Abstract: The psychometric properties of a new 28-item self-report measure of mentalization, the Mentalization Scale (MentS), were examined in 2 studies: with a sample of employed adults and university students (N1 = 288 + 278) and with a sample of persons with borderline personality disorder (BPD) and matched controls (N2 = 62 + 62). Besides the MentS, both studies employed measures of attachment and the Big Five; Study 1 also included assessments of empathy and emotional intelligence. MentS whole-scale internal consistency was good in the community and acceptable in the clinical sample (α = .84 and .75, respectively). A principal components analysis of Study 1 data yielded 3 interpretable factors, or subscales: Self-Related Mentalization (MentS-S), Other-Related Mentalization (MentS-O), and Motivation to Mentalize (MentS-M). These showed acceptable reliabilities (α = .74-.79), except for MentS-M in the clinical sample (α = .60). MentS scores further exhibited a coherent pattern of correlations with cognate constructs and the Big Five, relating positively to empathy, trait and ability emotional intelligence, openness, extraversion, and conscientiousness, and negatively to attachment avoidance and anxiety, and neuroticism. Persons with BPD scored significantly lower on MentS total and MentS-S. The proposed scale is thus deemed suitable for quick, yet meaningful, assessments of mentalization in both individual differences research and clinical contexts.

Abstract: Stories have long been theorized to influence how we perceive our social world and our peers. Empirical research on this topic has begun to grow, with many studies exploring how stories and social ...

Abstract: Mentalization-based interventions show promise in improving mental health outcomes for children and parents through increasing a family's reflective functioning, or ability to mentalize. Mentalizing involves the ability to understand behavior in relation to mental states, such as thoughts and feelings, and typically develops within the context of secure attachment relationships. One area not given much consideration when training foster parents is their capacity to mentalize. This study evaluated Family Minds, a newly developed psychoeducational intervention for foster parents, designed to increase their ability to mentalize. The current paper reports on the development and preliminary empirical evaluation of Family Minds in a quasi-experimental study where 102 foster parents received either Family Minds or a typical foster parenting class, which served as a control group. Results indicate that parents who received Family Minds significantly increased their levels of reflective functioning as assessed with the Parental Reflective Functioning Questionnaire and a new Five-Minute Speech Sample procedure coded using the Reflective Functioning Scale, and revealed a tendency to show decreased levels of parenting stress on the Parenting Stress Index, while the control group showed no such improvements. These findings support the hypothesis that a short-term psychoeducational intervention may improve foster parents' ability to mentalize themselves and their children. These skills are very beneficial for foster parents, as they frequently deal with children who come into their home with challenging behaviors, attachment issues, and negative internal working models of relationships. This type of intervention has the potential to lower placement breakdowns and improve the mental health of foster children.

Abstract: To flexibly adjust behaviour to that of other people around us requires some representation of their overt actions, but also of the driving forces behind them, that is, their goals, intentions, and emotions. Socio-affective and -cognitive functions enable such representations via creating vicarious affective states in the observer (empathy) or by accumulating abstract, propositional knowledge of another person’s mental state (Theory of Mind). While the empathic sharing of another’s emotions is implemented by those neural networks that also process first-hand emotion, Theory of Mind activates a widespread network that seems to process information independent of its specific modality or content. Crucially, these two routes can function independently as individual differences in the respective capacities and network activations are unrelated and selective impairments in one or the other function occur in psychopathology. However, they may co-activate and co-operate in complex social situations, deter...

Abstract: Objectives Associations between interpersonal problems and mentalization have rarely been investigated. In this study, we explored patterns of interpersonal problems, mentalization, symptom severity, and attachment during inpatient treatment and at follow-up. Additionally, we investigated whether mentalization predicts a decrease in interpersonal distress. Method We analyzed time-series data from patients with mental disorders. Data were collected at the beginning and at the end of inpatient treatment, and approximately 6 months after discharge from hospital. Results Patterns of correlations were stable from admission to the hospital until follow-up. Treatment significantly increased the levels of mentalization and decreased the levels of interpersonal problems and symptom severity, whereas attachment was only partially targeted. Improvements in mentalization significantly predicted reduction in interpersonal distress at each point in time. Conclusion Results revealed characteristic patterns of interpersonal problems, mentalization, symptom severity, and attachment. Mentalization was found to play a key role in the reduction of interpersonal distress.

Abstract: The relationship between attachment theory and psychoanalysis, historically, has not been an easy one (Cassidy & Shaver, 2008; Eagle, 2013; Fonagy, 2001). But in recent years, developments in both fields have led to a growing rapprochement (Eagle, 2013; Holmes, 2009). Changes in psychoanalytic thinking have made it more accommodating of attachment thinking; conversely, aspects of the development of attachment findings, applications, and theory have made it more pertinent to psychoanalysis. In this chapter we examine the disagreements between psychoanalysis and attachment theory, and point to some of the two disciplines’ common foundations. We then describe an approach to the role of attachment in human development that considers it in relation to the capacity to mentalize, that is, to understand ourselves and others in terms of intentional mental states, and places both attachment and mentalizing in the context of the development of epistemic trust—the capacity to trust others as a source of knowledge about the world. This approach builds on some of Bowlby’s assumptions drawn from evolutionary biology, placing some of the better founded psychoanalytic criticisms of attachment theory in a different perspective. We suggest that this context allows the ongoing significance of Bowlby and Ainsworth’s thinking for the psychoanalytic project to be appreciated.

Abstract: Looked after children represent a vulnerable group in society, many of whom are exposed to maltreatment, particularly in the form of relational trauma, prior to placement with a foster family Chal

Abstract: According to existing neuroimaging studies of social cognition, individuals use knowledge about themselves to infer the mental states of others and to mentalize in a different way when the other is perceived to be similar versus dissimilar to oneself. In this study, we examined whether adolescent boys make mental state inferences for their online game characters and whether adolescents who were diagnosed as addicted to the internet game perceived their personal game character to be similar to themselves. Twelve internet-addicted adolescents and fifteen adolescents without addiction reported whether short phrases described themselves, a well-known historical person, or their own game character while undergoing a functional magnetic resonance imaging (fMRI). Different patterns of activity emerged for adolescents with internet game addiction compared to healthy adolescents when they were thinking about themselves, another person, and their game characters. Specifically, when addicted adolescents were thinking about their own game characters, more global and significant medial prefrontal (MPFC) and anterior cingulate (ACC) activations were observed, than even when compared to thinking about themselves. The ACC activation was correlated with the symptom severity. The activation patterns demonstrated that addicted adolescents were most attached to their game characters and equated their game characters to human.

Abstract: The study of social cognition involves the attribution of states of mind to humans, as well as, quite recently, to nonhuman creatures, like God. Some studies support the role of social cognition in...

Abstract: The main goal of the current study is to verify the relationships between emotion dysregulation, mentalization, and romantic attachment in late adolescent girls (N = 120). Adolescence is a very dynamic and sensitive period, in which many changes occur in attachment and emotion regulation. The role of the primary attachment figures is gradually taken over by peers, and the beginnings of the development of romantic attachment are seen. In summary, this study was able to determine that the level of dysregulation of emotions in girls during late adolescence can be partially explained by mentalization and levels of anxiety (though not of avoidance) regarding a romantic partner, though attachment anxiety is more important for explaining emotion dysregulation than the level of mentalization. Only two aspects of emotion dysregulation show relationships with mentalization: nonacceptance of emotional responses and lack of emotional clarity. Adolescence is considered to be a critical period for interventions to protect against the onset of psychopathology. Confirmation of these relationships appears to be important for the design of therapeutic interventions. Our findings may suggest that attachment patterns, mentalization and emotion dysregulation may be good targets for therapeutic intervention in adolescence.

Abstract: Objective: Increase in the capacity to mentalize has been proposed to be an important mechanism of change in psychotherapy. However, mentalization has primarily been studied as an individual skill ...

Abstract: OBJECTIVE Theory of Mind (ToM) is a multifaceted construct that involves mental states attribution in social interactions. Patients with schizophrenia are impaired in ToM abilities, but recent studies showed that a non-negligible number of patients perform within normal ranges or close to normal, whereas other patients are very impaired in ToM tasks. The present study aims to comprehensively analyze differences between patients with "poor" and "fair" mentalizing abilities, as identified through a median-split procedure on mental state attribution task, and healthy controls, as well as to explore the role of clinical, demographical, and neurocognitive predictors of ToM performance within groups. METHOD One hundred twenty-two patients with schizophrenia and 67 healthy controls were assessed for ToM, attention, and executive functioning. In addition, patients' daily functioning and psychopathological profiles were also rated. RESULTS "Fair" mentalizers perform significantly better than "poor" mentalizers on cognitive abilities and quality of life and they differ from healthy controls in neurocognition and cognitive ToM performance, even though the global ToM performance is similar. Furthermore, regression models showed distinct contributing factors in each sub group: ToM is related to neurocognitive abilities and education in healthy subjects, while it is mainly associated with attention in "fair" group and it is related to clinical variables and executive functions in "poor" mentalizers. CONCLUSIONS Although preliminary, these data shed new light on the heterogeneity of ToM deficit among patients with schizophrenia and could reflect on daily clinical practice, as they are important to develop individualized step-by-step rehabilitative programs. (PsycINFO Database Record

Abstract: This book is intended as an inspiration and as an introduction to what Susan Hart has called neuroaffective developmental psychology. As an underlying theme throughout the book, she seeks to emphasize the importance of attachment for the formation of personality in all its diversity. This book presents a merger of systems that are not normally brought together in a structured psychodynamic context. Thus it operates on three levels: a neurobiological level, an intrapsychological level, and an interpersonal level. It also focuses on the brain structures that are essential for the formation of relationships, personality development, and emotions. It attempts to provide an understanding of the way that the uniquely human nervous system develops capacities for empathy, mentalization, and reflection that enable us to address such aspects as: past and present, interpersonal relations, ethics, art, and aesthetics. Susan Hart has endeavoured to make the text meaningful and comprehensible in order to make the topic interesting and inspiring to the reader, and to spark an interest in further studies.

Abstract: Previous research has found an association between insecure attachment and increased somatization in adults. However, the mechanisms underlying this association are unknown. In the present study, we examined whether the association between attachment insecurity and somatization in psychiatric patients diagnosed with medically unexplained somatic symptoms (MUSS) is mediated by mentalization deficits. Attachment security of 58 outpatients diagnosed with MUSS was measured with the Experiences in Social Relationships Questionnaire (ECR). Difficulty with understanding own emotions was measured with the Toronto Alexithymia Scale-20. In addition, others' mental state comprehension was measured with the Reading the Mind in the Eyes Test (RMET). Somatic symptom severity experienced by MUSS patients was related to attachment anxiety and alexithymia. These associations remained significant after controlling for sex, age, medication use, and depressive symptoms. Moreover, alexithymia mediated the association between anxious attachment and severity of somatic symptoms. Somatic symptom severity was also related to better RMET performance, although this association was not significant after controlling for sex, age, medication use, and depressive symptoms. Our findings may indicate that individuals with an anxious attachment style have difficulties in clarifying own emotions. This may in turn result in somatic experience of emotional distress and risk for development of MUSS.

Abstract: The aim of this study was to provide data on the preliminary validation of a clinician-report multidimensional assessment measure of mentalization (Mentalization Imbalances Scale, MIS). A random national sample of psychotherapists (N=190) completed the MIS to identify mentalization imbalances, and the Personality Disorder Checklist to assess the personality disorders (PDs) of randomly selected patients currently in their care. Factor analysis confirmed the presence of six factors that represented different imbalances of mentalization: cognitive, affective, automatic, external, imbalance toward others, and imbalance toward self. We found several significant relationships between patients' mentalization imbalances and personality pathology. Paranoid, schizoid, and schizotypal PDs were predicted by an imbalance toward self, an imbalance the patients shared with histrionic, avoidant, and obsessive compulsive PDs, whereas dependent, borderline, and histrionic PDs were related to an imbalance toward others. Cognitive imbalance was related to schizoid, narcissistic, and obsessive compulsive PDs, whereas affective imbalance predicted antisocial, borderline, narcissistic and histrionic PDs. Automatic imbalance was related to schizotypal, antisocial, and borderline PDs. MIS represents a reliable and valid measure that can help clinicians at understanding patients' specific difficulties of mentalization.

Abstract: This study examines the links between online maternal mentalization during mother–infant interaction, maternal sensitivity, and family triadic interaction while considering the cumulative role of two stressful contexts (cumulative stressful contexts): premature birth (a child-driven stressful context) and household chaos (an environment-driven stressful context). Two moderation models were tested on a sample of 134 families with 6-monthold infants (77 low-risk preterm, 57 full-term). Cumulative stressful contexts mitigated the relations between maternal mentalization and behavior, such that online maternal mentalization during mother–infant interaction was related to both maternal sensitivity and the quality of family triadic interaction under low cumulative stressful contexts, but not under high cumulative stressful contexts. Implications for understanding the influence of online maternal mentalization on maternal sensitivity and the family triad are discussed.

Abstract: People with autism spectrum disorder (ASD) report painful experiences through emotional misunderstandings with typically developing peers. There are limited intervention methodologies for ASD on the impact of emotional injuries and how to work with resulting trauma. This paper presents a rational-empirical model of trauma-related experiences with the first presentation of a new case conceptualization model for emotion-focused therapy for ASD. It describes the transformation of problematic emotion schemes through a sequence of emotional processing steps illustrated with a case example. These steps include: overcoming differentiation of core painful feelings (such as loneliness, shame, and fear); autobiographical memory recall of distanced trauma, using a novel method of video Interpersonal Process Recall; and articulation of the unmet needs contained in core painful feelings. This is followed by the expression of an emotional response to those feelings/needs; typically, self-soothing, protective anger and compassion responses offered interpersonally by group members. These emerging adaptive emotions facilitate mentalization of self and other that strengthens intrapersonal and interpersonal agency. This rational-empirical case conceptualization acts as a hypothesis for testing in subsequent trials.

Abstract: Maternal mentalization refers to a mother's capacity to understand mental-states of herself and her child and to regard her child as a psychological agent. In mother-infant interactions, this capacity is commonly conceptualized as maternal mind-mindedness, which can be divided into two dimensions: appropriate and nonattuned interpretations of the infants' mental-states. Appropriate mind-mindedness refers to interpretations that seem to be compatible with the infant's behaviors, whereas nonattuned mind-mindedness refers to noncompatible interpretations. The aim of this study was to investigate the cognitive mechanisms that contribute to mind-mindedness. Specifically, we investigated the role of executive functions in appropriate and nonattuned mind-mindedness, and the moderating roles of two infant-related factors, prematurity (as a stressful context) and child temperament (as a context of unpredictability and negative emotionality). To this end, mother-infant free play interactions were coded for mind-mindedness in a sample of 102 mothers and their 6-month-old infants (61 preterm, 41 full-term). When children were 66-months old, mothers completed cognitive tasks that assessed working memory updating, resistance to interference, response inhibition, and shifting. Appropriate mind-mindedness was positively associated with updating, and this link was stronger when infant temperament was rated as more difficult. Furthermore, among mothers of full-term infants, mothers' resistance to interference was negatively associated with nonattuned mind-mindedness. This link was not evident in the stressful context of premature birth. Mothers' response inhibition and shifting were not associated with either of the mind-mindedness dimensions. Implications on understanding variability in maternal mentalization during mother-infant interactions and the roles of executive functions in parenting are discussed.

Abstract: As a construct, the elaboration of countertransference experience (ECE) is intended to depict the implicit and explicit psychological work to which therapists submit their experiences with clients. Through ECE, defined as a mentalizing process of a particular kind, therapists' experiences are presumed to acquire and increase in mental quality and become available for meaning-making and judicious clinical use. In this paper, we claim that such an ongoing process facilitates engagement with common therapeutic factors, such as the therapeutic alliance and countertransference management, enhancing therapist responsiveness in psychotherapy. We synthesize relevant literature on countertransference, mentalization, and, in particular, therapists' mentalization, informed by a systematic literature review. As a result, we propose a model for assessing ECE in psychotherapy, comprising 6 diversely mentalized countertransference positions (factual-concrete, abstract-rational, projective-impulsive, argumentative, contemplative-mindful, and mentalizing), 2 underlying primary dimensions (experiencing, reflective elaboration), and 5 complementary dimensions of elaboration. Strengths and limitations of the model are discussed.

Abstract: BACKGROUND Psychotherapy patients can be more or less disabled by their psychological symptoms. The present study investigated whether mentalization and self-efficacy contribute to the association between psychological symptom severity and disabilities in activities and participation. METHODS The data of 216 psychotherapy inpatients were examined in a cross-sectional design. Bootstrapping-enhanced mediation analyses were performed to investigate whether self-efficacy and mentalization are mediators between psychological symptom severity and disabilities in activities and participation. The Hamburg Modules for the Assessment of Psychosocial Health-49 were used to measure psychological symptom severity and self-efficacy, mentalization was assessed with the Mentalization Questionnaire, and disabilities in activities and participation were operationalized with the ICF-Mental-A & P questionnaire. RESULTS Mentalization as well as self-efficacy functioned as mediators between psychological symptom severity and disabilities in activities and participation (p < 0.05). They were equally strong mediators, and both remained significant mediators when statistically controlling for the other mediator (p < 0.05). CONCLUSIONS Mentalization as well as self-efficacy explain a significant proportion of the relationship between psychological symptom severity and disabilities in activities and participation. Working on mentalizing and self-efficacy might be important mechanisms to reduce disability due to symptoms. The cross-sectional design is a limitation of the study.

Abstract: BACKGROUND We examined the relationship between general ability of mentalization, the specific aspect of affective mentalizing of self and others, emotion regulation strategies, and eating disorder (ED) symptoms. METHOD Twenty-five female adolescent and young adult inpatients with EDs, and 22 healthy subjects, were administered a semi-structured interview - the Reflective Function (RF) scale, self-rating scales assessing alexithymia, emotion regulation, depression and ED symptomatology, and a neurocognitive measure assessing Theory of Mind. RESULTS Participants with EDs presented lower levels of RF regarding the self and higher levels of alexithymia, using more emotional suppression and less cognitive reappraisal than controls. Elevated levels of general RF and self RF and attenuated alexithymia, along with elevated cognitive reappraisal and attenuated emotional suppression, were correlated with attenuated ED symptoms. Comorbidity with depressive symptoms predicted greater ED symptomatology. CONCLUSIONS High mentalization may serve as a coping mechanism to attenuate ED symptoms.

Abstract: Aims We investigated default mode network (DMN) electroencephalography (EEG) functional connectivity differences between individuals with self-reported high mentalization capability and low psychopathological symptoms, versus participants with mentalization impairments and high psychopathological symptoms. Methods Forty-nine students (35 women) with a mean age of 22.92 ± 2.53 years were administered the Mentalization Questionnaire (MZQ) and the Symptom Checklist-90-Revised. Five minutes of EEG during resting state were also recorded for each participant. DMN functional connectivity analyses were conducted by means of the exact Low Resolution Electric Tomography software (eLORETA). Results Compared to the individuals with high mentalization capability and lower self-reported psychopathological symptoms, participants with mentalization impairments and high psychopathological symptoms showed a decrease of EEG beta connectivity between: (i) the right and left medial frontal lobe, and (ii) the left medial frontal lobe and the right anterior cingulate cortex. Furthermore, while MZQ total score was positively associated with DMN network connections (i.e., right and left medial frontal lobes), several psychopathological symptoms (i.e., interpersonal sensitivity, depression, and psychoticism) were negatively associated with DMN connectivity. Conclusion Our results may reflect a top-down emotion regulation deficit which is associated with both internalizing and externalizing behavior problems.

Abstract: Aims:The purpose of this study was to explore how mentalization-based group therapy (MBT-G) for patients with borderline personality disorder may be both different and similar to a more traditional...

Abstract: Introduction We investigated the impact of attachment distress on affect-centered mentalization in a clinical and a non-clinical sample, comparing mentalization in a baseline condition to mentalization under a condition of attachment distress. Methods The sample consisted of 127 adults who underwent inpatient psychosomatic treatment, and 34 mentally healthy adults. Affect-centered mentalization was assessed by analyzing participants’ narratives on interpersonal situations in a baseline condition with the Levels of Emotional Awareness Scale (LEAS), and an experimental condition inducing attachment distress with the Adult Attachment Projective Picture System (AAP). Unlike the LEAS, the AAP is specifically designed to trigger attachment distress. In both conditions, the narratives were evaluated using the LEAS scoring system. Additionally, we assessed the impact of childhood trauma on affect-centered mentalization with the Childhood Trauma Questionnaire (CTQ). Results While the non-clinical sample displayed the same level of affect-centered mentalization in both conditions, the majority of the clinical sample reached higher scores in the attachment distress condition. There was no strong relationship between reported trauma and mentalization scores. Discussion Our findings lend strong empirical support to the assumption that affect-centered mentalization is modulated by attachment-related distress. Several possible explanations for the differences between and within the clinical and the non-clinical sample are discussed.

Abstract: Objective To determine if an interpersonal attribution bias associated with self-perception, the externalizing bias, was related to neural activations during mentalization. Methods A functional magnetic resonance imaging task involving verbal appraisals measured neural activations when thinking about oneself and others in 59 adults, including healthy women as well as women with and recovered from anorexia nervosa. Whole-brain regressions correlated brain function during mentalization with the externalizing bias measured using the Internal, Personal, and Situational Attributions Questionnaire. Results Women with anorexia nervosa had a lower externalizing bias, demonstrating a tendency to self-attribute more negative than positive social interactions, unlike the other groups. The externalizing bias was correlated with activation of the left inferior frontal gyrus and posterior insula, when comparing thinking about others evaluating oneself with direct self-evaluation. Discussion Externalizing biases may provide an office-based assay reflecting neurocognitive disturbances in social self-perception that are common during anorexia nervosa.

Abstract: There are conflicting results concerning risk of violence in schizophrenia. Empathy and mentalization deficits are associated both with schizophrenia and violence, however, there are only a few studies with equivocal results concerning their relationship. 88 violent and nonviolent paranoid schizophrenic and violent and nonviolent control males in psychiatric, forensic psychiatric and correctional institutions completed the Ekman 60 Faces test, Faux Pas Recognition Test, Eysenck IVE test, Interpersonal Reactivity Index, and the Spielberger Anger Expression Scale. Data were analysed with ANOVA and logistic regression models. Significant group differences with a characteristic pattern were detected in mentalization, facial affect recognition, fear and anger recognition, interpersonal distress, and frequency of direction of anger expression. Predictors of violent behaviour were different in the schizophrenic and non-schizophrenic groups. Lack of major differences in empathy and mentalization between violent and nonviolent schizophrenia patients suggests that such deficits are core features of schizophrenia but do not determine emerging violence in this illness. Our results emphasise the importance of distinguishing between violence related to core positive symptoms of schizophrenia and that emerging from independent comorbid antisocial personality traits in order to identify targets for screening, detection, prevention and management of violence risk in different subpopulations of schizophrenia patients.