human brain responses in visual and social cognitive brain areas and in brain areas associated with theory-of-mind related and empathic processing.

Trauma in childhood and adolescence and impaired executive functions are associated with uncertain reflective functioning in mothers with substance use disorder

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Uncertain reflective function in mothers with SUD are associated with trauma during childhood and adolescence.

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Impaired executive functions are significantly associated with uncertain reflective function.

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Certain reflective function is not associated with executive functions or trauma.

Aims

Impairments in reflective functioning are known to have adverse effects on the ability to display sensitive parenting as a caregiver. Several factors are associated with impairments in reflective functioning, such as impaired executive functioning and experienced trauma. We investigated how these factors contribute to an impaired reflective functioning style, such as pathological certain or uncertain reflective functioning. Extreme scores on these two subscales reflect two kinds of impairments in reflective functioning. We assessed executive functions, reflective functioning, and trauma in 43 mothers diagnosed with substance use disorders (SUD).

Methods

Certain or uncertain reflective functioning were assessed using the Reflective Functioning Questionnaire 8 (RFQ-8). Executive functions and trauma were assessed by administering various questionnaires, interviews and neuropsychological tests.

Results

High uncertain reflective functioning was more than six times as common (odds ratio) in mothers reporting high amounts of trauma in childhood and adolescence compared with mothers reporting low amounts of trauma. Impaired executive functions were also significantly associated with high uncertain reflective functioning. Certain reflective functioning did, however, not show any significant associations.

Conclusion

When the SUD mothers give information about relational trauma in childhood and adolescence, it might therefore be worth investigating and addressing the potential tendency to have an uncertain reflective functioning style.

Self-reported reflective functioning mediates the association between attachment insecurity and well-being among psychotherapists

Objective: Subjective well-being is a crucial variable for mental health practitioners. This study examines the influence of therapists' attachment dimensions and self-reported reflective functioning on their perceived well-being. Further, it examines if reflective functioning mediates the association between attachment insecurity and well-being. Method: A total of 416 experienced psychotherapists were enrolled in this cross-sectional study, and completed self-report measures of attachment insecurity, reflective functioning, and well-being. We tested the hypothesized mediation model with path analysis that examined indirect effects. Results: Both attachment anxiety and avoidance dimensions had a significant negative association with perceived well-being with small to medium effects. "Certainty" in reflective functioning had a small positive effect on therapist well-being. Reflective functioning mediated the association between insecure attachment dimensions and well-being, suggesting that therapist's lower ability to mentalize may partially account for the effects of higher attachment insecurity on lower well-being. Conclusion: The well-being of psychotherapists with greater insecure attachment may deserve special attention, and therapists' mentalizing capacities may be targeted by researchers and trainers as a core ability to be cultivated in order to preserve therapists' professional and personal resources.

The Mentalizing Approach to Psychopathology: State of the Art and Future Directions

Mentalizing is the capacity to understand others and oneself in terms of internal mental states. It is assumed to be underpinned by four dimensions: automatic–controlled, internally–externally focused, self–other, and cognitive–affective. Research suggests that mental disorders are associated with different imbalances in these dimensions. Addressing the quality of mentalizing as part of psychosocial treatments may benefit individuals with various mental disorders. We suggest that mentalizing is a helpful transtheoretical and transdiagnostic concept to explain vulnerability to psychopathology and its treatment. This review summarizes the mentalizing approach to psychopathology from a developmental socioecological evolutionary perspective. We then focus on the application of the mentalizing approach to personality disorders, and we review studies that have extended this approach to other types of psychopathology, including depression, anxiety, and eating disorders. We summarize core principles of mentalization-based treatments and preventive interventions and the evidence for their effectiveness. We conclude with recommendations for future research.

The mentalization profile in patients with eating disorders: a systematic review and meta-analysis

Context: Patients with eating disorders (EDs) may have a lower mentalization ability. To the best of our knowledge, no meta-analysis has so far addressed the multidimensional mentalization profile within these patients.Objective: To summarize the existing evidence of the mentalization profile and its association with EDs.Data sources: We searched for articles in PsychINFO, Embase and PubMed using the search terms mentalization, reflective function, adult attachment interview, alexithymia, Toronto Alexithymia Scale, eye test, Reading the Mind in the Eyes Test, Theory of Mind, mind-mindedness, mind-blindness, facial expression recognition, metacognition, ED, anorexia nervosa (AN) and bulimia nervosa (BN).Studies included: Quantitative studies including diagnosed patients with an ED, healthy controls (HCs) and relevant test methods.Data synthesis: Forty-four studies were included. Nine studies were eligible for the meta-analysis. Significantly lower mentalization ability about oneself was found in patients with an ED when compared to HCs. Groups were more comparable when dealing with mentalization ability of others. Non-significant but clinically relevant results include a tendency for a lower mentalization ability in patients with AN compared to patients with BN.Conclusion: The mentalization profile is complex and varies across dimensions of mentalization in patients with an ED. Different degrees of mentalization between various EDs were found, implying the necessity for further research on mentalization profiles in different ED diagnoses. The sparse existing literature was a limitation for this meta-analysis, emphasizing that further research on the mentalization profile in patients with EDs is needed.

Childhood abuse and neglect experiences, Hostile-Helpless attachment, and reflective functioning in mentally ill filicidal mothers

The present study represents the first empirical investigation of the mechanisms - a Hostile-Helpless (HH) attachment and reflective functioning (RF) - through which childhood abuse and neglect (CA&N) experiences may impact a mother's likelihood to commit filicide. The sample was comprised of 46 mentally ill mothers. Differences in attachment-derived risk variables between filicidal mothers (FM) and non-filicidal mothers (NFM) were also examined. FM (n = 23) reported lower RF, higher HH attachment, and a more severe history of CA&N, compared to NFM (n = 23), but did not differ on the severity of childhood experiences of loss of and/or separation from attachment figures. Bayesian analysis indicated that the mediated effect of more severe CA&N on the likelihood of committing filicide through higher HH attachment was significantly amplified by lower RF. A developmental interpretation of filicide is proposed and clinical implications for prevention and attachment-based interventions with at-risk mother-child dyads are discussed.

Relationship between Mentalizing and Working Conditions in Health Care

Mentalizing describes the human ability to comprehend one's own and others' mental states and is seen as one of the core competencies of psychotherapists. Current research has emphasized the importance of both early dyadic attachment as well as broader sociocultural environmental input on the development of mentalizing. This study investigates whether mentalizing skills, operationalized via reflective functioning (RF), might be influenced by training and working conditions. This study was a matched case-control comparison, cross-sectional study. RF was assessed in a total of 10 psychotherapy trainees working in private practice at the beginning (group A; n = 5) and end (group B; n = 5) of their psychotherapy training (training association: Gestalt Therapy, Institute of Integrative Gestalttherapy Vienna) and in a total of 40 health professionals (institution: General Hospital Vienna-Social Medical Center South, Vienna, Department of Psychiatry, acute psychiatric ward) at the beginning of (group C; n = 20) and without (group D; n = 20) mentalization based therapy training. The participants differed from each other regarding their training, but participants of the same institution were matched. RF scores were significantly higher in group A and B than in group C and D (A,C: p = 0.0065, Odds Ratio (OR): 0.0294; A,D: p = 0.0019, OR: 0.0132; B,C: p = 0.0065, OR: 0.0294, B,D: p = 0.0019, OR: 0.0132). RF scores were not significantly different among groups A and group B (A,B: p > 0.9999) or between groups C and D (C,D: p = 0.6050). The current study suggests that mentalizing skills might be rather slow to improve by training, but that they might be influenced by the context.

Does your child need therapy? Maternal reflective functioning and perceived need for and use of child mental health treatment

Interventions to improve reflective functioning (RF) are being delivered to parents of children with mental health needs, yet whether this population differs in RF is unknown. We examine if mothers with varying levels of child mental health (CMH) treatment need and use differ in RF in a community sample of 212 mothers. Participants completed measures of general RF, parental RF, children's symptoms, perceived treatment need, treatment utilization, and perceptions of treatment efficacy at baseline and one year later. Low maternal RF was associated with elevated child symptoms, and a greater perceived need for treatment. Among mothers who believed their child needed services, those with low general RF were less likely to be utilizing services at baseline and in the next year. Mothers with lower parental RF also believed that CMH treatment was less effective. Findings support the use of RF-based interventions with parents identified because of their child's mental health.

Association between parental alexithymic traits and self-reported postnatal reflective functioning in a birth cohort population. Findings from the FinnBrain Birth Cohort Study

Parental reflective functioning (PRF) refers to a parent's effort to see his/her child as a separate individual person from early on, and to be curious of the child's own thoughts and feelings. Parenting abilities are affected by the parent's emotion regulation and emotional availability. Alexithymia as a personality construct with emotional deficits and poor imagination could potentially affect also PRF, but studies on parental alexithymia are still scarce. The aim of the present study was to examine the association between parental alexithymic traits and PRF, which to date has not been explored. As most of the parenting research concern only mothers, an additional aim was to study also fathers. The 20-item Toronto Alexithymia Scale (TAS-20) and the 14-item Parental Reflective Functioning Questionnaire (PRFQ-Fi) were filled by 1882 mothers and 994 fathers at six months postpartum as part of the FinnBrain Birth Cohort Study. A significant negative association between TAS-20 total score and PRFQ-Fi total score among both genders was found. The main alexithymia dimension responsible for this association was Externally Oriented Thinking. The results suggest that alexithymic traits indeed are related to parental reflective functioning, but more studies are needed to explore the direction of this relation.

[Mentalizing as a Mechanism of Change in the Therapy of Conduct Disorder. A Controlled Case Study]

Mentalizing as a Mechanism of Change in the Therapy of Conduct Disorder. A Controlled Case Study This controlled case study is dedicated to mentalizing as a mechanism of change in the course of a mentalization-based therapy for the treatment of conduct disorder. Following an introduction to conduct, oppositional defiant disorder and the concept of mentalizing, the case study of a 17-year-old male patient is presented. The patient's mentalizing is measured with the Reflective Functioning Scale and assessed prior to and after treatment as well as in therapy sessions at three time points through the course of therapy. Analyses show that the capacity for mentalizing fluctuates noticeably within but also between the coded therapy sessions. During the course of therapy first an increase and then a slight decrease in mentalizing qualities become apparent. The comparison of the pre- and post-measurement shows a slight increase in the patient's mentalizing abilities. Additionally the patient no longer fulfilled the criteria of a conduct disorder. The results are discussed and implications for clinical practice are formulated.

Parenting stress and competence in borderline personality disorder is associated with mental health, trauma history, attachment and reflective capacity

BACKGROUND

Individuals with borderline personality disorder (BPD) may experience additional challenges in their parenting role, including increased stress and lower self-efficacy and satisfaction. These difficulties have been shown to impact their children, and may be implicated in the potential intergenerational transmission of personality vulnerabilities.

METHODS

Parental stress and competence variables were examined in a cross-sectional study of 284 parents (94.72% female, M = 37.37, SD = 8.04 years), of which 69 (24.30%) met caseness for BPD criteria. We completed a multivariate analysis of variance to test how parents with 'high BPD features' (meeting caseness for BPD) compared to those with 'low BPD features' on a range of parenting and mental health variables. Multivariate linear regression modelling was then utilised to explore whether these parenting variables were associated with personality and psychological wellbeing, recalled trauma history, orientation to attachment relationships and reflective capacity.

RESULTS

Individuals high in BPD features experienced more stress and lower competence in their parenting role than those low in BPD features. These parents also reported more personality vulnerabilities, poorer psychological wellbeing, recalled more traumatic experiences in their childhood, were more likely to endorse insecure attachment styles and had poorer reflective capacity. In the regression model, parenting stress and competence was associated with personality traits, general psychological wellbeing, recalled trauma history, attachment style and reflective capacity variables. Parental reflective capacity had the strongest association with parenting stress, satisfaction, efficacy, the perception of having a difficult child and a difficult parent-child relationship, and psychological wellbeing had the greatest association with parenting distress.

CONCLUSIONS

Parents who were able to imaginatively enter the subjective world of the child and hold the child's mind in mind with less certainty, reported reduced parenting stress and greater parenting satisfaction and efficacy. Helping to improve personality and mental health functioning, increasing parental reflective capacity and strengthening parent-child attachment relationships, may reduce parenting stress and increase parenting competence in individuals with BPD.

From Learning Psychiatry to Becoming Psychiatrists: A Qualitative Study of Co-constructive Patient Simulation

Objectives: Co-constructive patient simulation (CCPS) is a novel medical education approach that provides a participatory and emotionally supportive alternative to traditional supervision and training. CCPS can adapt iteratively and in real time to emergent vicissitudes and challenges faced by clinicians. We describe the first implementation of CCPS in psychiatry. Methods: We co-developed clinical scripts together with child and adolescent psychiatry senior fellows and professional actors with experience performing as simulated patients (SPs). We conducted the simulation sessions with interviewers blind to the content of case scenarios enacted by the SPs. Each hour-long simulation was followed by an hour-long debriefing session with all participants. We recorded and transcribed case preparation, simulation interactions, and debriefing sessions, and analyzed anonymized transcripts through qualitative analysis within a constructivist framework, aided by NVivo software. Results: Each of six CCPS sessions was attended by a median of 13 participants (range, 11-14). The first three sessions were conducted in person; the last three, which took place during the COVID-19 pandemic, via synchronized videoconferencing. Each of the sessions centered on clinically challenging and affectively charged situations informed by trainees' prior experiences. Through iterative thematic analysis we derived an alliterating "9R" model centered on three types of Reflection: (a) in action/"while doing" (Regulate, Relate, and Reason); (b) on action/"having done" (Realities, Restraints, and Relationships); and (c) for action/"will be doing" (with opportunities for Repair and Reaffirmation). Conclusions: CCPS is an experiential approach that fosters autonomous, meaningful, and individually tailored learning opportunities. CCPS and the 9R model for reflective practice can be effectively applied to psychiatry and have the potential to contribute uniquely to the educational needs of its trainees and practitioners.

Advances in research on attachment-related psychotherapy processes: seven teaching points for trainees and supervisors

While the rich body of attachment theory and research has inspired many psychotherapists, trainees and less experienced clinicians interested in attachment-informed work can often feel unsure about what processes are attachment-related and how to attend to them during therapy. Recent advances in attachment-informed psychotherapy research offer some practical guidance. Studies published over the last five years show that patients and therapists of different attachment classifications communicate in distinct ways during therapy sessions. In particular, Talia and his colleagues have introduced the Patient Attachment Coding System and the Therapist Attunement Scales, two measures that accurately predict patients' and therapists' Adult Attachment Interview and Reflective Functioning score based on the occurrence of distinct communication markers during therapy sessions. This paper discusses the implications of these recent studies for psychotherapy training and presents seven teaching points for supervisors and for the next generation of clinicians.

Mapping evidence from systematic reviews regarding adult attachment and mental health difficulties: a scoping review

OBJECTIVE

The aim of this scoping review was to map evidence gathered through systematic reviews regarding adult attachment and mental health difficulties. This review highlights established, emerging, and inconsistent findings, suggesting areas for future research, and implications for theory and practice.

METHODS

A systematic search for meta-analyses and systematic reviews measuring adult attachment and concerning mental health difficulties was conducted. In total, 17 studies met the selection criteria.

RESULTS

Findings were presented according to four identified themes, (1) measurement of attachment; (2) measurement of mental health difficulty; (3) intrapersonal processes related to attachment and mental health difficulties; and (4) interpersonal processes related to attachment and mental health difficulties.

CONCLUSIONS

This review highlights the connection between attachment style and mental health difficulties, and suggests that relationships can facilitate both mental health and illheath. However, the mechanisms through which insecure attachment confers risk for mental health difficulties require further research.

The protective role of mentalizing: Reflective functioning as a mediator between child maltreatment, psychopathology and parental attitude in expecting parents

BACKGROUND

Childhood maltreatment impacts parenting and has intergenerational consequences. It is therefore crucial to identify clinically responsive resilience-promoting factors in pregnant women and expecting men with history of childhood maltreatment. Mentalization, or reflective functioning, appears as a promising concept to understand risk and resilience in the face of childhood maltreatment.

OBJECTIVE

This study evaluated the multivariate relationship between exposure to childhood maltreatment, reflective functioning, psychological symptoms and parental attitude in expecting parents.

METHODS

Two hundred and thirty-five pregnant women and 66 expecting fathers completed self-report assessment measures of childhood trauma, reflective functioning, depression, post-traumatic stress disorder, parental sense of competence and antenatal attachment. Twenty-eight percent (n = 85) of the community sample reported personal histories of childhood maltreatment.

RESULTS

Structural equation modeling indicated that reflective functioning (a) partially mediated the association between childhood maltreatment and psychological symptoms during pregnancy and (b) independently predicted participants' perception of parental competence and psychological investment toward the unborn child.

CONCLUSION

Overall, this study provides empirical evidence of the protective role of reflective functioning during the prenatal period in parents with histories of childhood maltreatment.

Influence of maternal reflective functioning on mothers' and children's weight: A follow-up study

Based on cross-sectional research linking poor reflective functionining (RF) to eating disorders, the current follow-up study tested whether maternal RF would explain the variance of mothers' and children's weight beyond the effects of maternal emotional dysregulation. During pregnancy (Time 1 [T1]), 51 women were administered the Difficulties in Emotion Regulation Scale (DERS) and interviewed using the Adult Attachment Interview (AAI). Seven months after delivery (Time 2 [T2]), mother-baby dyads who remained in the study (n = 44) were videotaped (Feeding Scale) during their feeding interaction. Last (Time 3 [T3]), the weight of the 34 children who were still in the study was collected at 3 years of age. Maternal AAI-RF at T1 did not correlate with the DERS at T1 nor with the quality of the feeding interacions at T2. However, it correlated, significantly, with maternal body mass index (BMI) at T1, r = -.298, P = .034, and marginally significantly with baby's BMI at T3, r = -.296, P = .089. Moreover, multiple regression models showed a trend indicating that maternal AAI-RF might explain the variance of mothers' and children's weight beyond the effects of maternal emotional dysregulation. These findings suggest that working on maternal mentalization might contribute to helping prevent childhood obesity from pregnancy.

Mentalization and Depression: Theoretical Concepts, Treatment Approaches and Empirical Studies - an Overview

Objectives: The aim of this article is to outline the relevance of mentalization for the understanding of the dynamics and the psychotherapeutic treatment of depression, and to systematically review the literature on mentalization as it relates to the diagnosis of depression and the evaluation of depression treatment. Methods: The first part of the article consists of an overview of the theory of mentalization and its relevance for depression and its treatment. For the second part, a literature research was conducted in Scopus and PubMed to retrieve and then manually select empirical studies on depression and mentalization, focusing on studies applying the Reflective Functioning Scale based on the Adult Attachment Interview. Results: For our review, 15 studies were selected. These suggest that severe chronic and/ or treatment resistant depression is related to more pronounced mentalizing deficits. With respect to psychotherapy process and outcome, mentalization is a specific focus of psychodynamic therapy approaches, and proves to be an important mediating and moderating variable. Conclusion: Mentalization with its linkages to attachment theory offers rich possibilities for an in-depth understanding of the dynamics of depression and resulting mentalization based approaches to the treatment of the disorder. The small number of studies and their heterogeneous design allow only preliminary assumptions on the difference between severe, chronic and milder or episodic courses of depression with respect to mentalizing deficits and urge for further research.

Treatment of anxiety and mood comorbidities in cognitive-behavioral and psychodynamic therapies for panic disorder

BACKGROUND

It is not known whether common anxiety/mood comorbidities of panic disorder (PD) improve with panic-focused psychological treatment, nor whether there is differential efficacy between therapies in treating comorbidities.

METHODS

In a randomized controlled trial for PD with and without agoraphobia comparing Cognitive-Behavioral Therapy (CBT) and Panic-Focused Psychodynamic Psychotherapy (PFPP), symptomatic comorbidities of agoraphobia, MDD, GAD, and social anxiety disorder (SAD) were assessed pre-to-post treatment with the Anxiety Disorders Interview Schedule (ADIS). Comparative efficacy of CBT versus PFPP for treating comorbid disorders was tested at termination and 1 year's follow-up. Covariance between panic and comorbidity improvements was also analyzed.

RESULTS

Most treatment completers (n = 120) evidenced diagnostic remission of their comorbidity (range = 54-69%), which typically reflected a subclinical score on the ADIS (mean range = 1.3 to 1.8). These improvements were generally retained at follow-up. However, patients with MDD dropped out significantly more often (HR = 2.79). No significant symptom change or remission differences emerged between CBT and PFPP for any comorbidity at termination or at follow-up. Panic change was strongly related to improvements in agoraphobia (r = 0.70) and MDD (r = 0.53), moderately related for GAD (r = 0.31), and not significantly related for SAD (r = 0.20).

DISCUSSION

Patients completing panic-focused psychotherapies often experience meaningful remission for diagnoses of agoraphobia, MDD, GAD, and SAD, with no detectable differences between treatments, although sample sizes for the MDD and SAD comparisons were small. In addition, additional efforts may be needed to keep MDD-comorbid patients in treatment.

Panic-Focused Reflective Functioning and Comorbid Borderline Traits as Predictors of Change in Quality of Object Relations in Panic Disorder Treatments

Objective

To investigate whether (a) baseline levels of panic-specific reflection function (PSRF; i.e. patients' capacity to reflect on their panic symptoms) and improvement in this capacity over treatment; (b) baseline borderline personality disorder (BPD) traits and pre-post treatment improvement in BPD traits predict change in patients' quality of object relations.

Method

A subsample of 102 patients diagnosed with panic disorder from a larger randomized controlled trial received either Cognitive-Behavioral Therapy or Panic-Focused Psychodynamic Psychotherapy. We investigated whether baseline levels and change in both PSRF and BPD traits (as measured by the SCID-II) predicted pre-post change in quality of object relations (QOR), while controlling for pre-post treatment change in panic symptoms assessed by the Panic Disorder Severity Scale.

Results

In both treatments, higher baseline levels of PSRF and lower levels of BPD traits, as well as pre-post decrease in BPD traits, predicted improvement in QOR when controlling for symptomatic change.

Conclusions

The findings suggest that reduction in comorbid BPD traits can facilitate improvement in patients' quality of object relations even in brief symptom-focused psychotherapies. Additionally, patients with higher baseline levels of symptom-focused reflective function and lower BPD traits are more likely to demonstrate interpersonal change over the course of psychotherapy for panic disorder. Finally, our study highlights the importance of examining therapeutic change beyond reduction in symptoms, particularly in domains of interpersonal functioning.

Maternal and Child Sexual Abuse History: An Intergenerational Exploration of Children's Adjustment and Maternal Trauma-Reflective Functioning

Objective: The aim of the current study was to investigate associations, unique and interactive, between mothers’ and children’s histories of childhood sexual abuse (CSA) and children’s psychiatric outcomes using an intergenerational perspective. Further, we were particularly interested in examining whether maternal reflective functioning about their own trauma (T-RF) was associated with a lower likelihood of children’s abuse exposure (among children of CSA-exposed mothers).

Methods: One hundred and eleven children (M_age = 9.53 years; 43 sexual abuse victims) and their mothers (M_age = 37.99; 63 sexual abuse victims) participated in this study. Mothers completed the Parent Development Interview (PDI), which yielded assessments of RF regarding their own experiences of abuse, and also reported on their children’s internalizing and externalizing symptoms.

Results: Children of CSA-exposed mothers were more likely to have experienced CSA. A key result was that among CSA-exposed mothers, higher maternal T-RF regarding their own abuse was associated with lower likelihood of child CSA-exposure. Mothers’ and children’s CSA histories predicted children’s internalizing and externalizing symptoms, such that CSA exposure for mother or child was associated with greater symptomatology in children.

Conclusion: The findings show that the presence of either maternal or child CSA is associated with more child psychological difficulties. Importantly in terms of identifying potential protective factors, maternal T-RF is associated with lower likelihood of CSA exposure in children of CSA-exposed mothers. We discuss these findings in the context of the need for treatments focusing on increasing T-RF in mothers and children in the context of abuse to facilitate adaptation and reduce the intergenerational risk.

Defensive patterns in reflective group supervisions at Child Health Centres

Reflective group supervision with infant healthcare workers has been described in several publications. It aims to enhance their ability to help distressed families, and to comprehend and relieve themselves of the distress that they encounter in such work. The ultimate aim has been formulated as an effort at increasing the professional's reflective function. The present article adds to the literature by applying an ego-psychological perspective on the group process and investigating defensive patterns in such supervisions. This approach includes a critical discussion of the place of the reflective function concept in psychoanalytic metapsychology. The article also suggests a Bionian perspective to account for skewed communicative patterns in groups, so-called basic assumptions. Some technical recommendations are provided on the frame in group supervision. They aim to disarm such defenses and facilitate the group participants' possibilities of understanding and thus helping their colleague's problematic relationship with the family. To illustrate the discussion, and to help readers form an image of the supervision process, brief detailed accounts of such work are submitted.

To know or not to know? Mentalization as protection from somatic complaints

Somatization processes are usually associated with a lack of insight or with emotional unawareness, especially in adolescents where the ability for self-reflection is beginning to mature. However, the extent to which different levels of insight explain variations in somatization remains understudied. This study aimed to evaluate whether high-level emotional awareness (comprehension) but not low-level awareness (only attention) is needed to psychologically cope with suffering, thus leading to lower somatization. Specific predictions were: 1) High attention along with High comprehension will be associated with significantly lower frequency of somatic complaints than other combinations (Low attention and Low comprehension, or High attention but Low comprehension); 2) In absence of comprehension, no attention will be more optimal than attention only, because only-attention might work as an amplificatory of suffering without the possibility of processing it. Self-reports of meta-cognitive processes, somatization, and control variables were obtained from 264 adolescents from a non-clinical population (54.5% female; aged 12-18, M = 14.7, SD = 1.7). In line with expectations, results revealed significant differences in the effects of insight positions on somatization: Attention+Comprehension (M = 4.9, SE = 0.9) < Nothing (M = 7.1, SE = 0.3) < Only attention (M = 8.9, SE = 0.7). Compared to Nothing, Attention+comprehension was associated with significantly reduced somatic complaints (B = -2.2, p = 0.03, 95% CI -4,1 to 0.2). However, Only attention was associated with increased somatic complaints compared to the other two conditions (B = 1.8, p = 0.03, 95% CI 0.2 to 3.4; B = 4, CI 95% 1.6-6.3, p = 0.001, respectively). This highlights the role of higher-order awareness (i.e., comprehension or clarity) in the processing of suffering and stresses its value in the adaptive coping of emotional distress.

Attachment and reflective functioning in children with somatic symptom disorders and disruptive behavior disorders

Our goal in conducting this study was to examine whether children with somatic symptom disorders (SSD) and disruptive behavior disorders (DBD) have higher rates of insecure or disorganized attachment and difficulties in mentalizing (operationalized as reflective functioning) as compared to a control group. Participants were 131 children (8-15 years) spanning two groups-a clinical group (n = 85), comprised of children fitting the criteria of our target diagnostic classifications (SSD: N = 45; DBD: N = 40), as well as a comparison group of healthy control children (n = 46). Children completed the Child Attachment Interview, which was later coded by reliable raters for attachment security and reflective functioning (RF). Consistent with our predictions, children in the clinical group had significantly lower RF and were significantly more likely to have insecure (over 80%) and disorganized attachment (over 40%) than children in the comparison group. In addition, RF was significantly lower in children with DBD than children with SSD. Furthermore, in the SSD group, children's RF regarding self was significantly lower than RF regarding others. Finally, consistent with prior studies, RF and attachment were associated. The findings indicate that school-aged children with SSD and DBD have higher rates of insecure and disorganized attachment. Consistent with theory, RF and attachment were loosely coupled, but RF alone differentiated among the diagnostic subgroups. Implications for treatment and prevention are discussed.

In a father's mind: paternal reflective functioning, sensitive parenting, and protection against socioeconomic risk

This study utilized attachment theory as a framework for understanding how fathers' reflective functioning (RF) and social emotional (SE) and autonomy (AU) supportive behaviors relate to children's emotion regulation (ER) beyond effects of mothers' RF. Moreover, the study explored how fathers' RF may be a protective factor against risks associated with low income. Fathers (n = 77) and their toddlers participated. Fathers' RF was coded from narrative accounts of parenting and mothers' RF was assessed by questionnaire. Fathers' SE and AU supportive behaviors were coded from observations of father-child interactions; toddlers' ER was assessed as distress on a challenging task. Results show that, after accounting for mothers' RF, fathers' RF was directly associated with SE supportive behaviors; RF moderated the association between income and AU supportive behaviors. Fathers' SE and AU supportive behaviors were associated with children's distress. Fathers' RF plays a central role in parenting and in children's ER.

Ideal and actual partner assessments in male batterers with different attachment styles

Research analyzing male batterers' views of what constitutes an ideal partner is scarce, and rejected features have not been tested. Analyzing the association of attraction and rejection patterns with attachment could help us understand how these men choose their female partners and the biases that make violence against these women more likely. The objective of this study was to analyze these patterns in male batterers with different attachment styles, considering both their ideal and actual partner assessments and the discrepancies between the two. Participants were 108 male offenders who were serving sentences in Colombian prisons for violence against women. In addition to identifying their attachment styles (secure, dismissive, preoccupied, and fearful), the study had participants assess their ideal and actual partners. The results showed significant differences in their actual partner assessments and in ideal-actual partner discrepancies, but not in their ideals. Secure attachment was related to the best partner assessments (higher scores in positive features and lower scores in negative ones), whereas the fearfully attached participants stood out for showing the worst assessments (higher scores in negative features and lower scores in positive ones). The findings provide evidence of the association of attachment styles with attraction and rejection patterns and offer suggestions for tailoring interventions.

A Temperament-Attachment-Mentalization-Based (TAM) Theory of Personality and Its Disorders

Theories of personality and its disorders need, from time to time, to be revised and updated according to new empirical and conceptual developments. Such development has taken place in the realms of affective neuroscience, evolution, and social cognition. In this article, we outline a new personality theory, which claims that phenomena we usually ascribe to the concept personality are best understood by postulating a web consisting of three major constituents: temperament (mainly primary emotions), attachment, and self-consciousness (mentalizing). We describe these constituents, their neurobiological underpinnings, the subjective experiences they evoke, and their behavioral implications. We discuss the relevance of the espoused theory in the field of personality disorders with references to borderline, narcissistic, and avoidant personality disorders as well as the DSM-5 alternative model. Implications for social psychology, psychotherapy, and common sense self-understanding are outlined. The theory aims to bridge previous contradictions between natural sciences and hermeneutics by its propositions of the evolution of self-consciousness.

Mentalization-Based Treatment for Personality Disorders: Efficacy, Effectiveness, and New Developments

PURPOSE OF THE REVIEW

This review aims to outline the most recent evidence on the efficacy and effectiveness of mentalization-based treatment (MBT) for personality disorders (PD) from 2015 to 2018 and to describe new treatment developments.

RECENT FINDINGS

Since 2015, 14 new-primarily effectiveness-MBT trials have been published. The main body of studies investigated adult populations (n = 11), patients with a borderline personality disorder (BPD) diagnosis (n = 8), and compared MBT with another psychotherapeutic treatment (n = 6). The majority of studies suggest that MBT has the potential to improve the clinical outcomes for adolescents and adults with a PD diagnosis, particularly BPD, and also with comorbid diagnoses and there are indications for changes in mentalizing being a specific mechanism of change promoted by MBT. Despite promising findings, there is an urgent need for methodological sound and sufficiently powered studies to investigate both the efficacy and effectiveness of MBT, especially beyond BPD.

Parental mentalizing as a key resource for difficult transitions

This commentary on Ruiz et al.'s study focuses on the relevance of parental mentalizing for child development within a transactional framework. This view takes into account what kind of challenges in the parent, in the infant, or in the interaction have effects on child development and if this mediated by parental mentalizing. Differences between maternal and paternal mentalizing seem unrelated to the general level of reflective functioning but strongly influenced by social roles of parents. However, more sophisticated measures of mentalizing are needed to better understand subtle problems with regard to a dimensional and multifaceted model of mentalizing as well as interactional processes. To master the transition to parenthood in challenging circumstances such as preterm birth, it would be especially valuable to know if one parent's lower mentalizing can be counterbalanced by higher mentalizing in the other parent.

The steamy mirror of adolescent gamblers: Mentalization, impulsivity, and time horizon

This study aimed to first investigate the role that general impairment in mentalization plays in gambling disorder and to analyze the interplay among mentalizing, impulsivity, and time perspective in adolescent gambling. Four hundred and ten late adolescents took part in the study. Participants were administered the South Oaks Gambling Screen Revised for Adolescents (SOGS-RA), the Reflective Functioning Questionnaire (RFQ-8), the Functional and Dysfunctional Impulsivity Scale (FDIS), and the 14-item Consideration of Future Consequences scale (CFC-14). The results showed that male adolescents are far more likely at-risk/problem gamblers than female adolescents. Furthermore, data indicated that the higher the gambling severity, the higher the dysfunctional impulsivity and the shorter the time horizon. Linear regression analysis showed that impairments in mentalizing represent a significant predictor of gambling severity. Finally, to clarify if dysfunctional impulsivity was on the path from uncertain mentalizing to gambling severity or if mentalizing was the mediator of the impact of functional impulsivity on gambling severity, data were submitted to path analysis. Results indicated that deficit in mentalizing has a direct effect on gambling severity and mediates the association between dysfunctional impulsivity and gambling involvement. The relation between gambling severity and RFQ-8 scores suggests that general impairment in mentalizing plays a key role in adolescent problematic gambling.

Mentalization as Mediator between Adult Attachment and Interpersonal Distress

BACKGROUND

The aim of this study was to investigate the mediating role of mentalization in the association between adult attachment and interpersonal problems.

METHODS

The sample consisted of 89 patients with different types of mental disorders who were at the beginning of treatment in one of two medical centers. Both mediational analysis and path analysis were used to test the model.

RESULTS

The proposed model revealed a good model fit. The data indicate that mentalization fully mediates the effect of attachment on interpersonal distress. Symptom severity proved to be a strong confounding variable that influenced all other variables and reduced existing effects.

CONCLUSION

We conclude that both mentalization and symptom distress are key components in the association of adult attachment and interpersonal problems. Therefore, we recommend research on integrative psychotherapy concepts rather than unilateral approaches.

Assessing mentalization in psychotherapy: first validation of the Mentalization Imbalances Scale

The aim of this study was to provide data on the preliminary validation of a clinician-report multidimensional assessment measure of mentalization (Mentalization Imbalances Scale, MIS). A random national sample of psychotherapists (N=190) completed the MIS to identify mentalization imbalances, and the Personality Disorder Checklist to assess the personality disorders (PDs) of randomly selected patients currently in their care. Factor analysis confirmed the presence of six factors that represented different imbalances of mentalization: cognitive, affective, automatic, external, imbalance toward others, and imbalance toward self. We found several significant relationships between patients' mentalization imbalances and personality pathology. Paranoid, schizoid, and schizotypal PDs were predicted by an imbalance toward self, an imbalance the patients shared with histrionic, avoidant, and obsessive compulsive PDs, whereas dependent, borderline, and histrionic PDs were related to an imbalance toward others. Cognitive imbalance was related to schizoid, narcissistic, and obsessive compulsive PDs, whereas affective imbalance predicted antisocial, borderline, narcissistic and histrionic PDs. Automatic imbalance was related to schizotypal, antisocial, and borderline PDs. MIS represents a reliable and valid measure that can help clinicians at understanding patients' specific difficulties of mentalization.

Reflective Functioning on the Parent Development Interview: validity and reliability in relation to socio-demographic factors

The Reflective Functioning coding of the Parent Development Interview (PDI-RF) is a widely used method for assessing a caregivers' capacity for mentalization. However, little is known about its psychometric properties.The aim of this study was to examine the distributions and discriminant and criterion validity of the PDI-RF scale in relation to a number of demographic and socioeconomic factors.Mothers of infants and toddlers (N = 323) from low, medium, and high-risk samples were interviewed with the PDI and transcripts were coded for RF. Demographic and socio-economic data were recorded.The PDI-RF scale showed high inter-rater reliability, internal consistency, and criterion validity. Modest associations with some sociodemographic variables and PDI-RF were found, but together these only accounted for a small amount of variance in the measure, suggesting adequate discriminant validity. Overall, the scale had good psychometric properties, although some caveats for its use were identified.

Beyond diagnosis: Mentalization and mental health from a transdiagnostic point of view in adolescents from non-clinical population

An increasing volume of evidence suggests that mentalization (MZ) can be an important factor in the transition from mental health to mental illness and vice versa. However, most studies are focused on the role of MZ in specific disorders. This study aims to evaluate the relationship between MZ and mental health as a trans-diagnostic process. A sample of 172 adolescents aged 12 to 18 years old (M = 14.6, SD = 1.7; 56.4% of girls) was assessed on measures of MZ, psychopathology and psychological functioning from a multimethod and multi-informant perspective. Contrary to predictions, MZ was not associated with general psychopathology and comorbidity, even when explored from a broad, trans-diagnostic perspective. However, we observed a robust association linking MZ to functioning and well-being across many dimensions, involving social, role and several psychological indicators of adjustment and mental health. These results suggest that MZ may contribute to mental health beyond symptoms, not so much associated with psychopathology, but rather resilience and well-being.

Using the validated Reflective Functioning Questionnaire to investigate mentalizing in individuals presenting with eating disorders with and without self-harm

BACKGROUND

The present study builds on previous research which explored the relationship between mentalizing and eating disorders (ED) in a subgroup of patients with comorbid self-harm (SH). Whereas previous literature had linked this comorbidity to impulse-control difficulties, more recent advances have suggested that a lack of a mentalizing stance might be responsible for a more treatment-resistant and severe symptomatology in this subgroup of clients.

METHODS

A cross-sectional, quasi-experimental, questionnaire-based, between-groups design was employed and a measure of mentalizing was compared in individuals presenting with ED only, individuals presenting with ED and concurrent SH and a control group.

RESULTS

Individuals with ED with concurrent SH reported significantly more mentalizing ability impairment than individuals without concurrent SH. In addition, both groups differed significantly from the control group. Opposite scoring patterns were identified in hypo- and hypermentalizing with the comorbid group reporting the lowest scores in hypermentalizing and the highest scores in hypomentalizing.

CONCLUSIONS

The current findings confirm that individuals with concurrent ED and SH report more severe impairments in mentalizing ability. Such impairments entail difficulties in symbolic capacity and abstract thinking and a concretisation of inner life, exemplified by a rigid, often inflexible focus on the physical world. The clinical implications that a lack of a mentalizing stance can have on individuals' ability to engage with the therapeutic process and to initiate change are reflected upon.

Do interpersonal fears mediate the association between childhood maltreatment and interpersonal skills deficits? A matched cross-sectional analysis

Objective: Childhood maltreatment, interpersonal fear and a specific kind of interpersonal skills deficit (preoperational thinking) have all been associated with persistent depressive disorder (PDD). We hypothesize that interpersonal fears mediate the association between childhood maltreatment and preoperational thinking.Method: A total of 108 matched participants have been examined cross-sectionally (31 healthy controls, 30 patients with episodic depression and 47 patients with PDD) with the following instruments: the Childhood Trauma Questionnaire (CTQ-SF), a measure of interpersonal fear (CBASP Interpersonal Questionnaire) and the Lübeck Questionnaire of Preoperational Thinking.Results: Patients with PDD reported significantly more childhood maltreatment than patients with episodic depression (d = 0.65) and healthy controls (d = 1.29). They also had more interpersonal fears (d = 0.71 and d = 2.11 respectively) and higher levels of preoperational thinking (d = 0.90 and d = 2.78 respectively). The association between childhood maltreatment and preoperational thinking was mediated through interpersonal fears.Conclusions: Our findings might have important implications for psychotherapy of PDD because they demonstrate how specific problems in social interactions can be associated with interpersonal fears that arise secondary to childhood maltreatment.

Intervention effects on reflectivity explain change in positive parenting in military families with young children

Military families with young children often experience stress related to the unique circumstances of military families (e.g., deployment), and there is a need for interventions that are specifically tailored to military families with young children. The Strong Military Families (SMF) intervention responds to this need, and consists of two versions: A Multifamily Group (N = 34), and a Homebased psychoeducational written material program (N = 42; treated as the comparison group in this report). The Multifamily Group utilized an attachment-based parenting education curriculum and in vivo support of separations and reunions, encouraged peer support among parents, and connected families to additional services. In the present nonrandomized trial, we examine intervention effects on observed parenting behavior and affect, and test whether changes in parenting reflectivity account for intervention-related changes in observed parenting. Observed parenting behavior and affect were coded from the Caregiver-Child Structured Interaction Procedure (Crowell & Fleischmann, 1993), and parenting reflectivity was coded from the Working Model of the Child Interview (Zeanah & Benoit, 1995). Results suggest that relative to Homebased participants, Multifamily Group participants showed pre- and post- improvements in aspects of positive parenting (Emotional Responsivity, Positive Affect), but no decreases in negative parenting. The efficacy of the SMF Multifamily Group intervention does not appear to depend on parent risk level or preintervention parent behavior and affect. Further, a mediation model demonstrated that the intervention effects on parents' observed positive affect in an interaction task with their child were partially accounted for by intervention-related changes in their parenting reflectivity. (PsycINFO Database Record

Improvements in mentalization predict improvements in interpersonal distress in patients with mental disorders

Objectives

Associations between interpersonal problems and mentalization have rarely been investigated. In this study, we explored patterns of interpersonal problems, mentalization, symptom severity, and attachment during inpatient treatment and at follow‐up. Additionally, we investigated whether mentalization predicts a decrease in interpersonal distress.

Method

 We analyzed time‐series data from patients with mental disorders. Data were collected at the beginning and at the end of inpatient treatment, and approximately 6 months after discharge from hospital.

Results

Patterns of correlations were stable from admission to the hospital until follow‐up. Treatment significantly increased the levels of mentalization and decreased the levels of interpersonal problems and symptom severity, whereas attachment was only partially targeted. Improvements in mentalization significantly predicted reduction in interpersonal distress at each point in time.

Conclusion

Results revealed characteristic patterns of interpersonal problems, mentalization, symptom severity, and attachment. Mentalization was found to play a key role in the reduction of interpersonal distress.

School-Aged Children With Higher Reflective Functioning Exhibit Lower Cardiovascular Reactivity

Despite extensive theorizing regarding the regulatory role of reflective functioning (RF), few studies have explored the links between RF and physiological indices of emotion regulation, and none have examined these associations in children. Further, while scholars contend that RF promotes resilience via enhanced ability to process emotional experiences, including those occurring in attachment relationships, this argument has seldom been tested empirically in children. In the current study, we explore the association between RF and physiological measures of emotion reactivity and regulation, as well as the interaction of RF and attachment insecurity. We test these associations by examining children's (N = 76; 8–12 years old) cardiovascular responses [respiratory sinus arrhythmia (RSA)] to a standardized paradigm designed to evoke reactions regarding the experience and expression of attachment-related needs. Children also completed a semi-structured attachment interview, which was later coded for children's attachment insecurity (operationalized as attachment dismissal and preoccupation) and RF. Our findings were largely consistent with theory and our hypotheses, suggesting that higher RF is associated with lesser cardiovascular reactivity (higher levels of RSA) during the stressor task and better recovery following the task. These links were especially strong for children with greater attachment preoccupation but did not vary as a function of children's levels of attachment dismissal. These findings contribute to developmental theory in suggesting that RF is closely linked to physiological emotion regulation in children.

An investigation of the mentalization-based model of borderline pathology in adolescents

OBJECTIVE

According to mentalization-based theory, transgenerational transmission of mentalization from caregiver to offspring is implicated in the pathogenesis of borderline personality disorder (BPD). Recent research has demonstrated an association between hypermentalizing (excessive, inaccurate mental state reasoning) and BPD, indicating the particular relevance of this form of mentalizing dysfunction to the transgenerational mentalization-based model. As yet, no study has empirically assessed a transgenerational mentalization-based model of BPD. The current study sought firstly to test the mentalization-based model, and additionally, to determine the form of mentalizing dysfunction in caregivers (e.g., hypo- or hypermentalizing) most relevant to a hypermentalizing model of BPD.

METHOD

Participants were a mixed sample of adolescents with BPD and a sample of non-clinical adolescents, and their respective primary caregivers (n = 102; 51 dyads). Using an ecologically valid measure of mentalization, mediational analyses were conducted to examine the relationships between caregiver mentalizing, adolescent mentalizing, and adolescent borderline features.

RESULTS

Findings demonstrated that adolescent mentalization mediated the effect of caregiver mentalization on adolescent borderline personality pathology. Furthermore, results indicated that hypomentalizing in caregivers was related to adolescent borderline personality pathology via an effect on adolescent hypermentalizing.

CONCLUSIONS

Results provide empirical support for the mentalization-based model of BPD, and suggest the indirect influence of caregiver mentalization on adolescent borderline psychopathology. Results further indicate the relevance of caregiver hypomentalizing to a hypermentalizing model of BPD.

Attachment comes of age: adolescents' narrative coherence and reflective functioning predict well-being in emerging adulthood

This study investigated the effects of adolescents' attachment security and reflective functioning (RF) (assessed by the adult attachment interview [AAI]) in the prediction of well-being in adulthood. Adolescents (N = 79; M = 14.6 years old; SD = 3.5 years) completed the AAI at Time 1 (T1), which was subsequently coded for inferred attachment experiences, narrative coherence, and RF by three nonoverlapping teams of raters. Participants completed the Psychological General Well-being Index at T1 and 8 years later (Time 2, T2). Analyses showed that (a) both adolescent narrative coherence and RF were significant predictors of almost all indices of well-being at T2 in adulthood; (b) both narrative coherence and RF indirectly linked inferred loving parental care and T2 well-being; (c) when included in the same model, RF was a significant indirect effect linking inferred loving parental care and T2 well-being. These findings contribute to theory in suggesting that both RF and narrative coherence are predictive of subsequent psychological well-being and operate as links between inferred parental care and subsequent adjustment. Possible mechanisms underlying these findings are discussed.

Mentalizing oneself: detecting reflective functioning in life narratives

Reflective functioning (RF) is defined as the ability to infer mental states of others and oneself. While RF has been predominantly studied in attachment research, it might also occur in other autobiographical narratives because of its strong connection to self-organization and self-understanding. Therefore, this study took a first step combining research on RF with developmental narrative research. In a longitudinal lifespan study covering up to three measurements across 8 years and six age groups (N = 172), we aimed to detect RF in entire life narratives to explore its development with age and its contribution to causal-motivational coherence of life narratives. Although scores were initially low, RF could be identified in life narratives, and was found to develop throughout adolescence and to predict life narrative coherence above and beyond age. Results confirm RF as significantly contributing to narrative self-organization, indicating promising new paths in research on autobiographical narratives and self.

Is reduction of symptoms in eating disorder patients after 1 year of treatment related to attachment security and mentalization?

In a sample of 38 eating disorder (ED) patients who received psychotherapeutic treatment, changes in attachment security, and mentalization in relation to symptoms reduction were investigated. Attachment security improved in 1 year but was unrelated to improvement of ED or comorbid symptoms. Mentalization did not change significantly in 1 year. Pretreatment mentalization was negatively related to the severity of ED symptoms, trait anxiety, psycho-neuroticism, and self-injurious behavior after 1 year of treatment. We conclude that for ED patients, improving mentalization might increase the effect of treatment on core and comorbid symptoms.