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

Mentalizing as a Predictor of Well-Being and Emotion Regulation: Longitudinal Evidence from a Community Sample of Young Adults

Background: In recent years, mentalizing - the capacity to understand one's own and others' intentional mental states in social contexts - has been considered to be a protective capacity that enables adaptive processing of stress-related emotional arousal, benefits general well-being and underpins adaptive emotion regulation. Objective: Several studies using cross-sectional research designs have demonstrated the potential health-promoting effect of mentalizing in non-clinical samples. However, longitudinal evidence is scarce. The present study aimed to investigate whether mentalizing predicts well-being and emotion regulation strategies in a non-clinical sample of mainly young adults using a prospective longitudinal design. Methods: In a prospective research design, 135 participants completed questionnaires assessing well-being, psychological symptom severity and mentalizing capacity at baseline (T1). Twelve months later (T2), emotion regulation strategies (suppression and cognitive reappraisal), well-being and psychological symptom severity were assessed by self-report. The data were analyzed using multivariate linear regression analysis. Results: Impairments in mentalizing were a significant negative predictor of well-being 12 months later. Furthermore, impairments in mentalizing positively predicted suppression of emotional states at T2. No association was found between deficits in mentalizing and cognitive reappraisal of emotional states over the course of 1 year. Conclusion: The findings indicate that mentalizing is longitudinally associated with mental health indicators in a non-clinical adult sample. Specifically, ineffective mentalizing was associated with impaired psychological well-being and a tendency to suppress intense emotional states over a period of 1 year. Future research should replicate these findings using multiple measurement timepoints to etablish causality.

Emotional self-knowledge profiles and relationships with mental health indicators support value in 'knowing thyself'

"Know thyself" may be indicated by a balanced high pairing of two emotional self-knowledge indicators: attention to emotions and emotional clarity. Closely associated but often evaluated separately, emotional clarity is consistently, inversely associated with psychopathology, while evidence regarding attention to emotions is less consistent. Variables of high/low emotional clarity and attention to emotions yielded four emotional self-knowledge profiles which were analyzed for associations with mental health indicators (depression and anxiety symptoms, self-esteem, self-schema, resiliency, transcendence) in n = 264 adolescents. Here we report regression models which show that compared with neither, both high (attention + clarity) show higher positive self-schema (B = 2.83, p = 0.004), more resiliency (B = 2.76, p = 0.015) and higher transcendence (B = 82.4, p < 0.001), while high attention only is associated with lower self-esteem (B = - 3.38, p < 0.001) and more symptoms (B = 5.82, p < 0.001 for depression; B = 9.37, p < 0.001 for anxiety). High attention only is associated with most severe impairment all indicators excepting transcendence. Profiles including high clarity suggest protective effects, and 'implicit' versus 'explicit' emotional awareness are discussed. Balanced vs. imbalanced emotional self-awareness profiles dissimilarly affect mental health, which have implications for treatment and policy.

Somatization and symbolization

Psychoanalysis had its origins in an era when feelings that could not be recognized by the mind were being manifested in the body. Psychoanalysis works towards resolving this type of split by recognizing the existence of a dual language structure that includes both body and mind as constituents of the fabric of embodied meanings. The field of psychosomatics helps to provide keys to this language, marking the essential, patterned truths that are recognized at very basic levels and increasingly organize our perceptions as we make sense of the world. In disrupting the integration of embodied meanings, trauma impedes identity development. For some patients, learning to make meaning from somatic symptoms is an important adjunct to coming to know their own embodied experience. Two cases will be offered in which somatic symptoms provided important information that was channeled through the analytic experience as a way of making sense of what otherwise remained unknown.

The Kvetch: Assessment, Pathogenesis, and Treatment of Patients Who Are Clinically Impaired by Chronic Complaining

ABSTRACT

Clinicians often encounter patients whose presentations are characterized by long lists of complaints about their biological, psychological, interpersonal, and social conditions. The problems on which the complaints are based are variably reality-based and variably modifiable. Some of these patients display chronic complaining as a core, distinguishing feature. Accordingly, the aims of this article are to consider excesses of chronic complaining as psychiatric phenomena, explore possible pathogenetic contributions, describe approaches for treating conditions marked by clinically pertinent chronic complaining, and suggest areas for future research. Based on clinical observations enhanced by selective narrative literature review, we delineate and differentiate four groups of patients: 1) situational complainers; 2) chronic complainers due to unidentified medical problems; 3) mood-induced chronic complainers; and 4) personality-driven pan-dimensional chronic complainers. The last-mentioned group consists of help-seeking versus help-rejecting subtypes, the latter including a subset we designate as malignant chronic complainers. Strategies for managing these patients begin with detailed assessment of all complaints, ascertaining reality-based contributions to the complaints, including those initiated by patients themselves. Management approaches use specific biopsychosocial techniques based on patient-centered particulars. Psychotherapeutic strategies center on compassionate, empathic witnessing. Specific tactics include attending to unresolved grief and trauma, behavioral activation, cognitive and narrative restructuring and reframing methods, mentalizing and imaginal approaches, and psychodynamic methods including attention to attachment issues and transference. Sources of countertransference reactions to these patients should be identified and can be addressed. The many questions raised by these patients' presentations merit further research.

I don't understand how I feel: mediating role of impaired self-mentalizing in the relationship between childhood adversity and psychosis spectrum experiences

Introduction

Childhood adversity is associated with the severity of multiple dimensions of psychosis, but the mechanisms underpinning the close link between the two constructs is unclear. Mentalization may underlie this relationship, as impaired mentalizing is found in various stages of the psychosis continuum. Nonetheless, the differential roles of self- and other-mentalizing in psychosis are not well understood.

Methods

Parallel multiple mediation was conducted for the relationship between a diverse range of childhood adversity types, including intentional and nonintentional harm, and schizotypy (positive, negative, disorganized), psychotic-like experiences (PLE) and paranoia via self-mentalizing (attention to emotions and emotional clarity) and other-mentalizing in n = 1,156 nonclinically ascertained young adults.

Results

Significant parallel multiple mediation models were found for all psychotic outcomes except negative schizotypy. The associations between intentionally harmful childhood adversity and psychotic outcomes were significantly mediated by increased attention to emotions for most models and decreased emotional clarity for some models. No significant mediation was found for parental loss. Paternal abuse was only mediated by attention to emotions whereas the effects of maternal abuse were mediated by attention to emotions and emotional clarity. Other-mentalizing only showed mediating effects on one of thirty models tested.

Conclusion

Results highlight the mediating role of impaired self-mentalizing in the association between childhood adversity and psychosis. This is consistent with disturbances of self-concept and self-boundary characterizing, in particular, the positive dimension of psychosis. Maternal versus paternal figures may contribute differentially to the development of mentalizing. These results could inform future preventative interventions, focusing on the development and maintenance of self-mentalizing.

The regulatory role of affective inhibitory control in somatic symptoms among adolescents exposed to child maltreatment: a population-based study

Adolescents exposed to child maltreatment are at increased risk for various somatic symptoms, but which psychological factors that contribute to this relationship need to be further investigated. Emotion dysregulation is suggested to serve as a proximal link between child maltreatment and somatic complaints. The purpose of the present study was to investigate whether individual differences in affective inhibitory control, a central component in implicit emotion regulation, contribute to the risk of somatic symptoms in adolescents exposed to child maltreatment. Data were drawn from the UEVO study, a national population-based survey of adolescents between 12 and 16 years of age (N = 9240). For this study, we included participants who completed the emotional go/no-go task measuring affective inhibitory control (N = 7241; Mage/SD = 14 years/.87; 52% girls, 47% boys), of which N = 3349 reported at least one incident of maltreatment exposure (57% girls, 41% boys). Exposure to psychological abuse and sexual abuse were associated with somatic symptoms. Affective inhibitory control was related to somatic symptoms, both in the total sample and in adolescents exposed to child maltreatment. The strength of relationships between exposure to psychological abuse and somatic symptoms, as well as sexual abuse and somatic symptoms, were moderated by individual differences in affective inhibitory control problems. Our study suggests that psychological abuse and sexual abuse increase the risk for somatic symptoms in adolescence. Affective inhibitory control, a central component in implicit emotion regulation, was related to somatic symptoms and moderated the relationships between psychological abuse and somatic symptoms, and sexual abuse and somatic symptoms. Revealing these associations in a population-based sample indicates that treatment targeting affective inhibitory control may be beneficial and should be explored further in clinical settings.

Mentalization in Typically and Atypically Developing Iranian Children and Its Associations with Age, Sex, and Externalizing/Internalizing Symptoms

Mentalization refers to the ability to understand the mental states of oneself and those of others that motivate action and behavior. Mentalization has generally been linked to adaptive development and healthy functioning whereas diminished mentalization has been associated with maladaptive development and psychopathology. The vast majority of research on mentalization and developmental trajectories, however, is based on Western countries. The overall aim of this study was therefore to examine mentalizing abilities in a novel sample of 153 typically developing and atypically developing Iranian children (Mage = 9.41, SDage = 1.10, Range = 8–11, 54.2% females) recruited from a primary school and health clinic in Tehran. The children completed semi-structured interviews that were later transcribed and coded for mentalization. The parents provided reports on internalizing and externalizing symptoms, demographic information, and all formal diagnoses of the children. The results pointed at general age and sex differences across the two groups. Older children showed more adaptive mentalization compared to the younger children; boys and girls used different mentalizing strategies when facing difficult situations. The typically developing children were better at mentalizing than the atypically developing children. Finally, more adaptive mentalization was associated with lower externalizing and internalizing symptoms among all children. The findings of this study contributes with expanding mentalization research to also encompass non-Western populations and the results hold crucial educational and therapeutic implications.

Teachers during the COVID-19 Era: The Mediation Role Played by Mentalizing Ability on the Relationship between Depressive Symptoms, Anxious Trait, and Job Burnout

BACKGROUND

The COVID-19 outbreak caused severe changes in school activities over the past two years. Teachers underwent a re-planning of their teaching approaches, shifting from face-to-face teaching formats to remote ones. These challenges resulted in high levels of burnout. The identification of risk/protective factors contributing to burnout is crucial in order to inform intervention programs. Thus, we hypothesized a mediation role of teachers' mentalizing ability (processing of emotions, a component of mentalized affectivity) on the relationship between depression, anxiety, and depersonalization (burnout dimension). Two reverse models were computed. Job satisfaction, teachers' age and gender, school grade, and length of teaching experience served as covariates.

METHODS

466 (M(sd) = 46.2 (10.4) years) online questionnaires were completed by Italian teachers of primary (n = 204) and middle (n = 242) schools. Measures of burnout, depression, anxiety, and mentalization were administered.

RESULTS

The findings corroborated our hypotheses: in all models, processing emotions served as a mediator on the relationship between depression, anxiety, and depersonalization, and on the reciprocal one. Job satisfaction positively impacted processing emotion, and negatively impacted depression and depersonalization; women teachers reported high levels of the anxious trait.

CONCLUSIONS

Overall, it can be concluded that the ability to mentalize has a beneficial impact on teachers' well-being. Policymaking, clinical, and research implications were discussed.

Self- but not other-mentalizing moderates the association between BPD symptoms and somatic complaints in community-dwelling adolescents

OBJECTIVES

The aim of this study was to evaluate the potential moderator role of poor mentalization in the association between borderline personality disorder (BPD) traits and somatization, specifically focusing on the polarities of self- and other-mentalizing.

DESIGN

This is a cross-sectional, general population study evaluating adolescents (n = 162, 61.3% female; ages 12-18, M = 14.63, SD = 1.02). The relationship between BPD traits and somatization was evaluated with self-mentalization (attention to emotions and clarity of emotions) and other-mentalizing as moderator variables.

METHODS

One hundred sixty-two adolescents without serious mental health disorders were evaluated using self-report measures for borderline personality disorder traits (screening questionnaire for the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II), somatic symptoms using the Somatic Symptoms Questionnaire (SSQ), self-mentalizing using the Trait Meta-Mood Scale-24 (TMMS) and other-mentalizing using the Adolescent Mentalizing Interview (AMI)). Linear regressions were conducted to test the moderation effects of self- and other-mentalizing in the relationship between BPD symptoms and somatic complaints, controlling for age and sex. Moderation analysis was conducted using PROCESS version 3.5.

RESULTS

The association between BPD symptoms and somatic complaints was moderated by a self-mentalizing dimension (emotional clarity) (b = -0.019, 95% CI = -0.0379 to -0.0002, p = .0476), but not other-mentalizing (b = 0.027, 95% CI = 0.000 to 0.053, p = .051). The effect of BPD symptoms on somatization disappears when emotional clarity is high, regardless the level of attention to emotions.

CONCLUSIONS

Self-mentalizing appears to be an adaptive skill as it attenuates the relationship between BPD traits and somatization. Specifically, emotional clarity rather than simple attention to emotions is the aspect of self-mentalizing attenuating this association. These results support that self-mentalization is an important function in the management of body-associated emotions even in non-clinical levels of BPD traits. Findings suggest that strengthening self-mentalizing skills across development might contribute to resilience and salutogenesis.

Problematic Use of the Internet Mediates the Association between Reduced Mentalization and Suicidal Ideation: A Cross-Sectional Study in Young Adults

Suicide is a major public health problem, and it is urgent to investigate its underlying clinical and psychological concomitants. It has been suggested that low mentalization skills and problematic use of the internet (PUI) are factors that can play a role in suicidal behaviors. It is possible that poor mentalization skills contribute to leading to forms of PUI, which, in turn, can represent triggers for suicidal ideation (SI). We tested this hypothesis through a quantitative and cross-sectional study on a sample (n = 623) of young adults (age range: 18−34). Self-report measures investigating symptoms related to Social Media Addiction (SMA), Internet Gaming Disorder (IGD), mentalization capacity, and SI were used. A single mediation analysis with two mediators was carried out to evaluate the direct and indirect effects of mentalization on SI through the mediating role of SMA- and IGD-related symptoms, controlling for potential confounding factors (e.g., socio-demographic and addiction-related variables). The four explored variables were significantly associated with each other (all p < 0.001) across all subjects; the mediational model showed that the total effect of mentalization on SI was significant (B = −0.821, SE = 0.092 (95% CI: −1.001; −0.641)) and that both SMA- (B = −0.073, SE = 0.034 (95% CI: −0.145; −0.008)) and IGD-related symptoms (B = 0.046, SE = 0.027 (95% CI: −0.107; −0.001)) were significant mediators of such association. Our findings support the possibility that PUI severity plays a relevant role in mediating the association between low mentalization skills and levels of SI.

Clinical Manifestations of Body Memories: The Impact of Past Bodily Experiences on Mental Health

Bodily experiences such as the feeling of touch, pain or inner signals of the body are deeply emotional and activate brain networks that mediate their perception and higher-order processing. While the ad hoc perception of bodily signals and their influence on behavior is empirically well studied, there is a knowledge gap on how we store and retrieve bodily experiences that we perceived in the past, and how this influences our everyday life. Here, we explore the hypothesis that negative body memories, that is, negative bodily experiences of the past that are stored in memory and influence behavior, contribute to the development of somatic manifestations of mental health problems including somatic symptoms, traumatic re-experiences or dissociative symptoms. By combining knowledge from the areas of cognitive neuroscience and clinical neuroscience with insights from psychotherapy, we identify Clinical Body Memory (CBM) mechanisms that specify how mental health problems could be driven by corporeal experiences stored in memory. The major argument is that the investigation of the neuronal mechanisms that underlie the storage and retrieval of body memories provides us with empirical access to reduce the negative impact of body memories on mental health.

Meta-mood knowledge moderates the relationship between neuroticism and depression but not between neuroticism and anxiety in a sample of nonclinical adolescents

Research shows a strong link between neuroticism and internalizing psychopathology, such as depression and anxiety. However, it is unclear to what extent meta-mood knowledge (i.e., attention to emotion and emotional clarity) plays a role as a moderator in this relationship. To investigate this, we collected data on meta-mood knowledge, personality traits, depression, and anxiety in a sample of adolescents (N = 244; 53.7% girls) aged 12 to 18 years (M = 14.6, SD = 1.7) from Catalonia, Spain. Regarding the relationship between neuroticism and depression, results showed that emotional clarity buffered this relationship. Although attention to emotion did not, the joint moderating effect of attention to emotion and emotional clarity was significant. The results on the four different combinations of attention to emotion and emotional clarity showed that the relationship between neuroticism and depression was strongest for high attention and low clarity, less strong for low attention and low clarity, and even lower for high attention and high clarity. And importantly, these similar patterns of association disappeared at low attention and high clarity. In contrast to the relationship between neuroticism and depression, we found no statistically significant moderating effects for the relationship between neuroticism and anxiety. Based on these results, we argue the importance of examining individual differences in emotion-based cognition and understanding when the benefits of emotional clarity are associated with fewer disadvantages of excessive attention. These results provide preliminary evidence that the combination of low attention and high clarity may be an adaptive version of emotional self-awareness in relation to neuroticism and depression.

Measuring Mental Wellness of Adolescents: A Systematic Review of Instruments

Objective

Mental health is critical to the healthy development of adolescents. However, mental health encompasses more than the absence of mental illness; and should include indicators of mental wellness. A critical review of available mental wellness instruments for adolescents were conducted to identify operational definitions of mental wellness concepts for this population group.

Method

A systematic review of literature published between 2000 and 2020 was done to identify mental wellness instruments for adolescent populations. The review followed the PRISMA operational steps.

Results

We identified 2,543 articles from the search strategy and screened titles and abstracts for eligibility. After appraisal, 97 studies were included in the qualitative synthesis; of which, 79 mental wellness instruments were identified. Most studies did not provide a definition for mental wellness. We identified thirteen mental wellness concepts from 97 studies, namely: life satisfaction, mental wellbeing [general], resilience, self-efficacy, self- esteem, connectedness, coping, self-control, mindfulness/spiritual, hope, sense of coherence, happiness, and life purpose.

Conclusion

The review reflected previous research identifying a lack of consensus around the definitions of mental health, mental wellness, and mental wellbeing. This has implications for developing instruments for adolescents that adequately measure these constructs. Most of the instruments identified in the review were predominantly English and from developed countries. This indicates a need for instrument that are explicitly conceptualised and operationalised for adolescents in all their varied contexts.

Anxiety and Depression: The Moderating Effects of Attention to Emotion and Emotional Clarity

Anxiety and depression are the most common mental health problems. They often occur together and significantly affect well-being and daily functioning. However, it is unclear to what extent the two dimensions of meta-mood knowledge play a role in their comorbidity. Therefore, the aim of the current study was to examine the role of attention to emotion and emotional clarity in the relationship between anxiety and depression. A sample of 256 adults aged 32–66 years ( M = 46.21, SD = 5.53; 82.03% women) completed questionnaires on anxiety, depression, and meta-mood knowledge. Results showed that emotional clarity buffered the relationship between anxiety and depression. In addition, all combinations of attention to emotion and emotional clarity showed a significant and positive relationship with anxiety and depression symptom severity, with one exception. Interestingly, there was no statistically significant relationship between anxiety and depression when attention to emotion was low and emotional clarity was high. This last condition was interpreted as beneficial rather than detrimental, which in turn could help promote psychological resilience to better cope with emotional difficulties. Given these findings, this study highlights the role of attention to emotion and emotional clarity in assessing anxiety and risk of comorbid depression.

Theory of Mind in Somatization and Depression: Is It Cause or Phenomenon?

ABSTRACT

Although mentalization is important in somatic symptom disorder (SSD) and major depressive disorder (MDD), it is not fully understood. In this study, we aimed to investigate the relation between somatic and depressive symptoms with mentalization. A total of 48 patients diagnosed with SSD, 50 patients diagnosed with MDD, and 50 healthy individuals, participated the study. The Montgomery-Asperg Depression Scale, Symptom Checklist-90 Revised, and Reading the Mind in the Eyes Test (RMET) were applied to the participants. The patients with SSD showed significantly the lowest performance of theory of mind. There was no significant difference between MDD and healthy controls. High somatization score was found to be a predictor for low RMET scores (95% confidence interval, -0.339; p = 0.014). Mentalization deficit seems to be associated with somatization rather than depression.

Self- but Not Other-Dimensions of Mentalizing Moderate the Impairment Associated With Social Anxiety in Adolescents From the General Population

Mentalizing, or social cognition, refers to the brain's higher order capacity that allows humans to be aware of one's own and others' mental states (e.g., emotions, feelings, intentions). While cognition in social anxiety has been broadly analyzed, there is a paucity of research regarding the role of social cognition. Moreover, mentalizing or social cognition research is traditionally focused on the understanding of others' mental states, rather than self-mentalizing. Finally, most studies analyze the role of social cognition in the development or maintenance of social anxiety, yet no study to date has analyzed whether social cognition moderates functional impairment associated with it. This study analyzes whether self- and other-mentalizing moderate the relationship between social anxiety and impairment in social and self-functioning. A sample of 262 adolescents from the non-clinical population was assessed on measures of social anxiety, self- and other- mentalization, indicators of social functioning (social competence and sociometric status), and indicators of self-functioning (depression and self-esteem). Multiple linear regressions were conducted to test possible moderation effects of self-mentalizing and other-mentalizing on the relationships between social anxiety and social and self-functioning. Results revealed that other-mentalizing does not moderate social- nor self-functioning, while self-mentalizing moderates the impairment of all of them. While impairment in social functioning is buffered by one dimension of self-mentalizing (emotional clarity; b = 0.003, p = 0.043 and b = 0.016, p = 0.008 for social competence and sociometric status, respectively), impairment in self-functioning is strengthened by the other dimension (attention to emotions; b = -0.007, p = 0.008 and b = 0.009, p = 0.047 for self-esteem and depression, respectively). Probing the moderation at the 16th, 50th, and 84th percentiles revealed that the negative imbalance between dimensions (i.e., high attention and low clarity) tended to exacerbate impairment most on all indicators, while the positive imbalance (i.e., low attention and high clarity) was usually the most buffering condition. This supports that "low-flying" or implicit mentalizing provides more resilience than explicit mentalizing (i.e., high attention and high clarity). Findings suggest that the work on emotional self-awareness should be stressed in the intervention of the social anxiety spectrum conditions in order to improve prevention, functioning, and ultimately, treatments, of people impaired by symptoms of social anxiety.

Psychometric Properties of the Italian Mentalization Questionnaire: Assessing Structural Invariance and Construct Validity

Mentalization is an important interpersonal ability, necessary for adaptive interpersonal relationships and emotion regulation. Deficits in mentalization have been associated with poor psychological outcomes and have been observed in patients with Borderline Personality Disorder. The Mentalization Questionnaire (MZQ) has been developed as self-report measure of mentalization deficit. The aim of the study was to investigate the dimensionality of the MZQ in a nonclinical sample composed of Italian adults from the general population and to analyze its performance in categorizing individuals with higher risk of borderline symptoms. A non-clinical sample of 1,015 adults (709 women and 306 men) was administered the Italian versions of the MZQ, the Reflective Functioning Questionnaire (RFQ), and a measure of borderline psychopathology. A revised single-factor solution fitted the data well and demonstrated metric invariance across gender. The internal consistency (Ordinal α = 0.87) and stability (r = 0.84) were satisfactory. The MZQ was moderately associated with the RFQ dimensions. The ROC curve analysis showed that the MZQ was able to discriminate satisfactorily people with higher risk for borderline symptomatology from those with lower risk. The MZQ may, therefore, be considered a reliable and valid measure of mentalization for categorizing people at higher risk for borderline pathology.

Mentalizing mediates the association between emotional abuse in childhood and potential for aggression in non-clinical adults

BACKGROUND

Emotional abuse in childhood has been linked to a higher expression of aggressive behavior in adulthood. The identification of protective factors that mitigate this association is needed. Mentalizing-the capacity to understand behavior in terms of intentional mental states-appears to be a promising candidate factor that possibly modifies maladaptive consequences of early emotional abuse.

OBJECTIVE

This study investigated associations between the history of emotional abuse, aggressive behavior in adulthood and mentalizing capacities in a non-clinical sample of adults.

METHODS

214 healthy adults completed questionnaires measuring retrospectively rated experiences of emotional abuse in childhood, mentalizing capacities and aggressive behavior in a cross-sectional design.

RESULTS

Results indicated associations between emotional abuse in childhood, uncertainty about mental states, and aggressive behavior in adulthood. Moreover, certainty about mental states counteracted the negative effect of emotional abuse and partially mediated the associations between emotional abuse and aggressive behavior in adulthood.

CONCLUSION

This study extends current research and sheds further light on the relationship between emotional abuse in childhood, the health-promoting capacity of mentalizing, and aggressive behavior in non-clinical adults.

Different Dimensions of Affective Processing in Patients With Irritable Bowel Syndrome: A Multi-Center Cross-Sectional Study

Objective: Deficits in affective processing are associated with impairments in both mental and physical health. The role of affective processing in patients with functional somatic complaints such as irritable bowel syndrome (IBS) remains unclear. Most studies have focused on the capacity for emotional awareness and expression, but neglect other dimensions of affective processing. Therefore, this study aimed to systematically analyze differences in six different dimensions of affective processing between patients with IBS and healthy controls (HCs). Additionally, we exploratively investigated the impact of IBS symptom severity, psychological distress, and attachment styles on affective processing in IBS. Methods: A controlled cross-sectional multi-center study was conducted. Overall, 127 patients with IBS were compared with 127 matched HCs using multivariate analysis of variances. Affective processing was operationalized in line with the affect cascade model on six specific dimensions: emotional experience, emotional awareness, affect tolerance, affect differentiation, affect regulation, and emotional communication. They were measured using two subscales of the Mentalizing Questionnaire (MZQ) and four subscales of the Operationalized Psychodynamic Diagnosis-Structure Questionnaire (OPD-SQ). Linear regression analysis was used to investigate the influence of IBS symptom severity (IBS-Severity Scoring System, IBS-SSS), depression (Patient Health Questionnaire, PHQ-9), anxiety (General Anxiety Disorder, GAD-7), and anxious and avoidant attachment styles (Experiences in Close Relationships Scale, ECR-RD12) on the different dimensions of affective processing in IBS. Results: Patients with IBS compared to HCs showed deficits in all six dimensions of affective processing. Deficits were largest for affect tolerance (d = 0.849) and lowest for emotional experience (d = 0.222) and emotional awareness (d = 0.420). Moderate effect sizes were found for affect differentiation (d = 0.773), emotional communication (d = 0.665), and affect regulation (d = 0.552). Moreover, explorative analyses indicated that affective processing in patients with IBS was significantly influenced by levels of anxiety and insecure attachment. Conclusion: The results indicate a specific pattern of affective processing abilities in patients with IBS. The deficits in affective processing are more prominent in the area of understanding and tolerating difficult affective states than experiencing affective states. This opens interesting perspectives for the development of specific psychotherapeutic interventions. Clinical Trial Registration: DRKS00011685.

The relationship between global distress, mentalizing and well-being in a German teacher sample

Many studies have linked global distress including higher psychological symptom severity and high levels of stress with low levels of well-being among teachers, indicating a need to identify and empirically evaluate protective factors. Mentalizing—the capacity to understand behavior in terms of intentional mental states—may be a candidate protective factor to mediate this association, enhancing well-being in the face of high levels of global distress. The present study examines whether the capacity to mentalize can buffer subjectively experienced stress and psychological symptom severity in a sample of teachers. 215 teachers completed questionnaires measuring self-rated experiences of stress, psychological symptoms, mentalizing capacities and well-being in a cross-sectional design. Structural equation modeling was used to test mediation effects. Our findings show that mentalizing was positively associated with well-being. In addition, mentalizing counteracted the negative influence of stress and psychological symptom severity. However, a structural equation model assessing the mediating effect of global distress on well-being via mentalizing was not significant. Therefore, the data indicate that teachers’ capacity to mentalize, regardless of psychological symptom load and subjective experience of stress, has a positive impact on their well-being. The study highlights the protective function of mentalizing and forms a framework for psychological interventions to increase teachers’ well-being.

Self and Other Mentalizing Polarities and Dimensions of Mental Health: Association With Types of Symptoms, Functioning and Well-Being

Research suggests that the ability to understand one's own and others' minds, or mentalizing, is a key factor for mental health. Most studies have focused the attention on the association between global measures of mentalizing and specific disorders. In contrast, very few studies have analyzed the association between specific mentalizing polarities and global measures of mental health. This study aimed to evaluate whether self and other polarities of mentalizing are associated with a multidimensional notion of mental health, which considers symptoms, functioning, and well-being. Additionally, the level or depth of mentalizing within each polarity was also analyzed. A sample of 214 adolescents (12-18 years old, M = 14.7, and SD = 1.7; 53.3% female) was evaluated on measures of self- (Trait Meta-Mood Scale or TMMS-24) and other- mentalizing (Adolescent Mentalizing Interview or AMI), multi-informed measures of psychopathology and functioning based on Achenbach's system, and measures of psychological well-being (self-esteem, happiness, and motivation to life goals). Results revealed no association between mentalizing polarities and higher-order symptom factors (internalizing, externalizing, and global symptoms or "p" factor). Self-mentalizing was associated with self-esteem (B = 0.076, p < 0.0005) and motivation to life goals (B = 0.209, p = 0.002), and other-mentalizing was associated to general, social and role functioning (B = 0.475, p < 0.0005; B = 0.380, p = 0.005; and B = 0.364, p = 0.004). This association between aspects of self-other mentalizing and self-other function has important implications for treatment and prevention. Deeper mentalizing within each polarity (i.e., comprehension beyond simple attention to one's own mental states, and mentalizing referred to attachment figures vs. mentalizing referred to the characters of a story) revealed stronger associations with functioning and well-being. Because mentalizing polarities are associated with functioning and well-being but not with symptoms, a new hypothesis is developed: mentalizing does not contribute to resiliency by preventing symptoms, but by helping to deal with them, thus improving functioning and well-being independently of psychopathology. These findings support that promoting mentalizing across development may improve mental health, even in non-clinical population.

Emotional Comprehension Is Not Related to Duration of Distress from Daily Life Events

The main aim of this paper is to analyze to what extent insight (i.e., mentalization referring to one’s own mental state) moderates recovering from daily life events. A total of 110 participants (84.5% women; mean age: M = 21.5; SD = 3.2) filled in the Trait Meta-Mood Scale (TMMS-24) and the Eysenck Personality Questionnaire (EPQ-R), and were interviewed about impairment derived from daily life events (everyday life stresses) during the past year. Multivariate regression models were adjusted for neuroticism, sex, and socioeconomic status to analyze whether different degrees of insight moderated the relationship between the intensity and the duration of emotional distress. Results showed that the global measure of insight did not moderate recovering from daily-life distress. Regarding the subdimensions, attention to emotional reactions was related to an increased duration of distress. Results showed that, against our hypothesis, deeper comprehension of emotional reactions, operationalized here as “true insight”, was not associated to faster recovery. Limitations and recommendations for further studies are discussed considering these results.

Does Christian Spirituality Enhance Psychological Interventions on Forgiveness, Gratitude, and the Meaning of Life? A Quasi-Experimental Intervention with the Elderly and Youth

Scientific research has provided theoretical evidence on the implementation of religious/spiritual interventions (RSI) as a complementary health therapy, where spiritual improvements are also a factor to consider. Despite the above, there are few studies that have evaluated the clinical applicability of these findings. This study was an intervention with older and younger adults divided into two treatment groups and one control group. What is expected is that the two treatment groups will score better than the control group; however, the group with a Christian spiritual focus is expected to perform better than the group without a spiritual focus. Measures of gratitude, meaning of life, forgiveness, spirituality, religiosity, and expected prejudice were recorded. The hypothesis is fulfilled that Christian spirituality enhances psychological interventions on factors associated with personal well-being, mainly in older adults: spirituality (M = 26.00, SE = 2.127/M = 29.38, SE = 1.953, t (12) = -2.436, p < 0.05, r = 0.58), goals (M = 22.92, SE = 1.022/M = 24.54, SE = 0.739, t (12) = -2.298, p < 0.05, r = 0.55), and benevolence (M = 17.31, SE = 1.554/M = 21.08, SE = 1.603, t (12) = -3.310, p < 0.05, r = 0.69). The most powerful results of the study are those associated with religiosity/spirituality.

Internet Addiction and Related Clinical Problems: A Study on Italian Young Adults

The considerable prominence of internet addiction (IA) in adolescence is at least partly explained by the limited knowledge thus far available on this complex phenomenon. In discussing IA, it is necessary to be aware that this is a construct for which there is still no clear definition in the literature. Nonetheless, its important clinical implications, as emerging in recent years, justify the lively interest of researchers in this new form of behavioral addiction. Over the years, studies have associated IA with numerous clinical problems. However, fewer studies have investigated what factors might mediate the relationship between IA and the different problems associated with it. Ours is one such study. The Italian version of the SCL-90 and the IAT were administered to a sample of almost 800 adolescents aged between 16 and 22 years. We found the presence of a significant association between IA and two variables: somatization (β = 7.80; p < 0.001) and obsessive-compulsive symptoms (β = 2.18; p < 0.05). In line with our hypothesis, the results showed that somatization predicted the relationship between obsessive-compulsive symptoms and IA (β = -2.75; t = -3.55; p < 0.001), explaining 24.5% of its variance (ΔR ² = 1.2%; F = 12.78; p < 0.01). In addition, simple slopes analyses revealed that, on reaching clinical significance (+1 SD), somatization showed higher moderation effects in the relationship between obsessive-compulsive symptoms and IA (β = 6.13; t = 7.83; p < 0.001). These results appear to be of great interest due to the absence of similar evidence in the literature, and may open the way for further research in the IA field. Although the absence of studies in the literature does not allow us to offer an exhaustive explanation of these results, our study supports current addiction theories which emphasize the important function performed by the enteroceptive system, alongside the more cited reflexive and impulsive systems.

Stressful life events and hopelessness in adults: the mediating role of mentalization and emotional dysregulation

Objective:

Hopelessness is considered a risk factor for several mental and behavioral disorders. Research has shown that a stressful life event can be a significant predictor of hopelessness. The aim of the current research study was to explore the relationship between stressful life events and hopelessness, as well as to analyses the mediation effect of both mentalization and emotional dysregulation on this relationship.

Methods:

In a cross-sectional design, 607 participants recruited from the Spanish general population completed a series of measures.

Results:

Hopelessness was significantly related to stressful life events (r = 0.24, p < 0.001), emotion dysregulation variables (r = 0.18/0.38), and most measures of mentalization (r = 0.02/0.34). A good-fitting structural equation modeling-based mediation model (χ²/df = 2.04; root mean squared error of approximation = 0.042 [90%CI 0.033-0.050]; comparative fit index = 0.97; non-normed fit index = 0.97) showed that mentalization significantly mediated the relationship between stressful life events and hopelessness, while emotion dysregulation had no significant mediating effect.

Conclusions:

These results could have important clinical implications, such as the development of mentalization-based interventions for people living under a large number of stressors.

Longitudinal analysis of subjective well-being in preadolescents: The role of emotional intelligence, self-esteem and perceived stress

Subjective wellbeing has been conceptualized as a person's cognitive and affective evaluation of their life. In this line, life satisfaction and somatic complaints may be outstanding indicators of well-being. The aim of this longitudinal study was to analyze the combined contribution of trait emotional intelligence, self-esteem and perceived stress to well-being. Participants were 381 pupils aged 12-16 years (56.1% female). Hierarchical regression models and a fuzzy-set qualitative comparative analysis (QCA) were conducted. Trait emotional intelligence, self-esteem and low perceived stress were related in the expected direction to life satisfaction and somatic complaints. Findings support a specific pathway to improve wellbeing in preadolescents.

Using the Body When There Are No Words for Feelings: Alexithymia and Somatization in Self-Harming Adolescents

The present case-control study aimed to investigate the relationship between alexithymia and somatic complaints in the psychopathological setting of non-suicidal self-injury (NSSI). A clinical sample of 134 adolescents (115 females; 85.5%) from 12 to 18 years old engaging in NSSI was compared with a control group of 243 high-school students (157 females; 64.6%) from 13 to 18 years old. Data were collected using two questionnaires: The Youth Self-Report 11-18 and the 20 Toronto Alexithymia Scale. In both cases and controls, the presence of somatization and alexithymia was associated with more severe psychopathological problems. Analyses were conducted to explore the association between somatic disorders and alexithymia. In the clinical group, somatic complaints were reported by 95.9% of alexithymic individuals, whereas only 44.3% of alexithymic adolescents reported somatic complaints. A one-way relationship emerged between somatization and alexithymia: while alexithymia would seem to be a factor associated with self-injury, somatic disorders were strongly associated with alexithymia, but not necessarily with self-injury. Among the self-harming adolescents, those with both alexithymia and somatization had a more severe psychopathological picture than the individuals with alexithymia but no somatization. This would suggest that, in the setting of NSSI, greater difficulty with identifying feelings is associated with somatization, and alexithymia would be an attribute common to self-harming behavior and somatization, both of which are characterized by the body being used to express psychological and emotional problems. Future research could further investigate alexithymia in self-harming individuals, in relation to any presence or absence of somatic disorders, with longitudinal assessments on any differences in their manifestation of self-injury and its psychopathological correlates.