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Wais M, Bégin M, Sharp C, Ensink K. Trauma-related symptoms in adolescents: the differential roles of sexual abuse and mentalizing. Front Psychol 2024; 15:1364001. [PMID: 39021654 PMCID: PMC11252049 DOI: 10.3389/fpsyg.2024.1364001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 06/11/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Major gaps remain in our knowledge regarding childhood sexual abuse (CSA) related symptoms in adolescent psychiatric inpatients, as well as potential resilience factors like mentalizing. CSA is a risk factor for the early emergence of borderline personality features, posttraumatic stress, and sexual concerns. Mentalizing, which involves the capacity to understand our reactions and that of others in psychological terms, is a resilience factor for self and interpersonal functioning. The aim of this study was to address knowledge gaps by examining the contributions of CSA and mentalizing in a latent factor composed of borderline personality features, posttraumatic stress, and sexual concerns in a sample of adolescent psychiatric inpatients. We hypothesized that CSA and mentalizing would independently explain the variance in this latent factor. Method Participants were 273 adolescents aged 12-17 recruited from an adolescent inpatient psychiatric clinic. They completed the Reflective Function Questionnaire for Youth (RFQ-Y), the Trauma Symptom Checklist for Children (TSCC), and the Borderline Personality Features Scale for Children (BPFS-C). CSA was assessed using the Child Attachment Interview (CAI), the Computerized Diagnostic Interview Schedule for Children (C-DISC), as well as the Childhood Trauma Questionnaire (CTQ). Results 27.5% of adolescent psychiatric inpatients reported CSA. CSA and mentalizing were independently associated with a latent factor consisting of posttraumatic stress, borderline personality features, and sexual concerns. CSA explained 5.0% and RF explained 16.7% of the variance of the latent factor. When we consider both the unique and the shared contribution of CSA and mentalizing, the model explained 23.0% of the variance of this factor. Discussion CSA and mentalizing independently explained variance in a latent factor constituted of borderline personality features, posttraumatic stress, and sexual concerns. The direct effect of mentalizing was stronger and mentalizing explained comparatively more variance of trauma-related symptoms in adolescent psychiatric inpatients. The findings are consistent with the theory that mentalizing is an internal resilience factor in adolescent psychiatric inpatients. By implication, clinical interventions focused on promoting the development of mentalizing, such as Mentalization Based Treatment, may palliate mental health difficulties manifested by adolescent psychiatric inpatients including those associated with CSA.
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Affiliation(s)
- Marissa Wais
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - Michaël Bégin
- Département de Psychologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Karin Ensink
- École de Psychologie, Université Laval, Québec, QC, Canada
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Riazi SS, Manouchehri M. The mediating role of mentalization and integrative self-knowledge in the relationship between childhood trauma and fear of intimacy. Front Psychol 2024; 15:1384573. [PMID: 39006548 PMCID: PMC11239571 DOI: 10.3389/fpsyg.2024.1384573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/10/2024] [Indexed: 07/16/2024] Open
Abstract
Introduction Since intimacy is a fundamental human need within social relationships, and recognizing that a fear of intimacy correlates with various negative consequences, it becomes crucial to examine the origins and factors that contribute to addressing this issue. This research aimed to investigate the mediating roles of mentalization and integrative self-knowledge in the link between childhood trauma and the fear of intimacy. Methods Conducted as correlational descriptive research, our study incorporates a total sample of 303 adult women and men participants aged 20 to 50 in Tehran using the convenience sampling method. They completed the Fear of Intimacy Scale (FIS), the Childhood Trauma Questionnaire (CTQ), the Mentalization Scale (MentS), and the Integrative Self-Knowledge Scale (ISK). To analyze the research data at the descriptive level, frequency, percentage, standard deviation, and Pearson's correlation coefficient were used, while path analysis tested our hypotheses in SPSS version 26 and AMOS version 24. Fit indices were used to check the model's fit, and the mediation test was performed using the bootstrapping method. The fit indices revealed an excellent fit of the model with the data (χ2 = 1.51, χ2/df = 1.51, p = 0.219; RMSEA = 0.05; SRMR = 0.02; CFI = 0.99; NFI = 0.99; TLI = 0.99). Results Results indicate mentalization fully mediates the childhood trauma-fear of intimacy relationship (β = 0.14, p < 0.01). However, the indirect relationship between childhood trauma and fear of intimacy through integrative self-knowledge was insignificant. The results also showed that the path coefficient from mentalization to fear of intimacy was negative and significant (β = -0.41, p < 0.001), while the path coefficient from integrative self-knowledge to fear of intimacy was not significant (β = -0.02, p > 0.05). Discussion Based on the current findings indicating the complete mediation of mentalization and the insignificance of the mediation of integrative self-knowledge, we can deduce that enhancing the capacity for mentalization holds promise in effectively addressing intimacy-related issues. Overall, the study suggests mentalization effectively predicts the relationship between childhood trauma and fear of intimacy. This, in turn, may mitigate the detrimental effects of challenging childhood experiences on an individual's ability to engage in intimacy and cultivate emotional closeness.
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Affiliation(s)
| | - Mehdi Manouchehri
- Department of Clinical Psychology, Faculty of Medicine, Islamic Azad University of Medical Sciences, Tehran, Iran
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Springer N, Lueger-Schuster B. Navigating foster care: how parental drug use and caregiver attitudes shape children's mentalization processes-an exploratory longitudinal follow-up study: study protocol. Front Psychol 2024; 15:1295809. [PMID: 38939232 PMCID: PMC11210450 DOI: 10.3389/fpsyg.2024.1295809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
Background The current research concept of mentalization is used in the study to clearly identify affective and cognitive abilities of the caregiver-child dyad with the aim of compensating deficits on both sides with psychological-psychotherapeutic strategies. Methods The objective of this explorative, longitudinal intervention study is to provide an in-depth understanding of the psycho-social background of 30 children aged 6-12 years living in institutional or family-centered foster care. Data will be collected at three time points: before, after and 12 months after participating in the newly developed group intervention, which intends to address the particular needs of children of drug abusing parents living in foster care in the latency period. The study is conducted at the Faculty of Psychology of the University of Vienna in collaboration with the Association "Dialogue" (Verein Dialog). The treatment duration spans 5 months, during which two specifically trained psychotherapists conduct 10 group sessions for children and three group sessions for foster caregivers. All statistical analyses will consider the type of data available. Therefore, the primary outcome of the study will be assessed via the Friedman test due to the ordinal dependent variable as it is the non-parametric alternative to the one-way ANOVA for repeated measures. In addition, the Mann-Whitney U test is used to compare differences between two independent groups (children living in institutional foster care vs. family foster care). To assess potential correlations regarding the child and caregivers' capacity to mentalize, Spearman correlations (ρ) are conducted. To examine the secondary outcome, apart from the methods previously outlined, we will also utilize qualitative thematic analysis. Discussion The present study uses the current research concept of mentalization to identify affective and cognitive abilities of the caregiver-child dyad with the aim of compensating deficits on both sides with psychological-psychotherapeutic strategies. There are some limitations of the study to mention: the small sample size does not allow to generalize the results. Due to the lack of a comparison group, a randomized control study (RCT) was not conducted. The authors are aware of these limitations. However, the studies' findings, will help to deduce research questions for further studies.
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Affiliation(s)
- Nadja Springer
- Dialog – Individuelle Suchthilfe, Vienna, Austria
- Unit of Psychotraumatology, Faculty of Psychology, University of Vienna, Vienna, Austria
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García-Rico MA, Ricarte JJ, Jimeno MV, Latorre JM. Role of psychopathology on children credibility of sexual abuse testimony. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 94:101972. [PMID: 38460237 DOI: 10.1016/j.ijlp.2024.101972] [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: 04/23/2023] [Revised: 01/29/2024] [Accepted: 02/23/2024] [Indexed: 03/11/2024]
Abstract
When an alleged victim has a pre-existing psychopathological diagnosis, this can affect the rating of their version of the abuse in terms of credibility. The objective of this work is to analyze the relationship between the assessment of the credibility of the testimony of a CSA victim, the psychological problems that the child may have presented prior to sexual abuse and the possible psychological sequelae that she may present as a result of the abuse. 109 cases were selected in which the credibility of the testimony could be determined. Through forensic interviews and the study of the corresponding professional reports, the following were obtained: sociodemographic data, data on their previous psychological state and data on their psychological state after the reported events. The psychological state of the child after the reported events shows no relation to the forensic evaluation of the credibility of her testimony. The existence of a relationship between the absence of previous psychopathology and the fact that the victim's testimony is valued as a credible account is confirmed. This study reveals that children who presented psychological manifestations prior to their experience of abuse receive a lower credibility rating than those without previous psychopathological symptoms or diagnoses.
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Affiliation(s)
- María A García-Rico
- Equipo Psicosocial-Unidad Forense de Valoración Integral, Instituto de Medicina Legal y Ciencias Forenses de Albacete, Cuenca y Guadalajara. Subdirección de Cuenca. Ministerio de Justicia, Spain
| | - Jorge J Ricarte
- Unidad de Psicología Cognitiva Aplicada, IDINE, Spain; Facultad de Educación de Albacete, Spain
| | - María V Jimeno
- Unidad de Psicología Cognitiva Aplicada, IDINE, Spain; Facultad de Derecho de Albacete, Spain.
| | - José M Latorre
- Unidad de Psicología Cognitiva Aplicada, IDINE, Spain; Facultad de Medicina de Albacete, Spain
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Lassri D, Gewirtz-Meydan A, Nolte T. Transdiagnostic factors in the COVID-19 pandemic: Examining the role of childhood abuse and neglect in establishing latent profiles of risk and resilience. CHILD ABUSE & NEGLECT 2024:106808. [PMID: 38693009 DOI: 10.1016/j.chiabu.2024.106808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 04/01/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Ample studies have focused on the negative consequences of COVID-19 on mental well-being, but fewer have explored the specific role of childhood abuse and neglect in the context of risk and resilience during this unprecedented crisis. OBJECTIVE We aimed to identify distinct profiles of individuals based on their experiences of childhood abuse and neglect, coping strategies, and psycho-social transdiagnostic risk and protective factors, using a person-centered approach. PARTICIPANTS AND SETTING A convenience sample of 914 Israelis completed self-report questionnaires during the second wave of COVID-19. METHODS Latent Profile Analysis was employed based on levels of childhood abuse and neglect, coping strategies, and established factors underpinning risk and resilience in mental health: dissociation, self-criticism, self-efficacy, self-compassion, attachment insecurity, psychological resilience, mentalizing, distress disclosure, psychopathology, and relationship satisfaction. Profiles were compared in COVID-19-related distress and well-being using ANOVAs. RESULTS A four-profile solution was found to be optimal for describing individuals with different profiles of risk and resilience: "risk" (5.1 %)-individuals with meaningfully high levels of childhood abuse and neglect and dissociation; "vulnerable" (14.2 %)-individuals high in risk factors and low in protective factors; "moderately resilient" (47.6 %)-those with moderate levels of protective and risk factors; "highly resilient" (33.1 %)-individuals high in protective factors and low in risk factors; groups differed in mental well-being and COVID-19-related distress. CONCLUSIONS Results highlight the importance of childhood abuse and neglect in differentiating between the two distinct profiles of at-risk individuals. Implications for risk assessment and treatment in the context of potential traumatic stress are discussed.
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Affiliation(s)
- Dana Lassri
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Israel; Research Department of Clinical, Educational, and Health Psychology, University College London (UCL), United Kingdom.
| | - Ateret Gewirtz-Meydan
- School of Social Work, Faculty of Social Welfare & Health Sciences, University of Haifa, Israel. agewirtz-@univ.haifa.ac.il
| | - Tobias Nolte
- Research Department of Clinical, Educational, and Health Psychology, University College London (UCL), United Kingdom; Anna Freud, United Kingdom.
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Mohammadi Z, Dehghani M, Fathali Lavasani F, Farahani H, Ashouri A. A network analysis of ICD-11 Complex PTSD, emotional processing, and dissociative experiences in the context of psychological trauma at different developmental stages. Front Psychiatry 2024; 15:1372620. [PMID: 38532985 PMCID: PMC10963615 DOI: 10.3389/fpsyt.2024.1372620] [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: 01/18/2024] [Accepted: 02/27/2024] [Indexed: 03/28/2024] Open
Abstract
Objective Traumatic experiences are a significant risk factor for psychological disturbances, including disorders such as complex posttraumatic stress disorder, emotion-processing problems, and trauma-related dissociative experiences. The present investigation examined the coexistence of these symptoms using a network analysis model. Method This study included a sample of 406 people referred to comprehensive health centers in Tehran from September to December 2023 with psychopathological syndromes. Variables were assessed using The International Trauma Questionnaire, International Measurement of Exposure to Traumatic Event checklist, Baker Emotional Processing Questionnaire, and Dissociative Experiences. A regularized partial correlation network and Glasso algorithm, in combination with Extended Bayesian information criteria, were applied to estimate the network structure. Results Signs of unprocessed emotions and disturbance in self-organization symptoms were the most important symptoms in the symptom network, forming strong connections with other nodes. Thereby, these two symptoms can be regarded as the most important clinical manifestations in the symptom network following traumatic experiences. Three distinct symptom communities were identified: the community of traumatic experiences (childhood, adolescence, adulthood), the community of dissociative experiences (amnesia, depersonalization/derealization, and absorption), and the community of emotional processing (suppression, unpleasant emotional experience, Signs of unprocessed emotions, avoidance, and emotional control, posttraumatic stress disorder symptoms and disturbance in self-organization symptoms). The strongest edges observed were between childhood trauma-adolescence trauma (0.473) in the community of traumatic experiences, between amnesia and depersonalization/derealization (0.644) in the community of dissociative experiences, and between disturbance in self-organization symptoms and unprocessed emotions (0.324) in the community of emotional processing, indicating the recurrent occurrence of these symptoms. Conclusion In this study, disturbance in self-organization symptoms was identified as the central psychopathologic symptom in individuals experiencing traumas at different developmental stages. It seems that adolescent trauma and not childhood trauma plays a more decisive role in the symptoms that a person manifests after traumatic experiences. Also, posttraumatic stress disorder symptoms and disturbance in self-organization symptoms were recognized in the cluster of emotional processing symptoms and can have substantial roles in prioritizing therapeutic measures.
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Affiliation(s)
- Zahra Mohammadi
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mahmood Dehghani
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Fathali Lavasani
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | | | - Ahmad Ashouri
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
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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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Zorani S, Peles E. Is pain empathy associated with pain indices and trauma history? A comparison between patients receiving methadone maintenance treatment and healthy controls. J Psychiatr Res 2024; 171:286-295. [PMID: 38335639 DOI: 10.1016/j.jpsychires.2024.02.007] [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: 12/13/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND To study whether pain empathy and theory of mind (ToM) are related to pain indices and trauma experience, we studied opioid users receiving methadone maintenance treatment (MMT), a population with a history of traumas and a high prevalence of chronic pain. METHODS MMT patients (n = 53), substance abuse-free, with no impaired cognition (Montreal Cognitive Assessment (MoCA) ≥24), were compared to healthy controls (HC) matched by age and gender (n = 66). All participants were assessed using Reading the Mind in the Eyes (RMET) for ToM, empathy (Interpersonal Reactivity Index [IRI], Empathy Quotient Scale for Adults [EQ60]), and Pain Empathy [PE task]). An algometer was used for pain pressure threshold, and supra-pain threshold was rated using a visual analog scale (VAS). Catastrophizing, McGill pain, Negative life events (NLE), and MoCA questionnaires were administered. Substance abuse was tested in the urine of MMT patients and self-reported by HC. RESULTS MMT, compared to HC, were less educated with more NLE and a lower RMET (logistic regression). Groups had comparable empathy and pain indices, except for higher supra-threshold VAS rating and catastrophizing in univariate analyses. Pain empathy (PE) correlated with NLE in HC, and in MMT, with catastrophizing, which correlated with NLE, perceived stress, and pain intensity. Higher empathy was observed in 18 participants with a history of sexual abuse (83.3 % belong to the MMT group). CONCLUSIONS Pain Empathy was found to be associated with personal suffering experience in both groups, as reflected by correlations with NLE in HC and with catastrophizing, which correlates with NLE, stress, and pain intensity, in MMT.
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Affiliation(s)
- Shlomit Zorani
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; D Miriam and Sheldon G. Adelson Clinic for Drug Use, Treatment and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Einat Peles
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; D Miriam and Sheldon G. Adelson Clinic for Drug Use, Treatment and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Lassri D, Gewirtz-Meydan A. From trauma to intimacy: Examining the link between childhood maltreatment and adult sexual functioning - The mediating role of self-criticism. CHILD ABUSE & NEGLECT 2024; 149:106663. [PMID: 38350402 DOI: 10.1016/j.chiabu.2024.106663] [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: 05/29/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Childhood maltreatment has been linked to negative sexual functioning, but the underlying mechanisms for this association are poorly understood. OBJECTIVE Addressing this gap, this study investigates the mediating role of self-criticism in the association between childhood maltreatment and adult sexual functioning. PARTICIPANTS AND SETTING Two independent studies were conducted, each utilizing a distinct dataset to enhance the robustness and generalizability of the findings. The sample in Study 1 included 914 participants, while the sample in Study 2 consisted of 451 women. Both samples completed self-report online questionnaires; however, in Study 2, we purposefully oversampled for child sexual abuse survivors. METHODS This study employed a mediation model using PROCESS. RESULTS Study 1 confirmed the negative association between childhood maltreatment and sexual functioning, as well as the positive association between childhood maltreatment and self-criticism. Self-criticism was also negatively associated with sexual functioning. The mediation analysis revealed that self-criticism significantly mediated the association between childhood maltreatment and sexual functioning. Study 2 built upon these findings by oversampling childhood sexual abuse survivors and incorporating comprehensive measures of sexual functioning. The results in Study 2 replicated the findings of Study 1, providing a more representative understanding of the link between childhood maltreatment and sexual functioning. CONCLUSIONS The findings highlight the importance of self-criticism as a potential mechanism underlying the negative impact of childhood maltreatment on sexual functioning in adulthood. This knowledge can inform interventions and therapeutic approaches aimed at addressing self-criticism and improving sexual well-being in individuals with a history of childhood maltreatment.
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Affiliation(s)
- Dana Lassri
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Israel.
| | - Ateret Gewirtz-Meydan
- School of Social Work, Faculty of Social Welfare & Health Sciences, University of Haifa, Israel. agewirtz-@univ.haifa.ac.il
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Benzi IMA, Carone N, Parolin L, Martin-Gagnon G, Ensink K, Fontana A. Different epistemic stances for different traumatic experiences: implications for mentalization. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:708. [PMID: 38156583 PMCID: PMC10772857 DOI: 10.4081/ripppo.2023.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/04/2023] [Indexed: 12/30/2023]
Abstract
Traumatic experiences may impair reflective functioning (RF), making it difficult for individuals to understand their own and others' mental states. Epistemic trust (ET), which enables evaluating social information as reliable and relevant, may vary in association with RF. In this study, we explored the implications of different ET stances (i.e., trust, mistrust, and credulity) in the relation between different childhood traumatic experiences (i.e., emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and different types of RF impairments (uncertainty and certainty about mental states). A non-clinical community sample of 496 cisgender emerging adults (mage = 24.91, standard deviation = 2.66, 71.85% assigned female at birth, 63.63% heterosexual) reported on their childhood traumatic experiences, ET, and RF. We used structural equation models to examine direct and indirect associations. The results showed significant indirect effects between emotional abuse and uncertainty about mental states through credibility. We also observed significant indirect effects between emotional abuse and certainty about mental states through mistrust and credibility. The findings suggest that a lack of discrimination when evaluating knowledge from others (i.e., credulity) might promote increased uncertainty in RF when emerging adults have experienced emotional abuse in their childhood. Conversely, a tendency to view all information sources as unreliable or ill-intentioned (i.e., mistrust) may foster greater certainty in RF as a protective mechanism against an unreliable and potentially harmful world when combined with childhood emotional abuse. The implications for clinical practice and intervention are discussed.
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Affiliation(s)
| | - Nicola Carone
- Department of Brain and Behavioral Sciences, University of Pavia.
| | - Laura Parolin
- Department of Psychology, University of Milano-Bicocca, Milan.
| | | | - Karin Ensink
- Department of Psychology, Laval University, Quebec.
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Huang M, Hou J. Childhood maltreatment and suicide risk: The mediating role of self-compassion, mentalization, depression. J Affect Disord 2023; 341:52-61. [PMID: 37633526 DOI: 10.1016/j.jad.2023.08.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Childhood maltreatment (CM) is a well-established risk factor for depression and increased suicide risk. This study aimed to investigate the distinctive mechanisms of individual types of CM on young adult suicide risk, by exploring the potential mediating role of mentalization, self-compassion, and depression. METHODS A total of 4873 adults completed a survey screening for experiences of CM, self-compassion, mentalization, depression, and suicide risk. RESULTS The path analysis revealed significant direct effects of mentalization, self-compassion, and depression on suicide risk. Moreover, mentalization, self-compassion, and depression mediated the relationship between emotional abuse/neglect and suicide risk, whereas physical neglect contributed to suicide risk only through mentalization and depression. Furthermore, sexual abuse had a significant direct effect on suicide risk, whereas physical abuse did not show any direct or indirect effects. LIMITATIONS The cross-sectional design of the study limits its ability to establish causality, and the risk of recall bias in reporting physical or sexual abuse cannot be ignored. CONCLUSIONS This study represents the first identification of disturbances in self-compassion, mentalization, and depression that mediate the relationship between various types of CM and suicide risk in young adults. Our findings suggest substantive differences in the impact of emotional CM compared to other forms of CM. Enhancing self-compassion and mentalization abilities could be valuable intervention strategies for individuals with a history of emotional CM. Addressing factors that hinder the recall of relevant subjective experiences of physical and sexual abuse is also critical.
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Affiliation(s)
- Manxia Huang
- Department of Psychology, Institute of Education, China University of Geosciences, Wuhan, China.
| | - Jinbo Hou
- Student Mental Health Education Center, China University of Geosciences, Wuhan, China
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12
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Jańczak MO. Mentalization, emotional dysregulation and attachment to alternative attachment figures in retrospectively defined earned secure adults. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2023; 12:30-40. [PMID: 38756200 PMCID: PMC11094461 DOI: 10.5114/cipp/172328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 04/24/2022] [Accepted: 09/14/2023] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Researchers have tried to identify mechanisms through which an individual overcomes negative life experiences, proposing earning security as one of them. Retrospectively defined earned secures are recognized as individuals exhibiting secure attachments to their parents while evaluating the quality of their childhood care as low. This study aimed to examine attachment, mentalization, and emotional dysregulation in this group. We hypothesized that earned secures will report better mentalizing, lower emotion dysregulation, and more secure attachment to figures other than parents than insecure individuals. PARTICIPANTS AND PROCEDURE female adult sample (N = 272) completed the Experiences in Close Relationships-Relationship Structures questionnaire, Parental Bonding Instrument, Difficulties in Emotion Regulation Scale, and Mental State Task. The time devoted to psychotherapy and demographics were also controlled as contextual variables. RESULTS We identified an 'earned secure' group (14% of the sample), exhibiting secure attachment to mothers in adulthood despite reported inadequate care during childhood, along with the continuously secure, insecure, and 'lost secure' groups. People from the earned secure and secure groups reported better emotional regulation and some aspects of mentalization than those in the insecure and lost secure groups. They equally frequently reported the presence of an adult other than parents who were important to them in childhood, but the attachment to them was more secure. We did not find evidence of differences between the groups in the duration of psychotherapy. CONCLUSIONS Secure attachment to alternative attachment figures, along with some mentalization and emotional regulation aspects, may be considered significant factors for earning security.
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Affiliation(s)
- Monika Olga Jańczak
- Faculty of Psychology and Cognitive Sciences, Adam Mickiewicz University, Poznan, Poland
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Martin-Gagnon G, Fonagy P, Bégin M, Normandin L, Ensink K. Measuring mentalizing in youth: further validation of the reflective functioning questionnaire for youth (RFQY-13). Front Psychol 2023; 14:1260281. [PMID: 37908815 PMCID: PMC10613668 DOI: 10.3389/fpsyg.2023.1260281] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/03/2023] [Indexed: 11/02/2023] Open
Abstract
Objective This study investigated the psychometric properties, including the factor structure, validity, and reliability of the 13-item Reflective Function Questionnaire for Youth (RFQY-13), using a new scoring system. Method A community sample of 414 adolescents and a clinical sample of 83 adolescents (aged 12-21) completed the RFQY, the Borderline Personality Features Scale for Children (BPFS-C), the Beck Youth Inventories (BYI), the Child Behavior Checklist-Youth Self Report (CBCL-YSR) and the Movie for the Assessment of Social Cognition (MASC). Results Using the new scoring system, our results demonstrated configural and metric invariance, as well as adequate reliability and validity across both samples for the two-factor structure of the RFQY. The Uncertainty subscale also showed strong associations with psychopathology. Discussion The findings show that the RFQY-13, when used with the new coding system, has good psychometric properties and is a reliable measure of mentalizing for adolescents and young adults. We discuss clinical implications, limitations and future directions.
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Affiliation(s)
| | - Peter Fonagy
- Psychoanalysis Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Michaël Bégin
- Département de Psychologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Lina Normandin
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - Karin Ensink
- École de Psychologie, Université Laval, Québec, QC, Canada
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14
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Raimondi G, Imperatori C, Gostoli S, Gremigni P, Innamorati M. Italian Validation of the Short Version of the Failure to Mentalize Trauma Questionnaire in Adults at Risk Due to Childhood Trauma. Behav Sci (Basel) 2023; 13:843. [PMID: 37887492 PMCID: PMC10604537 DOI: 10.3390/bs13100843] [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: 09/05/2023] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
The impact of recurrent traumatic experiences during childhood may impede the integration of mentalization abilities and lead to psychopathology. Recently, the Failure to Mentalize Trauma Questionnaire (FMTQ), a comprehensive 29-item self-report scale aimed at identifying deficits in mentalization arising from childhood trauma, was developed. However, the length of the FMTQ may render it impractical for epidemiological studies involving multiple variables and measures. Furthermore, the initial testing revealed inadequate factor reliabilities for the two first-order factors. Therefore, this study aimed to shorten and create a unidimensional version (FMTQ-s) and investigate its psychometric properties, including internal consistency and convergent and concurrent validity, in a non-clinical Italian adult sample. The factor analysis supported a 13-item unidimensional version of the FMTQ with acceptable internal consistency (ordinal alpha = 0.88) and satisfactory convergent and concurrent validity. The FMTQ-s obtained scalar invariance between individuals with and without self-reported childhood traumas. Overall, the FMTQ-s appears to be a feasible and reliable tool for assessing deficits in mentalization resulting from childhood trauma.
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Affiliation(s)
- Giulia Raimondi
- Department of Human Sciences, European University of Rome, 00163 Rome, Italy; (G.R.); (C.I.)
- Department of Psychology “Renzo Canestrari”, University of Bologna, 40127 Bologna, Italy; (S.G.); (P.G.)
| | - Claudio Imperatori
- Department of Human Sciences, European University of Rome, 00163 Rome, Italy; (G.R.); (C.I.)
| | - Sara Gostoli
- Department of Psychology “Renzo Canestrari”, University of Bologna, 40127 Bologna, Italy; (S.G.); (P.G.)
| | - Paola Gremigni
- Department of Psychology “Renzo Canestrari”, University of Bologna, 40127 Bologna, Italy; (S.G.); (P.G.)
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, 00163 Rome, Italy; (G.R.); (C.I.)
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15
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Clarke A, Rose TA, Meredith PJ. Language skills and interpersonal trust in adolescents with and without mental illness. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:589-607. [PMID: 35614858 DOI: 10.1080/17549507.2022.2075466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The primary aim was to compare adolescents with mental illness and non-clinical adolescents on vocabulary, social problem-solving, trust in parents, attachment and mentalisation. A secondary aim was to investigate whether adolescents' language skills were associated with trust in parents. METHOD Seventy-eight adolescents (16-18 years) participated in this cross-sectional quantitative study: a clinical sample (n = 28, M = 16.7 years, 19F) recruited from a mental health service and a non-clinical sample (n = 50, M = 17.0 years, 28F). Standardised language measures and self-report measures of trust in parents; communication quality; attachment; and mentalisation were used. Primary and secondary aims were addressed through independent samples t-tests and Pearson's correlation analyses, respectively. RESULT Adolescents experiencing mental illness reported significantly poorer vocabulary, less trust in mother/father, greater attachment anxiety/avoidance, and poorer reflective functioning, than non-clinical adolescents. Expressive vocabulary of clinical (but not non-clinical) adolescents significantly negatively correlated with trust in mother (but not father). CONCLUSION Results highlight a role for speech-language pathologists (SLPs) in supporting communication needs of adolescents with mental illness. SLPs should consider trust by: i) understanding adolescents with mental illness may have difficulty trusting them potentially impacting therapeutic engagement; and ii) delivering services in ways that might build trust, such as involving adolescents in treatment planning.
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Affiliation(s)
- Angela Clarke
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
- Assertive Mobile Youth Outreach Service, Child and Youth Mental Health Services, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Tanya A Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Pamela J Meredith
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
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16
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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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17
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Ensink K, Bégin M, Martin-Gagnon G, Biberdzic M, Berthelot N, Normandin L, Fonagy P, Bernazzani O, Borelli JL. Post-traumatic-stress in the context of childhood maltreatment: pathways from attachment through mentalizing during the transition to parenthood. Front Psychol 2023; 14:919736. [PMID: 37359870 PMCID: PMC10289889 DOI: 10.3389/fpsyg.2023.919736] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/17/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction This study aimed to clarify the role of mentalizing in pathways from attachment to Post Traumatic Stress Symptoms (PTSS) in survivors of childhood maltreatment (CM). We focused on the transition to parenting, a critical period for reworking parenting representations to reduce intergenerational maltreatment cycles. Method Study participants included 100 pregnant CM survivors. We assessed PTSS with the SCID and attachment and mentalizing with the Adult Attachment Interview (AAI), which was rated for Attachment and Reflective Functioning (RF). Results Regarding Re-experiencing trauma symptoms, the results of the path analysis were consistent with mediation. CM survivors' mentalizing about their early relationships with their parents (RF-Other) directly impacted Re-experiencing trauma symptoms, and attachment had an effect on Re-experiencing trauma symptoms through mentalizing (RF-Other). Regarding Arousal/Reactivity symptoms, the results of the pathways analysis were consistent with partial mediation by mentalizing about early relationships with parents (RF-Other). In addition to the pathway from attachment via mentalizing (RF-Other) to Arousal/Reactivity, the pathway between attachment and Arousal/Reactivity also remained significant. Discussion This study provides new evidence of a mentalizing and attachment model of PTSS in CM survivors. The findings indicate that increased mentalizing about early relationships with parents is an important process associated with lower PTSS. Finally, we discuss the implications of developing interventions for CM survivors to reduce PTSS. Scaffolding the development of mentalizing regarding attachment relationships in which CM occurred may help CM survivors reduce the intrusion of traumatic memories and decrease trauma-related arousal and reactivity symptoms. Interventions to help CM survivors mentalize regarding parents and attachment relationships in which trauma occurred may be particularly important during the transition to parenting when activation of representations of parenting can trigger PTSS.
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Affiliation(s)
- Karin Ensink
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - Michaël Bégin
- Département de Psychologie, Université de Sherbrooke, Québec, QC, Canada
| | | | - Marko Biberdzic
- Department of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Nicolas Berthelot
- Department of Nursing, Université du Québec à Trois-Rivières, Québec, QC, Canada
| | - Lina Normandin
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - Peter Fonagy
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Odette Bernazzani
- Department of Psychiatry, Université de Montréal, Québec, QC, Canada
| | - Jessica L. Borelli
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
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18
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Locati F, Milesi A, Conte F, Campbell C, Fonagy P, Ensink K, Parolin L. Adolescence in lockdown: The protective role of mentalizing and epistemic trust. J Clin Psychol 2023; 79:969-984. [PMID: 36256870 PMCID: PMC9874639 DOI: 10.1002/jclp.23453] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/14/2022] [Accepted: 10/03/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Mentalizing is the ability to interpret one's own and others' behavior as driven by intentional mental states. Epistemic trust (openness to interpersonally transmitted information) has been associated with mentalizing. Balanced mentalizing abilities allow people to cope with external and internal stressors. Studies show that social isolation imposed by the COVID-19 pandemic was highly stressful for most people, especially for adolescents. Here we examine whether mentalizing and epistemic trust were protective factors in relation to emotional distress during the lockdown. METHOD A total of 131 nonclinical adolescents, aged between 12 and 18 years, were evaluated during the lockdown using the Reflective Functioning Questionnaire for Youth, Inventory of Parent and Peer Attachment, Perceived Stress Scale, and Difficulties in Emotion Regulation Scale. RESULTS Results from network analysis showed that epistemic trust and mentalizing were negatively associated with perceived stress and emotion dysregulation. Epistemic trust in fathers was associated with level of perceived stress, and epistemic trust in mothers with emotion dysregulation. CONCLUSION These findings suggest that epistemic trust and the capacity to mentalize were low in adolescents during lockdown, and this was associated with high levels of stress. However, robust levels of epistemic trust and mentalizing may have acted as protective factors that buffered individuals from the risk of emotional dysregulation during the lockdown.
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Affiliation(s)
| | - Alberto Milesi
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Federica Conte
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Chloe Campbell
- Psychoanalysis Unit, University College London and Anna Freud National Centre for Children and Families, London, UK
| | - Peter Fonagy
- Psychoanalysis Unit, University College London and Anna Freud National Centre for Children and Families, London, UK
| | - Karin Ensink
- Faculté des sciences sociales, Université Laval, Québec, Canada
| | - Laura Parolin
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
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19
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Lavender SR, Waters CS, Hobson CW. The efficacy of group delivered mentalization-based parenting interventions: A systematic review of the literature. Clin Child Psychol Psychiatry 2023; 28:761-784. [PMID: 35819989 DOI: 10.1177/13591045221113392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mentalization refers to the capacity to understand and interpret one's own and others mental states. There is good evidence for individualised treatments aimed at increasing this capacity with children and adolescents. However, there has been no focused synthesis of the literature concerning specifically group delivered mentalization-based parenting interventions. The current study aimed to systematically review the literature in relation to group delivered mentalization-based parenting interventions. Three databases were searched to identify N=515 studies that were screened and reported according to PRISMA guidelines. Inclusion criteria were met by N=10 studies. Interventions varied in terms of content, but often included psychoeducation, experiential group exercises and homework tasks. The length and setting of interventions did not appear to influence outcomes. Significant improvements in parental reflective functioning were found in eight of the ten studies. There was mixed evidence for the efficacy in terms of other parental and child outcomes. This may be due to the lack of high quality studies and the absence of longer-term follow-ups. There is a need for future research to conduct high quality studies with greater diversity in participating parents and long-term follow-up.
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20
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Fonagy P, Campbell C, Luyten P. Attachment, Mentalizing and Trauma: Then (1992) and Now (2022). Brain Sci 2023; 13:brainsci13030459. [PMID: 36979268 PMCID: PMC10046260 DOI: 10.3390/brainsci13030459] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023] Open
Abstract
This article reviews the current status of research on the relationship between attachment and trauma in developmental psychopathology. Beginning with a review of the major issues and the state-of-the-art in relation to current thinking in the field of attachment about the impact of trauma and the inter-generational transmission of trauma, the review then considers recent neurobiological work on mentalizing and trauma and suggests areas of new development and implications for clinical practice.
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Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
- Correspondence:
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
- Faculty of Psychology and Educational Sciences, KU Leuven, B-3000 Leuven, Belgium
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21
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Katzman W, Papouchis N. Effects of Childhood Trauma on Mentalization Capacities and Dissociative Experiences. J Trauma Dissociation 2023; 24:284-295. [PMID: 36744638 DOI: 10.1080/15299732.2023.2168829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study examined the relationship between childhood trauma, dissociation, and mentalization. Childhood trauma has been understood to affect both dissociation and mentalization, but it is unclear how these processes interact amidst the presence of childhood trauma. Specifically, the study sought to determine whether hypermentalization or hypomentalization would mediate the relationship between childhood trauma and dissociation. Mentalization describes the ability to understand the mental states of both the self and others, and suboptimal mentalization occurs when an individual experiences hypermentalizing, understood as a high level of certainty about mental states, or hypomentalizing, understood as a high level of uncertainty about mental states. 100 participants completed self-report measures assessing their experiences of childhood trauma using the Early Trauma Inventory Short Form Revised, dissociation using the Dissociative Experiences Scale II, and mentalization capacities using the Reflective Functioning Questionnaire. A series of mediation analyses were conducted, and it was found that neither hypermentalization or hypomentalization mediated the relationship between childhood trauma and dissociation. However, additional analyses revealed that dissociation mediated the relationship between childhood trauma and hypermentalization. The implications of the findings are explored and discussed within the context of the current literature, and the relationship between dissociation and mentalization is considered.
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Affiliation(s)
- William Katzman
- Clinical Psychology, Long Island University, Brooklyn, Long Island, USA
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22
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Emotion Regulation Strategies as Risk Factors for Developmental Psychopathology: a Meta-analytic Review of Longitudinal Studies based on Cross-lagged Correlations and Panel Models. Res Child Adolesc Psychopathol 2023; 51:295-315. [PMID: 36208360 DOI: 10.1007/s10802-022-00980-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 02/09/2023]
Abstract
Cross-sectional relationships between emotion regulation strategies (ERSs) and several psychopathological conditions among children and adolescents have been well-demonstrated. However, the longitudinal associations of ERSs on psychopathological manifestations during development remain unclear, especially considering their reciprocal influences over time. This meta-analytic review was based on a set of ERSs referring to a comprehensive evidence-based model of ER processes. Three hundred thirty-five studies were screened. The meta-analytic procedures were based on 60 studies (N = 20, 191; age: M [SD] = 10.27 [4.36]; years of follow-up: M [SD] = 2.23 [2.76]), which primarily assessed prospective associations between ERt1 and internalizing/externalizing psychopathology (PSY)t2. The cross-lagged correlations among these variables were also considered. Results showed: i) a small prospective association between ERt1 and PSY t2, which was independent of age and length of follow-up period. Adaptive and maladaptive domains of ER were significant moderators. Deficits in adaptive ER seemed more associated to externalizing PSY, whereas maladaptive ER was more associated to internalizing PSY; ii) cross-lagged correlations were comparable with ERt1 - PSY t2 associations. Nevertheless, the detrimental effects of PSY t1 on levels of adaptive ERt2 were larger than the protective effects of adaptive ERt1 on PSYt2. iii) When the other cross-lagged correlations were controlled for, the meta-analytic cross-lagged panel model demonstrated that maladaptive ERt1 was a significant predictor of PSYt2. ER processes should be considered transdiagnostic risk factors for psychopathology during development. Homotypic and heterotypic continuity of psychopathological conditions might reflect the stability or dynamic organization of adaptive and maladaptive ERSs over time.
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23
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Bryant RA. Attachment processes in posttraumatic stress disorder: A review of mechanisms to advance theories and treatments. Clin Psychol Rev 2023; 99:102228. [PMID: 36493729 DOI: 10.1016/j.cpr.2022.102228] [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: 07/21/2022] [Revised: 10/31/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
Current conceptualisations of posttraumatic stress disorder (PTSD) are driven by biological, learning, and cognitive models that have shaped current treatments of the disorder. The strong influence of these models has resulted in a relative neglect of social mechanisms that can influence traumatic stress. There is abundant evidence from experimental, observational, and clinical studies that social factors can moderate many of the mechanisms articulated in prevailing models of PTSD. In this review it is proposed that attachment theory provides a useful framework to complement existing models of PTSD because it provides explanatory value for social factors can interact with biological, learning, and cognitive processes that shape traumatic stress response. The review provides an overview of attachment theory in the context of traumatic stress, outlines the evidence for how attachment factors can moderate stress responses and PTSD, and considers how harnessing attachment processes may augment recovery from and treatment of PTSD. This review emphasizes that rather than conceptualizing attachment theory as an independent theory of traumatic stress, there is much to gain by integrating attachment mechanisms into existing models of PTSD to accommodate the interactions between cognitive, biological, and attachment processes.
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24
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Lassri D, Bregman-Hai N, Soffer-Dudek N, Shahar G. The Interplay Between Childhood Sexual Abuse, Self-Concept Clarity, and Dissociation: A Resilience-Based Perspective. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:2313-2336. [PMID: 35593092 PMCID: PMC9850382 DOI: 10.1177/08862605221101182] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite a robust consensus regarding the potentially negative implications of childhood sexual abuse (CSA), research investigating risk and protective factors-particularly among well-functioning young adults-is scant. Dissociation is one of the major maladaptive outcomes of CSA. Nevertheless, CSA explains only about 10% of the variance of dissociation. Possibly, this modest effect size is due to protective factors moderating the relation between CSA and dissociative symptoms. One such factor may be the extent to which one has succeeded in developing a clear and coherent sense of who they are. OBJECTIVE We aimed to explore whether self-concept clarity (SCC) moderates the relationship between CSA and dissociation (Model 1), and an alternative hypothesis, whereby CSA may moderate the relationship between SCC and dissociation (Model 2). PARTICIPANTS AND SETTING This was tested among 65 well-functioning young women drawn from an earlier study that intentionally oversampled CSA survivors. METHODS We included data from survivors of CSA by a known perpetrator (n = 35) and women with no sexual trauma (n = 30). RESULTS Findings were consistent with both Model 1 and Model 2, but only when depersonalization-derealization, namely detachment, was considered. Simple effects analyses revealed that CSA was related to depersonalization-derealization only under low SCC levels (Model 1), and SCC was negatively related to depersonalization-derealization only in the CSA group (Model 2). CONCLUSIONS Findings suggest that SCC is a protective factor, buffering the association between CSA and detachment (depersonalization-derealization) symptoms. Clinical implications are discussed.
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Affiliation(s)
- Dana Lassri
- The Paul Baerwald School of Social
Work and Social Welfare, The Hebrew University of
Jerusalem, Jerusalem, Israel
- Research Department of Clinical,
Educational and Health Psychology, UCL (University College
London), London, UK
| | - Noa Bregman-Hai
- Department of Psychology,
Ben-Gurion
University of the Negev, Beer-Sheva,
Israel
| | - Nirit Soffer-Dudek
- Department of Psychology,
Ben-Gurion
University of the Negev, Beer-Sheva,
Israel
| | - Golan Shahar
- Department of Psychology,
Ben-Gurion
University of the Negev, Beer-Sheva,
Israel
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25
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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: 3] [Impact Index Per Article: 1.5] [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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26
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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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Stagaki M, Nolte T, Feigenbaum J, King-Casas B, Lohrenz T, Fonagy P, Montague PR. The mediating role of attachment and mentalising in the relationship between childhood maltreatment, self-harm and suicidality. CHILD ABUSE & NEGLECT 2022; 128:105576. [PMID: 35313127 PMCID: PMC10466023 DOI: 10.1016/j.chiabu.2022.105576] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 01/01/2022] [Accepted: 02/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Although the relationship between childhood maltreatment, self-harm and suicidality is well-established, less is known about the mediating mechanisms explaining it. Based on a developmental mentalisation-based theoretical framework, childhood adversity compromises mentalising ability and attachment security, which in turn increase vulnerability to later stressors in adulthood. OBJECTIVE This study aimed to investigate the role of attachment and mentalising as potential mechanisms in the relationship between childhood maltreatment, self-harm and suicidality. PARTICIPANTS AND SETTING We recruited 907 adults from clinical and community settings in Greater London. METHODS The study design was cross-sectional. Participants completed self-report questionnaires on retrospectively rated childhood trauma, and current attachment to the romantic partner, mentalising, self-harm, suicidal ideation and attempt. We used structural equation modelling to examine the data and conceptualized childhood maltreatment as a general factor in a confirmatory bifactor model. RESULTS The results showed that childhood maltreatment was both directly associated with self-harm and suicidality and indirectly via the pathways of attachment and mentalising. CONCLUSIONS These findings indicate that insecure attachment and impaired mentalising partially explain the association between childhood maltreatment, self-harm and suicidality. Clinically, they provide support for the potential of mentalisation-based therapy or other psychosocial interventions that aim to mitigate the risk of self-harm and suicidality among individuals who have experienced childhood maltreatment via increasing understanding of self and other mental states.
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Affiliation(s)
- Maria Stagaki
- Division of Psychiatry, University College London, London, United Kingdom.
| | - Tobias Nolte
- Wellcome Trust Centre for Neuroimaging, University College London, London, United Kingdom; Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Janet Feigenbaum
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Brooks King-Casas
- Fralin Biomedical Research Institute, Department of Psychology, Virginia Tech, Roanoke, VA, United States of America
| | - Terry Lohrenz
- Fralin Biomedical Research Institute, Department of Psychology, Virginia Tech, Roanoke, VA, United States of America
| | - Peter Fonagy
- Anna Freud National Centre for Children and Families, London, United Kingdom; Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - P Read Montague
- Wellcome Trust Centre for Neuroimaging, University College London, London, United Kingdom; Fralin Biomedical Research Institute, Department of Psychology, Virginia Tech, Roanoke, VA, United States of America; Department of Physics, Virginia Tech, Blacksburg, VA, United States of America; Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Virginia Tech, Roanoke, VA, United States of America
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Sauvé M, Cyr C, St-Laurent D, Amédée LM, Dubois-Comtois K, Tarabulsy GM, Bernier A, Moss E. Transmission of parental childhood trauma to child behavior problems: Parental Hostile/Helpless state of mind as a moderator. CHILD ABUSE & NEGLECT 2022; 128:104885. [PMID: 33422283 DOI: 10.1016/j.chiabu.2020.104885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Little attention has been given to intergenerational transmission of risk, mainly whether caregivers' history of childhood maltreatment is linked to behavioral symptoms in their children and which protective/risk factors are involved in this transmission process. OBJECTIVE This study examined if parental Hostile/Helpless (H/H) state of mind with respect to attachment moderated the association between parental childhood trauma and behavior problems in maltreated children. PARTICIPANTS AND SETTING The sample included 61 parents and their children victims or at very high risk of maltreatment, aged between 1 and 6 years old. METHOD Parents retrospectively reported their childhood trauma and completed a measure of their children's behavior problems. Independent observers assessed H/H attachment representations. RESULTS Among parents with H/H states of mind, more severe traumatic childhood experiences were associated with more externalizing and internalizing behavior problems in their children. Among non-H/H parents, associations between parental childhood trauma and child behavior problems were not significant. CONCLUSIONS In the context of trauma, this study suggests that the absence of a H/H state of mind in parents (i.e., the presence of an organized attachment state of mind) is a protective factor for child adjustment. H/H mental representations of self and attachment experiences as targets of intervention for parents with histories of maltreatment may help reduce the transmission of risk in maltreating families.
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Affiliation(s)
- Michèle Sauvé
- Department of Psychology, Université du Québec à Montréal, Canada
| | - Chantal Cyr
- Department of Psychology, Université du Québec à Montréal, Canada; Institut-Universitaire Jeunes en Difficulté, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Canada.
| | - Diane St-Laurent
- Department of Psychology, Université du Québec à Trois-Rivières, Canada; Centre de Recherche Universitaire sur les Jeunes et les Familles, CIUSSS de la Capitale Nationale
| | | | - Karine Dubois-Comtois
- Department of Psychology, Université du Québec à Trois-Rivières, Canada; Centre de recherche, CIUSSS du-Nord-de-l'Île-de-Montréal, Canada
| | - George M Tarabulsy
- School of Psychology, Université Laval, Canada; Centre de Recherche Universitaire sur les Jeunes et les Familles, CIUSSS de la Capitale Nationale
| | - Annie Bernier
- Department of Psychology, Université de Montréal, Canada; Centre de Recherche Universitaire sur les Jeunes et les Familles, CIUSSS de la Capitale Nationale
| | - Ellen Moss
- Department of Psychology, Université du Québec à Montréal, Canada
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Are Affective Temperaments, Emotional Abuse, and Neglect Involved in Mentalization Abilities in Patients With Psychiatric Disorders? J Nerv Ment Dis 2022; 210:276-281. [PMID: 34710896 DOI: 10.1097/nmd.0000000000001440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patients who have experienced emotional abuse and neglect often develop psychiatric disorders in adulthood. However, whether emotional abuse, neglect, and mentalization abilities relate to one another and the role of possible mediators of this relationship in psychiatric patients are still unknown. We evaluated the potential role of affective temperament as a mediator of the relationship between emotional abuse and neglect and mentalization. We performed a cross-sectional study of 252 adult psychiatric inpatients. The Childhood Trauma Questionnaire, Mentalization Questionnaire, and Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) were administered. Results showed a significant indirect effect of emotional abuse and neglect on scores on the Mentalization Questionnaire through the TEMPS-A (b = 0.25, 95% confidence interval [0.143-0.375]), demonstrating that affective temperament mediates the relationship among emotional abuse, neglect, and mentalization impairment in psychiatric patients. A careful evaluation of mentalization abilities in patients with psychiatric disorders and who have a history of emotional abuse and neglect is necessary for a better understanding of psychopathology and for the choice of therapeutic strategies.
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Bizzi F, Locati F, Parolin L, Goetz Yael S, Brusadelli E. Advancement in the child attachment interview and the child and adolescent reflective functioning scale using a PDM-2 framework: case reports. RESEARCH IN PSYCHOTHERAPY: PSYCHOPATHOLOGY, PROCESS AND OUTCOME 2022; 25. [PMID: 35373961 PMCID: PMC9153759 DOI: 10.4081/ripppo.2022.586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022]
Abstract
The Child Attachment Interview (CAI) is a well-established semi-structured interview, widely used to identify attachment representations in middle childhood and adolescence. The application of the Child and Adolescent Reflective Functioning Scale (CRFS) to CAI narratives allows for an assessment of child mentalization, considered a strong predictor of attachment security. The 2nd edition of the Psychodynamic Diagnostic Manual (PDM-2) includes CAI and CRFS as valid and reliable assessment measures in order to assess the dominion of the Mental Functioning axis. The aim of the present paper is to investigate the informative power of CAI and CRFS for the overall understanding of mental functioning and personality in a PDM-2 framework. The present report includes the discussion of two clinical cases of school-aged children in applying the Psychodiagnostic Chart-Second Edition (PDC-2) to the CAI transcript. The first case concerns a young male, aged 10, suffering from Oppositional-Provocative Disorder (externalizing disorder), while the second case concerns a young female, aged 15, suffering from Somatic Symptoms Disorder (internalizing disorder). PDC-2 for children and adolescents was used. Data from the scoring of CAI and CRFS were combined with a systematic evaluation of the qualitative contents emerging from CAI transcripts. A detailed analysis suggests that both the CAI and CRFS are useful attachment-oriented measures, able to explore child’s mental states, and together with the application of PDC-2 they provide an essential contribution in the understanding of developmental psychopathology. Implications of this innovative approach for clinical assessment, treatment design, and interventions are further discussed.
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Degnan A, Berry K, Humphrey C, Bucci S. The role of attachment and dissociation in the relationship between childhood interpersonal trauma and negative symptoms in psychosis. Clin Psychol Psychother 2022; 29:1692-1706. [PMID: 35218114 PMCID: PMC9790513 DOI: 10.1002/cpp.2731] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/17/2022] [Accepted: 02/23/2022] [Indexed: 12/30/2022]
Abstract
Negative symptoms have an adverse impact on quality of life and functioning in psychosis. Service users with psychosis have identified negative symptoms as a priority for their recovery. Despite this, there is a lack of effective and targeted psychological interventions for negative symptoms and their underlying mechanisms remain poorly understood. Childhood trauma is a robust risk factor for positive symptoms in psychosis, but the association with negative symptoms is less well established. Our aim was to examine the association between childhood interpersonal trauma and negative symptoms and the psychological mediators of this relationship. Two hundred and forty participants experiencing psychosis completed validated self-report measures of childhood trauma, attachment, dissociation, compartmentalization, and symptoms. Mediation analyses showed that disorganized attachment and dissociative experiences mediated the association between childhood trauma and negative symptoms, when analysed individually and in a combined model. Models adjusted for age and positive and depressive symptoms. Avoidant attachment and compartmentalization were independently associated with negative symptoms but not childhood trauma and thus were not significant mediators. Childhood trauma was not independently associated with negative symptoms. This paper is the first to present empirical data to support a model implicating attachment and dissociation as important psychological processes in the link between childhood trauma and negative symptoms. These exploratory findings suggest that it may be beneficial to consider these relationships in trauma-informed formulations and interventions. Further longitudinal research is required to establish causality and test theoretical models of mechanisms in the pathway to negative symptoms.
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Affiliation(s)
- Amy Degnan
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthManchester Academic Health Sciences Centre, The University of ManchesterManchesterUK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthManchester Academic Health Sciences Centre, The University of ManchesterManchesterUK
| | - Charlotte Humphrey
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthManchester Academic Health Sciences Centre, The University of ManchesterManchesterUK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthManchester Academic Health Sciences Centre, The University of ManchesterManchesterUK
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Glaus J, Moser DA, Rusconi Serpa S, Jouabli S, Turri F, Plessen KJ, Schechter DS. Families With Violence Exposure and the Intergenerational Transmission of Somatization. Front Psychiatry 2022; 13:820652. [PMID: 35280182 PMCID: PMC8904725 DOI: 10.3389/fpsyt.2022.820652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Adults who have histories of childhood trauma have been noted to display greater somatization, dissociative symptoms and affect dysregulation. What happens in the parent-child relationship when those traumatized children become parents? A potential link to somatization in the child has been suggested by several prior studies. Children who have early attachment disturbances had more physical complaints if their mothers displayed less maternal sensitivity during observed parent-child interactions. Yet, the intergenerational link between maternal and child somatization has not been sufficiently explored in a longitudinal study in order to understand the potential impact of maternal trauma history and related psychopathology on subsequent child somatization and psychopathology. METHODS This paper examined prospective, longitudinal data of 64 mother-toddler dyads (mean age = 2.4 years, SD = 0.7) who were later studied when children had a mean age of 7 years. Mothers with and without histories of interpersonal violence (IPV; physical/sexual abuse and/or family violence exposure) were included. Mothers with IPV histories were oversampled. Linear and Poisson regression models were used to test the associations between maternal IPV-related post-traumatic stress disorder (PTSD) with maternal somatization severity when children were toddlers, and between maternal somatization and maternal interactive behaviors with child somatization by maternal report and clinician-rated assessment at school-age. RESULTS Maternal PTSD severity was significantly associated with increased maternal somatization severity (p = 0.031). Maternal somatization severity during the child's early childhood predicted both maternal report of child somatization (p = 0.011) as well as child thought problems (p = 0.007) when children were school-aged. No association was found between maternal somatization and child-reported psychopathology. The study did not find that maternal alexithymia, caregiving behaviors or child exposure to violence contributed significantly to the model examining the association between maternal and child somatization. CONCLUSION The results are in line with the hypothesis of intergenerational transmission of somatization in the context of IPV and related maternal PTSD during formative early development. We interpret this as an expression of psychological distress from mother to child, as maternal trauma and pathology affect the caregiving environment and, thus, the parent-child relationship. The authors conclude with a discussion of implications for parent-infant and early childhood intervention.
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Affiliation(s)
- Jennifer Glaus
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Dominik A Moser
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | | | - Sondes Jouabli
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Fiorella Turri
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Kerstin J Plessen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Daniel S Schechter
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.,Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, United States
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Gewirtz-Meydan A, Lassri D. #Me2PT: A qualitative analysis of a social media network campaign to raise awareness of the consequences of childhood sexual abuse. CHILD ABUSE & NEGLECT 2021; 121:105267. [PMID: 34418862 DOI: 10.1016/j.chiabu.2021.105267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 07/29/2021] [Accepted: 08/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Childhood sexual abuse (CSA) is a highly prevalent and serious stressor, linked to short- and long-term psychopathology and to posttraumatic stress disorder (PTSD) specifically. The hashtag #Me2PT, which stands for "me-too-post-trauma," was created in order to raise awareness of the longitudinal consequences of sexual abuse, as specifically manifested in symptoms of PTSD or complex PTSD. It was disseminated on social media networks during 2019 and offered a platform for CSA survivors to share their own personal experience of living with CSA-related posttraumatic symptoms. OBJECTIVE The current study was designed in order to examine the way survivors conveyed their experiences and perceptions with response to the invitation of the hashtag #Me2PT. All the posts were written in the Hebrew-language, and thematic analysis was carried on all the written narratives. PARTICIPANTS AND SETTING 40 Posts that were written in the Hebrew language under the hashtag campaign of #Me2PT. METHODS Thematic analysis was carried on the 40 posts by two of the authors. Shenton four criterions for qualitative study trustworthiness were employed with peer discussion on main results were discussed with the leaders of the campaign, survivors of CSA. RESULTS The authors identified four main themes within the written narratives of the survivors: (1) why am I writing, (2) my personal PTSD, (3) between life and death, and (4) post-trauma as 'a bleeding wound'. CONCLUSIONS These findings exemplify the constant mental pain and struggle that survivors deal with, but at the same time demonstrate the importance of hope, the comfort found in being understood, and the wish to live a meaningful life despite the pain. This paper may contribute to the understanding of survivors' experiences of living with CSA-related posttraumatic symptoms, as conveyed by them spontaneously and authentically, potentially informing best practice for professionals working with this population.
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Affiliation(s)
- Ateret Gewirtz-Meydan
- School of Social Work, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel. agewirtz-@univ.haifa.ac.il
| | - Dana Lassri
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Israel.
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Karaca Dinç P, Oktay S, Durak Batıgün A. Mediation role of alexithymia, sensory processing sensitivity and emotional-mental processes between childhood trauma and adult psychopathology: a self-report study. BMC Psychiatry 2021; 21:508. [PMID: 34654396 PMCID: PMC8520293 DOI: 10.1186/s12888-021-03532-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND There is overwhelming evidence for a strong association between childhood trauma and adult psychopathology. This study aimed to investigate the mediation roles of alexithymia, sensory processing sensitivity, and emotional-mental processes in the relationship between childhood traumas and adult psychopathology. METHODS The sample consisted of 337 people (78.9% female, 21.1% male) aged between 20 and 64 years. Participants filled the scales online via a Google form. Reading Mind in the Eyes (EYES), Sensory Processing Sensitivity Scale (SPS), Toronto Alexithymia Scale (TAS-26), Childhood Trauma Questionnaire (CTQ), and the Brief Symptom Inventory (BSI) were used. PROCESS (Model 4) macro was used to examine the mediating role of sensory processing sensitivity, alexithymia, and the EYES test results in the relationship between childhood trauma and psychopathology. RESULTS The results of mediation analysis demonstrated that sensory processing sensitivity and alexithymia mediated the relationship between childhood trauma and adult psychopathology. However, the EYES test (mentalization) did not mediate in this relationship. CONCLUSION This study shows that childhood traumas may relate to more psychological symptoms in individuals with high sensory processing sensitivity and alexithymia. Our study may contribute to the understanding of what may lead to a person's vulnerability to experiencing psychological symptoms after childhood trauma. It may be crucial that future treatment and intervention programs should include sensory sensitivity and alexithymia. Sensory processing sensitivity and alexithymia can be examined in the treatment of psychological problems of individuals who have experienced childhood trauma.
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Affiliation(s)
- Pelin Karaca Dinç
- Ankara University, Ankara, Turkey
- Department of Psychology, Faculty of Languages History and Geography, University of Ankara University, No:45-45/A 06100, Sıhhiye, Ankara, Turkey
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Bianco F, Levante A, Petrocchi S, Lecciso F, Castelli I. Maternal Psychological Distress and Children's Internalizing/Externalizing Problems during the COVID-19 Pandemic: The Moderating Role Played by Hypermentalization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910450. [PMID: 34639750 PMCID: PMC8507724 DOI: 10.3390/ijerph181910450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/19/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Abstract
In order to explore the psychological impact of the COVID-19 outbreak on the caregiver–child relationship, we investigated the interplay among COVID-19 exposure and children’s internalizing/externalizing problems during the Italian lockdown, hypothesizing a mediation effect played by maternal distress. Additionally, we included maternal reflective functioning (i.e., hypermentalization) as a moderator factor among this interplay. A total of 305 Italian mothers of children aged 6–13 years (M = 10.3; SD = 2.4) filled in an online survey. Findings revealed an indirect effect of maternal COVID-19 exposure on children’s anxious/depressed (k2 = 0.46) and attention problems (k2 = 0.32) via maternal distress. Hypermentalization moderated the impact of maternal COVID-19 exposure on children’s anxious/depressed problems (β = −1.08, p = 0.04). Hypermentalization moderated both the relation between maternal distress and children’s aggressive behaviors (β = 12.226; p < 0.001) and between maternal distress and children’s attention problems (β = 5.617, p < 0.001). We found pivotal significant effects of maternal hypermentalization on children’s anxious/depressed and attention problems, indicating that the higher the mother’s hypermentalization was, the higher the children’s problems were. Our results broaden what we knew on the role of maternal reflective and emotional functioning on children’s emotional/behavioral adjustment during stressful situations.
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Affiliation(s)
- Federica Bianco
- Department of Human and Social Sciences, University of Bergamo, Bergamo 24129, Italy
- Correspondence: (F.B.); (I.C.)
| | - Annalisa Levante
- Department of History, Society, and Human Studies, University of Salento, 73100 Lecce, Italy; (A.L.); (F.L.)
- Lab of Applied Psychology, Department of History, Society, and Human Studies, University of Salento, 73100 Lecce, Italy
| | - Serena Petrocchi
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Via Buffi 13, Lugano 6900, Switzerland;
| | - Flavia Lecciso
- Department of History, Society, and Human Studies, University of Salento, 73100 Lecce, Italy; (A.L.); (F.L.)
- Lab of Applied Psychology, Department of History, Society, and Human Studies, University of Salento, 73100 Lecce, Italy
| | - Ilaria Castelli
- Department of Human and Social Sciences, University of Bergamo, Bergamo 24129, Italy
- Correspondence: (F.B.); (I.C.)
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Ensink K, Fonagy P, Normandin L, Rozenberg A, Marquez C, Godbout N, Borelli JL. Post-traumatic Stress Disorder in Sexually Abused Children: Secure Attachment as a Protective Factor. Front Psychol 2021; 12:646680. [PMID: 34385945 PMCID: PMC8353276 DOI: 10.3389/fpsyg.2021.646680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 04/06/2021] [Indexed: 01/21/2023] Open
Abstract
The aim of the present study was to examine the hypothesis that attachment and childhood sexual abuse (CSA) interacted such that school aged CSA survivors with insecure attachment to parents would be at an elevated risk of developing post-traumatic stress disorder (PTSD) and trauma symptoms. Participants (n = 111, ages 7-12) comprised two groups, child CSA survivors (n = 43) and a matched comparison group of children (n = 68) recruited from the community. Children completed the Child Attachment Interview (CAI) as well as the Trauma Symptom Checklist for Children (TSCC). There was a significant interaction between sexual abuse history and attachment security, such that sexually abused children with insecure attachment representations had significantly more PTSD and trauma symptoms than sexually abused children with secure attachment to parents. The findings show that using a dual lens of attachment and CSA can facilitate the identification of children most at risk and has important implications for understanding risk and resilience processes.
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Affiliation(s)
- Karin Ensink
- Pavillon Félix-Antoine-Savard, Université Laval, Quebec, QC, Canada
| | - Peter Fonagy
- University College London, London, United Kingdom
| | - Lina Normandin
- Pavillon Félix-Antoine-Savard, Université Laval, Quebec, QC, Canada
| | - Abby Rozenberg
- Department of Psychological Science, Social and Behavioral Sciences Gateway, University of California, Irvine, Irvine, CA, United States
| | - Christina Marquez
- Department of Psychological Science, Social and Behavioral Sciences Gateway, University of California, Irvine, Irvine, CA, United States
| | | | - Jessica L. Borelli
- Department of Psychological Science, Social and Behavioral Sciences Gateway, University of California, Irvine, Irvine, CA, United States
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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: 6] [Impact Index Per Article: 2.0] [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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Fonagy P, Campbell C. Future directions in personality pathology. Curr Opin Psychol 2021; 37:145-151. [PMID: 33571731 DOI: 10.1016/j.copsyc.2021.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/07/2020] [Accepted: 01/02/2021] [Indexed: 12/12/2022]
Abstract
This article suggests two areas of future development in the realm of personality pathology. First, a reconceptualization of personality pathology in the context of research evidence suggestive of a single model for psychopathology. Recent work on the 'p factor', in combination with findings from clinical research, behavior genetics, molecular biology, and neurobiological models are considered in relation to this reconceptualization of personality pathology. Second, a cultural-developmental model for personality pathology is proposed, based on Gergely and Csibra's work on natural pedagogy, Tomasello's work on joint attention and intentionality, and our recent work on epistemic trust and the social-communicative nature of psychopathology.
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Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK; Anna Freud National Centre for Children and Families, London, UK.
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK; Anna Freud National Centre for Children and Families, London, UK
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Fischmann T, Asseburg LK, Green J, Hug F, Neubert V, Wan M, Leuzinger-Bohleber M. Can Psychodynamically Oriented Early Prevention for "Children-at-Risk" in Urban Areas With High Social Problem Density Strengthen Their Developmental Potential? A Cluster Randomized Trial of Two Kindergarten-Based Prevention Programs. Front Psychol 2020; 11:599477. [PMID: 33362662 PMCID: PMC7759147 DOI: 10.3389/fpsyg.2020.599477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
Children who live on the margins of society are disadvantaged in achieving their developmental potential because of the lack of a necessary stable environment and nurturing care. Many early prevention programs aim at mitigating such effects, but often the evaluation of their long-term effect is missing. The aim of the study presented here was to evaluate such long-term effects in two prevention programs for children-at-risk growing up in deprived social environments focusing on child attachment representation as the primary outcome as well as on self-reflective capacities of teachers taking care of these children. The latter was a key component for promoting resilient behavior in children. Five hundred and twenty-six children aged 36 to 60 months at risk due to immigration status, low family socio-economic status and child behavior were examined in a cluster-randomized study comparing two preventions, the psychodynamic, attachment-based holistic approach EARLY STEPS (ES) with the classroom based FAUSTLOS (FA) for their efficacy. Primary outcome was the child attachment representation measured by the Manchester Child Attachment Story Task (MCAST). Secondary outcomes were derived from (a) the Caregiver-Teacher Report Form (C-TRF: problem behaviors, including anxiety/depressive symptoms, emotional-reactive and somatic problems, social withdrawal, aggressive behavior, and attention deficit), from (b) the Strength and Difficulties Questionnaire (SDQ, parent version: resilience and wellbeing) and (c) Self-Reflective Scales for teachers (SRS: self-reflective capacities of teachers). Compared to baseline, attachment and behavioral problems improved in both programs. ES led to more secure and more organized attachment representations (medium effect sizes). Aggressive behavior and externalizing problems were reduced in the FA group compared with ES, particularly in boys (medium effect sizes). Self-reflective capacities of the teachers increased only in the ES group. High correlation between children's attachment type with the number of social risk factors and the increase of problematic social behavior strongly indicate that an increase in teachers' self-reflective capacities helps to change children's attachment patterns which thus strengthens the resilience of these children-at-risk [An ethical vote from LPPKJP 2009-02-25 was obtained and the trial registered; Clinical trial registration information: The trial was registered 14.02.2012 (DRKS00003500; https://www.drks.de)].
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Affiliation(s)
- Tamara Fischmann
- International Psychoanalytic University Berlin, Berlin, Germany.,Sigmund-Freud-Institut, Frankfurt am Main, Germany
| | | | - Jonathan Green
- The University of Manchester, Manchester, United Kingdom
| | | | | | - Ming Wan
- The University of Manchester, Manchester, United Kingdom
| | - Marianne Leuzinger-Bohleber
- Sigmund-Freud-Institut, Frankfurt am Main, Germany.,University Medicine Johannes-Gutenberg-University, Mainz, Germany
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Ventura Wurman T, Lee T, Bateman A, Fonagy P, Nolte T. Clinical management of common presentations of patients diagnosed with BPD during the COVID-19 pandemic: the contribution of the MBT framework. COUNSELLING PSYCHOLOGY QUARTERLY 2020. [DOI: 10.1080/09515070.2020.1814694] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Tamara Ventura Wurman
- Research Department of Clinical, Education and Health Psychology, UCL, London, United Kingdom
- Halliwick Unit, St Ann’s Hospital, Barnet, Enfield and Haringey Mental Health NHS Trust, London, United Kingdom
- Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Tennyson Lee
- DeanCross Personality Disorder Service, East London Foundation NHS Trust, London, United Kingdom
- Centre for the Understanding of Personality Disorder (CUSP), London, United Kingdom
| | - Anthony Bateman
- Research Department of Clinical, Education and Health Psychology, UCL, London, United Kingdom
- Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Peter Fonagy
- Research Department of Clinical, Education and Health Psychology, UCL, London, United Kingdom
- Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Tobias Nolte
- Halliwick Unit, St Ann’s Hospital, Barnet, Enfield and Haringey Mental Health NHS Trust, London, United Kingdom
- Anna Freud National Centre for Children and Families, London, United Kingdom
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, UCL, London, United Kingdom
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Paillat C, Rasho A, Guarnaccia C. La famille face aux violences extrafamiliales : émotions et victimisation dans la narration de parents et enfants en UMJ. PRAT PSYCHOL 2020. [DOI: 10.1016/j.prps.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Clarke A, Meredith PJ, Rose TA. Exploring mentalization, trust, communication quality, and alienation in adolescents. PLoS One 2020; 15:e0234662. [PMID: 32542008 PMCID: PMC7295212 DOI: 10.1371/journal.pone.0234662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 05/30/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION A growing body of evidence has demonstrated the importance of mentalization for adolescents' psychosocial functioning; however, further research is needed to understand links between mentalization and other socio-cognitive factors. The aim of this quantitative, cross-sectional study was to investigate the relationship between a teen's capacity to mentalize and three attachment-related factors: parent-teen trust, parent-teen communication, and parent-teen alienation. METHODS In an online survey, 82 (mainly) Australian adolescents (57 female; 23 male; 2 non-binary; mean age 17.09 years) completed: i) The Children's Eyes Test, which measured mentalization; and ii) The Inventory of Parent and Peer Attachment-45, which measured trust, communication quality, and alienation. RESULTS In teens' relationships with both mothers and fathers, trust and communication quality were significantly positively correlated (p = .001) when controlling for age and gender. Both were significantly negatively correlated with alienation (p = .001) with control variables included. Capacity to mentalize did not correlate with trust, communication quality, or alienation in relationships with either mothers or fathers (p ≤ .05). CONCLUSIONS Possible reasons are proposed for why no relationship was found between mentalization and trust, communication quality, or alienation. Implications for future research are discussed.
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Affiliation(s)
- Angela Clarke
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Pamela J. Meredith
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Tanya A. Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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[From Pretending to Play to Playing Pretend: The Role of Epistemic Trust in Mentalization-Based Therapy with Children]. Prax Kinderpsychol Kinderpsychiatr 2020; 68:742-759. [PMID: 31957567 DOI: 10.13109/prkk.2019.68.8.742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
From Pretending to Play to Playing Pretend: The Role of Epistemic Trust in Mentalization-Based Therapy with Children Although all forms of psychotherapy encourage the patient to focus on their mental states and those of other people, it is a distinguishing characteristic of Mentalization-Based Therapy (MBT; Fonagy u. Bateman, 2006; Bateman u. Fonagy, 2016) to place such focus at the center of treatment. In MBT-Child there is the added element of play, which is considered a primary vehicle for enhancing mentalization (Midgley, Ensink, Lindqvist, Malberg, Muller, 2017). However, pre-mentalizing modes during play are developmentally normative in children. Thus, it can be difficult to distinguish between play as a goal of treatment, and the psychic equivalence and pretend modes. This paper presents some thoughts about how we can unravel the relationships between restoring mentalizing and the process by which children in therapy "learn to play". We begin by introducing the theoretical principles that underlie MBT and MBT-C, with particular focus on defining the pre-mentalizing modes. Then, we discuss recent innovations in thinking about the role of epistemic trust in psychotherapy and present a possible use of this concept in understanding pre-mentalizing modes during playing. We suggest ways in which mentalization-based techniques used when children are in pre-mentalizing modes may restore epistemic trust and act as a mechanism of change in child psychotherapy, opening up the child's capacity to both play and mentalize in relation to their social environment. Finally, we present a clinical case of a mentalization focused treatment with a 9-year old child to illustrate our views.
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Huang YL, Fonagy P, Feigenbaum J, Montague PR, Nolte T. Multidirectional Pathways between Attachment, Mentalizing, and Posttraumatic Stress Symptomatology in the Context of Childhood Trauma. Psychopathology 2020; 53:48-58. [PMID: 32294649 PMCID: PMC7265765 DOI: 10.1159/000506406] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 02/08/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Exposure to traumatic stressful events in childhood is an important risk factor for the development of posttraumatic symptomatology. From a mentalization-based developmental perspective, childhood adversity can affect attachment in children and may result in insecure attachment and impaired mentalizing abilities, which increase the lifetime risk for psychopathology. The present cross-sectional study examined the potential mediating role of attachment insecurity and impaired mentalizing on the relationship between childhood trauma and posttraumatic symptomatology. METHOD Adults who had experienced childhood neglect and abuse (n = 295, 184 patients with personality disorder and 111 community controls) completed self-report measures of posttraumatic stress disorder (PTSD) symptoms, dissociative experiences, adult attachment insecurity, and mentalizing. RESULTS Structural equation modelling results revealed that attachment insecurity together with lower mentalizing mediated the link between childhood trauma and PTSD symptoms, and lower mentalizing mediated the link between childhood trauma and dissociative experiences. CONCLUSION The findings show that attachment insecurity and lower mentalizing play significant mediating roles in the reporting of posttraumatic symptomatology among survivors of childhood abuse and neglect, with treatment implications for mentalization-based therapy as beneficial for individuals with a history of childhood trauma.
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Affiliation(s)
- Yu Lien Huang
- Department of Psychology, Fo Guang University, Yilan, Taiwan
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, UCL, London, United Kingdom
| | - Janet Feigenbaum
- Research Department of Clinical, Educational and Health Psychology, UCL, London, United Kingdom
| | - P Read Montague
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, UCL, London, United Kingdom.,Computational Psychiatry Unit, Virginia Tech Carilion Research Institute, Roanoke, Virginia, USA
| | - Tobias Nolte
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, UCL, London, United Kingdom, .,Anna Freud National Centre for Children and Families, London, United Kingdom,
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Berthelot N, Lemieux R, Garon-Bissonnette J, Lacharité C, Muzik M. The protective role of mentalizing: Reflective functioning as a mediator between child maltreatment, psychopathology and parental attitude in expecting parents. CHILD ABUSE & NEGLECT 2019; 95:104065. [PMID: 31255871 DOI: 10.1016/j.chiabu.2019.104065] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Childhood maltreatment impacts parenting and has intergenerational consequences. It is therefore crucial to identify clinically responsive resilience-promoting factors in pregnant women and expecting men with history of childhood maltreatment. Mentalization, or reflective functioning, appears as a promising concept to understand risk and resilience in the face of childhood maltreatment. OBJECTIVE This study evaluated the multivariate relationship between exposure to childhood maltreatment, reflective functioning, psychological symptoms and parental attitude in expecting parents. METHODS Two hundred and thirty-five pregnant women and 66 expecting fathers completed self-report assessment measures of childhood trauma, reflective functioning, depression, post-traumatic stress disorder, parental sense of competence and antenatal attachment. Twenty-eight percent (n = 85) of the community sample reported personal histories of childhood maltreatment. RESULTS Structural equation modeling indicated that reflective functioning (a) partially mediated the association between childhood maltreatment and psychological symptoms during pregnancy and (b) independently predicted participants' perception of parental competence and psychological investment toward the unborn child. CONCLUSION Overall, this study provides empirical evidence of the protective role of reflective functioning during the prenatal period in parents with histories of childhood maltreatment.
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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.
| | - 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; Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, 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; 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
| | - Carl Lacharité
- 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 de l'enfant vulnérable et négligé, Canada
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, United States; Center for Human Growth & Development, University of Michigan, United States
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Borelli JL, Cohen C, Pettit C, Normandin L, Target M, Fonagy P, Ensink K. Maternal and Child Sexual Abuse History: An Intergenerational Exploration of Children's Adjustment and Maternal Trauma-Reflective Functioning. Front Psychol 2019; 10:1062. [PMID: 31156503 PMCID: PMC6530340 DOI: 10.3389/fpsyg.2019.01062] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/24/2019] [Indexed: 11/20/2022] Open
Abstract
Objective: The aim of the current study was to investigate associations, unique and interactive, between mothers’ and children’s histories of childhood sexual abuse (CSA) and children’s psychiatric outcomes using an intergenerational perspective. Further, we were particularly interested in examining whether maternal reflective functioning about their own trauma (T-RF) was associated with a lower likelihood of children’s abuse exposure (among children of CSA-exposed mothers). Methods: One hundred and eleven children (Mage = 9.53 years; 43 sexual abuse victims) and their mothers (Mage = 37.99; 63 sexual abuse victims) participated in this study. Mothers completed the Parent Development Interview (PDI), which yielded assessments of RF regarding their own experiences of abuse, and also reported on their children’s internalizing and externalizing symptoms. Results: Children of CSA-exposed mothers were more likely to have experienced CSA. A key result was that among CSA-exposed mothers, higher maternal T-RF regarding their own abuse was associated with lower likelihood of child CSA-exposure. Mothers’ and children’s CSA histories predicted children’s internalizing and externalizing symptoms, such that CSA exposure for mother or child was associated with greater symptomatology in children. Conclusion: The findings show that the presence of either maternal or child CSA is associated with more child psychological difficulties. Importantly in terms of identifying potential protective factors, maternal T-RF is associated with lower likelihood of CSA exposure in children of CSA-exposed mothers. We discuss these findings in the context of the need for treatments focusing on increasing T-RF in mothers and children in the context of abuse to facilitate adaptation and reduce the intergenerational risk.
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Affiliation(s)
- Jessica L Borelli
- THRIVE Laboratory, Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Chloe Cohen
- THRIVE Laboratory, Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Corey Pettit
- THRIVE Laboratory, Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Lina Normandin
- Department of Psychology, Laval University, Quebec, QC, Canada
| | - Mary Target
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Peter Fonagy
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Karin Ensink
- Department of Psychology, Laval University, Quebec, QC, Canada
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Attachment and reflective functioning in children with somatic symptom disorders and disruptive behavior disorders. Eur Child Adolesc Psychiatry 2019; 28:705-717. [PMID: 30350093 DOI: 10.1007/s00787-018-1238-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/13/2018] [Indexed: 01/11/2023]
Abstract
Our goal in conducting this study was to examine whether children with somatic symptom disorders (SSD) and disruptive behavior disorders (DBD) have higher rates of insecure or disorganized attachment and difficulties in mentalizing (operationalized as reflective functioning) as compared to a control group. Participants were 131 children (8-15 years) spanning two groups-a clinical group (n = 85), comprised of children fitting the criteria of our target diagnostic classifications (SSD: N = 45; DBD: N = 40), as well as a comparison group of healthy control children (n = 46). Children completed the Child Attachment Interview, which was later coded by reliable raters for attachment security and reflective functioning (RF). Consistent with our predictions, children in the clinical group had significantly lower RF and were significantly more likely to have insecure (over 80%) and disorganized attachment (over 40%) than children in the comparison group. In addition, RF was significantly lower in children with DBD than children with SSD. Furthermore, in the SSD group, children's RF regarding self was significantly lower than RF regarding others. Finally, consistent with prior studies, RF and attachment were associated. The findings indicate that school-aged children with SSD and DBD have higher rates of insecure and disorganized attachment. Consistent with theory, RF and attachment were loosely coupled, but RF alone differentiated among the diagnostic subgroups. Implications for treatment and prevention are discussed.
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Henschel S, Doba K, Nandrino JL. Emotion Regulation Processes and Psychoform and Somatoform Dissociation in Adolescents and Young Adults with Cumulative Maltreatment. J Trauma Dissociation 2019; 20:197-211. [PMID: 30074853 DOI: 10.1080/15299732.2018.1502714] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The relationship between childhood trauma and dissociative experiences is widely acknowledged. However, the association between emotion regulation difficulties (ERD), anxiety/depression and dissociation in adolescents and young adults with cumulative maltreatment (CM) remains unclear. The present study examined the role of ERD at both intrapersonal and interpersonal levels and anxiety/depression symptoms in the development of psychoform or somatoform dissociation in adolescents and young adults with CM. We assessed 58 participants with CM and 55 participants without childhood trauma history between the age of 12 and 22 years old. Participants completed self-reports of ERD, anxiety/depression, psychoform dissociation and somatoform dissociation. The results revealed that adolescents and young adults exposed to CM displayed high levels of psychoform and somatoform dissociation, ERD and anxiety/depression symptoms. It was also found that intrapersonal and interpersonal ERD predicted psychoform dissociation, whereas anxiety/depression predicted somatoform dissociation in adolescents and young adults with CM. Intrapersonal and interpersonal ERD and anxiety/depression are therapy targets for clinical interventions in adolescents and young adults with CM and dissociative symptoms.
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Affiliation(s)
- Sébastien Henschel
- a Sciences Cognitives et Sciences Affectives , Univ. Lille, CNRS, UMR 9193 -SCALAb , Lille , France
| | - Karyn Doba
- a Sciences Cognitives et Sciences Affectives , Univ. Lille, CNRS, UMR 9193 -SCALAb , Lille , France.,b Fondation Santé des Etudiants de France , Clinique médico-psychologique , Villeneuve d'Ascq , France
| | - Jean-Louis Nandrino
- a Sciences Cognitives et Sciences Affectives , Univ. Lille, CNRS, UMR 9193 -SCALAb , Lille , France.,b Fondation Santé des Etudiants de France , Clinique médico-psychologique , Villeneuve d'Ascq , France
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Affiliation(s)
- Alec M Smidt
- a Department of Psychology , University of Oregon , Eugene , Oregon , USA
| | - Jennifer J Freyd
- a Department of Psychology , University of Oregon , Eugene , Oregon , USA
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Abstract
The aim of this longitudinal study was to examine the course of sexualized behavior problems (SBP) over 2 years in a sample comprised of 104 children aged 2-12, including 62 children with histories of child sexual abuse (CSA). Parents completed questionnaires assessing SBP, internalizing and externalizing difficulties at baseline, as well as 2 years later. In more than half (56.7%) of children with clinically significant SBP at baseline, sexualized behaviors persisted and remained at a clinically significant level over time. In children with CSA, 48.4% presented persistent SBP, 27.4% presented transitory SBP, while 19.4% did not present clinically significant SBP at either time. CSA increased the relative risk of persistent SBP 3.29 times, and for each one-unit increase in scores of externalizing difficulties, the odds of persistent SBP increased by 21%. The findings suggest that SBP consequent to CSA, especially when it co-occurs with externalizing difficulties, is likely to remain at levels warranting clinical intervention.
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