Associations between maternal smartphone use and mother-infant responsiveness: A cluster analysis of potential risk and protective factors.

Contradictory results in the extant literature suggests that additional risk factors should be considered when exploring the impacts of maternal smartphone use on mother-infant relationships. This study used cluster analysis to explore whether certain risk factors were implicated in mother-infant dyads with high smartphone use and low mother-infant responsiveness. A cross-sectional survey of 450 participants in the UK measured infant social-emotional development, maternal depressive, anxiety and stress symptoms, wellbeing, social support, smartphone use, and mother-infant responsiveness. Participants were predominantly White (95.3%) and living with a partner (95.2%), with infants who were born full-term (88.9%). Cluster analysis identified three clusters characterized as; cluster (1) "infant at risk" showing high infant development concerns, high maternal smartphone use, and low mother-infant responsiveness; cluster (2) "mother at risk" showing high maternal depressive, anxiety, and stress scores, low social support, high maternal smartphone use, and low mother-infant responsiveness, and cluster (3) "low risk" showing low maternal smartphone use and high mother-infant responsiveness. Significant differences were found between all risk factors, except for maternal smartphone use and mother-infant responsiveness between clusters 1 and 2 suggesting that both clusters require early intervention, although interventions should be tailored towards the different risk factors they are presenting with.

Resultados contradictorios en la literatura existente sugieren que se deben considerar factores de riesgo adicionales cuando se explora el impacto del uso que la madre hace del teléfono inteligente en las relaciones madre­infante. Este estudio usó un análisis de grupo para explorar si ciertos factores de riesgo estaban implicados en las díadas madre­infante con uso elevado del teléfono inteligente y la baja sensibilidad madre­infante. Una encuesta transversal de 450 participantes en el Reino Unido midió el desarrollo socioemocional del infante, los síntomas maternos depresivos, de ansiedad y estrés, el bienestar, el apoyo social, el uso del teléfono inteligente, así como la sensibilidad madre­infante. Las participantes eran predominantemente blancas (95.3%) y convivían con una pareja (95.2%), con infantes nacidos en un período de gestación completo (88.9%). Los análisis de grupo identificaron tres grupos caracterizados como: grupo 1) "infante bajo riesgo," mostrando altas preocupaciones sobre el desarrollo del infante, uso elevado del teléfono inteligente por parte de la madre, así como baja sensibilidad madre­infante; grupo 2) "madre bajo riesgo," mostrando altos puntajes de depresión, ansiedad y estrés maternos, bajo apoyo social, uso elevado del teléfono inteligente por parte de la madre, así como baja sensibilidad madre­infante; y grupo 3) "bajo riesgo," mostrando bajo uso del teléfono inteligente por parte de la madre, y alta sensibilidad madre­infante. Se encontraron diferencias significativas en todos los factores de riesgo, excepto en el caso del uso del teléfono inteligente por parte de la madre y la sensibilidad madre­infante entre los grupos 1 y 2, lo cual indica que ambos grupos requieren de una temprana intervención, aunque las intervenciones se deben moldear en términos de los diferentes factores de riesgo que se le presenta a cada grupo.

Les résultats contradictoires dans les recherches existantes suggèrent que des facteurs de risque supplémentaires devraient être pris en considération en explorant les impacts de l'utilisation maternelle du smartphone sur les relations mère­bébé. Cette étude a utilisé une analyse typologique afin d'explorer si certains facteurs de risque étaient impliqués chez les dyades mère­nourrisson avec une utilisation élevée du smartphone et une réaction mère­nourrisson faible. Une étude transversale de 450 participantes au Royaume Uni a mesuré le développement socio­émotionnel du bébé, les symptômes dépressives, d'anxiété et de stress maternel, le bien­être maternel, le soutien social, l'utilisation du smartphone et la réaction mère­nourrisson. Les participantes étaient essentiellement Blanches (95,3%), vivant avec un partenaire (95,2%), avec des bébés étant nés à terme (88,9%). Une analyse typologique a identifié trois clusters (types) avec ces caractéristiques: type 1) "nourrisson à risque" avec des problèmes de développement infantile élevés, une utilisation maternelle du smartphone élevée, et une réaction mère­bébé faible; type 2) "mère à risque" faisant état de scores maternels élevés de dépression, d'anxiété et de stress, d'un soutien social faible, avec une utilisation maternelle du smartphone élevée, et une réaction mère­bébé faible, et type 3) "risque faible" montrant peu d'utilisation maternelle du smartphone et une réaction élevée mère­bébé. Des différences importantes ont été trouvées entre tous les facteurs de risque, saut pour l'utilisation maternelle du smartphone et la réaction maternelle entre les types 1 et 2, ce qui suggère que les deux types exigent une intervention précoce, bien que les interventions devraient être adaptées aux différents facteurs de risque avec lesquelles elles se présentent.

An examination of behavioural and emotional problems in children exposed prenatally to the 27F Chilean earthquake: findings from the ELPI cohort.

PURPOSE: Associations between prenatal earthquake exposure and children's mental health remain unclear. Moreover, there is a paucity of research using quasi-experimental statistical techniques to diminish potential selection bias. Thus, this study aimed to explore the impact of prenatal exposure to the Chilean earthquake of 2010 on children's behavioural and emotional problems between 1½ and 3 years old using propensity score matching. METHODS: Participants included 1549 families from the Encuesta Longitudinal de la Primera Infancia cohort in Chile. Maternal reports using the Child Behaviour Checklist (CBCL) were used to assess behavioural and emotional problems between 1½ and 3 years old. Information on prenatal earthquake exposure was collected via maternal report. The Kernel matching estimator was used to compare the average treatment effects of children who were exposed to the earthquake compared to those who were not. RESULTS: Five of the seven CBCL outcomes were statistically significant after matching and adjustment for multiple testing, suggesting greater difficulties for exposed children which included emotional reactivity, anxious/depressed, sleep problems, attention problems, and aggression (mean difference of 0.69, 0.87, 0.73, 0.85, 3.51, respectively). The magnitude of the effect was small to medium. CONCLUSION: Findings contribute to the potential causal inferences between prenatal earthquake exposure and increased behavioural and emotional problems in early childhood. Results suggest that in utero experiences may have long-term consequences for infants' well-being, supporting the need for specific interventions in pregnancy after natural disasters.

General and age-specific fertility rates in non-affective psychosis: population-based analysis of Scottish women.

PURPOSE: Women diagnosed with non-affective psychosis have a lower general fertility rate (GFR) and age-specific fertility rate (ASFR) than women in the general population. Contemporary data on GFR in this group remain limited, despite substantive changes in prescribing and management. We calculated contemporary estimates of the GFR and ASFR for women diagnosed with non-affective psychosis compared with the general population of women without this diagnosis. METHODS: A population-based design combined routinely collected historical maternity and psychiatric data from two representative areas of Scotland. Women were included from the NHS Grampian or Greater Glasgow and Clyde areas and were aged 15-44 between 2005 and 2013 inclusive. The 'exposed' group had a diagnosis of non-affective psychosis (ICD-10 F20-F29) and was compared to the general population of 'unexposed' women in the same geographical areas. RESULTS: Annual GFR between 2005 and 2013 for women with non-affective psychosis varied from 9.6 to 21.3 live births/1000 women per year in the exposed cohort and 52.7 to 57.8 live births/1000 women per year in the unexposed cohort, a rate ratio (RR) of 0.28 [p < 0.001; 95% CI (0.24, 0.32)]. ASFR for all 5-year age groups was lower in the exposed cohort than amongst unexposed women. CONCLUSION: We highlight continued low fertility rates in women with a diagnosis of non-affective psychosis, despite widespread availability of prolactin-sparing atypical antipsychotics. Accurate estimation of fertility rates remains crucial in developing needs-matched perinatal care for these women. Methodological improvements using routine datasets to investigate perinatal mental health are also urgently needed.

Experiential techniques and therapeutic relationship in the treatment of narcissistic personality disorder: The case of Laura.

Experiential techniques can be used to address maladaptive interpersonal patterns in patients with personality disorders (PDs) as long as they are delivered minding about the therapeutic relationship. We present the case study of Laura, a 38-year-old woman presenting with covert narcissism, generalized anxiety disorder, depression, and complicated grief treated with metacognitive interpersonal therapy. Laura initially refused to engage in any experiential work out of fear of being judged and abandoned by her therapist. To navigate this therapeutic obstacle, the therapist focused on exploring and eventually repairing early alliance ruptures. Thereafter, Laura engaged in experiential work, which helped her address her narcissistic interpersonal patterns. After 2 years, Laura's symptoms and narcissistic problematic behaviors decreased. This case study can help us understand how experiential techniques can be successfully used in PD psychotherapy as long as attention to the therapy relationship is paid.

"There's more love between us": The parental experience of attending Mellow Babies, a targeted, early intervention program for parents and their babies.

It is recognized that parenthood in the context of psychosocial adversity can have negative implications for infant development. Parenting programs are the first line of intervention to improve outcomes for families; however, evidence for the effectiveness of group-based, targeted early interventions is still scarce. Preliminary findings indicate Mellow Babies (MB) as a promising group-based parenting program for families at risk for parenting difficulties. Using thematic analysis, we aimed to understand: (i) the aspects of the intervention that enabled parents to complete the program and (ii) the relational and behavioral changes perceived as valuable for parents and their babies post-intervention. In total, 68 parents residing in the United Kingdom were interviewed after completing MB (49 mothers and 19 fathers; 88% self-identified as British). Three themes and six subthemes were generated from the data. Parents identified several intervention components as beneficial, including the facilitators' interpersonal skills and multi-dimensional, group-based approach. Participant reflections highlighted three underlying mechanisms that enabled positive change: (i) the sense of community cultivated within the group, (ii) the process of formulating and re-conceptualizing one's difficulties, and (iii) the opportunity to reshape interpersonal interactions. Findings are discussed within the context of perinatal and infant mental health.

Se reconoce que la paternidad/maternidad dentro del contexto de la adversidad sicosocial puede tener implicaciones negativas para el desarrollo del infante. Los programas sobre la crianza son la línea frontal de intervención para mejorar los resultados para las familias, sin embargo, la evidencia para la eficacia de las intervenciones tempranamente identificadas, con base en el grupo, es escasa. Los resultados preliminares indican que Bebés Apacibles (Mellow Babies / MB) es un prometedor programa de crianza con base en el grupo para familias bajo riesgo de dificultades en la crianza. Haciendo uso de análisis temáticos, nos propusimos comprender: i) los aspectos de la intervención que les permite a los progenitores completar el programa y ii) los cambios relacionales y de comportamiento que se percibieron como valiosos para los progenitores y sus bebés con posterioridad a la intervención. En total, se entrevistaron 68 progenitores residentes del Reino Unido después de completar MB (49 mamás y 19 papás; 88% autoidentificados como británicos). De la información surgieron tres temas y seis subtemas. Los progenitores identificaron como beneficiosos varios componentes de la intervención, incluyendo las habilidades interpersonales de quienes facilitaban la participación y el acercamiento multidimensional con base en el grupo. Las reflexiones de los participantes subrayaron tres mecanismos subyacentes que permitieron el cambio positivo: i) el sentido de comunidad cultivado dentro del grupo; ii) el proceso de formular y reconceptualizar las propias dificultades; y iii) la oportunidad de volver a darle forma a las interacciones interpersonales. Los resultados se discuten dentro del contexto de la salud mental perinatal y del infante.

On reconnaît généralement que la parentalité dans le contexte d'adversité psychosociale peut avoir des implications négatives pour le développement du bébé. Les programmes de parentage sont la première ligne d'intervention afin d'améliorer les résultats pour les familles. Cependant les preuves de l'efficacité d'interventions précoces ciblées et basées sur un groupe sont encore rares. Des résultats préliminaires indiquent que Bébés d'humeur joyeuse, Mellow Babies (MB) est un programme de parentage basé sur un groupe prometteur pour les familles à risque de difficultés de parentage. En utilisant une analyse thématique nous nous sommes donné pour but de comprendre: i) les aspects de l'intervention qui permettent aux parents de finir le programme et ii) les changements relationnels et comportementaux qui sont perçus comme étant précieux pour les parents et leurs bébé après l'intervention. Au total 68 parents résidant au Royaume Uni ont été interviewés après avoir terminé le programme MB (49 mères et 19 pères; 88% s'étant auto-identifiés comme britanniques). Trois thèmes et six sous-thèmes ont émergé des données. Les parents ont identifié plusieurs composantes de l'intervention comme étant bénéfiques, y compris les compétences interpersonnelles du facilitateur ou de la facilitatrice et son approche multi-dimensionnelle, basée sur un groupe. Les réflexions des participants ont mis en lumière trois mécanismes sous-jacents qui permettait un changement positif: i) le sens de communauté cultivé au sein du groupe; ii) les processus de formulation et de ré-conceptualisation de ses propres difficultés; et iii) l'opportunité de refaçonner les interactions interpersonnelles. Les résultats sont discutés dans le contexte de la santé mentale du nourrisson et périnatale.

Metacognitive interpersonal group therapy for adolescents with avoidant personality disorder: The case of Sofia.

INTRODUCTION: Early intervention studies for adolescents and early adults are required to explore the acceptability and effectiveness of psychological therapies across the full range of personality disorders (PDs) beyond just borderline PD. The main aim of the current paper was to describe a Metacognitive Interpersonal Therapy group adaptation for adolescents (MIT-GA) presenting with PDs featuring overcontrol and social inhibition, and in particular Avoidant PD characteristics. METHODS: We report findings from a single case of a female adolescent diagnosed with Avoidant PD providing preliminary data on feasibility and the possible effectiveness of MIT-GA. RESULTS: Evidence of acceptability and meaningful clinical gains are described. CONCLUSIONS: Results suggest that MIT-GA could be a powerful treatment option in patients with generalized social avoidance who do not currently receive gold-standard psychotherapeutic treatments. This intervention also appears to be effective and cost-effective in initiating significant clinical changes in profiles of young patients with non-borderline PD symptoms.

Deconstructing pathways to resilience: A systematic review of associations between psychosocial mechanisms and transdiagnostic adult mental health outcomes in the context of adverse childhood experiences.

Adverse childhood experiences (ACEs) are identified with increased risk of adult mental health difficulties and negative impacts on well-being. However, there is a need to go beyond simple associations and identify candidate mechanisms underpinning the ACEs-mental health relationship. Further methodological heterogeneity points to issues around the operationalization of ACEs and the importance of modelling data using robust research designs. The aim of the current review was to synthesize studies that utilized formal mediation and/or moderation analyses to explore psychological and social variables on the pathway between clearly defined ACEs (as measured by the ACE questionnaire and Childhood Trauma Questionnaire [CTQ]) and common mental health outcomes (depressive, anxiety and post-traumatic stress disorder [PTSD] symptoms) across community samples aged over 18. A total of 31 papers were retrieved for critical appraisal. The majority of the studies explored factors mediating/moderating the link between child adversity and depression and less on anxiety and trauma. Most mechanisms were tested in only single studies, limiting the consistency of evidence. Evidence indicated that the mechanisms underlying associations between ACEs and adult mental health are likely to reflect multiple intervening variables. Further, there are substantial methodological limitations in the extant literature including the proliferation of causal inferences from cross-sectional designs and both measurement and conceptual issues in operationalizing adversity. Consistent transdiagnostic mechanisms relevant to common mental health problems were identified, including perceived social support, emotion regulation and negative cognitive appraisals/beliefs. Further research using longitudinal design is required to delineate the potential contribution of the identified mechanisms.

Service users experience of psychological interventions in primary care settings: A qualitative meta-synthesis.

Primary care mental health services play a crucial role in public mental health by providing local and accessible psychological interventions that meet individuals' needs. Despite growing research investigating service users' perspectives of psychological interventions, a qualitative systematic review in this context is not available. The present meta-synthesis collates the existing articles and gives a thematic synthesis of qualitative studies on service users' experience of psychological interventions in primary care. Multiple databases (CINAHL, EMBASE, PsychINFO, MEDLINE, and Cochrane Library) were searched for published qualitative studies of service users' experiences of psychological interventions delivered in primary care. Articles were included if they met inclusion criteria. Study quality was assessed using the Critical Appraisal Skills Programme tool. All types of psychological interventions were considered across model and delivery format (e.g., face-to-face, computerised programmes, and group). NVIVO was used to code the dataset and themes were extracted following thematic synthesis. Twenty-two studies were included. Four analytical themes and 10 subthemes emerged. The identified themes were as follows: (1) 'Access and Acceptability: facilitators and barriers', (2) 'Structural aspects'; (3) 'Therapeutic process' and (4) 'Outcomes'. A model of interrelationships between themes is proposed. Findings suggest several 'essential ingredients' across psychological interventions and modalities. The crucial role of relational factors, the importance of assessing service users' perceptions of treatment features (e.g., remote delivery) and of tailoring the intervention to their needs were emphasised. Results also suggest involving service users more in discussions and decisions about psychological interventions offered might enhance access, acceptability, and engagement. Recommendations for practice and research are provided.

What factors influence dyadic synchrony? A systematic review of the literature on predictors of mother-infant dyadic processes of shared behavior and affect.

Dyadic behavioral synchrony is a complex interactional process that takes place between the mother and her infant. In the first year of life, when the infant is prelinguistic, processes such as synchrony enable the dyad to communicate through shared behavior and affect. To date, no systematic review has been carried out to understand the risk and protective factors that influence behavioral synchrony in the mother-infant dyad. The aim of this review was to identify and evaluate the factors that influence behavioral synchrony in the mother-infant dyad, when the infant is between 3 and 9 months old. Key electronic databases were searched between 1970 and April 2021, and 28 eligible studies were identified for review. As the results were largely heterogeneous, four subgroups of factors were identified: (i) infant demographics, (ii) physiological factors, (iii) maternal mental health, and (iv) miscellaneous factors. Identified risk factors and covariates suggest that social determinants of health, underpinned by biological factors, play a large role in influencing behavioral synchrony within the dyad. Implications for the need to identify additional risk and protective factors, as well as design support for at-risk families are discussed.

La sincronía diádica del comportamiento es un proceso complejo de interacción que se lleva a cabo entre la madre y su infante, y en el primero año de vida, cuando el infante está en la época prelingüística. Los procesos como la sincronía le permiten a la díada comunicarse a través del comportamiento y el afecto compartido. Hasta la fecha, ninguna revisión sistemática se ha llevado a cabo para comprender los factores de riesgo y de protección que influyen la sincronía del comportamiento en la díada madre-infante. El propósito de esta revisión fue identificar y evaluar los factores que influyen la sincronía del comportamiento en la díada madre-infante, cuando el infante tiene entre 3 y 9 meses de nacido. Se investigaron bancos claves de datos electrónicos entre 1970 y abril de 2021, y se identificaron 28 estudios aptos para la revisión. Como los resultados fueron en gran parte heterogéneos, se identificaron cuatro subgrupos de factores: (i) datos demográficos del infante, (ii) factores fisiológicos, (iii) salud mental materna, y (iv) factores misceláneos. Los factores de riesgo y covariantes identificados señalan que los determinantes sociales de salud, sustentados por factores biológicos, juegan un papel grande en cuanto a influir la sincronía del comportamiento dentro de la díada. Se discuten las implicaciones para la necesidad de identificar factores de riesgo y de protección adicionales, así como también diseñar el apoyo para familias bajo riesgo.

La synchronie comportementale dyadique est un processus interactionnel complexe qui prend place entre la mère et son bébé. Dans la première année de la vie, quand le bébé ne parle pas, les processus tels que la synchronie permettent à la dyade de communiquer à travers un comportement et un affect partagés. Jusqu'à présent aucune revue systématique n'a été faite pour comprendre les facteurs de risque et les facteurs de protection qui influencent la synchronie comportementale chez la dyade mère-bébé. Le but de cette revue était d'identifier et d'évaluer les facteurs qui influencent la synchronie comportementale chez la dyade mère-bébé, quand le bébé avait entre 3-9 mois. Les bases de données électroniques clés ont fait l'objet des recherches entre 1970 et avril 2021, et 28 études admissibles ont été identifiée pour la revue. Puisque les résultats étaient largement hétérogènes, quatre sous-groupes de facteurs ont été identifiés: (1) données démographiques du bébé, (ii) facteurs physiologiques, (iii) santé mentale maternelle, et (iv) facteurs divers. Les facteurs de risque identifiés et les co-variables suggèrent que les déterminants sociaux de la santé, sous-tendus par des facteurs biologiques, jouent un rôle important en influençant la synchronie comportementale au sein de la dyade. Les implications quant au besoin d'identifier des facteurs de risque et de protection supplémentaire, ainsi que des soutiens aux familles à risque sont discutées.

The Impact of Contextual, Maternal and Prenatal Factors on Receptive Language in a Chilean Longitudinal Birth Cohort.

A secondary analysis was conducted on longitudinal data collected from ELPI, a representative Chilean survey to model Chilean infant's receptive language using contextual, maternal and prenatal factors. The sample for the current study comprised children aged between 36 and 48 months (n = 3921). The sample was re-assessed when children were aged 60-72 months (n = 3100). Linear regression analyses were conducted. At the first time point, all the predictors included were significant (living area, health system provision, maternal intelligence and education, adolescent pregnancy, maternal medical appointments during pregnancy, and presence of a significant other at childbirth), except for smoking during pregnancy. The model explained 13% of the variance. However, when timepoint one receptive language scores were included in the analyses for when children were aged 60-72 months, only two variables remained as significant predictors: previous receptive language scores and maternal education, explaining 21% of the variance. Findings and implications are discussed.

Building the alliance and using experiential techniques in the early phases of psychotherapy for avoidant personality disorder.

Individuals experiencing avoidant personality disorder (AvPD) tend to make sense of social interactions via maladaptive self-and other attributions. They also experience difficulties in recognizing emotions. A further feature of AvPD psychopathology is the tendency to resort to maladaptive coping strategies, such as behavioral avoidance and perfectionism. Despite its impact, psychological treatments for AvPD remains poorly investigated. Herein, we describe the first five sessions of Metacognitive Interpersonal Therapy with a 28-year-old woman, whose treatment goal was to reduce social avoidance. We describe how this goal was achieved through a combination of working through the therapeutic relationship, alongside experiential techniques such as guided imagery, rescripting, and bodily work. Through this treatment configuration, the patient was able to increase self-awareness of her own emotions, enabling her to realize that she was guided by rigid schemas; specifically seeing herself as inadequate and others as judgmental. Finally, implications for the treatment of AvPD are discussed.

Disentangling genes, attachment, and environment: A systematic review of the developmental psychopathology literature on gene-environment interactions and attachment.

The role of genetics in relation to attachment is of continued interest to developmental psychology. Recent research has attempted to disentangle genetic main effects, environmental effects, and gene and environment (G × E) interactions in the development of attachment security/insecurity and disorganization. We systematically reviewed associations between gene markers and attachment, including G × E interactions, identifying 27 eligible studies. Inconsistent results emerged for associations between both gene effects and G × E interactions on attachment organization. Where G × E interactions used attachment as the environmental factor in the interaction, we observed more consistent results for differential susceptibility of G × E interactions on offspring behavior. Small sample size and heterogeneity in measurement of environmental factors impacted on comparability of studies. From these results, we propose that the future of research into the role of genetic effects in attachment lies in further exploration of G × E interactions, particularly where attachment acts as an environmental factor impacting on other child developmental outcomes emerging from the caregiving environment, consistent with differential susceptibility approaches to developmental psychopathology. In addition, from a methodological perspective, establishing the role of gene markers in such models will require a shift toward contemporary genomics, including genome-wide analysis (including novel genes and chromosomal loci), and epigenetic individual variations.

The revised Psychosis Attachment Measure: Measuring disorganized attachment.

OBJECTIVES: The Psychosis Attachment Measure (PAM) is currently the most widely used and validated measure of attachment in psychosis. However, the PAM does not assess disorganized attachment, the type of attachment that has been most closely linked with vulnerability to psychosis. This study aimed to expand the PAM to capture the concept of disorganized attachment and to examine its psychometric properties in a psychosis sample. METHODS: Clinical and academic experts in the field of psychosis and service user representatives were asked to assess the comprehensiveness and comprehensibility of the pool of disorganized items. This process resulted in 12 items hypothesized to capture disorganized attachment that were included with the original items of the PAM. A sample of 144 individuals with either a self-reported diagnosis of, or treatment for, a psychosis-related condition completed a battery of online measures comprising the revised PAM, existing measures of adult disorganized attachment and constructs hypothesized to be conceptually related to disorganized attachment. RESULTS: An exploratory factor analysis was conducted with three factors retained; these were labelled anxious, avoidant and disorganized attachment. The factors displayed good internal consistency and test-retest reliability and the disorganized factor displayed good construct validity with related measures and constructs. CONCLUSIONS: These results provide preliminary evidence that the revised PAM captures the concept of disorganized attachment. However, confirmatory psychometric evaluation of the revised PAM is required, within a separate psychosis sample, to confirm its factor structure. The relationship between these results and the current literature, in addition to the clinical and research implications, are discussed. PRACTITIONER POINTS: We present an expanded version of the Psychosis Attachment Measure (PAM), revised to capture the concept of disorganised attachment in adulthood. This expanded measure showed good reliability and the new disorganized subscale demonstrated construct validity. These results provide preliminary evidence that disorganized attachment can be measured using a simple self-report measure with individuals with psychosis. Further research is required to confirm the structural dimensionality of the revised PAM within a new sample using confirmatory factor analysis. Following further psychometric validation the use of this measure has the potential to be expanded to other mental health conditions in which disorganized attachment has been implicated in the development and maintenance of difficulties, for example, trauma-related conditions and borderline personality disorder.

The intertwined path of perfectionism and self-criticism in a client with obsessive-compulsive personality disorder.

Psychotherapy for obsessive-compulsive personality disorder (OCPD), where perfectionism is a defining criterion, is understudied. Despite a high prevalence few evidence-based treatments are available for the presentation. Here we describe the course of a 6-month program of metacognitive interpersonal therapy with an OCPD patient with prominent perfectionism and self-criticism, which were considered primary outcomes of the case study. Therapy aimed initially at increasing awareness of maladaptive interpersonal schemas and promoting a healthy self. First, behavioral experiments were used to try and counteract perfectionism. Second, experiential techniques, such as guided imagery and rescripting, were used to help the client in connect with different, healthier aspects of the self, thus increasing personal and interpersonal wellbeing. Qualitative and quantitative outcomes at the intervention end and at 1-month follow-up are summarized. Finally, we reflect on how this case study can inform treatment of perfectionism in OCPD.

Antenatal caregiving representations and perinatal behavior in mothers with severe lifetime psychopathology.

Psychopathology poses a risk for optimal parenting. The current study explored antenatal caregiving representations as markers for later risk of nonoptimal maternal behavior among mothers with severe mental illness. Sixty-five mothers diagnosed with psychosis, bipolar disorder, depression (psychopathology group), and nonclinical controls participated in a longitudinal study from pregnancy to 16 weeks after birth. Mental health diagnoses and caregiving representations were assessed during pregnancy. Maternal behavior was assessed during the 5-min recovery phase of the still-face paradigm at 16 weeks. Mothers with psychopathology reported significantly higher levels of "heightened" caregiving representations (i.e., separation anxiety from the child) than did controls. The only significant diagnostic group difference in perinatal maternal behavior was that mothers diagnosed with depression exhibited more overriding-intrusive behavior than did nonclinical control mothers. Regression modeling results showed that antenatal caregiving representations of "role reversal" predicted significantly lower levels of sensitivity and higher levels of overriding-intrusive behavior independent of the effect of psychopathology. The findings can be interpreted in the context of representational transformation to motherhood during pregnancy. The results provide preliminary evidence for the potential of a new questionnaire measure of caregiving representations as a screening instrument for antenatal representational risk.

La sicopatología presenta un riesgo para la crianza óptima. El presente estudio exploró las representaciones antenatales de la prestación de cuidado como señales para un posterior riesgo de conducta materna no óptima entre madres con una enfermedad mental severa. Sesenta y cinco madres con diagnosis de sicosis, trastorno bipolar, depresión (grupo de sicopatología), así como madres en el grupo control no clínico participaron en un estudio longitudinal desde el embarazo hasta 16 semanas después del nacimiento. Se evaluaron los diagnósticos de salud mental y las representaciones de la prestación de cuidado durante el embarazo. La conducta materna fue evaluada durante la fase de cinco minutos de recuperación del paradigma de la Cara Inmóvil a las 16 semanas. Las madres con sicopatología reportaron niveles significativamente más altos de representaciones "agudizadas" de la prestación de cuidado (v.g. ansiedad de estar separadas de su niño) que las madres del grupo de control. La única significativa diferencia de grupo de diagnóstico en cuanto a la conducta materna perinatal fue que las madres con diagnosis de depresión presentaron una conducta predominantemente más intrusa que las madres del grupo de control no clínico. Los resultados del uso de modelos de regresión mostraron que las representaciones antenatales de la prestación de cuidado en cuanto al 'cambio de roles' predijeron niveles significativamente más bajos de sensibilidad y niveles más altos de conductas predominantemente intrusas, independiente del efecto de la sicopatología. Se pueden interpretar los resultados en el contexto de la transformación de representación hacia la maternidad durante el embarazo. Los resultados aportan evidencia preliminar para la posibilidad de una nueva medida de cuestionario sobre las representaciones de la prestación de cuidado como instrumento de detección del riesgo de la representación antenatal.

La psychopathologie pose un risque pour le parentage optimal. Cette étude a exploré les représentations de soin anténatal en tant que marqueurs de risque ultérieur de comportement maternel non-optimal chez les mères atteintes d'une maladie mentale sérieuse. Soixante-cinq mères ayant été diagnostiquées avec une psychose, un trouble maniaco-dépressif, une dépression (groupe psychopathologie) et des contrôles non-cliniques ont participé à une étude longitudinale de la grossesse à 16 semaines après la naissance. Les diagnostics de santé mentale et les représentations de soin ont été évaluées durant la grossesse. Le comportement maternel a été évalué durant la phase de récupération de cinq minutes du paradigme de Visage Immobile à 16 semaines. Les mères avec une psychopathologie ont fait état de niveaux bien plus élevés de représentations 'accrues' de soin (anxiété de séparation d'avec l'enfant) que les contrôles. La seule différence importante de diagnostic de groupe dans le comportement maternel périnatal était que les mères diagnostiquées avec une dépression ont fait preuve de plus de comportement prépondérant-intrusif que les mères du groupe de contrôle non-clinique. Les résultats du modèle de régression ont montré que les représentations anténatales de soin de 'l'inversion des rôles' ont prédit des niveaux de sensibilité bien plus bas et des niveaux de comportement prépondérant-intrusif bien plus élevés quel que soit l'effet de la psychopathologie. Les résultats peuvent être interprétés dans le contexte de la transformation représentationnelle de la maternité durant la grossesse. Les résultats offrent des preuves préliminaires quant au potentiel d'un nouveau questionnaire comme mesure de représentations de soin en tant qu'instrument de dépistage du risque représentationnel anténatal.

Metacognitive Interpersonal Mindfulness-Based Training for Worry About Interpersonal Events: A Pilot Feasibility and Acceptability Study.

Individuals with personality disorders experience worry and repetitive thoughts regarding interpersonal scenarios. Mainstream mindfulness-based approaches may be insufficient to soothe these individual's distress due to difficulties in letting thoughts go and refocusing attention to the present moment. For this reason, we devised an adapted form of mindfulness-based program called Metacognitive Interpersonal Mindfulness-Based Training (MIMBT) for personality disorders. In this pilot study, 28 individuals attended nine weekly sessions to evaluate the feasibility and acceptability, and to establish preliminary outcomes. All individuals completed the program. Attendance was very high (96%). Significant changes were observed on the primary outcome of reduction in repetitive thinking, measured using the Metacognition Questionnaire-30. We also observed a decrease in depression severity. Despite important limitations, this pilot study suggests that MIMBT has the potential to be a viable and well-accepted option for increasing positive outcomes in the treatment of personality disorders. Clinical considerations and directions for future research are discussed.

Hair cortisol in the perinatal period mediates associations between maternal adversity and disrupted maternal interaction in early infancy.

Existing literature points to the possibility that cortisol could be one link between maternal adversity and poorer parenting quality, but most studies have examined salivary cortisol concentrations rather than hair cortisol concentrations. The current study examined hair cortisol concentration (HCC) during the third trimester of pregnancy as a mediator between maternal adversity indicators (childhood abuse, severe mental illness, symptomatic functioning) and maternal caregiving behavior at 4 months postpartum. Forty-four women participated in the study: 30 with severe mental disorders, and 14 nonclinical controls. HCC was assessed during the third trimester of pregnancy (HCC-P) and at 4 months postpartum (HCC-4M). Sexual, physical, and emotional abuse were assessed by the Adverse Childhood Experiences Study Questionnaire. Maternal disrupted interaction was reliably coded from mother-infant video interactions during a Still-Face Procedure. Mediation models indicated that maternal HCC-P and HCC-4M mediated associations between maternal psychopathology (severe mental illness, symptomatic functioning) and maternal disrupted interaction at 4 months. Maternal HCC at 4 months also mediated associations between experienced childhood abuse and overall disrupted interaction. Our findings indicate that HCC may be a potential early biomarker for future caregiving challenges among mothers with severe mental illness and histories of childhood abuse.

Antenatal caregiving representations among expectant mothers with severe mental illness: a cross-sectional study.

Objective: The study explores predictors of antenatal caregiving representations among mothers with a history of severe mental illness (SMI). Background: Attachment research has demonstrated that multifactorial assessment of antenatal caregiving representations predicts later maternal behaviour and child attachment. However, the field lacks research among clinical groups. Knowledge of factors influencing caregiving representations during pregnancy can contribute to our understanding of caregiving risk among SMI-mothers and inform intervention decisions. Method: The current study is a cross-sectional subsample of the WARM study. Participants were 65 Danish or Scottish pregnant women with a history of either schizophrenia, bipolar disorder, moderate-severe depression, or non-clinical controls. Caregiving representations, adverse childhood experiences, social support and current symptom severity were assessed during pregnancy. Results: Symptom severity was associated with more non-optimal caregiving representations expecting less parental enjoyment, more difficulties separating from the child, and more feelings of caregiving helplessness. Lack of social support and adverse childhood experiences served as independent predictors of caregiving representations. Parental mental illness during own childhood predicted role reversed expectations. Conclusion: Antenatal caregiving representations can be assessed with a time-efficient self-report measure that assesses caregiving as a multidimensional construct. Prenatal treatment planning should target individual difficulties in undertaking transformation of the caregiving system.

Clinical staging model in offspring of parents with bipolar disorder: a systematic review.

OBJECTIVE: We sought to systematically review the literature on the psychiatric risk of offspring of parents with bipolar disorder (OPBD) using a developmental psychopathology framework. The review also sought to establish the utility of clinical stage modelling as a framework for identifying precursor disorders to later onset of bipolar disorder (BD) in OPBD. METHODS: A systematic search was performed using EMBASE, PsychINFO and Medline. Reference lists of included studies and previous reviews were also searched. Studies were included if they reported diagnostic outcomes for child, adolescent and young adult offspring of parents diagnosed with BD. RESULTS: Twenty-six studies were identified representing 21 individual cohorts. The review identified that OBPD present as a high-risk group for a range of mood and non-mood disorders in childhood, adolescence and young adulthood. The trajectory of risk was from non-mood disorders in childhood via non-bipolar mood disorders in early adolescence towards mania/hypomania in late adolescence and early adulthood. From a clinical staging perspective, childhood anxiety disorders were associated with later onset of BD. Recurrent substance use disorder was identified as a risk in OPBD during late adolescence and early adulthood. Quality ratings indicated that studies were methodologically robust. CONCLUSIONS: Our review provides evidence for a developmental psychopathology trajectory of precursor risks to BD in OPBD. There is support for clinical stage modelling as a conceptual framework for understanding developmental risk in OPBD and as a tool for developing early and individualized intervention strategies.

The problem of overcontrol: Perfectionism, emotional inhibition, and personality disorders.

BACKGROUND AND AIMS: Some individuals with Personality Disorders (PD), particularly of a non-Borderline type, present with difficulties relating to over-control of cognitions, emotion and behavior, perfectionistic traits, and impaired social interactions. The current study sought to evaluate the strength of association, and interactions of both emotional inhibition and perfectionism in PD's, after controlling for symptoms and interpersonal problems. METHOD: We recruited a sample of 578 treatment seeking outpatients. Diagnosis of PD was made with the SCID-II. Individual's completed measures of perfectionism (Frost-MPS), Emotional Inhibition (EIS), Depression (BDI-II), Anxiety (STAI-Y), Global symptoms (SCL-90-R), and interpersonal problems (IIP-32). RESULTS: Perfectionism was related to interpersonal problems, to the majority of PD symptomatology and to PD severity via number of SCID-II criteria met. Emotional inhibition was linked to symptoms and interpersonal problems as well as with avoidant, dependent, depressive and paranoid PDs; and with overall PD Severity. Inhibition and perfectionism were correlated with each other. Both variables predicted PD above and beyond other variables assessed. Mediation modeling demonstrated that the effect of emotional inhibition on PD severity was fully mediated by perfectionism and interpersonal problems. CONCLUSIONS: Psychological mechanisms of overcontrol are a maintaining factor in many PDs. Both perfectionism and emotional inhibition impact on a broad range of PDs and there is an urgent need for research into these processes, and to adapt psychological interventions to consider these factors.