Abstract: Antisocial personality disorder (ASPD) is an under-researched mental disorder. Systematic reviews and policy documents identify ASPD as a priority area for further treatment research because of the scarcity of available evidence to guide clinicians and policymakers; no intervention has been established as the treatment of choice for this disorder. Mentalization-based treatment (MBT) is a psychotherapeutic treatment which specifically targets the ability to recognise and understand the mental states of oneself and others, an ability shown to be compromised in people with ASPD. The aim of the study discussed in this paper is to investigate whether MBT can be an effective treatment for alleviating symptoms of ASPD. This paper reports on a sub-sample of patients from a randomised controlled trial of individuals recruited for treatment of suicidality, self-harm, and borderline personality disorder. The study investigates whether outpatients with comorbid borderline personality disorder and ASPD receiving MBT were more likely to show improvements in symptoms related to aggression than those offered a structured protocol of similar intensity but excluding MBT components. The study found benefits from MBT for ASPD-associated behaviours in patients with comorbid BPD and ASPD, including the reduction of anger, hostility, paranoia, and frequency of self-harm and suicide attempts, as well as the improvement of negative mood, general psychiatric symptoms, interpersonal problems, and social adjustment. MBT appears to be a potential treatment of consideration for ASPD in terms of relatively high level of acceptability and promising treatment effects. ISRCTN ISRCTN27660668 , Retrospectively registered 21 October 2008

Abstract: A growing body of work suggests that in some circumstances, humans may be capable of ascribing mental states to others in a way that is fast, cognitively efficient, and implicit (implicit mentalizing hypothesis). However, the interpretation of this work has recently been challenged by suggesting that the observed effects may reflect "submentalizing" effects of attention and memory, with no ascription of mental states (submentalizing hypothesis). The present study employed a strong test between these hypotheses by examining whether apparently automatic processing of another's visual perspective is influenced by experience-dependent beliefs about whether that person can see. Altercentric interference was observed when participants judged their own perspective on stimuli involving an avatar wearing goggles that participants believed to be transparent but not when they believed the goggles to be opaque. These results are consistent with participants ascribing mental states to the avatar and not with the submentalizing hypothesis that altercentric interference arises merely because avatars cue shifts in spatial attention. (PsycINFO Database Record

Abstract: Background : Sexual abuse is a well-recognised risk factor for child psychopathology. Little is known regarding whether child and maternal mentalization can be considered a potential resource or protective factor in this context, respectively, mediating or moderating the relationship between sexual abuse and psychopathology. Objective : The aims of this study were (1) to explore the relationships between child and maternal mentalizing, measured as reflective functioning (RF), and child depressive symptoms and externalising difficulties; and (2) to examine whether child mentalizing mediates the relationship between child sexual abuse (CSA) and psychopathology. Method : A total of 168 children aged 7–12 years and their mothers participated in the study. The sample included 74 dyads where children had experienced sexual abuse. The Child Attachment Interview was rated by using the Child Reflective Functioning Scale to assess children’s mentalization, and the Child Depression Inventory was used to assess depressive symptoms. Mothers completed the Parent Development Interview to assess maternal RF and the Child Behavior Checklist to assess their child’s externalising difficulties. A model involving direct and indirect paths from CSA, child and maternal RF to child psychopathology was examined using Mplus software. Results : Child mentalization partially mediated the relationships between CSA and depressive symptoms, as well as the relationship between CSA and externalising difficulties. Maternal mentalization was an independent predictor of child externalising difficulties, with higher maternal RF associated with less externalising difficulties. Discussion : The findings indicate that by ages 7–12, child mentalization is an important inner resource associated with lower depression and externalising. In addition, this study provides new evidence of the importance of the parent’s mentalizing stance for the development of self-regulation and externalising difficulties in both abused and non-abused children. The clinical implications are discussed. Keywords: Child depression; child mentalization; child sexual abuse; externalising difficulties; maternal mentalization; reflective functioning (Published: 27 January 2016) Responsible Editor: Julian D. Ford, University of Connecticut Health Center, USA. For the abstract or full text in other languages, please see Supplementary files under ‘Article Tools’ Citation: European Journal of Psychotraumatology 2016, 7 : 30611 - http://dx.doi.org/10.3402/ejpt.v7.30611

Abstract: Prior work has established that analytic thinking is associated with disbelief in God, whereas religious and spiritual beliefs have been positively linked to social and emotional cognition. However, social and emotional cognition can be subdivided into a number of distinct dimensions, and some work suggests that analytic thinking is in tension with some aspects of social-emotional cognition. This leaves open two questions. First, is belief linked to social and emotional cognition in general, or a specific dimension in particular? Second, does the negative relationship between belief and analytic thinking still hold after relationships with social and emotional cognition are taken into account? We report eight hypothesis-driven studies which examine these questions. These studies are guided by a theoretical model which focuses on the distinct social and emotional processing deficits associated with autism spectrum disorders (mentalizing) and psychopathy (moral concern). To our knowledge no other study has investigated both of these dimensions of social and emotion cognition alongside analytic thinking. We find that religious belief is robustly positively associated with moral concern (4 measures), and that at least part of the negative association between belief and analytic thinking (2 measures) can be explained by a negative correlation between moral concern and analytic thinking. Using nine different measures of mentalizing, we found no evidence of a relationship between mentalizing and religious or spiritual belief. These findings challenge the theoretical view that religious and spiritual beliefs are linked to the perception of agency, and suggest that gender differences in religious belief can be explained by differences in moral concern. These findings are consistent with the opposing domains hypothesis, according to which brain areas associated with moral concern and analytic thinking are in tension.

Abstract: The question as to whether or not children can be affected by the traumatization of their parents has been the topic of a long-standing debate This article provides a critical review of 72 research studies on traumatized parents with symptoms of posttraumatic stress disorder (PTSD), the parent-child interaction, and the impact on their nonexposed child (0-18 years) The evidence suggests that traumatization can cause parenting limitations, and these limitations can disrupt the development of the young child From the studies reviewed several patterns emerged: Relational patterns of traumatized parents who are observed to be emotionally less available and who perceive their children more negatively than parents without symptoms of PTSD; relational patterns of children who at a young age are easily deregulated or distressed and at an older age are reported to face more difficulties in their psychosocial development than children of parents without symptoms of PTSD; and relational patterns that show remarkable similarities to relational patterns between depressed or anxious parents and their children Mechanisms such as mentalization, attachment, physiological factors, and the cycle of abuse offer a valuable perspective to further our understanding of the relational patterns This article builds on previous work by discussing the emerged patterns between traumatized parents and their nonexposed children from a relational and transactional perspective

Abstract: The aim of this prospective study was to examine temporal pathways from mothers’ reflective functioning (RF) through parenting to infant attachment measured more than 16 months later. Participants were 88 mother–infant dyads from demographically diverse backgrounds and included a group of mothers with histories of childhood maltreatment. RF was assessed using the RF rating of the Adult Attachment Interview before the birth of the baby. Parenting was assessed when the infants were 6 months old using the Maternal Sensitivity scale, as well as when they were 16 months using the Disconnected and Extremely Insensitive Parenting scale. Infant attachment was assessed when the infants were 16 months old using the Strange Situation. As hypothesised, the study findings showed that mothers’ mentalization regarding their own early attachment relationships was associated with later parenting and infant attachment. Negative parenting behaviours explained the link between mothers’ RF about their own attachment relationships and infant attachment disorganization. The findings suggest that mothers’ mentalization about their early attachment relationships has important implications in the transition to becoming parents themselves. Mentalization appears to be particularly important in helping mothers screen and inhibit negative parenting behaviours that would otherwise undermine infant attachment security and organization.

Abstract: In this review article, we outline the evidence linking attachment adversity to psychosis, from the premorbid stages of the disorder to its clinical forms. To better understand the neurobiological mechanisms through which insecure attachment may contribute to psychosis, we identify at least five neurobiological pathways linking attachment to risk for developing psychosis. Besides its well documented influence on the hypothalamic-pituary-adrenal (HPA) axis, insecure attachment may also contribute to neurodevelopmental risk through the dopaminergic and oxytonergic systems, as well as bear influence on neuroinflammation and oxidative stress responses. We further consider the neuroscientific and behavioral studies that underpin mentalization as a suite of processes potentially moderating the risk to transition to psychotic disorders. In particular, mentalization may help the individual compensate for endophenotypical impairments in the integration of sensory and metacognitive information. We propose a model where embodied mentalization would lie at the core of a protective, resilience response mitigating the adverse and potentially pathological influence of the neurodevelopmental cascade of risk for psychosis.

Abstract: This chapter provides an update of the mentalizing approach to borderline personality disorder (BPD). We present a multilevel approach to BPD from a developmental psychopathology life-span perspective, discussing developmental pathways involved in the emergence of BPD from infancy to adolescence and (young) adulthood, locating the origins of the social cognition or mentalizing impairments typical of BPD patients in attachment disruptions. We also discuss in this context emerging findings stressing the importance of gene–environment transactions in BPD, and research findings concerning the neurobiology of impairments in mentalizing and attachment in these patients. Finally, we outline mentalization-based treatment for BPD and we present a new view on the mechanisms of change in the treatment of BPD rooted in extant theories concerning the intergenerational transmission of social knowledge and social learning, suggesting that this mechanism may be the missing link that connects and is shared by all effective treatments of BPD. Keywords: borderline personality disorder (BPD); development; attachment; mentalizing; reflective functioning; social cognition; stress; psychodynamic

Abstract: In this study, the psychometric properties of the Dissociative Experiences Scale-II (DES-II) were tested in a sample of Italian adults, and a nomological network of dissociative functioning based on current psychodynamic research was examined. A total of 794 participants (55% females) ranging in age from 18 to 64 completed the DES-II and other measures of theory of mind, alexithymia, attachment style, and empathy. The Italian translation of the DES-II showed high internal consistency, adequate item-to-scale homogeneity, and good split-half reliability. A single-factor solution including the 8 items of pathological dissociation (DES-T) adequately fit the data. Participants who reported higher levels of dissociative experiences showed significantly lower scores on theory of mind and empathy than other participants. They also showed significantly higher scores on alexithymia, preoccupied attachment, and fearful attachment. Results of the study support the view that people who suffer from severe dissociative experiences may also have difficulties mentalizing and regulating affects and that they may feel uncomfortable in close relationships because they have a negative view of the self. This can inform clinical work with dissociative individuals, who could benefit from therapies that consider their potential problems with mentalization, empathy, affect regulation, and attachment.

Abstract: The cross-generational transmission of mammalian sociality, initiated by the parent's postpartum brain plasticity and species-typical behavior that buttress offspring's socialization, has not been studied in humans. In this longitudinal study, we measured brain response of 45 primary-caregiving parents to their infant's stimuli, observed parent-infant interactions, and assayed parental oxytocin (OT). Intra- and inter-network connectivity were computed in three main networks of the human parental brain: core limbic, embodied simulation and mentalizing. During preschool, two key child social competencies were observed: emotion regulation and socialization. Parent's network integrity in infancy predicted preschoolers' social outcomes, with subcortical and cortical network integrity foreshadowing simple evolutionary-based regulatory tactics vs complex self-regulatory strategies and advanced socialization. Parent-infant synchrony mediated the links between connectivity of the parent's embodied simulation network and preschoolers' ability to use cognitive/executive emotion regulation strategies, highlighting the inherently dyadic nature of this network and its long-term effects on tuning young to social life. Parent's inter-network core limbic-embodied simulation connectivity predicted children's OT as moderated by parental OT. Findings challenge solipsistic neuroscience perspectives by demonstrating how the parent-offspring interface enables the brain of one human to profoundly impact long-term adaptation of another.

Abstract: Mentalizing, or theory of mind, has been argued to be critical for supporting religious beliefs and practices involving supernatural agents. As individuals with autism spectrum conditions have been found to have deficits in mentalizing, this raises the question as to how they may conceive of gods and behave in relation to gods. To examine this, we compared high functioning individuals with autism (HFA) to typically developing individuals across seven key aspects of religious cognition and behaviour: (1) strength of belief; (2) anthropomorphism of god concepts; (3) felt closeness towards the god; (4) prayer habits; (5) attraction to prayer; (6) efficacy of prayer; and (7) a sense of agency whilst praying. A battery of mentalizing tasks was administered to measure mentalizing ability, along with the Autism-Spectrum Quotient. As expected, typically developing subjects performed better than HFA subjects in the advanced mentalizing task. However, no statistically significant differences were found with first order and second order false belief tasks. In contrast to our predictions and previous research on the religiosity of HFA, we found very little differences between the groups in their religious cognition and behaviour. Moreover, the relationship between mentalizing ability and most of our measures of religious cognition and behaviour was weak and negative. Our data suggest that HFA's deficits in mentalizing appear to have only minimal impact on the way they interact and think about gods. We end the paper by re-evaluating the role mentalizing may have in religious cognition and behaviour.

Abstract: Developmental clinical research in recent years has highlighted the value treating psychotic disorders at the earliest stage to reduce long-term morbidity. It is now suggested that treatment during the clinical high risk states (CHR), preceding by 1–4 years the onset of psychotic disorders, may delay or prevent the onset of psychosis, and contribute to a more positive prognosis. In this article, we wish to provide a rationale and clinical illustration of mentalization-based treatment (MBT) as an indicated preventive treatment for CHR. We will first review the notion of high-risk for psychosis, providing a trans-theoretical developmental framework for conceptualizing the clinical progression from sub-clinical towards clinical psychotic states. Second, we address the commonalities and differences between the constructs of mentalization and metacognition, and discuss their relevance in preventive psychotherapeutic treatment for CHR. Thirdly, we provide a clinical illustration of MBT to emerging psychosis. Finally, we conclude by discussing the specific contributions of MBT approach in youths at CHR, and the necessary research for evaluating its relevance in the context of risk for developing psychosis.

Abstract: Aim: The present study investigates the role of attachment representation and mentalization as possibly protective factors in the relationship between early maltr

Abstract: The evolved capacity for third-party punishment is considered crucial to the emergence and maintenance of elaborate human social organization and is central to the modern provision of fairness and justice within society. Although it is well established that the mental state of the offender and the severity of the harm he caused are the two primary predictors of punishment decisions, the precise cognitive and brain mechanisms by which these distinct components are evaluated and integrated into a punishment decision are poorly understood. Using fMRI, here we implement a novel experimental design to functionally dissociate the mechanisms underlying evaluation, integration, and decision that were conflated in previous studies of third-party punishment. Behaviorally, the punishment decision is primarily defined by a superadditive interaction between harm and mental state, with subjects weighing the interaction factor more than the single factors of harm and mental state. On a neural level, evaluation of harms engaged brain areas associated with affective and somatosensory processing, whereas mental state evaluation primarily recruited circuitry involved in mentalization. Harm and mental state evaluations are integrated in medial prefrontal and posterior cingulate structures, with the amygdala acting as a pivotal hub of the interaction between harm and mental state. This integrated information is used by the right dorsolateral prefrontal cortex at the time of the decision to assign an appropriate punishment through a distributed coding system. Together, these findings provide a blueprint of the brain mechanisms by which neutral third parties render punishment decisions. SIGNIFICANCE STATEMENT Punishment undergirds large-scale cooperation and helps dispense criminal justice. Yet it is currently unknown precisely how people assess the mental states of offenders, evaluate the harms they caused, and integrate those two components into a single punishment decision. Using a new design, we isolated these three processes, identifying the distinct brain systems and activities that enable each. Additional findings suggest that the amygdala plays a crucial role in mediating the interaction of mental state and harm information, whereas the dorsolateral prefrontal cortex plays a crucial, final-stage role, both in integrating mental state and harm information and in selecting a suitable punishment amount. These findings deepen our understanding of how punishment decisions are made, which may someday help to improve them.

Abstract: Maternal reflective functioning (RF) has been associated with children’s behavioral development. This study examined maternal prenatal and postnatal RF, as measured by the Pregnancy Interview and Parent Development Interview, as multidimensional constructs. It was also examined whether the RF-dimensions were associated with children’s temperament and externalizing behavior, as assessed by several questionnaires. The sample consisted of 123 first-time mothers (M age = 22.85 years, SD = 2.21) and their children (M age = 19.97 months, SD = 0.85, 56% male). Two related but distinct dimensions were found for prenatal RF, termed self-focused and child-focused mentalization. Three dimensions were observed for postnatal RF, termed self-focused, child-focused, and relation-focused mentalization. Results showed that prenatal RF negatively related to reported child physical aggression. Postnatal self-focused RF was positively linked to externalizing behavior and negative emotionality in offspring, while relation-focused RF scores were negatively associated with child physical aggression. Findings show that it is important to also look at the specific RF-dimensions when examining the effects of maternal RF on children’s behavioral development, as differential associations with behavioral outcomes exist. Discussion further focuses on the importance of these findings in prevention and clinical practice, and suggestions are being made to further improve the measurement of maternal RF-dimensions.

Abstract: Objective: To investigate (a) whether expert clinicians within psychodynamic therapy (PDT) and cognitive-behavioral therapy (CBT) agree on key features of child psychotherapy process using the Child Psychotherapy Process Q-Set (CPQ); (b) whether these two prototypes can be empirically distinguished; and (c) whether promoting mentalization (operationalized as reflective functioning [RF]) is a shared component of the way expert clinicians conceptualize these two treatment models. Method: Thirty-one raters with expertise in PDT, CBT, and RF provided ratings of the 100 CPQ items to describe an ideal prototype session that adheres to the principles of their treatment model. Two Q-factor analyses with varimax rotation were conducted. Results: Expert clinicians reached a high level of agreement on their respective PDT and CBT prototypes. These prototypes loaded onto two independent factors. The RF process prototype loaded onto both factors. Conclusions: From the theoretical perspective of expert clinicia...

Abstract: In Fonagy and Target's (1996, 2000) developmental model of mentalization, play is theorized as a precursor of later mentalization and reflective function (RF); however, the relationship between play and later mentalization and RF has yet to be empirically tested. These processes are particularly important in the context of trauma, but an empirical model of the relationships among mentalization, play, and trauma is currently lacking. The aim of this longitudinal study was to examine whether children's capacity to engage in pretend play, to symbolize, and to make play narratives was associated with later RF in those children. Thirty-nine sexually abused children and 21 nonabused children (aged 3 to 8) participated in the study. The Children's Play Therapy Instrument was used to assess children's free play. Three years after the play assessment, children's RF was assessed using the Child Attachment Interview, coded with the Child and Adolescent Reflective Functioning Scale. Pretend play completion was associated with later other-understanding. Play was also found to mediate the relationship between sexual abuse and children's later mentalization regarding others. These findings are consistent with Fonagy and Target's emphasis on the role of pretend play in the development of a nuanced sense of the qualities of the mind and reality. In sum, the findings lend support to Fonagy and Target's account of playing with reality, and the development of mentalization suggests that it may be more than "fiction." Furthermore, these results suggest that children's ability to create meaningful and coherent play sequences after sexual abuse is associated with the development of a better understanding of their relationships with others. Clinical implications and future directions are discussed.

Abstract: This paper attempts to summarize the evolution of interest in the concept of mentalization which has been researched and enriched by the linking of many disciplines alongside that of psychoanalysis and attachment theory. Taking into account the work of Professors Fonagy and Target and many others, the paper describes factors that enable the development of the capacity to mentalize and those that interfere. It will consider how the quality of attachment affects the transformation of pre-mentalized modes of experience to the recognition of psychic reality of self and other. While mentalizing is part and parcel of all therapies, a mentalization-based therapy was developed in the context of treatment of borderline personality disorder patients by Professors Bateman and Fonagy. The paper will illustrate key concepts in the theory of mentalization with the vignette taken from clinical practice.

Abstract: Within social psychology, it is well accepted that trait inference is the dominant tool for understanding others’ behavior. Outside of social psychology, a different consensus has emerged, namely, that people predominantly explain behavior in terms of mental states. Both positions are based on limited evidence. The trait literature focuses on trait ascriptions to persons, not explanations of behavior. The mental state literature focuses on explanations of ordinary behaviors (for which social scripts provide mental states), not of expectancy-violating behaviors. We examined the critical test case for the two opposing positions: explanations of expectancy-violating behaviors. Participants provided open-ended explanations of puzzling actions, which were content-analyzed for use of mental states, traits, and other causal background factors. Across four studies, three stimulus sets, and two subpopulations, people overwhelmingly offered mental states when explaining puzzling actions (compared with ordinary acti...

Abstract: To explore the effectiveness of a mentalization-based therapeutic intervention specifically developed for parents in entrenched conflict over their children. To the best of our knowledge, this is the first randomized controlled intervention study in the United Kingdom to work with both parents postseparation, and the first to focus on mentalization in this situation. Using a mixed-methods study design, 30 parents were randomly allocated to either mentalization-based therapy for parental conflict—Parenting Together, or the Parents’ Group, a psycho-educational intervention for separated parents based on elements of the Separated Parents Information Program—part of the U.K. Family Justice System and approximating to treatment as usual. Given the challenges of recruiting parents in these difficult circumstances, the sample size was small and permitted only the detection of large differences between conditions. The data, involving repeated measures of related individuals, was explored statistically, using hierarchical linear modeling, and qualitatively. Significant findings were reported on the main predicted outcomes, with clinically important trends on other measures. Qualitative findings further contributed to the understanding of parents’ subjective experience, pre- and posttreatment. Findings indicate that a larger scale randomized controlled trial would be worthwhile. These encouraging findings shed light on the dynamics maintaining these high-conflict situations known to be damaging to children. We established that both forms of intervention were acceptable to most parents, and we were able to operate a random allocation design with extensive quantitative and qualitative assessments of the kind that would make a larger-scale trial feasible and productive.

Abstract: Tutkielmaan liittyva artikkeli / Article associated the thesis : Infant Ment Health J. 2016 Jul;37(4):317-34. doi: 10.1002/imhj.21574. Epub 2016 Jun 24

Abstract: In this article the authors attempt to explore the contemporary socially toxic situation between Black and Hispanic male youth and police officers from both a historical perspective and through the lens of the psychoanalytic concept of mentalization. As a result of the failure to mentalize Black and Hispanic male youth they are not depicted as vulnerable or in need of guidance and support but rather their behavior are quickly criminalized resulting in a punitive social response. The authors conclude that effective change warrants multiple systems to address this situation, including mental health, education, criminal justice system, as well as the creation of employment opportunities.