Abstract: Mentalizing-the capacity to understand others' and one's own behavior in terms of mental states-is a defining human social and psychological achievement. It involves a complex and demanding spectrum of capacities that are susceptible to different strengths, weakness, and failings; personality disorders are often associated with severe and consistent mentalizing difficulties (Fonagy & Bateman, 2008). In this article, we will argue for the role of mentalizing in the therapeutic relationship, suggesting that although mentalization-based treatment may be a specific and particular form of practice, the "mentalizing therapist" is a universal constituent of effective psychotherapeutic interventions.

Abstract: The nativist view of mentalizing—the view that humans have an inherent capacity to think about the mental states of others—has been recently reinvigorated by reports that adults and infants automat...

Abstract: The aim of this study was to examine preliminary evidence of the validity of the Trauma Reflective Functioning Scale and to investigate reflective functioning (RF) and attachment in pregnant women with histories of trauma, with a particular focus on the capacity to mentalize regarding trauma and its implications for adaptation to pregnancy and couple functioning. The Adult Attachment Interview was used to assess attachment, unresolved trauma and mentalization (measured as RF) regarding relationships with attachment figures (RF-G) and trauma (RF-T) in 100 pregnant women with histories of abuse and neglect. The majority (63%) of women had insecure attachment states of mind and approximately half were unresolved regarding trauma. Furthermore, the majority of women manifested deficits specific to RF-T. Their RF-T was significantly lower than their RF-G; the findings indicate that women with histories of childhood abuse and neglect do not manifest a generic inhibition of reflectiveness, but a collapse of mentalization specific to trauma. Low RF-T, indicative of difficulty in considering traumatic experiences in mental state terms, was associated with difficulty in investment in the pregnancy and lack of positive feelings about the baby and motherhood. In addition, low RF-T was also associated with difficulties in intimate relationships. Results of a regression analysis with RF indicated that RF-T was the best predictor of investment in pregnancy and couple functioning. In sum, the study provides preliminary evidence that RF-T can be reliably measured and is a valid construct that has potential usefulness for research and clinical practice. It highlights the importance of mentalization specifically about trauma and suggests that it is not the experience of trauma per se, but the absence of mentalization regarding trauma that is associated with difficulties in close relationships and in making the transition to parenthood.

Abstract: Objectives It has been argued that attachment theory could enhance our knowledge and understanding of psychotic phenomenology. Design We systematically reviewed and critically appraised research investigating attachment and psychotic phenomenology in clinical and non-clinical samples. Methods We searched databases Pub Med, PsycINFO, Medline and Web of Science using the keywords. Attachment, Adult Attachment, Psychosis, Schizotypy and Schizophrenia and identified 29 studies assessing adult attachment in combination with psychotic phenomenology. Result The findings indicated that both insecure anxious and insecure avoidant attachment are associated with psychotic phenomenology. Insecurely attached individuals are more vulnerable to developing maladaptive coping strategies in recovering from psychosis. The importance of attachment experiences for processing social information, mentalization skills and developing social relationships, including therapeutic relationships, in samples with psychosis is also highlighted. Conclusion Attachment style is a clinically relevant construct in relation to development, course and treatment of psychosis. Practitioner points Understanding the role of attachment in symptoms may help to gain insight into the development or persistence of symptoms. Associations between attachment and recovery style suggest that it may be helpful to improve attachment security in a context of therapeutic relationships or other social relationships before encouraging people to explore their experiences of psychosis. Associations between insecure attachment and impaired mentalization skills may help in understanding interpersonal difficulties and this knowledge can be used to improve recovery.

Abstract: Patients affected by brain tumours may show behavioural and emotional regulation deficits, sometimes showing flattened affect and sometimes experiencing a true 'change' in personality. However, little evidence is available to the surgeon as to what changes are likely to occur with damage at specific sites, as previous studies have either relied on single cases or provided only limited anatomical specificity, mostly reporting associations rather than dissociations of symptoms. We investigated these aspects in patients undergoing surgery for the removal of cerebral tumours. We argued that many of the problems described can be ascribed to the onset of difficulties in one or more of the different levels of the process of mentalizing (i.e. abstracting and reflecting upon) emotion and intentions, which impacts on everyday behaviour. These were investigated in terms of (i) emotion recognition; (ii) Theory of Mind; (iii) alexithymia; and (iv) self-maturity (personality disorder). We hypothesized that temporo/limbic areas would be critical for processing emotion and intentions at a more perceptual level, while frontal lobe structures would be more critical when higher levels of mentalization/abstraction are required. We administered four different tasks, Task 1: emotion recognition of Ekman faces; Task 2: the Eyes Test (Theory of Mind); Task 3: Toronto Alexithymia Scale; and Task 4: Temperament and Character Inventory (a personality inventory), both immediately before and few days after the operation for the removal of brain tumours in a series of 71 patients (age range: 18-75 years; 33 female) with lesions located in the left or right frontal, temporal and parietal lobes. Lobe-based and voxel-based analysis confirmed that tasks requiring interpretation of emotions and intentions at more basic (less mentalized) levels (Tasks 1 and 2) were more affected by temporo/insular lesions, with emotion recognition (Task 1) being maximally impaired by anterior temporal and amygdala lesions and Task 2 (found to be a 'basic' Theory of Mind task involving only limited mentalization) being mostly impaired by posterior temporoparietal lesions. Tasks relying on higher-level mentalization (Tasks 3 and 4) were maximally affected by prefrontal lesions, with the alexithymia scale (Task 3) being mostly associated with anterior/medial lesions and the self-maturity measure (Task 4) with lateral prefrontal ones.

Abstract: In daily life, perceivers often need to predict and interpret the behavior of group agents, such as corporations and governments. Although research has investigated how perceivers reason about individual members of particular groups, less is known about how perceivers reason about group agents themselves. The present studies investigate how perceivers understand group agents by investigating the extent to which understanding the ‘mind’ of the group as a whole shares important properties and processes with understanding the minds of individuals. Experiment 1 demonstrates that perceivers are sometimes willing to attribute a mental state to a group as a whole even when they are not willing to attribute that mental state to any of the individual members of the group, suggesting that perceivers can reason about the beliefs and desires of group agents over and above those of their individual members. Experiment 2 demonstrates that the degree of activation in brain regions associated with attributing mental states to individuals—i.e., brain regions associated with mentalizing or theory-of-mind, including the medial prefrontal cortex (MPFC), temporo-parietal junction (TPJ), and precuneus—does not distinguish individual from group targets, either when reading statements about those targets’ mental states (directed) or when attributing mental states implicitly in order to predict their behavior (spontaneous). Together, these results help to illuminate the processes that support understanding group agents themselves.

Abstract: In order to Test Fonagy's (Fonagy & Bateman, 2008) hypotheses on the relationships among borderline personality disorder (BPD), mentalization, and attachment, nonclinical adolescents were assigned to a high-BPD group (n = 29), an average- BPD group (n = 31) and a low-BPD group (n = 29). Participants in the three groups were administered the Reading the Mind in the Eyes Test (RET), the Lack of Emotional Clarity Scale from the Difficulties in Emotion Regulation Scale, and the Attachment Style Questionnaire (ASQ). High-BPD adolescents scored significantly lower than low-BPD adolescents on the RET (d= -0.66), and significantly higher than both other groups on the DERS LEC. When the effect of the ASQ scales was controlled for, the high-BPD group did not show any significant difference from the other groups on mentalization measures. These findings were consistent with Fonagy's (Fonagy & Bateman, 2008) model of BPD.

Abstract: The aim of the current chapter is to review and discuss the literature on the social-cognitive basis of BPD with the ultimate goal of providing an integrated framework for theory and research. The chapter begins with a description of the behavioral phenotype of disrupted interpersonal relationships in BPD, especially in the context of adolescence, which justifies a social-cognitive approach to BPD. Next, the ever-expanding empirical support for the social-cognitive basis of interpersonal disruptions in BPD in adults and adolescents is discussed. Acknowledging the multi-component nature of the construct of social cognition, and reflecting the three major developmental theories of BPD (Linehan’s biosocial theory, Fonagy’s mentalization-based theory, and attachment theory), this literature is organized by reference to the three social-cognitive constructs most often studied in relation to BPD: emotion recognition, mentalizing (or theory of mind) and trust. After reviewing empirical evidence in support of the relation of these constructs to BPD features, a possible resolution is presented to understand and explain inconsistencies among findings by suggesting a recursive social-information processing model culminating in hypermentalizing in BPD. As such, a framework for future research in the social cognition of BPD is provided by integrating the biosocial, mentalizing and attachment approaches to BPD.

Abstract: Mentalization (i.e., the ability to think about states of mind (e.g., thoughts, feelings, intentions) in the self and other people) and metacognition (‘thinking about thinking’) have increasingly been linked both theoretically and empirically, as both constructs involve the capacity for meta-representation within social contexts. Promising evidence is emerging for the value of metacognitive psychotherapy in the treatment of people with schizophrenia. In this chapter, we present the rationale for adapting a mentalization-based treatment (MBT) approach to the recovery of mental state understanding in schizophrenia.

Abstract: This chapter presents the adaptation of transference-focused psychotherapy for personality disorders in adolescents (TFP-A). This treatment is based on contemporary psychoanalytic object relations theory as developed by Kernberg (1984, 1992) and supported by findings from current evidence-based and neurobiological research (Clarkin, Levy, Lenzenweger, & Kernberg, 2004; Clarkin & Posner, 2005; Doering et al., 2010; Levy et al., 2006). The specificity of the treatment involves assessing dominant pathological object relations activated in the here-and-now interaction with the therapist, as well as engaging the adolescent in a contract that helps him prioritize mentalization and thinking about his motivations rather than acting out. In addition there is a specific approach to dealing with parents in order to create a mental space for the adolescent where he can exercise both autonomy and responsability for his difficulties. Furthermore, the consistent emphasis on intrepreting transference and countertransference reactions is a defining feature of this treatment. The therapist uses these reactions to identify split self- and other-respresentations that prevent integration of the personality and without which the adolescents is not able to use his mentalization capacities in order to deal with the challenges of adolescence. Finally a clinical vignette is presented that illustrates how these principles are applied in the context of the treatment of an adolescent.

Abstract: The NOURISHED study: Nice OUtcomes for Referrals with Impulsivity, Self Harm and Eating Disorders. Eating Disorders (ED) and Borderline Personality Disorder (BPD) are both difficult to treat and the combination presents particular challenges. Both are associated with vulnerability to loss of mentalization (awareness of one’s own and others’ emotional state). In BPD, Mentalization Based therapy (MBT) has been found effective in reducing symptoms. In this trial we investigate the effectiveness and cost-effectiveness of MBT adapted for Eating disorders (Mentalization Based Therapy for Eating Disorders (MBT-ED)) compared to a standard comparison treatment, Specialist Supportive Clinical Management (SSCM-ED) in patients with a combination of an Eating Disorder and either a diagnosis of BPD or a history of self-harm and impulsivity in the previous 12 months. We will complete a multi-site single-blind randomized controlled trial (RCT) of MBT-ED vs SSCM-ED. Participants will be recruited from three Eating Disorder Services and two Borderline Personality Disorder Services in London. Participants allocated to MBT-ED will receive one year of weekly group and individual therapy and participants allocated to SSCM-ED will receive 20 sessions of individual therapy over 1 year. In addition, participants in both groups will have access to up to 5 hours of dietetic advice. The primary outcome measure is the global score on the Eating Disorders Examination. Secondary outcome measures include total score on the Zanarini BPD scale, the Object Relations Inventory, the Depression Anxiety Stress Scales, quality of life and cost-effectiveness. Measures are taken at recruitment and at 6 month intervals up to 18 months. This is the first Randomised Controlled Trial of MBT-ED in patients with eating disorders and symptoms of BPD and will provide evidence to inform therapy decisions in this group of patients. During MBT-ED mentalization is encouraged, while in SSCM-ED it is not overtly addressed. This study will help elucidate mechanisms of change in the two therapies and analysis of therapy and interview transcripts will provide qualitative information about the conduct of therapy and changes in mentalization and object relations. ISRCTN51304415

Abstract: Aims: Concepts of mentalization, affect consciousness, and mindfulness have been increasingly emphasized as crucial in psychotherapy of diverse orientations. Different measures have been developed ...

Abstract: This article articulates some of the problems that surround the use of the term trauma in psychoanalytic theory and suggests that the key element for a theory of pathogenesis and mental functioning is not the either/or of external versus internal causation or trauma versus drive. Rather, it is an understanding of whether, or to what extent, the raw data of existential experience is or is not transformed into psychological experience. From this perspective, trauma is whatever outstrips and disrupts the psyche’s capacity for representation or mentalization. Absent the potential for mental representation, these events and phenomena are historical only from an external, third-person perspective. Until they are mentalized, they remain locked within an ahistorical, repetitive process as potentials for action, somatization, and projection.

Abstract: Aim This article addresses the problem of explaining emotional pathology (levels of personality organization) using the concepts of theory of mind (ToM) and mentalization. Although these terms are used interchangeably to describe the "ability to interpret the behavior of others in terms of mental states," they do not have identical status in emotional disorders. ToM refers to a "cold" knowledge, whereas mentalization requires the activation of relational and emotional representations, as well as processing of emotional experience (whether reflection or defense). The aim of the study was to compare the cognitive (ToM) and affective (mentalization) aspects of "understanding the behavior of others in terms of mental states" in the clinical group--consisting of patients with borderline personality organization (N = 30); and the control group (N = 30). Method The Borderline Personality Inventory was used as a diagnostic questionnaire for the organization of personality, the Strange Stories Test was employed to measure ToM, and the Mental States Task instrument measured mentalization. Results With respect to mentalization, different patterns of results were obtained: the activation of overwhelming mental states and primitive defenses in the clinical group; as well as the inhibition of the recognition of mental content by defenses, such as denial and suppression of emotions, in the control group. No differences were observed in ToM between groups. Conclusions In explaining the personality organization levels, only the affective, and not the cognitive, aspects of "understanding the behavior of others in terms of mental states" are significant. People with borderline personality organization, as well as healthy individuals, use "cold" knowledge about internal states. However, the activation of relational and emotional representations triggers different mental states in both groups.

Abstract: The capacity to interpret others people's behavior and mental states is a vital part of human social communication. This ability, also called mentalizing or Theory of Mind (ToM), may also serve as a protective factor against aggression and antisocial behavior. This study investigates the relationship between two measures of psychopathy (clinical assessment and self-report) and the ability to identify mental states from photographs of the eye region. The participants in the study were 92 male inmates at Bergen prison, Norway. The results showed some discrepancy in connection to assessment methodology. For the self-report (SRP-III), we found an overall negative association between mental state discrimination and psychopathy, while for the clinical instrument (PCL-R) the results were more mixed. For Factor 1 psychopathic traits (interpersonal and affective), we found positive associations with discrimination of neutral mental states, but not with the positive or negative mental states. Factor 2 traits (antisocial lifestyle) were found to be negatively associated with discrimination of mental states. The results from this study demonstrate a heterogeneity in the psychopathic construct where psychopathic traits related to an antisocial and impulsive lifestyle are associated with lower ability to recognize others' mental states, while interpersonal and affective psychopathic traits are associated with a somewhat enhanced ability to recognize others' emotional states.

Abstract: In this chapter, we apply the mentalization construct to provide a framework for understanding not only emerging personality disorder in adolescence but also adolescent breakdown more broadly (see also Chap. 12, current volume). We summarize the neurodevelopmental changes that occur in adolescence and how these temporarily compromise different facets of mentalization. We describe the principles and structure of mentalization-based treatment for adolescents (MBT-A), which incorporates monthly sessions of mentalization-based treatment for families (MBT-F). We then discuss the particular relevance of the mentalization construct for understanding self-harm in adolescence and describe the results of a recent pragmatic small-scale randomized superiority trial comparing MBT-A with treatment as usual (TAU) for adolescents with self-harm.

Abstract: The capacity to interpret others people’s behavior and mental states is a vital part of human social communication. This ability, also called mentalizing or Theory of Mind (ToM), may also serve as a protective factor against aggression and antisocial behavior. This study investigates the relationship between two measures of psychopathy (clinical assessment and self-report) and the ability to identify mental states from photographs of the eye region. The participants in the study were 92 male inmates at Bergen prison, Norway. The results showed some discrepancy in connection to assessment methodology. For the self-report (SRP-III), we found an overall negative association between mental state discrimination and psychopathy, while for the clinical instrument (PCL-R) the results were more mixed. For Factor 1 psychopathic traits (interpersonal and affective), we found positive associations with discrimination of neutral mental states, but not with the positive or negative mental states. Factor 2 traits (antisocial lifestyle) were found to be negatively associated with discrimination of mental states. The results from this study demonstrate a heterogeneity in the psychopathic construct where psychopathic traits related to an antisocial and impulsive lifestyle are associated with lower ability to recognize others’ mental states, while interpersonal and affective psychopathic traits are associated with a somewhat enhanced ability to recognize others’ emotional states.

Abstract: A number of leading practice models have been found to be effective in the treatment of Borderline Personality Disorder (BPD). These include Dialectical Behavior Therapy, Transference Focused Psychotherapy and Mentalization Based Treatment. This article reviews the current evidence for these dominant practice models, and concludes that no single treatment has been found to be consistently superior in the treatment of BPD. Given the lack of evidence priviledging one single model of treatment, and the fact that it is not always feasible or desirable for social workers to practice using pure manualized treatment models, there is a need to develop more integrative approaches to treatment with this vulnerable population. By highlighting specific similarities and differences between practice techniques, this paper attempts to pave the way toward developing a more integrative treatment approach to working with individuals with BPD, an approach where interventions are selected based on appraisal of the evidence, clinical expertise, and client need.

Abstract: Eating disorders are serious, chronic disorders that are associated with significant physical, psychological and social costs. Many studies have demonstrated a connection between insecure patterns of attachment and eating disorders. In the last decade the theory of mentalization has emerged from the developmental and attachment theory literature in relation to mental health conditions. Mentalizing refers to a person's capacity to understand the thoughts, feelings, needs, intentions and desires that underlie the behaviour of self and others. The construct of mentalizing can be measured by a person's capacity for 'Reflective Functioning' (RF). Poor mentalizing capacity is seen to limit a person's ability to relate with others, maintain a sense of self and regulate difficult emotions. Deficits in mentalizing capacity have been linked to the psychopathology, including eating disorders. This paper will present the current theory about the role of attachment theory and mentalizing in the development and maintenance of eating disorders. It will describe a study conducted to investigate attachment styles and mentalizing (reflective functioning) capacity of adolescents aged 13-17 with eating disorders, and reflective functioning of their mothers. The aims of the research project will be outlined, followed by details of the methodology. Finally, results including quantitative and qualitative data will be presented.

Abstract: Background: A psychomotor physiotherapist and a clinical psychologist had collaborated on patients consistently for several years, when their individual therapeutic approach had turned out to be insufficient Aim: The aim of this study was to investigate the therapists’ understanding of their patients and the therapeutic processes they had been involved in, and to develop concepts in order to understand the concurrent therapeutic processes Design and method: This qualitative study is based on a grounded theory approach The two strategically chosen therapists participated in “mini focus-group” interviews, in data transcription and in the analyzing process Findings: Three empirical categories emerged from the therapists’ experiences The core category “Body awareness: a vital aspect in mentalization” was comprised of two main categories: (1) “The over-stretched children in the grown-up patients”; and (2) “The traumatized children in the grown-up patients” Conclusion: Reduced body awareness seeme

Abstract: Psychotherapy of personality disorders (PD) is gaining momentum, though the progress has been mostly concerned borderline PD, with the other disorders largely neglected. In parallel, many empirically tested approaches focus on a limited understanding of psychopathology, for example poor mentalization or affect dysregulation, while PD are complex entities; they require clinicians paying attention to multiple therapy targets in order to be treated effectively and for a hope of actual recovery. I contend here that a more comprehensive account of psychopathology is needed; therefore the papers in this special issue focus on some of these aspects, such as difficulties in mental state understanding, dysfunctional representations of self with others, poor affect regulation and lack of access to adaptive and healthy self-aspects. The papers included in this special issue try and provide the readers with an intensive qualitative account of how therapists can act and yield improvements in these domains, with the hope of improving clinicians’ abilities to treat PD no matter what their preferred orientation is.

Abstract: This article proposes an understanding of children with reactive attachment disorder (RAD) through psychoanalytic thought and mentalization theory. RAD is presented followed by a discussion on attachment and the need for a better understanding of this disorder. Theories from British psychoanalytic thinkers are used to describe what might be transpiring in the early relationship between mother and child. Particular attention is given to how children's internal objects are influenced by a compromised early mother-child relationship.

Abstract: Indirect evidence suggests partially common pathogenetic mechanisms for Neurological Soft Signs (NSS), neurocognition, and social cognition in schizophrenia. However, the possible association between NSS and mentalizing impairments has not yet been examined. In the present study, we assessed the ability to attribute mental states to others in patients with schizophrenia and predicted that the presence of theory of mind deficits would be significantly related to NSS. Participants were 90 clinically stable patients with a DSM-IV diagnosis of schizophrenia. NSS were assessed using the Neurological Evaluation Scale (NES). Theory of mind deficits were assessed using short verbal stories designed to measure false belief understanding. The findings of the study confirmed our hypothesis. Impaired sequencing of complex motor acts was the only neurological abnormality correlated with theory of mind deficits. By contrast, sensory integration, motor coordination and the NES Others subscale had no association with patients׳ ability to pass first- or second-order false belief tasks. If confirmed by future studies, the current findings provide the first preliminary evidence for the claim that specific NSS and theory of mind deficits may reflect overlapping neural substrates.

Abstract: This paper outlines the organisation of a new project that aims to develop a model for adapting mentalization-based treatment (MBT) for therapeutic work with couples (MBT-CT), where one or both partners present with personality problems which may be contributing to their relationship difficulties. Describing how the Tavistock Centre for Couple Relationships (TCCR) has developed this project and how a therapeutic model is beginning to emerge from the work, the paper focuses on the rationale and specifics of getting the project off the ground and some of the emerging clinical issues. It does not include clinical illustrations.

Abstract: Major depressive disorder afflicts an estimated 17% of individuals during their lifetimes at tremendous suffering and costs. Cognitive therapy and psychodynamic therapy may be effective treatment options for major depressive disorder, but the effects have only had limited assessment in systematic reviews. The two modern forms of psychotherapy, "third wave" cognitive therapy and mentalization-based treatment, have both gained some ground as treatments of psychiatric disorders. No randomised trial has compared the effects of these two interventions for major depressive disorder. We performed two systematic reviews with meta-analyses and trial sequential analyses using The Cochrane Collaboration methodology examining the effects of cognitive therapy and psycho-dynamic therapy for major depressive disorder. We developed a thorough treatment protocol for a randomised trial with low risks of bias (systematic error) and low risks of random errors ("play of chance") examining the effects of third wave' cognitive therapy versus mentalization-based treatment for major depressive disorder. We conducted a randomised trial according to good clinical practice examining the effects of "third wave" cognitive therapy versus mentalisation-based treatment for major depressive disorder. The first systematic review included five randomised trials examining the effects of psychodynamic therapy versus "no intervention' for major depressive disorder. Altogether the five trials randomised 365 participants who in each trial received similar antidepressants as co-interventions. All trials had high risk of bias. Four trials assessed "interpersonal psychotherapy" and one trial "short psychodynamic supportive psychotherapy". Both of these interventions are different forms of psychodynamic therapy. Meta-analysis showed that psychodynamic therapy significantly reduced depressive symptoms on the Hamilton Depression Rating Scale (HDRS) compared with "no intervention" (mean difference -3.01 (95% confidence interval -3.98 to -2.03; p = 0.00001), no significant heterogeneity between trials). Trial sequential analysis confirmed this result. The second systematic review included 12 randomised trials examining the effects of cognitive therapy versus "no intervention" for major depressive disorder. Altogether a total of 669 participants were randomised. All trials had high risk of bias. Meta-analysis showed that cognitive therapy significantly reduced depressive symptoms on the HDRS compared with "no intervention" (four trials; mean difference -3.05 (95% confidence interval, -5.23 to -0.87; p = 0.006)). Trial sequential analysis could not confirm this result. The trial protocol showed that it seemed feasible to conduct a randomised trial with low risks of bias and low risks of random errors examining the effects of "third wave" cognitive therapy versus mentalization-based therapy in a setting in the Danish healthcare system. It turned out to be much more difficult to recruit participants in the randomised trial than expected. We only included about half of the planned participants. The results from the randomised trial showed that participants randomised to "third wave" therapy compared with participants randomised to mentalization-based treatment had borderline significantly lower HDRS scores at 18 weeks in an unadjusted analysis (mean difference -4.14 score; 95% CI -8.30 to 0.03; p = 0.051). In the adjusted analysis, the difference was significant (p = 0.039). Five (22.7%) of the participants randomised to "third wave" cognitive therapy had remission at 18 weeks versus none of the participants randomised to mentalization-based treatment (p = 0.049). Sequential analysis showed that these findings could be due to random errors. No significant differences between the two groups was found regarding Beck's Depression Inventory (BDI II), Symptom Checklist 90 Revised (SCL 90-R), and The World Health Organization-Five Well-being Index 1999 (WHO 5). We concluded that cognitive therapy and psychodynamic therapy might be effective interventions for depression measured on HDRS and BDI, but the review results might be erroneous due to risks of bias and random errors. Furthermore, the effects seem relatively small. The trial protocol showed that it was possible to develop a protocol for a randomised trial examining the effects of "third wave" cognitive therapy versus mentalization-based treatment with low risks of bias and low risks of random errors. Our trial results showed that "third wave" cognitive therapy might be a more effective intervention for depressive symptoms measured on the HDRS compared with mentalization-based treatment. The two interventions did not seem to differ significantly regarding BDI II, SCL 90-R, and WHO 5. More randomised trials with low risks of bias and low risks of random errors are needed to assess the effects of cognitive therapy, psychodynamic therapy, "third wave" cognitive therapy, and mentalization-based treatment.

Abstract: This article raises the question of whether the traditional approach in intercultural training focusing on knowledge about cultural differences and skills to avoid culture clash is sufficient in order to prepare intercultural communication trainees for dynamic and psychologically demanding multicultural environments. Inspired by the concept of mentalizing in the psycho-therapeutic method called Mentalization-based treatment, training that encourages imaginatively “seeing the other from the inside and oneself from the outside” is suggested as better able to prepare for complex intercultural realities. Tolerance is seen as tolerance for being in the intercultural process as much as tolerance for others’ differences. A theoretical discussion between the notion of mentalizing in mentalization-based treatment and perceptions of empathy, imagination and mindfulness further provides insight into the role of interactive tools such as case work and role plays in intercultural training. These, in turn, are seen as best suited to fulfil the goals and ambitions of the theories. However, experiences gained from them must be verbalized in order to cause increased awareness.