Abstract: Adults with Asperger syndrome can understand mental states such as desires and beliefs (mentalizing) when explicitly prompted to do so, despite having impairments in social communication. We directly tested the hypothesis that such individuals nevertheless fail to mentalize spontaneously. To this end, we used an eye-tracking task that has revealed the spontaneous ability to mentalize in typically developing infants. We showed that, like infants, neurotypical adults’ (n = 17 participants) eye movements anticipated an actor’s behavior on the basis of her false belief. This was not the case for individuals with Asperger syndrome (n = 19). Thus, these individuals do not attribute mental states spontaneously, but they may be able to do so in explicit tasks through compensatory learning.

Abstract: A test of advanced theory of mind (ToM), first introduced by F. Happe (1994), was adapted for children (mental, human, animal, and nature stories plus unlinked sentences). These materials were closely matched for difficulty and were presented to forty-five 7- to 12-year-olds with autism and 27 control children. Children with autism who showed ToM impairment on independent tests performed significantly more poorly than controls solely on the mental, human, and animal stories with greatest impairment on the former and least on the latter. Thus, a mentalizing deficit may affect understanding of biologic agents even when this does not explicitly require understanding others' mental states.

Abstract: This study used fMRI to investigate the functioning of the Theory of Mind (ToM) cortical network in autism during the viewing of animations that in some conditions entailed the attribution of a mental state to animated geometric figures. At the cortical level, mentalizing (attribution of metal states) is underpinned by the coordination and integration of the components of the ToM network, which include the medial frontal gyrus, the anterior paracingulate, and the right temporoparietal junction. The pivotal new finding was a functional underconnectivity (a lower degree of synchronization) in autism, especially in the connections between frontal and posterior areas during the attribution of mental states. In addition, the frontal ToM regions activated less in participants with autism relative to control participants. In the autism group, an independent psychometric assessment of ToM ability and the activation in the right temporoparietal junction were reliably correlated. The results together provide new evidence for the biological basis of atypical processing of ToM in autism, implicating the underconnectivity between frontal regions and more posterior areas.

Abstract: edited by E.L. Jurist, A. Slade, S. Bergner Other Press , New York, NY , 2008 ; 454 pp ; US $28.00 This edited volume explores the concepts of mentalization and reflective functioning, as articulat...

Abstract: The authors describe the development of a theory-driven assessment and research protocol at the Adolescent Treatment Program of The Menninger Clinic. First, the theoretical framework behind a mentalization-based model for assessment and treatment is described. Next, the process whereby measures were selected to operationalize key components of the mentalization-based model is discussed, including a brief discussion of each measure and assessment procedure. The next section describes the clinical and research use of the data collected. Here, the authors describe how outcomes assessment information is integrated into the clinical decision-making process, and they outline the research questions they aim to answer through the assessment protocol. The authors conclude with a section on the challenges, pitfalls, and future directions of the project.

Abstract: In the second volume of his trilogy on attachment theory, John Bowlby (1973: 210) wrote: when the actual experiences they have had during childhood are known and can be taken into account, the pathological fears of adult patients can often be seen in a radically new light. Paranoid symptoms that had been regarded as autogenous and imaginary are seen to be intelligible, albeit distorted, responses to historical events. Yet 35 years later the relationships between attachment and psychotic experiences are poorly understood. While attachment security is clearly compromised in individuals diagnosed with schizophrenia (Dozier, 1990; Dozier and Lomax, 1994; Dozier and Lee, 1995; Mickelson et al., 1997; Tyrrell et al., 1999; Dozier et al., 2001), it is not yet clear how Q1 the developmental pathways leading to schizophrenia differ from those leading, also from insecure early attachments, to other psychopathological disorders. Likewise, no developmental pathway unique to schizophrenia has been found to lead from the low levels of parental care and high levels of parental overprotection (Parker et al., 1982; Onstad et al., 1994; Winther Helgeland and Torgersen, 1997; Willinger et al., 2002) and low security in close relationships (Tait, Birchwood and Trower, 2004; Ponizovsky, Nechamkin and Rosca, 2007) reported by persons with this diagnosis, as such experiences are reported by persons with other diagnoses as well. While these data have been helpful in developing

Abstract: The aims of this study were to develop a new measure of impulsive aggressiveness, and to assess whether this measure was associated with deficits in mentalized affectivity and adult attachment styles in a sample of 637 non-clinical participants. Extending Fonagy and Bateman's (2004) hypothesis, the mediating role of poor affectivity mentalization in the relationship between insecure attachment styles and impulsive aggression was also evaluated. Selected insecure attachment styles (R 2 adjusted = .18, p < .001) and deficits in mentalized affectivity (R 2 adjusted = .25, p < .001) were significantly associated with impulsive aggressiveness. The overall regression model accounted for roughly 33% of the variance in impulsive aggressiveness. Mentalization deficits significantly mediated the effects of attachment styles on impulsive aggressiveness, although effect size measures suggested that only partial mediation occurred.

Abstract: This article discusses and illustrates the use of mentalization-based psychodynamic psychotherapy for disturbances of awareness of the self and others in patients with psychotic-spectrum disorders. The literature on impairments of mental processes involved in self-awareness and awareness of others occurring in psychotic illnesses and the relationship between childhood trauma and the emergence of psychotic symptoms is reviewed. A case illustrates how mentalization-based treatment can facilitate treatment engagement and be used to manage enactments in the psychotherapy with a patient with a psychotic disorder. Mentalization-based psychotherapy may offer a useful adjunct to antipsychotic medication and psychosocial evidence-based treatments in the care of individuals in the early phase of psychotic disorders.

Abstract: Background. Schizophrenia patients show disturbances on a range of tasks that assess mentalizing or 'Theory of Mind' (ToM). However, these tasks are often developmentally inappropriate, make large demands on verbal abilities and explicit problem-solving skills, and involve after-the-fact reflection as opposed to spontaneous mentalizing. Method. To address these limitations, 55 clinically stable schizophrenia out-patients and 44 healthy controls completed a validated Animations Task designed to assess spontaneous attributions of social meaning to ambiguous abstract visual stimuli. In this paradigm, 12 animations depict two geometric shapes' interacting' with each other in three conditions: (1) ToM interactions that elicit attributions of mental states to the agents, (2) Goal-Directed (GO) interactions that elicit attributions of simple actions, and (3) Random scenes in which no interaction occurs. Verbal descriptions of each animation are rated for the degree of Intentionality attributed to the agents and for accuracy. Results. Patients had lower Intentionality ratings than controls for ToM and GO scenes but the groups did not significantly differ for Random scenes. The descriptions of the patients less closely matched the situations intended by the developers of the task. Within the schizophrenia group, performance on the Animations Task showed minimal associations with clinical symptoms. Conclusions. Patients demonstrated disturbances in the spontaneous attribution of mental states to abstract visual stimuli that normally evoke such attributions. Hence, in addition to previously established impairment on mentalizing tasks that require logical inferences about others' mental states, individuals with schizophrenia show disturbances in implicit aspects of mentalizing.

Abstract: The study investigated alexithymia in relation to facial imitation, empathy, attachment (models-of-self and-others), and reported emotional contagion and the degree of correspondence between facial responses (somatic affect) and reported emotional contagion (mentalization of affects). Pictures of angry, happy, and sad faces were presented to 102 participants at exposure times from subliminal (17–23 ms) to clearly supraliminal (2,500 ms). Electromyographic (EMG) activity from the corrugator and zygomaticus muscles was measured, and emotional contagion was reported after exposures. Self-report questionnaires measured alexithymia (TAS-20), attachment (RSQ), and empathy (IRI). Alexithymia correlated negatively with models-of-self (p < .01) and models-of-others (p < .0001), with a marginally significant correlation with empathy (p = .06). An interaction (p < .05) was found between alexithymia and facial expression with corrugator response as dependent measure, indicating corrugator imitation only for the low-a...

Abstract: Studies demonstrating selective brain networks subserving motivation and mentalization (i.e. attributing states of mind to others) during social interactions have not investigated their mutual independence. We report the results of two fMRI studies using a competitive game requiring players to use implicit ‘on-line’ mentalization simultaneously with motivational processes of gains and losses in playing against a human or a computer opponent. We delineate a network, consisting of bilateral temporoparietal junction, temporal pole (TP), medial prefrontal cortex (MPFC) and right fusiform gyrus, which is sensitive to the opponent’s response (challenging>not challenging the player) and opponent type (human>computer). This network is similar to a known explicit ‘off-line’ mentalization circuit, suggesting its additional involvement in implicit ‘on-line’ mentalization, a process more applicable to real-life social interactions. Importantly, only MPFC and TP were selective to mentalization compared to motivation, highlighting their specific operation in attributing states of mind to others during social interactions.

Abstract: The primary aim of this article is to give a theoretical and empirical background for clinical interventions in family-oriented treatment for substance use disorders. The article refers to an ongoing research project, which is based on the concepts of mentalization and parental reflective functioning. Theory of mentalization and attachment theory is explored as explanatory tools of both addictive problem and risk/resilience factors in offspring. Mentalization is defined as the competence to envision mental states in self and others and to understand behaviour in terms of mental states. Substance use is discussed as clinical expressions of impaired mentalizing skills and disorders of state- and affect regulation. Parental reflective function particularly refers to parents’ competences to interpret the mind of their own infant or child. Parental reflective functioning, as ‘minding the baby’, promotes sensitive care, which again serves to protect the infant and the immature brain from potentially dangerous stress and physiological arousal. Substance use often makes the parent ‘absent-minded’ and thus imposes a risk of impaired interactions between caregivers and the extra vulnerable substance exposed child.

Abstract: The chapter starts with a historical overview of the subject of narcissism in psychoanalysis. Some sociophilosophical definitions of narcissism are explained and the connection to self psychology is described. It is especially referred to Honneth's Struggle for Recognition, which is related to the need for selfobject experiences. An outline of different concepts concerning narcissism, especially in the European psychoanalytic tradition, follows and leads to a clearer understanding of Kohut's conception of the self and its selfobjects. Because self psychology can often be understood as applied developmental psychology, useful links to attachment research are described and the move to the level of representation by mentalization is clarified. Further development of self psychology in the direction of intersubjectivity helps to supply connections to systems theory. Recently developed theories of empathy with reference to neurobiological findings provide a dynamic perspective of the activation of empathy. Thus, empathy seems to be better understood as a sort of contagion on which cognitive cortical processes are superimposed. Finally, the therapeutic process in psychoanalytic self psychology is portrayed. This process implies a disruption and repair process by which transmuting internalization can take place. More current theories of self psychology view this process in its essence intersubjectively as a co-construction between patient and analyst. The paper concludes with some hints for a paradigm shift in the direction of a more holistic understanding of the self.

Abstract: The primary aim of this article is to give a theoretical and empirical background for clinical interventions in family-oriented treatment for substance use disorders. The article refers to an ongoing research project, which is based on the concepts of mentalization and parental reflective functioning. Theory of mentalization and attachment theory is explored as explanatory tools of both addictive problem and risk/resilience factors in offspring. Mentalization is defined as the competence to envision mental states in self and others and to understand behaviour in terms of mental states. Substance use is discussed as clinical expressions of impaired mentalizing skills and disorders of state- and affect regulation. Parental reflective function particularly refers to parents’ competences to interpret the mind of their own infant or child. Parental reflective functioning, as ‘minding the baby’, promotes sensitive care, which again serves to protect the infant and the immature brain from potentially dangerous s...

Abstract: Intervention with infants, preschoolers, and their families requires that the child and adolescent psychiatrist shift perspective from a one-person psychology to a multiperson or Brelational[ psychology. Assessment and intervention with children younger than 5 years therefore necessitate that the clinician pay close attention to the unique characteristics of the parentYchild relationship. These characteristics include adaptation to each other’s temperaments, developmental capacities, and biological and psychological needs and desires, and to the demands of the particular environment with which the parentYchild relationship contends. Central to this work is the observation of parentY child interactionVholding, communicating, feeding, grooming/diapering, dressing, and, of course, playing. For those who practice in clinics or private offices, these observations occur during free and unstructured interactions in an environment where age-appropriate toys are available for the child. The content of the child’s spontaneous play; the parent’s affective, behavioral, and verbal responses to the child and their play; the child’s response during play while the parent speaks with the therapist; and the child’s direct response to the parentVall are key sources of information regarding the nature of the interaction. The child and adolescent psychiatrist alternately considers the child’s and parent’s perspectives, while also stepping outside of both individual perspectives to view the childYparent relationship. Thus, in addition to developmental and psychiatric vantage points, a relational vantage point is adopted. In an effort to maximize the potential for adaptive socialYemotional functioning of parent and child, particular attention is paid to both protective and risk factors within the relationship. One such factor, the presence of which is considered a protective element and the absence of which implies risk, is that of Bmentalization.[ Mentalization is the capacity to reflect on, and hold in mind, the mental states (i.e., feelings, thoughts, beliefs) of oneself and others. Empirical research suggests that this capacity is a parental trait that forms in the first years of life within the context of the attachment relationship with the parent’s own caregivers. The parent’s mentalization capacity affects the parent’s caregiving behavior with her own child and, in turn, the child’s attachment behavior with the parent. The processes involved in mentalization have been operationalized as a range of Bself-reflective functioning[ or BRF.[ Reflective functioning was originally developed as a codification of verbal examples of mentalization ranging from examples of low RF to high RF. It was used to code narrative content from the Adult Attachment Interview (C. George et al., unpublished, 1984). High RF was found to correlate significantly with secure adult attachment and subsequently with the Assistant Editors

Abstract: Objectives General practitioners (GPs) treat more than 90% of common mental disorders. However, the content of their interventions remains undefined. The present study aimed to explore GPs' processes of understanding the patients with emotional problems. Design The study was qualitative using semi-structured interviews with 14 general practitioners sampled purposively. Observation was done in the surgeries of four of the GPs. Methods Analysis of the interviews was made by Interpretative Phenomenological Analysis (IPA). Observation notes were analysed from a hermeneutic-phenomenological perspective, inspired by IPA. Results GPs had very different approaches to patients with emotional problems. Physical symptoms were the usual reason for consulting the GP. Understanding patients' perception of the meaning of their bodily symptoms in their complex life-situation was considered important by some of the participants. Arriving at this understanding often occurred through the narrative delivered in different narrative styles mirroring the patients' mental state. Awareness of relational factors and self-awareness and self-reflexivity on the part of the GP influenced this process. Other participants did not enter this process of understanding patients' emotional problems. Conclusions The concept of mentalization could be used to describe GPs' processes of understanding their patients when making psychosocial interventions and could form an important ingredient in a general practice theory in this field. Only some participants had a mentalizing approach. The study calls attention to the advantage of training this capacity for promoting professional treatment of patients and a professional dialogue across sector borders.

Abstract: Background Our knowledge about medically unexplained symptoms (mus) is increasing, but translating this knowledge into more effective treatment, particularly if symptoms are severe, continues to be problematical Aim To clarify the physical aspect of mentalisation (body-mentalisation) and to outline a theoretical perspective of body-mentalisation, starting from theories such as the attachment theory and the mentalisation theory, and to describe the diagnostic and therapeutic value of this approach Methods Clinical experience with body-mentalisation led to a systematic literature search (via PsycInfo and Medline) Results Body-mentalisation is the ability to detect the signals of our own and of other, to respond to them and perceive the links with underlying mental states Poor body-mentalisation occurs frequently in patients with severe mus and can be treated successfully by means of intensive residential or day-therapy programmes Conclusion Body-mentalisation may turn out to be a useful concept in connection with the treatment of persons with severe mus More research is needed to test the diagnostic validity and therapeutic relevance of this concept

Abstract: BACKGROUND: Clinical experience and recent research convey that patients with personality disorders who harm themselves with a suicidal intention should be treated differently than those who do so without a suicidal intention. The purpose of this article is to give an overview of non-suicidal self-harm in these patients. MATERIAL AND METHOD: The article is based on a non-systematic literature search in PsycINFO, Medline, Clinical Evidence and Cochrane and own clinical experience. RESULTS: Self-harm in patients with personality disorders is associated with borderline personality traits. Up to 70 % of patients with borderline personality disorders have reported non-suicidal self-harm. Non-suicidal self-harm is one of the risk factors for suicide. Borderline personality disorder develops due to interaction between genetic vulnerability and a traumatic and unsafe upbringing. The patients are often influenced by intense negative emotions and have reduced ability to regulate and handle these in interpersonal situations. Self-harm can give short-term alleviation of the inner pain associated with emotion dysregulation. Dialectical behavior therapy and mentalization-based therapy is shown to reduce the prevalence of self-harm in patients with borderline personality disorder. Acute referral to in-patient treatment should only be used in crises that cannot be handled in out-patient treatment. The regular general practitioner can function as a stable attachment figure and contribute to self-regulation. INTERPRETATION: Non-suicidal self-harm in patients with personality disorders should be given more attention. Language: no

Abstract: In order for us to begin to understand the effect of abusive experiences in childhood on young people's personality development and symptomatology, we have to draw upon a number of theories. The most important of these relate to attachment, mentalization, dissociation, trauma, and how abusive experiences affect the development of the individual and their developing brain. In this article I will share with you my attempts to understand the young people that come to stay on our intensive care unit and consider how these theories inform our understanding of them and the treatment approach that we try to provide.

Abstract: Sure to become the standard text for all students and practicing psychotherapists, whatever their background, the "Textbook of Psychotherapeutic Treatments" addresses all the major psychotherapeutic modalities in one comprehensive, ...

Abstract: A new self-report measure of mentalization, the 46-item Reflective Function Questionnaire (RFQ46), was investigated for reliability and validity. Relationships between borderline personality disorder (BPD), eating disorder (ED), impulsivity and mentalization were also explored. The RFQ46 was administered alongside a battery of conceptually-related questionnaires to 403 clinical and non-clinical participants. The clinical sample comprised patients attending specialist units for BPD and ED across 5 sites. A subset of these patients was interviewed to acquire diagnostic information. The non-clinical sample comprised staff and students from two colleges and one general hospital, the latter sample having been previously recruited in a pilot study. After initial data screening the RFQ46 was reduced to 15 items. An exploratory factor analysis revealed two conceptually coherent and internally reliable factors (of.75, .63), with an overall alpha of .77. The RFQ15 evidenced strong construct validity in that it positively related to measures of empathy and theory of mind, and negatively with ED, BPD, depression and impulsivity. ROC analysis supported the RFQ15’s power to discriminate between clinical and non-clinical populations. Comorbid patients appeared to have lower mentalization levels than patients with a single diagnosis. Anorexic, rather than bulimic attitudes were more closely related to mentalization. Mentalization was found to mediate the effect of multi-impulsivity on BPD and ED. Results suggest that mentalization can be effectively measured through self-report, and meaningful differences can be detected between clinical and non-clinical populations and between diagnostic categories. The present study’s results will assist future research into new mentalization-based treatments for BPD and ED.

Abstract: We are now poised to enter the middle age of contemporary studies and treatment of complex dissociative disorders. The International Society for the Study of Trauma and Dissociation (ISSTD) had its...

Abstract: Major Depression is a common and complex disorder that is often difficult to treat. Mentalization, facilitated by secure attachment, has been found to serve as a protective function against Borderl ...

Abstract: Mentalization includes the ability to apprehend and reflect upon one's subjective state, as well as an appreciation of one's agency (Fonagy & Target, 2006). Masochism is a character pattern that is traditionally defined as pleasure in pain or suffering (Million, 1996). In some cases the etiology of this character pattern may mirror failures on the part of the caregiving surround that contribute to deficits in the ability to mentalize self (Fonagy, Gergely, & Target, 2007; Benjamin, 1988). When this occurs masochism may be more profitably understood as an inability to register pain, rather than pleasure in pain. A case example demonstrates that when a deficit in mentalization underlies masochistic functioning, treatment may include interventions aimed at helping the patient improve the ability to reflect upon his or her mental state, especially negative affect such as pain and anger, and connect to a sense of agency.

Abstract: The ability to attribute mental and emotional states to other people and to oneself is crucial to social interactions. This ability is necessary to understand the mind and feelings of others and oneself, to understand the behaviour and actions of other people, to behave socially as expected, but also to lie and to cheat. The representational abilities are complex and consequently, several concepts emerged in neuroscience, development psychology and medicine, reflecting and dealing with their different aspects. The main concepts are theory of mind (ToM, synonymous with mind reading and mentalizing) and empathy. In short, theory of mind is the ability to attribute intentional mental states to other people and ToM deficits are paradigmatic for autism/ Asperger syndrome. Moreover, during the last years, evidence has been growing that many mental disorders are also associated with impaired representational abilities. Using functional imaging, several studies showed that the particular representational abilities like empathy and theory of mind correlate with individual, mutually overlapping, but not identical neuronal networks. Furthermore, there are controversial discussions about the correlation in attributing mental and emotional states to oneself and to other people. Even though these concepts are not broadly used in a clinical context, they could be important; the idea of impaired representational abilities might help to explain some of the social interaction deficits, which handicap many mentally ill persons. One main concern is - due to the different contexts in which these concepts emerged - that they are not defined and differentiated from each other precisely enough. To our knowledge, until recently there have been no validated, reliable instruments to measure ToM deficits in the German speaking countries available, in spite of the fact that such tests would facilitate clinical work with these representational concepts. Accurate detection and identification of the deficits in the representational abilities are necessary to refine and further validate existing therapies - a psychodynamic treatment using the theory of mind concept (the mentalization-based treatment of borderline personality disorder) has already been designed - or to develop new therapies, aiming at improvement of the integration of mentally ill patients in general and their social integration in particular.

Abstract: iii, 80 p. Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2009. Includes bibliographical references (p. 70-72).