Decreased emotional reactivity after 3-month socio-affective but not attention- or meta-cognitive-based mental training: A randomized, controlled, longitudinal fMRI study.

Meditation-based mental training interventions show physical and mental health benefits. However, it remains unclear how different types of mental practice affect emotion processing at both the neuronal and the behavioural level. In the context of the ReSource project, 332 participants underwent an fMRI scan while performing an emotion anticipation task before and after three 3-month training modules cultivating 1) attention and interoceptive awareness (Presence); 2) socio-affective skills, such as compassion (Affect); 3) socio-cognitive skills, such as theory of mind (Perspective). Only the Affect module led to a significant reduction of experienced negative affect when processing images depicting human suffering. In addition, after the Affect module, participants showed significant increased activation in the right supramarginal gyrus when confronted with negative stimuli. We conclude that socio-affective, but not attention- or meta-cognitive based mental training is specifically effective to improve emotion regulation capabilities when facing adversity.

Differential benefits of mental training types for attention, compassion, and theory of mind.

Mindfulness- and, more generally, meditation-based interventions increasingly gain popularity, effectively promoting cognitive, affective, and social capacities. It is unclear, however, if different types of practice have the same or specific effects on mental functioning. Here we tested three consecutive three-month training modules aimed at cultivating either attention, socio-affective qualities (such as compassion), or socio-cognitive skills (such as theory of mind), in three training cohorts and a retest control cohort (N = 332). While attentional performance improved most consistently after attention training, compassion increased most after socio-affective training and theory of mind partially improved after socio-cognitive training. These results show that specific mental training practices are needed to induce plasticity in different domains of mental functioning, providing a foundation for evidence-based development of more targeted interventions adapted to the needs of different education, labor, and health settings.

The closing of the theory of mind: A critique of perspective-taking.

Theory of mind (ToM) is defined as the ability to attribute mental states to oneself and others and is often said to be one of the cornerstones of efficient social interaction. In recent years, a number of authors have suggested that one particular ToM process occurs spontaneously in that it is rapid and outside of conscious control. This work has argued that humans efficiently compute the visual perspective of other individuals. In this article, we present a critique of this notion both on empirical and theoretical grounds. We argue that the experiments and paradigms that purportedly demonstrate spontaneous perspective-taking have not as yet convincingly demonstrated the existence of such a phenomenon. We also suggest that it is not possible to represent the percept of another person, spontaneous or otherwise. Indeed, the perspective-taking field has suggested that humans can represent the visual experience of others. That is, going beyond assuming that we can represent another's viewpoint in anything other than symbolic form. In this sense, the field suffers from the same problem that afflicted the "pictorial" theory in the mental imagery debate. In the last section we present a number of experiments designed to provide a more thorough assessment of whether humans can indeed represent the visual experience of others.

The role of the IPL in person identification.

We investigate the brain activations when identifying a newly encountered individual as being the same as a person previously perceived, a fundamental but seldom acknowledged process. In an identity condition, two faces had to be identified as the same person in contrast to a control condition, in which two faces had to be recognised as belonging to similar looking twins. Our results demonstrate an increase of neural activation in frontal as well as in parietal areas including the left inferior parietal lobe and the precuneus during identification. We introduce mental files theory to model this process as a linking of co-referential files and identify important connections to other domains in neurological and cognitive science (e.g., delusional misidentification syndromes, theory of mind).

It matters what you practice: differential training effects on subjective experience, behavior, brain and body in the ReSource Project.

Mindfulness interventions have gained much attraction, also due to their promise to improve health and wellbeing. However, not enough attention is devoted to the differentiation between various mental practice types. Here, we summarize findings from the ReSource Project, a 9-month longitudinal mental training study comparing practices focusing on (a) present-moment attention and interoception, (b) socio-emotional processes such as compassion and loving kindness and (c) meta-cognitive processes and perspective-taking on self and others. We find evidence for differential training effects of these practice types on all levels of observation, ranging from distinct phenomenological fingerprints and structural brain plasticity to selective improvements in social cognition, altruism and peripheral physiology, including the cortisol response to psychosocial stress. We argue for a more differentiated view on the concept of mindfulness and meditation.

Combining resting state functional MRI with intraoperative cortical stimulation to map the mentalizing network.

OBJECTIVE: To infer the face-based mentalizing network from resting-state functional MRI (rsfMRI) using a seed-based correlation analysis with regions of interest identified during intraoperative cortical electrostimulation. METHODS: We retrospectively included 23 patients in whom cortical electrostimulation induced transient face-based mentalizing impairment during 'awake' craniotomy for resection of a right-sided diffuse low-grade glioma. Positive stimulation sites were recorded and transferred to the patients' preoperative normalized MRI, and then used as seeds for subsequent seed-to-voxel functional connectivity analyses. The analyses, conducted with an uncorrected voxel-level p-value of 0.001 and a false-discovery-rate cluster-level p-value of 0.05, allowed identification of the cortical structures, functionally coupled with the mentalizing-related sites. RESULTS: Two clusters of responsive stimulations were identified intraoperatively - one in the right dorsolateral prefrontal cortex (dlPFC, n = 13) and the other in the right inferior frontal gyrus (IFG, n = 10). A whole group level analysis revealed that stimulation sites correlated mainly with voxels located in the pars triangularis of the IFG, the dorsolateral and dorsomedial prefrontal cortices, the temporo-parietal junction, the posterior superior temporal sulcus, and the posterior inferior temporal/fusiform gyrus. Other analyses, taking into consideration the location of the responsive sites (IFG versus dlPFC cluster), highlighted only minor differences between both groups. CONCLUSIONS: The present study successfully demonstrated the involvement of a large-scale neural network in the face-based mentalizing that strongly matches networks, classically identified using task-based fMRI paradigms. We thus validated the combination of rsfMRI and stimulation mapping as a powerful approach to identify functional networks in brain-damaged patients.

[Mentalization based treatment (MBT) for borderline personality disorder among a population of French-speaking patients]. / Implémentation francophone de la thérapie basée sur la mentalisation (TBM) pour le trouble de personnalité limite.

INTRODUCTION: Borderline Personality Disorder is a frequent disorder that is challenging for therapists to treat due to the prevalence of self-damaging and suicidal behaviours and interruptions of the therapeutic alliance, as well as a poor response to psychotropic treatments. In recent years, several empirically-validated psychotherapeutic treatments have been developed, including Mentalisation-Based Therapy, which is an integrative psychodynamic approach created in Britain. Although numerous studies have showed Mentalisation-Based Therapy to be an efficient treatment of Borderline Personality Disorder, its specific components have yet to be assessed. Furthermore, there have been no empirical studies conducted among groups of French-speaking patients. The purpose of this study is twofold: To provide an initial assessment of the efficacy of the mentalisation-based psycho-educational component, which is the first component of any mentalisation-based therapy, and to provide the first assessment of this approach among a population of French-speaking patients. METHOD: Over a three-month period, 14 Borderline Personality Disorder sufferers followed a psycho-educational Mentalisation-Based Therapy programme consisting of group sessions to introduce patients to mentalisation and weekly individual interviews. Patients filled in various question forms assessing, among others, the intensity of their depression, their degree of hopelessness, their emotional regulation strategies, and their reflective abilities. RESULTS: The psycho-educational component of Mentalisation-Based Therapy is significantly associated with improved cognitive emotional regulation, empathy and reflective abilities, and with a reduced sense of hopelessness. The programme retention rate was of 71.4%. CONCLUSION: Despite the small sample size and the short treatment period, these preliminary results demonstrate the efficiency of the psycho-educational phase of Mentalisation-Based Therapy, and in particular the positive effects of the treatment on depressive symptomatology and self-regulation processes among patients with a Borderline Personality Disorder diagnosis.

How to Design and Equip a Mentalization-Based Play Therapy Room.

Designing and equipping a play therapy room as a differentiated tool in a psychodynamic approach to child psychotherapy is seldom discussed. This article sketches out the equipment and furnishing of a play therapy room to be used for mentalization-based psychodynamic psychotherapy and gives examples of the use of such a room in practice.

Low-grade inflammation decreases emotion recognition - Evidence from the vaccination model of inflammation.

The ability to adequately interpret the mental state of another person is key to complex human social interaction. Recent evidence suggests that this ability, considered a hallmark of 'theory of mind' (ToM), becomes impaired by inflammation. However, extant supportive empirical evidence is based on experiments that induce not only inflammation but also induce discomfort and sickness, factors that could also account for temporary social impairment. Hence, an experimental inflammation manipulation was applied that avoided this confound, isolating effects of inflammation and social interaction. Forty healthy male participants (mean age = 25, SD = 5 years) participated in this double-blind placebo-controlled crossover trial. Inflammation was induced using Salmonella Typhi vaccination (0.025 mg; Typhim Vi, Sanofi Pasteur, UK); saline-injection was used as a control. About 6 h 30 m after injection in each condition, participants completed the Reading the Mind in the Eyes Test (RMET), a validated test for assessing how well the mental states of others can be inferred through observation of the eyes region of the face. Vaccination induced systemic inflammation, elevating IL-6 by +419% (p < .001), without fever, sickness symptoms (e.g., nausea, light-headedness), or mood changes (all p's > .21). Importantly, compared to placebo, vaccination significantly reduced RMET accuracy (p < .05). RMET stimuli selected on valence (positive, negative, neutral) provided no evidence of a selective impact of treatment. By utilizing an inflammation-induction procedure that avoided concurrent sicknesses or symptoms in a double-blinded design, the present study provides further support for the hypothesis that immune activation impairs ToM. Such impairment may provide a mechanistic link explaining social-cognitive deficits in psychopathologies that exhibit low-grade inflammation, such as major depression.

Theory of mind in a first-episode psychosis population using the Hinting Task.

Deficiencies in theory of mind (ToM) are common in psychosis and may largely explain impaired social functioning. Currently, it is unclear whether impairments in ToM are explained by the more general cognitive deficits related to psychosis or whether ToM is impaired in psychosis independently of other cognitive deficits. This study examined ToM using the Hinting Task in young adults (n = 66) with first-episode psychosis and matched controls (n = 62). The participants were administered a broad neuropsychological assessment. Participants with psychosis performed worse than controls on the Hinting Task. However, 75% of the variance between the groups was explained by general cognitive deficits, especially impaired processing speed and episodic memory. Hinting Task performance of the best functioning patient group did not differ from that of the control group. When the psychosis group was divided according to diagnosis, the Hinting Task difference between individuals with schizophrenia and controls remained significant even when general cognitive performance was controlled for, suggesting specific verbal ToM deficits in schizophrenia. In contrast, those with other psychotic disorders did not differ from controls. Our results suggest that ToM deficits can be seen in early phases of psychotic disorders, schizophrenia in particular, and are partly independent of other cognitive functions.

Giving others the option of choice: An fMRI study on low-cost cooperation.

Successful social relationships require a consideration of a partner's thoughts and intentions. This aspect of social life is captured in the social mindfulness paradigm (SoMi task), in which participants make decisions that either limit or preserve options for their interaction partner's subsequent choice. Here we investigated the neural correlates of spontaneous socially mindful and unmindful behaviours. Functional magnetic resonance data were acquired from 47 healthy adolescents and young adults (age 16-27) as they completed the SoMi task. Being faced with socially relevant choices was associated with activity in the medial prefrontal cortex, anterior cingulate, caudate, and insula, which is consistent with prior neuroeconomical research. Importantly, socially mindful choices were associated with activity in the right parietal cortex and the caudate, whereas unmindful choices were associated with activity in the left prefrontal cortex. These neural findings were consistent with the behavioural preference for mindful choices, suggesting that socially mindful decisions are the basic inclination, whereas socially unmindful responses may require greater effort and control. Together, these results begin to uncover the neural correlates of socially mindful and unmindful choices, and illuminate the psychological processes involved in cooperative social behaviour.

[A mentalization-based perspective on childhood autism treatment]. / Perspective de prise en charge d'enfants atteints de troubles du spectre autistique par psychothérapie inspirée des thérapies basées sur la mentalisation.

Mentalization is a process by which a subject makes sense of both his own mental representations and of those around him. Disturbances in the mentalization process are found in several psychiatric disorders, notably borderline personality disorders for which mentalization-based treatments (MBT) have been developed and evaluated. Children with Autism Spectrum Disorder (ASD) display a theory of mind impairments, which corresponds to disturbances in the mentalization process. Although no MBT protocol for patients with ASD has been described in the literature, such treatment appears promising to improve theory of mind and functional outcome of these children. In this paper, we propose to discuss the theoretical ground of MBT therapeutic effect in children with ASD without intellectual disabilities and to describe a clinical protocol to test this perspective.

Alpha/Theta Neurofeedback Increases Mentalization and Default Mode Network Connectivity in a Non-Clinical Sample.

Several studies showed the effectiveness of alpha/theta (A/T) neurofeedback training in treating some psychiatric conditions. Despite the evidence of A/T effectiveness, the psychological and neurobiological bases of its effects is still unclear. The aim of the present study was to explore the usefulness of the A/T training in increasing mentalization in a non-clinical sample. The modifications of electroencephalographic (EEG) functional connectivity in Default Mode Network (DMN) associated with A/T training were also investigated. Forty-four subjects were enrolled in the study and randomly assigned to receive ten sessions of A/T training [neurofeedback group (NFG) = 22], or to act as controls [waiting list group (WLG) = 22]. All participants were administered the mentalization questionnaire (MZQ) and the Symptom Checklist-90-Revised (SCL-90-R). In the post training assessment, compared to WLG, NFG showed a significant increase of MZQ total scores (3.94 ± 0.73 vs. 3.53 ± 0.77; F1;43 = 8.19; p = 0.007; d = 0.863). Furthermore, A/T training was also associated with a significant increase of EEG functional connectivity in several DMN brain areas (e.g. Posterior Cingulate Cortex). Taken together our results support the usefulness of the A/T training in enhancing mentalization and DMN connectivity.

Neural mechanisms underlying valence inferences to sound: The role of the right angular gyrus.

We frequently infer others' intentions based on non-verbal auditory cues. Although the brain underpinnings of social cognition have been extensively studied, no empirical work has yet examined the impact of musical structure manipulation on the neural processing of emotional valence during mental state inferences. We used a novel sound-based theory-of-mind paradigm in which participants categorized stimuli of different sensory dissonance level in terms of positive/negative valence. Whilst consistent with previous studies which propose facilitated encoding of consonances, our results demonstrated that distinct levels of consonance/dissonance elicited differential influences on the right angular gyrus, an area implicated in mental state attribution and attention reorienting processes. Functional and effective connectivity analyses further showed that consonances modulated a specific inhibitory interaction from associative memory to mental state attribution substrates. Following evidence suggesting that individuals with autism may process social affective cues differently, we assessed the relationship between participants' task performance and self-reported autistic traits in clinically typical adults. Higher scores on the social cognition scales of the AQ were associated with deficits in recognising positive valence in consonant sound cues. These findings are discussed with respect to Bayesian perspectives on autistic perception, which highlight a functional failure to optimize precision in relation to prior beliefs.

Barriers and facilitators to the implementation of mentalization-based treatment (MBT) for borderline personality disorder.

There are several evidence-based treatments for borderline personality disorder, but very little is known about the success or failure of implementation in daily practice. This study aims to investigate the success or failure of newly started mentalization-based treatment programs, and to explore the barriers and facilitators. The implementation trajectories of seven different mentalization-based treatment programs in six mental health clinics in the Netherlands were included in a multiple case study combining a qualitative and quantitative design. Semi-structured interview data were collected from several stakeholders of each program. Narrative reconstructions of each interview were assessed by 12 independent experts. Results showed that several programs struggled to implement their program successfully, leading to discontinuation in three programs. According to the experts, particularly elements at the organizational level (i.e. organizational support) and team level (i.e. leadership) contributed to implementation outcome. These findings have important implications for the translation of guidelines and research findings in daily practice. Copyright © 2017 John Wiley & Sons, Ltd.

Challenging the Myth of Right Nondominant Hemisphere: Lessons from Corticosubcortical Stimulation Mapping in Awake Surgery and Surgical Implications.

For many years, the right hemisphere (RH) was considered as nondominant, especially in right-handers. In neurosurgical practice, this dogma resulted in the selection of awake procedure with language mapping only for lesions of the left dominant hemisphere. Conversely, surgery under general anesthesia (possibly with motor mapping) was usually proposed for right lesions. However, when objective neuropsychological assessments were performed, they frequently showed cognitive and behavioral deficits after brain surgery, even in the RH. Therefore, to preserve an optimal quality of life, especially in patients with a long survival expectancy (as in low-grade gliomas), awake surgery with cortical and axonal electrostimulation mapping has recently been proposed for resection of right tumors. Here, we review new insights gained from intraoperative stimulation into the pivotal role of the RH in movement execution and control, visual processes and spatial cognition, language and nonverbal semantic processing, executive functions (e.g., attention), and social cognition (mentalizing and emotion recognition). These original findings, which break with the myth of a nondominant RH, may have important implications in cognitive neurosciences, by improving our knowledge of the functional connectivity of the RH, as well as for the clinical management of patients with a right lesion. In brain surgery, awake mapping should be considered more systematically in the RH. Moreover, neuropsychological examination must be achieved in a more systematic manner before and after surgery within the RH, to optimize care by predicting the likelihood of functional recovery and by elaborating specific programs of rehabilitation.

First empirical evaluation of outcomes for mentalization-based group therapy for adolescents with BPD.

Adolescent borderline personality disorder (BPD) is a devastating disorder, and it is essential to identify and treat the disorder in its early course. A total of 34 female Danish adolescents between 15 and 18 years old participated in 1 year of structured mentalization-based group therapy. Twenty-five adolescents completed the study, of which the majority (23) displayed improvement regarding borderline symptoms, depression, self-harm, peer-attachment, parent-attachment, mentalizing, and general psychopathology. Enhanced trust in peers and parents in combination with improved mentalizing capacity was associated with greater decline in borderline symptoms, thereby pointing to a candidate mechanism responsible for the efficacy of the treatment. The current study provides a promising rationale for the further development and evaluation of group-format mentalization-based treatment for adolescents with borderline traits. (PsycINFO Database Record

Changes in Neurocognitive Functioning After 6 Months of Mentalization-Based Treatment for Borderline Personality Disorder.

Patients with borderline personality disorder (BPD) have deficits in neurocognitive function that could affect their ability to engage in psychotherapy and may be ameliorated by improvements in symptom severity. In the current study, 18 patients with BPD completed neurocognitive tests prior to beginning mentalization-based therapy and again after 6 months of treatment. Twenty-eight nonpsychiatric controls were tested over the same period of time but received no intervention. Before starting treatment, patients performed lower than controls on tests assessing sustained attention and visuospatial working memory. After 6 months of treatment, patients showed significantly greater increases in sustained attention and perceptual reasoning than controls, with initial deficits in sustained attention among patients resolving after treatment. Improved emotion regulation over the follow-up period was associated with increased auditory-verbal working memory capacity, whereas interpersonal functioning improved in parallel with perceptual reasoning. These findings suggest that changes in neurocognitive functioning may track improvements in clinical symptoms in mentalization-based treatment for BPD.

Técnicas terapéuticas basadas en la teoría de la mentalización en grupos de adolescentes y sus familias en el contexto de hospital de día / Therapeutic techniques based on the mentalization theory in groups of teens and their familiess in the context of day hospital

En el presente trabajo, se presenta un breve resumen de algunas de las bases teóricas de la Teoría de la Mentalización, en relación con su aplicación clínica en el contexto terapéutico del Hospital de Día de Adolescentes de orientación psicodinámica, una reflexión acerca de la relación entre los factores terapéuticos de este formato de terapia intensiva, y el favorecimiento de una mentalización mejor y más integrada en los pacientes y sus familias, que se puede observar durante el tratamiento. Además, se expone una experiencia de grupo psicoeducativo con las familias de los pacientes, inspirado en la Terapia Basada en la Mentalización para Adolescentes, como ejemplo de la aplicabilidad de este modelo en este tipo de dispositivos. El marco que proporciona la teoría de la mentalización puede ser útil para estructurar y optimizar las estrategias psicoterapéuticas del Hospital de Día - Centro Educativo Terapéutico (AU)

In this paper, a brief summary about some of the Theory of Mentalization’s fundaments is presented, in relation to its application in a psychodynamic Adolescents’ Day Hospital setting. It is a reflection about the possible relationship between the therapeutic factors of this kind of intensive therapy and the improvement in the capacity to mentalize, in a more integrated way, that is generally observed in patients and their families during treatment. I present a pilot experience of a psychoeducation group with families, inspired in Mentalization-Based Therapy for Adolescents, as an example of the applicability of this model to this type of therapeutic settings. The theoretical frame of Mentalization can be useful to optimize and give structure to the psychotherapeutic strategies at a Day Hospital (AU)

Efectos de un programa piloto de desarrollo cognitivo ‘teoría de la mente’ en tres niños con autismo: componente emocional / Effects of a ‘theory of mind’ cognitive development pilot programme in three children with autism: emotional component

Introducción. La teoría de la mente se define como la capacidad para predecir, comprender y actuar frente a la conducta de otras personas, sus conocimientos, sus intenciones, sus emociones y sus creencias. Se plantea como una alternativa viable para establecer un programa adaptado a las características de los niños diagnosticados con trastorno del espectro autista. Casos clínicos. Se describe el efecto de un programa piloto de desarrollo cognitivo ‘teoría de la mente’ en las habilidades emocionales de tres niños con trastorno del espectro autista. Caso 1: niño de 9 años, con escasa identificación y expresión emocional, así como dificultades para mantener conversaciones fluidas y coherentes. Caso 2: niño de 10 años, con lenguaje mecánico, poco fluido, y dificultades para iniciar y mantener una conversación. Caso 3: niña de 8 años que presenta déficits en las conductas comunicativas no verbales usadas en la interacción social y dificultades para adaptarse a situaciones no cotidianas. En los tres casos se presenta mejoría de las capacidades emocionales posterior a la implementación del programa; además, los padres, docentes o terapeutas percibieron cambios positivos en las habilidades adaptativas de los niños. Conclusiones. Los aspectos metodológicos y estructurales del programa de desarrollo cognitivo fueron adecuados para los niños con autismo participantes de la investigación. Debido al carácter preliminar del estudio, se sugiere para futuras investigaciones una muestra mayor y un diseño doble ciego con aleatorización caso/control que permitan la generalización de los resultados (AU)

Introduction. Theory of mind is defined as the capacity to predict, understand and act when faced with other people’s behaviour, their knowledge, their intentions, their emotions and their beliefs. It is proposed as a feasible alternative for establishing a programme adapted to the characteristics of children diagnosed with autism spectrum disorder. Case reports. The effect of a ‘theory of mind’ cognitive development pilot programme on the emotional skills of three children with autism spectrum disorder is reported. Case 1: 9-year-old boy, with scarce emotional identification and expression, as well as difficulties to hold fluent and coherent conversations. Case 2: 10-year-old boy, with mechanical, not very fluent language, and difficulties to start and maintain a conversation. Case 3: 8-year-old girl who presents deficits in the non-verbal communicative behaviours used in social interaction and difficulties to adapt to situations other than everyday ones. In the three cases there is an improvement in the emotional capacities following implementation of the programme; moreover, their parents, teachers or therapists perceived positive changes in the children’s adaptive skills. Conclusions. The methodological and structural aspects of the cognitive development programme were well-suited to the children with autism who took part in the research study. Due to the preliminary nature of this study, it is suggested that future research should utilise a larger sample and a double-blind design with randomised case-controls that allow the findings to be generalised (AU)