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

Observer-based and computerized measures of the patient's mentalization in psychotherapy: A scoping review

OBJECTIVE

In recent decades, mentalizing has found its permanent place both in therapeutic practice and in psychotherapy research. Inconsistent results and null results are often found. Therefore, the different methodological approaches should be examined in more detail. A scoping review was conducted to provide an overview of the approaches that measure the patient's mentalizing ability based on therapy sessions or in the course of psychotherapy.

METHOD

For the scoping review, a literature search was conducted in four databases. A total of 3217 records were identified.

RESULTS

We included 84 publications from 43 independent studies. Most studies used the Reflective Functioning Scale and applied the scale to therapy sessions or the Adult Attachment Interview. The other identified approaches used a computerized text analysis measure or clinician-report measures. Mostly good psychometric properties of the measures were reported. The Reflective Functioning Scale applied to the Adult Attachment Interview was the only measure that proved to be sensitive to change.

CONCLUSION

More economical variants to the time-consuming Reflective Functioning Scale applied to the Adult Attachment Interview are being developed continuously. In some cases, there is no standardized approach, or the measures are used only sporadically and require further and more comprehensive psychometric evaluations.

Pretreatment unresolved-disorganized attachment status in eating disorder patients associated with stronger reduction of comorbid symptoms after psychotherapy

Research shows that the Unresolved-disorganized attachment representation (U), resulting from experiences of loss or abuse, is associated with a range of psychiatric conditions. However, clinical implications of U are yet unclear.Objective: To investigate how U is related to symptoms and recovery of eating disorder (ED) patients.Method: First, 38 ED patients starting psychotherapeutic treatment were compared to 20 controls without ED on the prevalence of U, assessed with the Adult Attachment Interview. Second, in the patient group relations between U and ED symptoms, depression, anxiety and subjective experience of symptoms were investigated. Third, we compared, 1 year afterwards, recovery of patients with and without U.Results: The prevalence of U was higher in ED patients than in controls. Symptom severity was not related to U. ED patients with U at the start of treatment improved significantly more regarding anxiety, depression and subjective experience of symptoms than did patients without U.Discussion: The differential recovery of ED patients with or without U confirms the trauma-related heterogeneity of patients found in other diagnostic groups and calls for further investigation into the treatment needs of patients with different attachment representations.

Systematic Review on Mentalization as Key Factor in Psychotherapy

Background: Mentalization processes seem to be of high relevance for social learning and seem important in all psychotherapies. The exact role of mentalization processes in psychotherapy is still unknown. The aim of the present systematic review is to investigate whether mentalization is related to the therapeutic outcome and, if so, whether it has a moderating, mediative, or predictive function. Method: A systematic review with an electronic database search was conducted. A total of 2567 records were identified, and 10 studies were included in the final synthesis. Results: Psychotherapy research is still in an initial phase of examining and understanding the impact of mentalization on psychotherapy outcome. The small number of studies and the executed study designs and statistical analyses indicate the possible role that mentalization has in psychotherapy. Conclusion: Generally, strongly elaborated study designs are needed to identify the role of mentalization in psychotherapy. Mentalization seems to be differently represented in differential treatment approaches. Nevertheless, it should be noted that the patient’s mentalizing capacity seems to be relevant to the psychotherapy process. Psychotherapies should be adapted to this.