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Tironi M, Charpentier Mora S, Liotti M, Fiorini Bincoletto A, Tanzilli A, Cavanna D, Lingiardi V, Speranza AM, Giovanardi G, Bizzi F. Adverse childhood experiences and psychological maladjustment in adolescence: The protective role of epistemic trust, mentalized affectivity, and reflective functioning. J Clin Psychol 2024. [PMID: 39101491 DOI: 10.1002/jclp.23733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) are psychosocial factors acknowledged as significant contributors to health consequences later in adolescence, including psychological maladjustment. The research suggests that, at a transdiagnostic and transtheoretical level, working on restoring epistemic trust (ET), mentalized affectivity (MA), and reflective functioning (RF) in adolescents with ACEs assumes a central role in the therapeutic process. However, there are still few studies that attempted to investigate the specific role of these sociocognitive factors in the detrimental positive association between levels of experienced ACEs during childhood and psychological maladjustment in nonclinical adolescents. METHODS A community sample of 306 Italian cisgender adolescents (61.4% assigned females at birth; age range 13-19 years old; Mage = 16.1, SD = 1.64) self-reported ACEs (Childhood Trauma Questionnaire-Short Form), psychological maladjustment (Strengths and Difficulties Questionnaire), ET (Epistemic Trust, Mistrust and Credulity Questionnaire), MA (Brief-Mentalized Affectivity Scale for Adolescence), and RF (Reflective Functioning Questionnaire). A multiple mediation regression analysis has been performed to explore the association between ACEs and psychological maladjustment through the interaction with socio-cognitive factors. RESULTS ACEs are positive predictors of psychological maladjustment later in adolescence. Regardless of gender differences, epistemic mistrust and credulity, processing and expressing emotions, and uncertainty about mental states mediated this association, while epistemic trust, identifying emotions, and certainty about mental states did not configure as significant mediators. CONCLUSION Findings suggest that ET disruptions and deficits in RF are risk factors, while MA is a protective factor within the link between ACEs and psychological maladjustment in adolescence. These links help to specify the role of sociocognitive factors in the development of mental problems in adolescents who have been exposed to adverse experiences in childhood.
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Affiliation(s)
- Marta Tironi
- Department of Educational Sciences, University of Genoa, Genoa, Italy
| | | | - Marianna Liotti
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Annalisa Tanzilli
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Donatella Cavanna
- Department of Educational Sciences, University of Genoa, Genoa, Italy
| | - Vittorio Lingiardi
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Speranza
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Guido Giovanardi
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Fabiola Bizzi
- Department of Educational Sciences, University of Genoa, Genoa, Italy
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Yang L, Huang M. Childhood maltreatment and mentalizing capacity: A meta-analysis. CHILD ABUSE & NEGLECT 2024; 149:106623. [PMID: 38245975 DOI: 10.1016/j.chiabu.2023.106623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/02/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND The protective role of mentalizing capacity against the adverse effects of childhood maltreatment (CM) is acknowledged; however, empirical studies have yielded diverse conclusions regarding the relationship between childhood maltreatment and mentalizing capacity. OBJECTIVE This meta-analytic review aims to comprehensively summarize and quantify the association between childhood maltreatment and mentalizing capacity. PARTICIPANTS AND SETTING A total of 23 studies involving 3910 participants were included in the analysis. METHODS Systematic searches across eight bibliographic databases identified peer-reviewed publications describing empirical studies on the interplay between CM and mentalizing capacity. Effect sizes (r) were synthesized using random-effects models. A moderated effects analysis was conducted on five variables: participant gender, age group, mental health status, mentalizing capacity measurement, and childhood maltreatment measurement. RESULTS The findings showed a significant moderate negative correlation between childhood maltreatment and mentalizing capacity (r = -0.21, 95 % CI = [-0.26, -0.15]). This suggests that heightened severity of childhood maltreatment corresponds to lower mentalizing capacity. Moreover, the strength of this correlation was influenced by participant gender, age group, mental health status, mentalizing capacity measurement, and CM measurement. CONCLUSIONS The controversy surrounding the link between CM and mentalizing capacity gains clarity when considering significant moderating variables. The pooled effect provides a preliminary definition of the magnitude and direction of this correlation.
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Affiliation(s)
- Linhua Yang
- Department of Psychology, Institute of Education, China University of Geosciences, Wuhan, China
| | - Manxia Huang
- Department of Psychology, Institute of Education, China University of Geosciences, Wuhan, China.
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Arabadzhiev Z, Paunova R. Complexity of mentalization. Front Psychol 2024; 15:1353804. [PMID: 38487663 PMCID: PMC10937435 DOI: 10.3389/fpsyg.2024.1353804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/25/2024] [Indexed: 03/17/2024] Open
Abstract
The ability to understand other people’s emotions, thoughts, and behaviors is associated with an individual’s ability and his attitude in the context of relationships. The development of this process is associated with different psychosocial factors: parental competence, building a secure attachment and reduced risk of violence in the family as well as the future intrapersonal relationships and social reality of one person Mentalization is empirically associated with resolving psychological tasks in normative dilemmas and also, can influence on the outcome of personal and situational crises. And so forth, passing through the different stages of life and prevention of dysfunctional patterns in the family is facilitated. This text aims to investigate the main characteristics of mentalization, its connection with the etiopathogenesis of some main mental disorders, their course and prognosis. Several studies in recent years confirmed that these connections can enroll mentalization to prevention and psychological therapy in some mental disorders and dysfunctional thinking patterns. On the other hand, it serves as a basis for psychotherapeutic competence expressed in the ability to connect, differentiate, and separate, as the main interactional stages of the psychotherapeutic process.
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Affiliation(s)
- Zlatoslav Arabadzhiev
- Department of Psychiatry and Medical Psychology, Medical University of Plovdiv, Plovdiv, Bulgaria
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Ensink K, Deschênes M, Bégin M, Cimon L, Gosselin T, Wais M, Normandin L, Fonagy P. Dimensional model of adolescent personality pathology, reflective functioning, and emotional maltreatment. Front Psychiatry 2024; 14:1302137. [PMID: 38268556 PMCID: PMC10806145 DOI: 10.3389/fpsyt.2023.1302137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Childhood emotional abuse (CEA) is a recognized risk factor for adolescent mentalizing challenges. However, there's limited understanding about how CEA might influence personality development and elevate the risk of adolescent personality pathology. A deeper grasp of these pathways is crucial, given that adolescence is a pivotal developmental phase for identity integration, personality consolidation, and the emergence of personality disorders. As the emphasis shifts to dimensional perspectives on adolescent personality pathology, the spotlight is increasingly on adolescents' evolving personality organization (PO). Within this framework, personality disorder manifestations stem from inherent vulnerabilities in PO. A comprehensive understanding of how CEA leads to these inherent vulnerabilities in PO can inform enhanced interventions for at-risk adolescents. Nonetheless, our comprehension lacks insight into potential pathways to PO, especially those involving external factors like maltreatment and individual traits like mentalizing. This study sought to bridge these gaps by employing latent factor analysis and structural equation modeling to explore connections between emotional maltreatment, adolescent mentalizing, and PO. Methods A community-based cohort of 193 adolescents (aged 12-17) took part in self-report assessments: the Childhood Experience of Care and Abuse Questionnaire (CECA.Q), the Reflective Functioning Questionnaire for Youth (RFQ-Y), and the Inventory for Personality Organization for Adolescents (IPO-A). Results The structural equation model revealed a significant direct influence of CEA on both RFQ-Confusion and PO, and a noteworthy direct effect of RFQ-Confusion on PO. Remarkably, the model accounted for 76.9% of the PO variance. CEA exhibited a significant indirect impact on PO through RFQ-Confusion, which was accountable for 52.3% of the CEA effect on PO, signifying a partial mediation by mentalizing. Discussion These insights carry substantial clinical implications, especially for devising integrated, trauma-informed strategies for adolescents with personality pathologies. This is particularly relevant for enhancing mentalizing and bolstering personality consolidation among adolescent CEA survivors.
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Affiliation(s)
- Karin Ensink
- École de Psychologie, Université Laval, Québec, QC, Canada
| | | | - Michaël Bégin
- Département de Psychologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Laurie Cimon
- Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada
| | | | - Marissa Wais
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - Lina Normandin
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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Cossette-Côté F, Daigneault I, Lecomte T, Francoeur A, Brassard A. Explaining the Association Between Childhood Maltreatment and Psychological Adjustment in Youth in a Romantic Relationship. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:1119-1132. [PMID: 38045837 PMCID: PMC10689713 DOI: 10.1007/s40653-023-00562-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Flavie Cossette-Côté
- Psychology Department, Université de Montréal, 90 Vincent D’Indy Ave, Outremont, Montréal, QC H2V 2S9 Canada
| | - Isabelle Daigneault
- Psychology Department, Université de Montréal, 90 Vincent D’Indy Ave, Outremont, Montréal, QC H2V 2S9 Canada
| | - Tania Lecomte
- Psychology Department, Université de Montréal, 90 Vincent D’Indy Ave, Outremont, Montréal, QC H2V 2S9 Canada
| | - Audrey Francoeur
- Psychology Department, Université de Montréal, 90 Vincent D’Indy Ave, Outremont, Montréal, QC H2V 2S9 Canada
| | - Audrey Brassard
- Psychology Department, Université de Sherbrooke, 2500, boulevard de l’Université Sherbrooke, Sherbrooke, Québec J1K 2R1 Canada
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Meijer L, Franz MR, Deković M, van Ee E, Finkenauer C, Kleber RJ, van de Putte EM, Thomaes K. Towards a more comprehensive understanding of PTSD and parenting. Compr Psychiatry 2023; 127:152423. [PMID: 37722204 DOI: 10.1016/j.comppsych.2023.152423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The impact of post-traumatic stress disorder (PTSD) on parenting and the parent-child relationship has been well-documented in the scientific literature. However, some conceptual and methodological challenges within this research field remain. PROCEDURE We reflect on a number of challenges that we identified while examining the literature in preparation of an individual participant data meta-analysis on the relationships between PTSD and parenting. FINDINGS We address 1) the presence of 'trauma-islands'; 2) the need for transdiagnostic theoretical frameworks for mechanisms between PTSD and parenting; 3) the lack of developmental perspectives; 4) the overuse of self-reported retrospective measures; 5) the need to study more diverse samples and cultural contexts; and 6) the lack of research on resilience and post-traumatic growth in parenting. Based on these reflections, we offer suggestions on strategies for responding to these challenges through: 1) welcoming open science; 2) working towards shared theoretical frameworks; 3) doing more longitudinal research 4) expanding the methodological palette; 5) centering lived experience; and 6) taking systemic inequality into account. CONCLUSION With this commentary, we aim to open a discussion on next steps towards a more comprehensive understanding of the association between PTSD and parenting, and inspire collaborative research.
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Affiliation(s)
- Laurien Meijer
- Sinai Centrum Arkin Mental Health Care, Amstelveen, Laan van de Helende Meesters 2, 1186 AM Amstelveen, the Netherlands; Department of Interdisciplinary Social Science, Utrecht University, Padualaan 14, 3584 CH Utrecht, the Netherlands.
| | - Molly R Franz
- Department of Psychology, University of Maryland Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, United States
| | - Maja Deković
- Department of Clinical Child and Family Studies, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands
| | - Elisa van Ee
- Psychotraumacentrum Zuid Nederland, Den Bosch, Bethaniestraat 10, 5211 LJ 's Hertogenbosch, the Netherlands; Behavioural Science Institute, Radboud University, Thomas Van Aquinostraat 4, 6525 GD Nijmegen, the Netherlands
| | - Catrin Finkenauer
- Department of Interdisciplinary Social Science, Utrecht University, Padualaan 14, 3584 CH Utrecht, the Netherlands
| | - Rolf J Kleber
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands; ARQ National Psychotrauma Centre, Diemen, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands
| | - Elise M van de Putte
- Wilhelmina Children's Hospital / University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, the Netherlands
| | - Kathleen Thomaes
- Department of Psychiatry, Amsterdam University Medical Centre/VUmc, Laan van de Helende Meesters 2, 1186 AM Amstelveen, the Netherlands
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Milan S, Dau ALB. Childhood Maltreatment History and Borderline Personality Symptoms: The Role of Mentalization Difficulties Among Vulnerable Women. J Pers Disord 2023; 37:369-382. [PMID: 37721780 DOI: 10.1521/pedi.2023.37.4.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Mentalization difficulties may be one reason why individuals who experienced childhood maltreatment (CM) are at increased risk for borderline personality (BP) symptoms. The goal of this study was to identify specific aspects of mentalization associated with CM and determine their role in the short-term course of BP symptoms. A total of 253 mothers with a previous mental health diagnosis completed online surveys at three times over 9 months. A cross-lag panel model was tested to estimate reciprocal effects between mentalization measures and BP symptoms and indirect effects from CM to mentalization to BP symptoms. At baseline, women with more CM endorsed more difficulty with general mentalization, emotional clarity, and reflecting on childhood experiences. Lack of emotional clarity and disorganized responding about childhood served as indirect paths from CM to subsequent BP symptoms and showed bidirectional associations with BP symptoms over time. Thus, these may be particularly important treatment targets in this population.
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Affiliation(s)
- Stephanie Milan
- From Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut
| | - Ana Luisa Barbosa Dau
- From Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut
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Martin-Gagnon G, Normandin L, Fonagy P, Ensink K. Adolescent mentalizing and childhood emotional abuse: implications for depression, anxiety, and borderline personality disorder features. Front Psychol 2023; 14:1237735. [PMID: 37539005 PMCID: PMC10394633 DOI: 10.3389/fpsyg.2023.1237735] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/26/2023] [Indexed: 08/05/2023] Open
Abstract
Background There is preliminary evidence that childhood emotional abuse (CEA) is a risk factor for adolescent mentalizing difficulties (Uncertainty/Confusion about mental states) and borderline personality features and that Uncertainty/Confusion about mental states mediate the relationship between CEA and adolescent borderline personality features, but these findings need replication. Furthermore, no previous studies have examined the relationship between adolescent mentalizing deficits, anxiety, and depression in the context of CEA. Objectives This study examined the associations between CEA, adolescent borderline personality features, depression and anxiety symptoms and tested a pathway model where Uncertainty/Confusion about mental states mediates the relationships between CEA and adolescent borderline personality features, depression and anxiety symptoms. Method A clinical sample of 94 adolescents completed the Reflective Function Questionnaire for Youth (RFQY) to assess mentalizing, the Childhood Experiences of Care and Abuse Questionnaire (CECA-Q), the Borderline Personality Disorders Features Scale (BPFS-C), and the Beck Youth Inventories for Depression (BDI-Y) and Anxiety (BAI-Y). Results Uncertainty/Confusion about mental states partially mediated the relationship between CEA and borderline traits as well as anxiety. In addition, there was an indirect effect where CEA predicted Uncertainty/Confusion about mental states, which then predicted depression. Discussion The findings are consistent with the mentalizing model of psychopathology and provide new evidence that Uncertainty/Confusion about mental states might be a critical mentalizing deficit that characterizes the associations between CEA and adolescent BPD features and depression and anxiety symptoms. Uncertainty/Confusion may be a transdiagnostic risk factor for adolescent psychological distress and dysfunction. We discuss the clinical implications.
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Affiliation(s)
| | - Lina Normandin
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - Peter Fonagy
- Psychoanalysis Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Karin Ensink
- École de Psychologie, Université Laval, Québec, QC, Canada
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Garon-Bissonnette J, Dubois-Comtois K, St-Laurent D, Berthelot N. A deeper look at the association between childhood maltreatment and reflective functioning. Attach Hum Dev 2023; 25:368-389. [PMID: 37131288 DOI: 10.1080/14616734.2023.2207558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/23/2023] [Indexed: 05/04/2023]
Abstract
Childhood maltreatment is theorized as impeding the development of reflective functioning (RF; ability to perceive and interpret oneself and others in terms of mental states). However, previous research typically failed to support this association or yielded small sized and mixed associations. This study aims to provide a deeper look at the association between childhood maltreatment and RF by characterizing two non-mentalizing categories. One-hundred-and-sixteen pregnant women (mean age = 27.62, SD = 4.52) from the community (48.3% with a university degree, 96.5% in a relationship with the other parent) retrospectively reported on childhood abuse and neglect using the Childhood Trauma Questionnaire. They also participated in the Adult Attachment Interview subsequently coded using the Reflective Functioning Scale. Participants with poor to low RF were allocated to one of two groups (disavowal-distancing or distorted-inconsistent) using indicators provided in the RF Scale. No association was found between childhood maltreatment and overall RF when controlling for education level. A multinomial logistic regression revealed that childhood maltreatment was strongly predictive of a disrupted, over-analytical and inconsistent reflection about mental states but not of a tendency to discourse little about mental states. This tendency was rather only predicted by education level. Findings suggest that childhood maltreatment would lead to specific impairments in RF and that not considering how individuals fail to mentalize about attachment relationships may mask strong associations between RF and its determinants and correlates, including childhood maltreatment.
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Affiliation(s)
- Julia Garon-Bissonnette
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, CAN
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille (CEIDEF), Trois-Rivières, CAN
- CERVO Brain Research Center, Québec, CAN
- Interdisciplinary Research Center on Intimate Partner Relationship Problems and Sexual Abuse (CRIPCAS), Montréal, CAN
- Groupe de recherche et d'intervention auprès des enfants vulnérables et négligés (GRIN), Trois-Rivières, CAN
| | - Karine Dubois-Comtois
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, CAN
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille (CEIDEF), Trois-Rivières, CAN
- Groupe de recherche et d'intervention auprès des enfants vulnérables et négligés (GRIN), Trois-Rivières, CAN
- Centre de recherche, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, CAN
| | - Diane St-Laurent
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, CAN
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille (CEIDEF), Trois-Rivières, CAN
- Groupe de recherche et d'intervention auprès des enfants vulnérables et négligés (GRIN), Trois-Rivières, CAN
- Centre de recherche universitaire sur les jeunes et les familles (CRUJeF), Québec, CAN
| | - Nicolas Berthelot
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille (CEIDEF), Trois-Rivières, CAN
- CERVO Brain Research Center, Québec, CAN
- Interdisciplinary Research Center on Intimate Partner Relationship Problems and Sexual Abuse (CRIPCAS), Montréal, CAN
- Groupe de recherche et d'intervention auprès des enfants vulnérables et négligés (GRIN), Trois-Rivières, CAN
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, CAN
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Janse van Rensburg E, Woolard A, Hill NTM, Reid C, Milroy H, Ohan JL, Lin A, Chamberlain C. The effect of childhood maltreatment on adult survivors' parental reflective function, and attachment of their children: A systematic review. Dev Psychopathol 2023:1-15. [PMID: 37052290 DOI: 10.1017/s0954579423000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Parental reflective function (PRF) is a candidate mechanism in the transmission of intergenerational trauma. This systematic review examined (1) the association between parental history of childhood maltreatment and PRF, (2) how PRF relates to attachment in children of parent survivors, and (3) whether PRF moderates the association between parental maltreatment history and child attachment. METHODS Ten databases were searched (from inception to 10th November 2021). Inclusion criteria were primary study, quantitative, parent participants, measures of childhood maltreatment, and postnatal PRF. Exclusion criteria were qualitative, intervention follow-up, gray literature, or a review study. Risk of bias was assessed using recommended tools. Data were narratively synthesized. RESULTS One-thousand-and-two articles were retrieved, of which eleven met inclusion criteria (N = 974 participants). Four studies found a significant association between parental childhood maltreatment and disrupted PRF, six did not, one found mixed results. One study reported the association between childhood maltreatment and attachment (nonsignificant results). DISCUSSION There is no clear evidence PRF is routinely disrupted in parent survivors, though there is high heterogeneity in studies. Future research should standardize design to better understand whether PRF is a candidate mechanism in intergenerational trauma. OTHER PROSPERO CRD42020223594.
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Affiliation(s)
- Elmie Janse van Rensburg
- Embrace, Telethon Kids Institute, WA, Australia
- School of Psychological Science, The University of Western Australia, WA, Australia
- Youth Mental Health Team, Telethon Kids Institute, WA, Australia
| | - Alix Woolard
- Embrace, Telethon Kids Institute, WA, Australia
- Youth Mental Health Team, Telethon Kids Institute, WA, Australia
- Medical School, University of Western Australia, WA, Australia
| | - Nicole T M Hill
- Youth Mental Health Team, Telethon Kids Institute, WA, Australia
- Centre for Child Health Research, University of Western Australia, WA, Australia
| | - Carol Reid
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Helen Milroy
- Embrace, Telethon Kids Institute, WA, Australia
- Youth Mental Health Team, Telethon Kids Institute, WA, Australia
- Medical School, University of Western Australia, WA, Australia
| | - Jeneva L Ohan
- School of Psychological Science, The University of Western Australia, WA, Australia
| | - Ashleigh Lin
- Youth Mental Health Team, Telethon Kids Institute, WA, Australia
- Centre for Child Health Research, University of Western Australia, WA, Australia
| | - Catherine Chamberlain
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Ruiz-Parra E, Manzano-García G, Mediavilla R, Rodríguez-Vega B, Lahera G, Moreno-Pérez AI, Torres-Cantero AM, Rodado-Martínez J, Bilbao A, González-Torres MÁ. The Spanish version of the reflective functioning questionnaire: Validity data in the general population and individuals with personality disorders. PLoS One 2023; 18:e0274378. [PMID: 37023214 PMCID: PMC10079014 DOI: 10.1371/journal.pone.0274378] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/26/2022] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION Mentalization or reflective functioning (RF) is the capacity to interpret oneself or the others in terms of internal mental states. Its failures have been linked to several mental disorders and interventions improving RF have a therapeutic effect. Mentalizing capacity of the parents influences the children's attachment. The Reflective Functioning Questionnaire (RFQ-8) is a widely used tool for the assessment of RF. No instrument is available to assess general RF in Spanish-speaking samples. The aim of this study is to develop a Spanish version of the RFQ-8 and to evaluate its reliability and validity in the general population and in individuals with personality disorders. METHODS 602 non-clinical and 41 personality disordered participants completed a Spanish translation of the RFQ and a battery of self-reported questionnaires assessing several RF related constructs (alexithymia, perspective taking, identity diffusion and mindfulness), psychopathology (general and specific) and interpersonal problems. Temporal stability was tested in a non-clinical sub-sample of 113 participants. RESULTS Exploratory and confirmatory factor analyses suggested a one-factor structure in the Spanish version of the RFQ-8. RFQ-8 understood as a single scale was tested, with low scorings reflecting genuine mentalizing, and high scorings uncertainty. The questionnaire showed good internal consistence in both samples and moderate temporal stability in non-clinical sample. RFQ correlated significantly with identity diffusion, alexithymia, and general psychopathology in both samples; and with mindfulness, perspective taking, and interpersonal problems in clinical sample. Mean values of the scale were significantly higher in the clinical group. DISCUSSION This study provides evidence that the Spanish version of the RFQ-8, understood as a single scale, has an adequate reliability and validity assessing failures in reflective functioning (i.e., hypomentalization) in general population and personality disorders.
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Affiliation(s)
- Eduardo Ruiz-Parra
- Department of Neurosciences, Faculty of Medicine and Nursing, University of the Basque Country, Bilbao, Spain
- Department of Psychiatry, Basurto University Hospital, Osakidetza Basque Health Service, Bilbao, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | | | - Roberto Mediavilla
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
- Department of Psychiatry, School of Medicine, Autonomous University of Madrid (UAM), Madrid, Spain
- La Paz Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Beatriz Rodríguez-Vega
- Department of Psychiatry, School of Medicine, Autonomous University of Madrid (UAM), Madrid, Spain
- La Paz Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
- Department of Psychiatry, Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain
| | - Ana I. Moreno-Pérez
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
- Department of Psychiatry, Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain
| | - Alberto M. Torres-Cantero
- Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain
- Department of Preventive Medicine, Virgen de la Arrixaca University Clinical Hospital, El Palmar, Murcia, Spain
| | - Juan Rodado-Martínez
- Department of Psychiatry, School of Medicine, University of Murcia, Murcia, Spain
- Department of Psychiatry, Reina Sofía University Hospital, Murcia, Spain
| | - Amaia Bilbao
- Research Unit, Basurto University Hospital, Osakidetza Basque Health Service, Bilbao, Bizkaia, Spain
- Health Service Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
- Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | - Miguel Ángel González-Torres
- Department of Neurosciences, Faculty of Medicine and Nursing, University of the Basque Country, Bilbao, Spain
- Department of Psychiatry, Basurto University Hospital, Osakidetza Basque Health Service, Bilbao, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
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12
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Gori A, Topino E. Exploring and Deepening the Facets of Mentalizing: The Integration of Network and Factorial Analysis Approaches to Verify the Psychometric Properties of the Multidimensional Mentalizing Questionnaire (MMQ). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4744. [PMID: 36981653 PMCID: PMC10049311 DOI: 10.3390/ijerph20064744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Mentalization is a complex and multifaceted trans-theoretical and trans-diagnostic construct that has found increasing application in the clinical context. This research aimed at deepening the psychometric properties of the Multidimensional Mentalizing Questionnaire (MMQ), a 33-item theoretically based self-report questionnaire allowing for a comprehensive assessment of mentalizing, by integrating factor analysis and network analysis approaches. A sample of 1640 participants (Mage = 33 years; SD = 13.28) was involved in the research. The six-factor structure was confirmed for the MMQ, and both the total and the subdimensions demonstrated good reliability. The network analysis has further enriched these results, showing the central role of the items attributable to Emotional Dysregulation or Reflexivity in influencing the network as well as the contribution of aspects related to Relational Discomfort in managing the flow of communication flow. Such findings may have useful clinical implications and emphasize the usefulness of the MMQ in both research and clinical practice.
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Affiliation(s)
- Alessio Gori
- Department of Health Sciences, University of Florence, Via di San Salvi 12, Pad. 26, 50135 Florence, Italy
- Integrated Psychodynamic Psychotherapy Institute (IPPI), Via Ricasoli 32, 50122 Florence, Italy
| | - Eleonora Topino
- Department of Human Sciences, LUMSA University of Rome, Via della Traspontina 21, 00193 Rome, Italy
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13
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Current parental maltreatment and emerging adult psychopathology: indirect effects through family functioning across gender. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04443-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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14
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Moser DA, Graf S, Glaus J, Urben S, Jouabli S, Pointet Perrizolo V, Suardi F, Robinson J, Rusconi Serpa S, Plessen KJ, Schechter DS. On the complex and dimensional relationship of maternal posttraumatic stress disorder during early childhood and child outcomes at school-age. Eur Psychiatry 2023; 66:e20. [PMID: 36734250 PMCID: PMC9970153 DOI: 10.1192/j.eurpsy.2023.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Several studies have shown associations between maternal interpersonal violence-related posttraumatic stress disorder (PTSD), child mental health problems, and impaired socioemotional development. However, the existing literature lacks evidence linking constellations of risk factors such as maternal interpersonal-violence-related PTSD, psychopathology, and interactive behavior with toddlers and outcome measures at school-age. METHODS This study involved a prospective, longitudinal investigation of 62 mothers and examined the relationship between maternal variables measured when children were in early childhood (mean age 27 months), and child outcomes when children were school-age (age mean = 83.2 months) while retaining a focus on the context of maternal PTSD. To identify and weigh associated dimensions comparatively, we employed sparse canonical correlation analysis (sCCA) aimed at associating dimensions of a dataset of 20 maternal variables in early childhood with that of more than 20 child outcome variables (i.e., child psychopathology, life-events, and socioemotional skills) at school-age. RESULTS Phase 1 variables with the highest weights were those of maternal psychopathology: PTSD, depressive and dissociative symptoms, and self-report of parental stress. The highest weighted Phase 2 child outcome measures were those of child psychopathology: PTSD, anxiety, and depressive symptoms as well as peer bullying and victimization. CONCLUSIONS sCCA revealed that trauma-related concepts in mothers were significantly and reliably associated with child psychopathology and other indicators of risk for intergenerational transmission of violence and victimization. The results highlight the dimensional and multifaceted nature-both for mothers as well as children-of the intergenerational transmission of violence and associated psychopathology.
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Affiliation(s)
- Dominik Andreas Moser
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland.,Institute of Psychology, University of Bern, Bern, Switzerland
| | - Shannen Graf
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Jennifer Glaus
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Sébastien Urben
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Sondes Jouabli
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Francesca Suardi
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - JoAnn Robinson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Sandra Rusconi Serpa
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Kerstin Jessica Plessen
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Daniel Scott Schechter
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York, USA
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15
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Dehghan Manshadi Z, Fallah A, Chavoshi H. Childhood maltreatment and sense of parenting competence: The mediating role of parental reflective functioning and perceived social support. CHILD ABUSE & NEGLECT 2023; 135:105949. [PMID: 36434980 DOI: 10.1016/j.chiabu.2022.105949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/02/2022] [Accepted: 11/06/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Childhood maltreatment has a negative impact on a sense of parenting competition. However, its underlying mechanisms are still unknown. The present research aimed to investigate the roles of parental reflective functioning and social support as mediating factors in the relationship between childhood maltreatment and negative feeling of parenting competence. METHODS A cross-sectional study was carried out on 489 parents of children aged 5 to 13 between October 23 and December 12, 2021, in Shiraz, Iran. Participants completed the Childhood Trauma Questionnaire (CTQ), Parenting Sense of Competence Scale (PSOC), Perceived Social Support Scale (PSSS), and Parental Reflective Functioning Questionnaire (PRFQ). Structural equation modeling (SEM) was applied using AMOS 22 to test our conceptual model. RESULTS The results of structural equation modeling indicated that childhood maltreatment had a negative direct effect on the sense of parenting competence. Furthermore, childhood maltreatment had a negative indirect effect on the sense of parenting competence through both parental reflective functioning and perceived social support. CONCLUSIONS The findings suggested that increased exposure to childhood maltreatment may have decreased parental competence. However, the important role of parental reflective functioning and perceived social support in the relationship between childhood maltreatment and parenting competence should not be ignored. These results can have some implications for counselors working with parents with childhood trauma experiences.
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Affiliation(s)
| | - Arezoo Fallah
- Department of Clinical Family Psychology, Family Research Institute, Shahid Beheshti University, Tehran, Iran
| | - Haniyeh Chavoshi
- Department of Clinical Psychology, Shiraz University, Shiraz, Iran
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16
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d'Huart D, Hutsebaut J, Seker S, Schmid M, Schmeck K, Bürgin D, Boonmann C. Personality functioning and the pathogenic effect of childhood maltreatment in a high-risk sample. Child Adolesc Psychiatry Ment Health 2022; 16:95. [PMID: 36451183 PMCID: PMC9710065 DOI: 10.1186/s13034-022-00527-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND While the psychopathological sequalae of childhood maltreatment are widely acknowledged, less is known about the underlying pathways by which childhood maltreatment might lead to an increased risk for mental health problems. Recent studies indicated that impaired personality functioning might mediate this relationship. The aim of the present paper was to extend the current literature by investigating the mediating effect of impaired personality functioning between different types of childhood maltreatment and self-reported mental health problems in a high-risk sample. METHODS Overall, 173 young adults (mean age = of 26.61 years; SD = 3.27) with a history of residential child welfare and juvenile justice placements in Switzerland were included in the current study. The Childhood Trauma Questionnaire (CTQ-SF), Semi-structured Interview for Personality Functioning DSM-5 (STiP-5.1) and the self-report questionnaires of the Achenbach System of Empirically Based Assessment scales (ASEBA) were used. Mediation analyses were conducted through structural equation modeling. RESULTS Overall, 76.3% (N = 132) participants indicated at least one type of childhood maltreatment, with emotional neglect being most commonly reported (60.7%). A total of 30.6% (N = 53) participants self-reported mental health problems. Emotional abuse (r = 0.34; p < .001) and neglect (r = 0.28; p < .001) were found to be most strongly associated with mental health problems. In addition, impaired personality functioning was fond to be a significant mediator for overall childhood maltreatment (β = 0.089; p = 0.008) and emotional neglect (β = 0.077; p = 0.016). Finally, impaired self-functioning was found to be a significant mediator when both self-functioning and interpersonal functioning were included as potential mediators in the relationship between overall childhood maltreatment (β1 = 0.177, p1 = 0.007) and emotional neglect (β1 = 0.173, p1 = 0.003). CONCLUSION Emotional neglect may be particularly important in the context of childhood maltreatment, personality functioning, and mental health problems and, therefore, should not be overlooked next to the more "obvious" forms of childhood maltreatment. Combining interventions designed for personality functioning with trauma-informed practices in standard mental health services might counteract the psychopathological outcomes of maltreated children and adolescents.
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Affiliation(s)
- Delfine d'Huart
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland.
| | - Joost Hutsebaut
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Viersprong Institute for Studies on Personality Disorders, De Viersprong, Halsteren, The Netherlands
| | - Süheyla Seker
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - Marc Schmid
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - David Bürgin
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
- Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Cyril Boonmann
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
- LUMC Curium - Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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17
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Rosso AM. Psychoanalytic Interventions with Abusive Parents: An Opportunity for Children's Mental Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13015. [PMID: 36293590 PMCID: PMC9602324 DOI: 10.3390/ijerph192013015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Research has extensively shown that most people who experience maltreatment in their childhood develop mental disorders, psychosocial adjustment problems, and, in many cases, become maltreating adults themselves. Preventing child maltreatment and treating abused children and abusive parents are, therefore, pressing public health issues. As established by the UK Children Act in 1989, child development is enhanced by remaining in the family whenever the child's safety is assured. Thus, developing prevention and intervention programs for the purpose of repairing, whenever possible, the child-parent relationship should be a social priority. This narrative review focuses on the psychoanalytic studies related to intrapsychic dynamics and therapeutic intervention for physically abusive parents. The role of the transgenerational transmission of abuse and parents' narcissistic fragility is crucial. Psychoanalytic interventions focus on helping the parent work through their past painful experiences and narcissistic vulnerability. Parent-child psychotherapy and mentalization-based treatment have been found to be prevalent, while there is scarce literature regarding intensive individual psychoanalytic treatment. Within the framework of attachment theory, brief interventions were developed; however, they did not prove effective for those parents who suffered experiences of maltreatment or severe neglect in childhood and for whom long-term parent-child psychotherapy resulted, which proved to be the most effective.
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Affiliation(s)
- Anna Maria Rosso
- Department of Education, University of Genoa, 16128 Genoa, Italy
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18
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Doba K, Saloppé X, Choukri F, Nandrino JL. Childhood trauma and posttraumatic stress symptoms in adolescents and young adults: The mediating role of mentalizing and emotion regulation strategies. CHILD ABUSE & NEGLECT 2022; 132:105815. [PMID: 35914329 DOI: 10.1016/j.chiabu.2022.105815] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/13/2022] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Childhood trauma (physical, emotional, sexual abuse and/or physical and emotional neglect) represents a specific risk for developmental perturbations and long-term negative outcomes. Adolescents and young adults with childhood trauma have rarely experienced a single type of traumatic event but rather multiple traumatic experiences. However, studies on adolescent PTSD are sparse. This study examines the possible mediating role of mentalizing, cognitive and interpersonal emotion regulation strategies between multiple types of childhood trauma exposure and PTSD in adolescents and young adults. METHODS The sample consisted of 456 adolescents and young adults aged 15 and 25, recruited from four high schools and one university. Participants completed self-report questionnaires assessing childhood trauma, mentalizing, cognitive and interpersonal strategies of emotion regulation and PTSD. RESULTS Structural Equation Modeling revealed that multiple types of childhood trauma exposure have a significant indirect effect on PTSD symptoms through its association with hypomentalizing and maladaptive cognitive strategies of emotion regulation (i.e. self-blame, rumination, catastrophizing). Results also showed a significant indirect effect between multiple types of childhood trauma exposure and PTSD symptoms through its association with hypomentalizing and maladaptive interpersonal strategies of emotion regulation (i.e. emotional reactivity and tendency to avoid emotional connection). Indirect paths were also run in reverse to control for the direction of the effect. CONCLUSION Our findings show that exposure to multiple types of childhood trauma contributes to severe PTSD through several complex pathways including both hypomentalizing and maladaptive emotion regulation strategies in adolescence and young adulthood.
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Affiliation(s)
- Karyn Doba
- University of Lille, CNRS, UMR 9193-SCALab, Sciences Cognitives et Sciences Affectives, F-59000 Lille, France; Fondation Santé des Etudiants de France, Clinique FSEF Villeneuve d'Ascq, 59653 Villeneuve d'Ascq, France.
| | - Xavier Saloppé
- University of Lille, CNRS, UMR 9193-SCALab, Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
| | - Fatima Choukri
- University of Lille, CNRS, UMR 9193-SCALab, Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
| | - Jean-Louis Nandrino
- University of Lille, CNRS, UMR 9193-SCALab, Sciences Cognitives et Sciences Affectives, F-59000 Lille, France; Fondation Santé des Etudiants de France, Clinique FSEF Villeneuve d'Ascq, 59653 Villeneuve d'Ascq, France
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19
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Conceptualisation and Measurement of Reflective Process in Psychotherapy: A Systematic Scoping Review. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09568-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AbstractPsychological therapies use talk as a means to produce change for individuals who are experiencing distress. Despite a significant body of research comparing approaches, there is little evidence for the superiority of one model over another. The process of reflection has been suggested as a common factor across modalities, and research aiming to measure this phenomenon is emerging. This scoping review is focussed on the conceptualisations, measurement and process outcomes of reflective talk as it occurs during therapy. Twenty-two studies were selected from a total of 3712 papers identified following a systematic search of SCOPUS, MEDLINE, PsychINFO and Web of Science databases. A variety of descriptors emerged: intrapersonal constructs such as mentalization and metacognition tended to view reflectivity as an individually acquired skill or trait, where other descriptors adopted an interpersonal understanding of reflection as co-constructed through dialogue. Our findings suggest a shift from individual to intersubjective understandings of reflecting processes in therapy may be a valuable area for future research.
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20
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Cruz D, Lichten M, Berg K, George P. Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment. Front Psychiatry 2022; 13:800687. [PMID: 35935425 PMCID: PMC9352895 DOI: 10.3389/fpsyt.2022.800687] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Children exposed to adverse childhood experiences (ACEs) and pervasive interpersonal traumas may go on to develop PTSD and, in most cases, will further undergo a significant shift in their developmental trajectory. This paper examines contemporary research on Developmental Trauma (DT), which is inextricably linked to disruptions in social cognition, physiological and behavioral regulation, and parent-child attachments. Developmental trauma associated with early experiences of abuse or neglect leads to multi-faceted and longstanding consequences and underscores critical periods of development, complex stress-mediated adaptations, and multilevel, trans-theoretical influences in the diagnostic formulation and treatment of traumatized children, adolescents, and adults. Psychological and medical correlates of Developmental Trauma Disorder are considered, and directions for future research are discussed.
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Affiliation(s)
- Daniel Cruz
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
| | | | - Kevin Berg
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
| | - Preethi George
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
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21
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Rosso AM. When Parents Fail to Mind the Child: Lower Mentalizing in Parents Who Maltreat Their Children. Front Psychol 2022; 13:853343. [PMID: 35903725 PMCID: PMC9317950 DOI: 10.3389/fpsyg.2022.853343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Mentalization is considered an essential ability for social cognition as well as a crucial competency in parenting to further the development of internal structures that are decisive for self organization and affect regulation in children. Yet, few empirical studies have investigated whether, and to what extent, parents who maltreat their children poorly mentalize. The aim of this research was to study the mentalization ability in a group of parents who maltreated their children and had been referred by the Courts for Child Custody and Parenting Plan Evaluation (Group 1), and in a comparison, non-clinical group of parents (Group 2). Adult Attachment Interview (AAI), rated in terms of both the Berkeley AAI System and the Reflective Functioning Scale was administered. Group 1 had severely impaired reflective functioning (RF) in 83.3% of cases, whilst impaired RF was found in only 12.5% of Group 2 parents. For the most part, parents in Group 1 showed Negative Reflective Functioning, systematically resisting taking a reflective stance, and the parents who most severely maltreated their children showed distorted and/or self-serving passages associated with a particular type of dismissing pattern of attachment (DS2) based on the derogation of attachment. The frequent occurrence of derogation in these parents likely explains how much the devaluation of relationships and attachment needs, presumably acquired during childhood with defensive purposes and in order to exclude the pain and perception of emotional weakness from awareness, hinders the capacity to care for children in the full respect of their needs.
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22
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The structure and correlates of the 20-item Maternal-Fetal Attachment Scale in a population-based sample of Hungarian expectant women. Midwifery 2022; 112:103422. [DOI: 10.1016/j.midw.2022.103422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022]
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Garon-Bissonnette J, Duguay G, Lemieux R, Dubois-Comtois K, Berthelot N. Maternal childhood abuse and neglect predicts offspring development in early childhood: The roles of reflective functioning and child sex. CHILD ABUSE & NEGLECT 2022; 128:105030. [PMID: 33752901 DOI: 10.1016/j.chiabu.2021.105030] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/01/2021] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Recent evidence suggests that offspring of mothers having been exposed to childhood abuse and neglect (CA&N) are at increased risk of developmental problems and that boys are more affected by maternal CA&N than girls. Since impairments in reflective functioning (RF) have been associated with maternal CA&N and offspring development, RF could represent a key mechanism in these intergenerational risk trajectories. OBJECTIVE This study evaluated mediating (RF) and moderating (child sex) mechanisms in the association between maternal CA&N and child development. PARTICIPANTS AND SETTING In a longitudinal setting, 111 mothers completed measures during pregnancy and between 11 and 36 months postpartum. METHODS CA&N and impairments in RF were assessed during pregnancy and offspring development was measured during the longitudinal follow-up using the Ages and Stages Questionnaires (ASQ-3). Child development was operationalized in two ways: using the global score at the ASQ-3 and using a dichotomous score of accumulation of delays across domains of development. RESULTS Structural equation modeling indicated that RF mediated the association between maternal CA&N and offspring development. Child sex moderated the association between CA&N and the clustering of developmental problems (Wald = 5.88, p = 0.02), with boys being particularly likely to accumulate developmental delays when their mother experienced CA&N (RR = 2.62). Accumulation of developmental problems was associated with impairments in maternal RF in girls and with maternal exposure to CA&N in boys. CONCLUSIONS Results provide novel insights on the role of mentalization and child sex in the association between maternal CA&N and child development.
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Affiliation(s)
- Julia Garon-Bissonnette
- Department of Psychology, Université du Québec à Trois-Rivières, Canada; Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Canada; Groupe de recherche et d'intervention auprès des enfants vulnérables et négligés, Canada; Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Canada
| | - Gabrielle Duguay
- Department of Psychology, Université du Québec à Trois-Rivières, Canada; Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Canada; Groupe de recherche et d'intervention auprès des enfants vulnérables et négligés, Canada
| | - Roxanne Lemieux
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Canada; Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Canada; Groupe de recherche et d'intervention auprès des enfants vulnérables et négligés, Canada; Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Canada
| | - Karine Dubois-Comtois
- Department of Psychology, Université du Québec à Trois-Rivières, Canada; Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Canada; Groupe de recherche et d'intervention auprès des enfants vulnérables et négligés, Canada
| | - Nicolas Berthelot
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Canada; Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Canada; Groupe de recherche et d'intervention auprès des enfants vulnérables et négligés, Canada; Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Canada.
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24
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Berthelot N, Savard C, Lemieux R, Garon-Bissonnette J, Ensink K, Godbout N. Development and validation of a self-report measure assessing failures in the mentalization of trauma and adverse relationships. CHILD ABUSE & NEGLECT 2022; 128:105017. [PMID: 33692012 DOI: 10.1016/j.chiabu.2021.105017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/31/2021] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The way people process trauma and adverse relationships may be more predictive of subsequent adaptation than trauma exposure in itself. However, there is currently no self-report instrument assessing failures in the mentalization of trauma and adverse relationships. OBJECTIVE We developed the Failure to Mentalize Trauma Questionnaire (FMTQ) and evaluated its psychometric properties. The FMTQ is a 29-item self-report instrument designed to assess different indications of failures in the mentalization of trauma and adverse relationships. PARTICIPANTS AND SETTING A total of 975 participants (84 % women; 37 % exposed to child maltreatment) were recruited in the course of larger research protocols on parenting. METHODS Participants completed the FMTQ and measures of childhood maltreatment, psychopathology (post-traumatic stress symptoms, dissociative symptoms, level of personality dysfunction), general mentalization and intimate partner violence. RESULTS Exploratory factor analysis, supported by a confirmatory factor analysis, identified seven factors with good internal consistency that corresponded to different types of failures in the mentalization of trauma and adverse relationships and that loaded on a general factor. A dose-effect association was observed between the severity of childhood maltreatment, and the severity of failures in the mentalization of trauma and adverse relationships (rs = .49, p < .01). The FMTQ total score explained a significant proportion of variance in psychopathology and intimate partner violence, both in participants with histories of childhood maltreatment and participants without childhood maltreatment. CONCLUSION The FMTQ is a promising, concise and efficient measure of failures in the mentalization of trauma and adverse relationships that may facilitate clinical screening and research with adults who experienced trauma.
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Affiliation(s)
- Nicolas Berthelot
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Canada; Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Canada; CERVO Brain Research Center, Canada; Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Canada; Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Canada.
| | - Claudia Savard
- Department of Educational Fundamentals and Practices, Université Laval, Canada; CERVO Brain Research Center, Canada; Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Canada
| | - Roxanne Lemieux
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Canada; Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Canada; Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Canada
| | - Julia Garon-Bissonnette
- Department of Psychology, Université du Québec à Trois-Rivières, Canada; Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Canada; CERVO Brain Research Center, Canada; Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Canada; Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Canada
| | - Karin Ensink
- Department of Psychology, Université Laval, Canada
| | - Natacha Godbout
- Department of Sexology, Université du Québec à Montréal, Canada; Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Canada
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Zhao Y, Han L, Teopiz KM, McIntyre RS, Ma R, Cao B. The psychological factors mediating/moderating the association between childhood adversity and depression: A systematic review. Neurosci Biobehav Rev 2022; 137:104663. [PMID: 35429512 DOI: 10.1016/j.neubiorev.2022.104663] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 10/18/2022]
Abstract
Accumulating evidence suggests that individuals with a history of childhood adversity are at greater risk for developing depression. Potential psychological mechanisms have not been well-established. Our study aims to identify psychological variables consistently mediating/moderating the link between childhood adversity to depression. We systematically searched articles from 1990 to October 2021 on online databases including PubMed, Web of Science and PsycINFO. Studies that examined a mediating/moderating role of psychological variables between childhood adversities and depression were included. Totally, 33 records were included. The review identified maladaptive schema, negative automatic thoughts, and avoidance as mediators of the relationship between childhood adversity and depression. Additionally, resilience was identified as both a mediator and moderator of the association between childhood adversity and depression. In general, cognitive dysfunction, avoidance behaviors and impaired resilience may be a by-product of childhood adversity and may contribute to increased risk for depression. Interventions that target at challenging negative cognition and improving resilience may be effective to prevent or treat depression in individuals with a history of childhood adversity.
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Affiliation(s)
- Yuxiao Zhao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing 400715, PR China
| | - Lin Han
- The First Affiliated Hospital of Xi'an Medical University, Xi'an, PR China
| | - Kayla M Teopiz
- Mood Disorders Psychopharmacology Unit, University of Toronto, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University of Toronto, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, Canada
| | - Ruining Ma
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing 400715, PR China
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing 400715, PR China; National Demonstration Center for Experimental Psychology Education, Southwest University, Chongqing 400715, PR China.
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26
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Wang X, Ding F, Cheng C, He J, Wang X, Yao S. Psychometric Properties and Measurement Invariance of the Childhood Trauma Questionnaire (Short Form) Across Genders, Time Points and Presence of Major Depressive Disorder Among Chinese Adolescents. Front Psychol 2022; 13:816051. [PMID: 35478747 PMCID: PMC9036057 DOI: 10.3389/fpsyg.2022.816051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/15/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose The Childhood Trauma Questionnaire-Short Form (CTQ-SF) is a widely used self-report tool designed to assess juveniles' experiences of abuse and neglect. The current study examined the psychometric properties, particularly measurement invariance of the CTQ-SF in Chinese non-clinical adolescents and adolescents with major depressive disorder (MDD). Methods Participants included 1,507 high school students (non-clinical sample) from Hunan Province and 281 adolescent patients with major depressive disorder (MDD sample) from The Second Xiangya Hospital. We examined the reliability and validity of CTQ-SF, confirm the five-factor model of the CTQ-SF. Multiple-group confirmatory factor analysis (CFA) was used to examine the measurement invariance across genders, presence of depression, and over time. Results The CTQ-SF had good internal consistency in a non-clinical sample (Cronbach's α = 0.85) and MDD sample (Cronbach's α = 0.86). Good test-retest reliability (ICC = 0.72) and Adequate validity were also observed. Good fit of the five-factor CTQ-SF model was confirmed in both samples. Multiple-group CFA confirmed that the CTQ-SF had the scalar invariance across genders and the presence of MDD, as well as over time. Conclusion The CTQ-SF is an effective and reliable tool for assessing child maltreatment in Chinese adolescents (non-clinical sample and MDD sample). The results suggest that the horizontal and longitudinal invariance of CTQ-SF are strongly established, which means CTQ-SF can be meaningfully used to compare outcomes among Chinese adolescents (non-clinical sample and MDD sample). The experience of child maltreatment, especially neglect (emotional and physical), was found to be common in Chinese adolescents.
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Affiliation(s)
- Xin Wang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
- Medical Psychological Institute, Central South University, Changsha, China
- China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, China
| | - Fengjiao Ding
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
- Medical Psychological Institute, Central South University, Changsha, China
- China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, China
| | - Chang Cheng
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
- Medical Psychological Institute, Central South University, Changsha, China
- China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, China
| | - Jiayue He
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
- Medical Psychological Institute, Central South University, Changsha, China
- China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, China
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
- Medical Psychological Institute, Central South University, Changsha, China
- China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, China
| | - Shuqiao Yao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
- Medical Psychological Institute, Central South University, Changsha, China
- China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, China
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27
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Dollberg DG, Hanetz-Gamliel K. Mediation-Moderation Links Between Mothers' ACEs, Mothers' and Children's Psychopathology Symptoms, and Maternal Mentalization During COVID-19. Front Psychiatry 2022; 13:837423. [PMID: 35370808 PMCID: PMC8968198 DOI: 10.3389/fpsyt.2022.837423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/21/2022] [Indexed: 11/21/2022] Open
Abstract
Research has suggested adverse childhood experiences (ACEs) as a transdiagnostic risk factor for a variety of affective disorders. They are also linked with a parent's tendency toward affect dysregulation and hyperarousal, which may interfere with parenting and children's wellbeing. On the other hand, maternal mentalization can serve as a moderating factor that can help parents regulate their arousal, shielding children during adverse circumstances. We studied the mediated links between ACEs and mothers' and children's psychopathology symptoms during COVID-19 to determine whether maternal mentalization and the child's age moderate these links. Using results from 152 Israeli mothers of children aged 3-12 years recruited during the month-long lockdown in Israel, we documented that the mothers' ACEs were linked with increased risk of depressive and anxiety symptoms and with children's internalizing and externalizing behaviors. Moreover, as hypothesized, the mothers' symptoms of depression and anxiety mediated the links between their ACEs and their children's internalizing behaviors. In addition, the mothers' mentalization skills and, in the case of their depressive symptoms, their child's age, moderated these indirect links. For mothers of young children (3-6 years old) with higher mentalization levels, the link between the mothers' ACEs and the children's behavior problems was weaker compared to mothers with low mentalization levels. For mothers of older children (6-12 years old), and only in the case of maternal depressive symptoms, higher levels of maternal mentalization were linked with more internalizing behaviors. We discuss the potential clinical implications of the findings.
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Affiliation(s)
- Daphna G. Dollberg
- School of Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Tel Aviv-Yafo, Israel
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28
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Dollberg DG, Harlev Y, Malishkevitch S, Leitner Y. Parental Reflective Functioning as a Moderator of the Link Between Prematurity and Parental Stress. Front Psychiatry 2022; 13:804694. [PMID: 35280157 PMCID: PMC8905191 DOI: 10.3389/fpsyt.2022.804694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
We examined group differences between parents, both mothers and fathers, of premature and full-term infants to determine whether they differed in their reports of subjective parenting stress and in their level of parental reflective functioning (PRF). We also tested whether each parent's reflective functioning moderated the links between birth status (prematurity vs. full-term) and parenting stress. A sample of 73 cohabiting, heterosexual Israeli families with a premature (28-36th week gestational age, N = 34) or full-term infant (37th week and above gestational age, N = 39) participated, comprising the two parents' groups. Infants' age averaged 7.07 months (SD = 1.28). Each parent completed the Parent Stress Inventory (PSI) individually to determine his/her subjective personal and childrearing stress levels. The Parent Development Interview (PDI-R2-S) was used to obtain each parent's PRF (self and child/relation-focused) level. Findings showed that the premature and full-term parents did not differ in their PSI scores or PRF levels. However, mothers' self-focused PRF moderated the link between prematurity and personal parenting stress, whereas fathers' self-focused PRF moderated the link between prematurity and childrearing parenting stress. Furthermore, fathers' and mothers' PRF operated differently in the premature and full-term parents' groups. The findings highlight the importance of mothers' and fathers' PRF in predicting parents' subjective stress in general and particularly in the case of infant prematurity. We discuss these findings and their relevance for preventive and therapeutic perinatal interventions.
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Affiliation(s)
- Daphna G Dollberg
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Yael Harlev
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Sivan Malishkevitch
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Yael Leitner
- Child Development Center, Dana-Dwek Children's Hospital, Sourasky Medical Center, Tel Aviv, Israel
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Leyton F, Olhaberry M, Morán J, De la Cerda C, León MJ, Sieverson C, Alfaro Á, Hernández C, Alvardo R, Steele H. Video Intervention Therapy for primary caregivers in a child psychiatry unit: a randomized feasibility trial. Trials 2021; 22:754. [PMID: 34717750 PMCID: PMC8557018 DOI: 10.1186/s13063-021-05668-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/30/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND During child psychiatry hospitalization, working with the families or attachment figures is a challenge, most of the children who are admitted to these units come from multi-problem families, with limited research in this area. Video feedback (VF) interventions have proved to be a powerful resource to promote parental and child well-being in small children and has been used with parents with a psychiatric condition. Parental Reflective Functioning (PRF) is one of the parental abilities that can be improved with VF and could be especially important in coping with conflict and negative emotions in older children. The aim of this study is to implement Video Intervention Therapy (VIT) to enhance PRF in primary caregivers of inpatient psychiatric children. As there is no published research using VF with parents of children with severe psychopathology in a hospitalized context. This report, then, becomes a much needed pilot study providing evidence for a larger randomized control trial (RCT). METHODS The study is a single-center, two-arm feasibility randomized control trial with a qualitative component. Block randomization was done to generate a 2:1 allocation, leaving more participants in the intervention group. The intervention comprises four modules; every module has both one video-recorded play session and one VIT session (in a group setting) per week. Evaluation of the caregivers included assessments of PRF and well-being, and child assessment included parent-ratings and clinician-ratings of symptomatology and general functioning. RESULTS Thirty participants were randomized; eligibility and recruitment rate were 70.6% and 83.3%, respectively. The compliance-to-intervention rate was 85% in the VIT group and 90% in the control group. All participants completed entry evaluation and 90% at the 3-month follow-up. The intervention was acceptable to participants and feasible for therapists to deliver. Outcome data must be treated with caution due to the small numbers involved, yet indicate that the VIT may have a positive effect in improving parental and child mental health outcomes. CONCLUSIONS VIT for primary caregivers of child inpatient children was feasible to deliver and acceptable for participants, therapist, and the staff unit involved; there is sufficient evidence to undertake a full-scale effectiveness RCT. TRIAL REGISTRATION ClinicalTrials.gov NCT03374904 . Registered on 14 December 2017.
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Affiliation(s)
- Fanny Leyton
- Escuela de Psicología, Pontificia Universidad Católica, Av. Vicuña Mackenna 4860, Macul, Santiago, Chile.
- Departamento de Pediatría, Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Subida Leopoldo Carvallo, 200, Valparaíso, Chile.
| | - Marcia Olhaberry
- Escuela de Psicología, Pontificia Universidad Católica, Av. Vicuña Mackenna 4860, Macul, Santiago, Chile
- Programa Salud Mental Perinatal, Red de Salud UC Christus, Santiago, Chile
| | - Javier Morán
- Escuela de Psicología, Universidad de Valparaíso, Valparaíso, Chile
| | - Cecilia De la Cerda
- Departamento de Psicología de la Facultad de Ciencias Sociales de la Universidad de Playa Ancha, Valparaíso, Chile
| | - María José León
- Milenium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
| | - Catalina Sieverson
- Programa Salud Mental Perinatal, Red de Salud UC Christus, Santiago, Chile
| | - Ángela Alfaro
- Departamento de Pediatría, Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Subida Leopoldo Carvallo, 200, Valparaíso, Chile
| | - Camila Hernández
- Departamento de Pediatría, Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Subida Leopoldo Carvallo, 200, Valparaíso, Chile
| | - Rubén Alvardo
- Program of Mental Health, School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Howard Steele
- Center for Attachment Research, Psychology Department, New School for Social Research, New York, USA
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30
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Yuen WS, Lo HC, Wong WN, Ngai FW. The effectiveness of psychoeducation interventions on prenatal attachment: A systematic review. Midwifery 2021; 104:103184. [PMID: 34753018 DOI: 10.1016/j.midw.2021.103184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/30/2021] [Accepted: 10/23/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Positive prenatal attachment facilitates parental role adaptation and psychological adjustment during pregnancy, which is a significant predictor of postpartum attachment. The objective of this systematic review was to examine the effect of psychoeducation interventions on prenatal attachment of pregnant women and their partners. DESIGN Systematic literature searches of randomized controlled trials (RCTs) were conducted from January 2000 to January 2021, using databases: CINAHL, Embase, Medline, PsycInfo, PubMed, Web of Science and Cochrane Central Register of Controlled Trial and through hand-searching. Studies were independently selected by two reviewers, who also assessed the methodological quality of the included studies using the Cochrane Risk of Bias Tool. Narrative synthesis was conducted due to the significant clinical and methodological heterogeneity. SETTING/PARTICIPANTS Fifteen studies met the eligibility criteria for this review, among which 11 studies focused on pregnant women and four studies on their partners. FINDINGS The psychoeducation interventions in the included studies showed consistent favorable effects on prenatal attachment. Nine out of the 11 included studies showed statistical significant effects on maternal fetal attachment. Three out of the four studies reported significant effects favoring paternal fetal attachment. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The preliminary evidence suggests that psychoeducation interventions have potential favorable effects on maternal fetal attachment and can enhance paternal fetal attachment. However, more studies are needed for investigating the effects of psychoeducation on paternal fetal attachment and for enhancing the validity of the evidence. Our review recommends that healthcare professionals to include psychoeducation as a part of their prenatal care for promoting prenatal attachment. Common characteristics of the interventions could act as references when designing psychoeducation programs for enhancing prenatal attachment.
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Affiliation(s)
- Wing Shan Yuen
- Undergraduate student, School of Nursing, The Hong Kong Polytechnic University
| | - Hiu Ching Lo
- Undergraduate student, School of Nursing, The Hong Kong Polytechnic University
| | - Wing Nga Wong
- Undergraduate student, School of Nursing, The Hong Kong Polytechnic University
| | - Fei Wan Ngai
- Assistant Professor, School of Nursing, The Hong Kong Polytechnic University.
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Link between History of Childhood Maltreatment and Emotion Dysregulation in Adults Suffering from Attention Deficit/Hyperactivity Disorder or Borderline Personality Disorder. Biomedicines 2021; 9:biomedicines9101469. [PMID: 34680586 PMCID: PMC8533068 DOI: 10.3390/biomedicines9101469] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 01/26/2023] Open
Abstract
Childhood maltreatment (CM) may have a long-term effect on emotion regulation. This study aimed to explore the relationship between CM and emotion dysregulation (ED) in a heterogeneous population. Four hundred seventy French-speaking outpatients (N = 279 ADHD, N = 70 BPD, N = 60 ADHD + BPD, N = 61 clinical controls) completed the Emotion Reactivity Scale (ERS), the Cognitive Emotional Regulation Questionnaire (CERQ), the Childhood Trauma Questionnaire (CTQ), and the Relationship Scales Questionnaire (RSQ). Reports of childhood maltreatment experiences were significantly associated with increased levels of emotion reactivity in all our groups and in the whole population, with a greater use of non-adaptive cognitive emotion regulation strategies and insecure attachment patterns. Emotional abuse showed the strongest effect. Further analysis indicated that an anxious attachment style significantly mediated the relationship between CM and the use of non-adaptive cognitive emotion regulation strategies and emotion reactivity. The results of our study suggest an impact of CM on ED and a potentially marked effect of emotional abuse. They also indicate a potentially mediating role of insecure attachment in the relationship between a history of childhood abuse and emotion reactivity and a higher use of non-adaptive cognitive emotion regulation strategies in adulthood.
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Abstract
Abstract
Purpose of Review
Maternal prenatal substance use presents a multilevel risk to child development and parenting. Although parenting interventions are increasingly integrated into substance use treatment, prenatal parenting processes have not received equal attention within these interventions. This article aims to synthesize the evidence on the specific prenatal risk factors affecting the development of early parenting of substance-using mothers, as well as interventions focusing on those factors.
Recent Findings
Both neurobiological and psychosocial risk factors affect the prenatal development of parenting in the context of maternal substance use. Maternal–fetal attachment, mentalization, self-regulation, and psychosocial risks are important in treatment and highly intertwined with abstinence. Although parenting interventions seem to be highly beneficial, most studies have not differentiated between pre- and postnatal interventions or described pregnancy-specific intervention elements.
Summary
Due to the salience of pregnancy in treating substance-using parents, interventions should begin prenatally and include pregnancy-specific parenting focus. Further research on prenatal interventions is warranted.
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Family Minds: A randomized controlled trial of a group intervention to improve foster parents' reflective functioning. Dev Psychopathol 2021; 34:1177-1191. [PMID: 33583462 DOI: 10.1017/s095457942000214x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Family Minds is a brief group psychoeducational parenting intervention designed to increase the reflective functioning (RF) and mentalization skills of foster parents. RF is important for foster parents who have to build relationships with children whose adverse experiences increase their risk for psychosocial challenges. A randomized controlled trial (RCT) for Family Minds was conducted in Texas with 89 foster parents. The main aims of this study were to examine whether the intervention could significantly increase the RF/mentalization skills of the foster parents and decrease their parenting stress. After 6 weeks, compared with the control group, intervention foster parents improved their RF via a lowering of pre-mentalizing and also significantly decreased parenting stress related to parent-child dysfunctional interactions. Other measures of RF and parenting stress showed no significant differences between groups. Foster child behavior was not significantly different between groups, although data at 6 months showed a possible lowering of internalizing symptoms for children of intervention parents. This RCT provides some encouraging evidence that Family Minds may increase RF in foster parents, improve parental sensitivity and their ability to emotionally regulate, decrease parenting stress related to challenging interactions with their foster children, and possibly decrease children's internalizing behavior.
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34
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Hayden MC, Müllauer PK, Beyer KJP, Gaugeler R, Senft B, Dehoust MC, Andreas S. Increasing Mentalization to Reduce Maladaptive Defense in Patients With Mental Disorders. Front Psychiatry 2021; 12:637915. [PMID: 33776819 PMCID: PMC7991294 DOI: 10.3389/fpsyt.2021.637915] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/16/2021] [Indexed: 01/22/2023] Open
Abstract
Background: There are indications of associations between the ability to mentalize and psychological defense mechanisms. However, only a few studies have focused on these associations, and even fewer have included empirical analyses. In the present study, we aimed to fill this research gap by analyzing the link between the ability to mentalize and psychological defense mechanisms in patients with mental disorders. We examined whether changes in defense mechanisms are predicted by an increase in mentalization or whether such changes are only related to reductions in psychopathology and interpersonal problems. Methods: A clinical sample of N = 89 patients was studied during and after inpatient psychiatric rehabilitation. Repeated-measures analyses of variance were performed to determine changes in mentalization, psychological defense, psychopathology, and interpersonal problems over the course of therapy and post-treatment. Linear regression analyses were used to predict the change in defense patterns based on an increase in mentalization. Results: Maladaptive defense mechanisms were significantly reduced during inpatient therapy and remained low until follow-up, whereas neurotic and adaptive defense mechanisms did not change significantly. The results of the regression analyses indicated that mentalization played an important role in the reduction in maladaptive defense during and after inpatient rehabilitation for mental disorders, whereas reductions in psychopathology and interpersonal distress were only partially associated with a reduction in maladaptive defense. Conclusion: We conclude that mentalization is vital for reducing maladaptive defense mechanisms, which are commonly associated with mental disorders. In therapy, an increase in patients' capacity to mentalize may be a practicable approach to diminish maladaptive defense mechanisms.
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Affiliation(s)
- Markus C Hayden
- Institut für Psychologie, Alpen-Adria-Universität Klagenfurt, Klagenfurt, Austria.,Klinik Bad Reichenhall der Deutschen Rentenversicherung Bayern-Süd, Bad Reichenhall, Germany
| | - Pia K Müllauer
- Institut für Psychologie, Alpen-Adria-Universität Klagenfurt, Klagenfurt, Austria
| | - Klea J P Beyer
- Institut für Psychologie, Alpen-Adria-Universität Klagenfurt, Klagenfurt, Austria
| | - Richard Gaugeler
- Öffentliches Krankenhaus Waiern, Feldkirchen in Kärnten, Austria
| | - Birgit Senft
- Reha-Klinik für Seelische Gesundheit und Prävention, Klagenfurt, Austria
| | | | - Sylke Andreas
- Institut für Psychologie, Alpen-Adria-Universität Klagenfurt, Klagenfurt, Austria
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35
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Berthelot N, Lemieux R, Garon-Bissonnette J, Drouin-Maziade C, Martel É, Maziade M. Uptrend in distress and psychiatric symptomatology in pregnant women during the coronavirus disease 2019 pandemic. Acta Obstet Gynecol Scand 2020; 99:848-855. [PMID: 32449178 DOI: 10.1111/aogs.13925] [Citation(s) in RCA: 251] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Prenatal maternal distress has a negative impact on the course of pregnancy, fetal development, offspring development, and later psychopathologies. The study aimed to determine the extent to which the coronavirus disease 2019 (COVID-19) pandemic may aggravate the prenatal distress and psychiatric symptomatology of pregnant women. MATERIAL AND METHODS Two cohorts of pregnant volunteer women were evaluated, one that was recruited before the COVID-19 pandemic (n = 496) through advertisements in prenatal clinics in Quebec, Canada, from April 2018 to March 2020; the other (n = 1258) was recruited online during the pandemic from 2 April to 13 April 2020. Prenatal distress and psychiatric symptomatology were measured with the Kessler Distress Scale (K10), Post-traumatic Checklist for DSM-5 (PCL-5), Dissociative Experiences Scale (DES-II), and Positive and Negative Affect Schedule (PANAS). RESULTS The 1754 pregnant women (Mage = 29.27, SD = 4.23) were between 4 and 41 gestational weeks (M = 24.80, SD = 9.42), were generally educated (91.3% had post-high-school training), and financially well-resourced (85.3% were above the low-income cut-off). A multivariate analysis of covariance controlling for age, gestational age, household income, education, and lifetime psychiatric disorders showed a large effect size (ES) in the difference between the two cohorts on psychiatric symptoms (Wilks' λ = 0.68, F6,1400 = 108.50, P < .001, partial η2 = 0.32). According to post-hoc analyses of covariance, the COVID-19 women reported higher levels of depressive and anxiety symptoms (ES = 0.57), dissociative symptoms (ES = 0.22 and ES = 0.25), symptoms of post-traumatic stress disorder (ES = 0.19), and negative affectivity (ES = 0.96), and less positive affectivity (ES = 0.95) than the pre-COVID-19 cohort. Women from the COVID-19 cohort were more likely than pre-COVID-19 women to present clinically significant levels of depressive and anxiety symptoms (OR = 1.94, χ2 [1] = 10.05, P = .002). Multiple regression analyses indicated that pregnant women in the COVID-19 cohort having a previous psychiatric diagnosis or low income would be more prone to elevated distress and psychiatric symptoms. CONCLUSIONS Pregnant women assessed during the COVID-19 pandemic reported more distress and psychiatric symptoms than pregnant women assessed before the pandemic, mainly in the form of depression and anxiety symptoms. Given the harmful consequences of prenatal distress on mothers and offspring, the presently observed upsurge of symptoms in pregnant women calls for special means of clinical surveillance.
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Affiliation(s)
- Nicolas Berthelot
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,Center d'Études Interdisciplinaires sur le Développement de l'Enfant et la Famille (CEIDEF), Trois-Rivières, QC, Canada.,CERVO Brain Research Center, Quebec City, QC, Canada.,Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Montreal, QC, Canada
| | - Roxanne Lemieux
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,Center d'Études Interdisciplinaires sur le Développement de l'Enfant et la Famille (CEIDEF), Trois-Rivières, QC, Canada
| | - Julia Garon-Bissonnette
- Center d'Études Interdisciplinaires sur le Développement de l'Enfant et la Famille (CEIDEF), Trois-Rivières, QC, Canada.,CERVO Brain Research Center, Quebec City, QC, Canada.,Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Montreal, QC, Canada.,Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Christine Drouin-Maziade
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,Center d'Études Interdisciplinaires sur le Développement de l'Enfant et la Famille (CEIDEF), Trois-Rivières, QC, Canada
| | - Élodie Martel
- Center d'Études Interdisciplinaires sur le Développement de l'Enfant et la Famille (CEIDEF), Trois-Rivières, QC, Canada.,CERVO Brain Research Center, Quebec City, QC, Canada.,Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Michel Maziade
- CERVO Brain Research Center, Quebec City, QC, Canada.,Faculty of Medicine, Université Laval, Quebec City, QC, Canada
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Jussila H, Ekholm E, Pajulo M. A New Parental Mentalization Focused Ultrasound Intervention for Substance Using Pregnant Women. Effect on Self-reported Prenatal Mental Health, Attachment and Mentalization in a Randomized and Controlled Trial. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-019-00205-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
AbstractThe effect of a novel mentalization-based parenting intervention was explored on prenatal self-reported mentalization (P-PRFQ), attachment (MFAS), depression (EPDS) and anxiety (STAI) among women with substance use problems. The participants were 90 pregnant women referred to obstetric outpatient care due to recent or current substance use and randomized into intervention (n = 46) and control (n = 44) groups. The intervention group received three interactive 4D ultrasound sessions and a week-by-week pregnancy diary. The control condition was constituted of treatment-as-usual in obstetric care. Unfortunately, the efficacy of the intervention on maternal prenatal mental health, attachment, and parental mentalization was not substantiated. The negative results may be related to the small sample size, the patient-reported outcomes, or insufficient efficacy within this high-risk group. In the context of high psychosocial risks and follow-up by Child Welfare Services, the patient-reported outcomes may have underestimated prenatal adversity. The role of the research context, methodology, and possible sources of bias in the outcome assessment are discussed.The trial registration number in the ClinicalTrials.gov: NCT03413631
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Ogawa M, Hashimoto T, Tanaka M, Tachibana M, Seki R, Sato A, Okayama J, Endo M, Saito N, Sato Y, Watanabe H, Nakazato M, Mori E, Shozu M, Iyo M. The Effect of Grandmothers' Presence on the Provision of Multidisciplinary Perinatal Support for Pregnant and Postpartum Women with Psychosocial Problems. J Multidiscip Healthc 2019; 12:1033-1041. [PMID: 31853181 PMCID: PMC6914659 DOI: 10.2147/jmdh.s228320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/27/2019] [Indexed: 12/24/2022] Open
Abstract
Background Pregnant and postpartum women with psychosocial problems are prone to face limited or absent perinatal functional support from biological grandmothers due to familial dysfunction. The study aimed to investigate whether the involvement and presence of biological maternal grandmothers providing practical support for their pre/postnatal daughters (ie, pregnant women) during the perinatal period may influence the number of support services provided by multidisciplinary agencies, including child consultation centers and municipal offices. Participants and methods This is a retrospective cohort study based on the medical records of all pregnant women with psychosocial problems that visited, gave birth, and received intervention from the hospital-based child protection unit at the Chiba University Hospital between February 2018 to March 2019. The primary outcome was to identify whether there was a difference in the number of multidisciplinary agencies providing perinatal support between pregnant women with and without the presence of functional support from biological maternal grandmothers during the perinatal period. Results We identified 114 pregnant and postpartum women with psychosocial problems. Seventy-six of these participants (66.7%) had functional support from their biological maternal grandmothers during the perinatal period, and 38 participants (33.3%) did not. The number of agencies involved with participants who lacked functional support was significantly higher than participants with functional support (t(55.14) = 2.98, p < 0.01). This finding was consistent among pregnant and postpartum primipara participants (n = 70) (t(68) = 3.87, p < 0.001), but not multipara (n = 44). Conclusion The findings indicate that the presence and functional support of biological maternal grandmothers influence the support that is needed from multidisciplinary perinatal support systems by pregnant and postpartum women with psychosocial problems. Primipara mothers without support from their own mothers may need greater multidisciplinary support.
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Affiliation(s)
- Michi Ogawa
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tasuku Hashimoto
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Psychiatry, Satsuki-kai Sodegaura-Satsukidai Hospital, Chiba, Japan
| | - Mami Tanaka
- Center for Forensic Mental Health, Chiba University, Chiba, Japan
| | - Masumi Tachibana
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryota Seki
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Aiko Sato
- Department of Psychiatry, Chiba University Hospital, Chiba, Japan
| | - Jun Okayama
- Department of Maternal-Fetal Medicine, Chiba University Hospital, Chiba, Japan
| | - Mamiko Endo
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoki Saito
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Hiroyuki Watanabe
- Division of Medical Treatment and Rehabilitation, Center for Forensic Mental Health, Chiba University, Chiba, Japan.,Department of Psychiatry, Gakuji-kai Kimura Hospital, Chiba, Japan
| | - Michiko Nakazato
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Psychiatry, International University of Health and Welfare Atami Hospital, Atami, Japan
| | - Emi Mori
- Department of Health Promotion Nursing, Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
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