Salivary testosterone and cortisol levels in borderline personality disorder before and after a 12-week group dialectical behavior therapy intervention.

Background: Borderline Personality Disorder (BPD) is a chronic, debilitating, and difficult to treat condition. BPD has recently been linked to steroid hormone dysregulation and medical conditions characterized by disturbed androgen metabolism. This study aimed to investigate cortisol and testosterone levels in BPD, and changes in hormones following psychological treatment. Methods: Participants with BPD (n = 33) completed a 12-week Dialectical Behavior Therapy group program. Pre and post salivary testosterone and cortisol were analyzed. Baseline hormones in the BPD group were compared to age-and-sex matched controls (n = 33). Non-parametric tests were utilized to investigate group differences, pre-post treatment hormone and symptom changes, and associations between symptoms and hormone levels. Results: Participants with BPD had significantly higher testosterone levels than controls. Mean testosterone levels in females with BPD were double that of female controls. Testosterone and cortisol levels were related, and some BPD symptoms were associated with with hormone levels. BPD symptoms reduced significantly with treatment, however pre to post hormone levels did not change. Conclusions: This study supports an association between BPD symptoms and neuroendocrine dysfunction at baseline, however we found no reduction in hormone dysfunction post treatment. Further research into relationships between stress signaling and neuroendocrine disturbances in BPD may inform aetiological and treatment models. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12618000477224. Registered on 3 April 2018.

What aspects of mindfulness and emotion regulation underpin self-harm in individuals with borderline personality disorder?

BACKGROUND: Self-harm presents significant risk for individuals with borderline personality disorder (BPD). Both self-harm and BPD are associated with deficits in mindfulness and emotion dysregulation. Previous research suggests that thought suppression and emotional inexpressivity may underpin self-harm in people with BPD, suggesting potential links to self-harm functions common for those with BPD. More research is needed to strengthen our understanding of this relationship. AIMS: This study examines how BPD symptoms, mindfulness, emotion dysregulation and self-harm functions are related. METHODS: Australian community outpatients diagnosed with BPD (N = 110) completed measures of mindfulness, emotion dysregulation and self-harm functions. Serial mediation analyses were conducted to examine relationships between variables. RESULTS: BPD symptoms, chronic emptiness, mindfulness skills, describing and non-reacting, emotion dysregulation areas of emotion regulation strategies and poor emotional clarity were associated with recent self-harm. Various combinations of describing, strategies and clarity mediated the path between emptiness and self-harm functions more likely to be endorsed by individuals with a diagnosis of BPD. Describing was associated with all but anti-suicide function, while strategies was associated with all but anti-dissociation. CONCLUSION: The study highlights how individuals with BPD experiencing chronic emptiness may benefit from treatment targeting describing skills and adaptive emotion regulation strategies.

Mindfulness and Imagery Enhanced Behavioral Parenting: Effectiveness Pilot of the Confident Carers Cooperative Kids Program.

Mindfulness is increasingly offered to parents of children presenting with behavioral problems, either as a stand-alone intervention, or integrated within existing behavioral parenting interventions. There is relatively modest support for mindful parenting, with small to medium effect size improvements demonstrated across child and parent outcome measures. Here we introduce a mindfulness and imagery enhanced behavioral parenting program. We argue blending mindfulness, imagery and behavioral skills could produce improved parenting engagement and perseverance, leading to stronger outcomes. Pilot data is presented from two contrasting real world clinical settings. Parents attending the 8-week Confident Carers Cooperative Kids (CCCK) group program in a university clinic setting were invited to be included in the study (n = 20). Permission was also gained to use archival data from a community organisation offering CCCK groups to parents who were at risk of child welfare involvement (n = 14). Pre- and post-intervention measures were completed across both groups on parent-reported child behavior, parent wellbeing, adaptive parenting, and mindful parenting. Parents from both groups achieved significant pre- to post-intervention improvements in child behavior problems, parent wellbeing, adaptive parenting, and mindful parenting, with large effect sizes. Larger improvements in child behavior problems were reported by parents from the community group compared with the university group. The CCCK intervention appears beneficial across child and parent outcomes, including for families most in need. A larger sample is required to replicate and extend these promising findings.

A qualitative examination of the reintegration experiences of Australian Defense Force families.

The profound development that occurs during the first five years of a child's life may contribute to military families with young children facing unique challenges during reintegration. Yet, little is known about the reintegration experiences of military families with young children, and less so from the perspectives of non-deployed parents and families outside of the US. In this qualitative study, we explored the reintegration experiences of Australian Defense Force (ADF) families with young children (five years and younger). Through written responses to open-ended prompts, ADF service members (n = 9) and their non-deployed spouses (n = 38) reflected on periods of reintegration and discussed their family's adaption during this time. Using thematic analysis, six themes representing the reintegration experiences of these families were generated from the data. Four themes were generated from the combined experiences of service members and non-deployed parents, while a further two themes were generated from the experiences of non-deployed parents only. Relational and parenting challenges were at the forefront of reintegration experiences. These findings offer meaningful implications for practice and research to improve the quality of parent-child relationships and enhance outcomes for military families with young children during reintegration.

The implications of parent mental health and wellbeing for parent-child attachment: A systematic review.

BACKGROUND: Parent mental health and wellbeing may have implications for understanding attachment transmission. In this systematic review, we synthesise the published literature to determine the nature of the relationship between parent mental health and wellbeing and the intergenerational transmission of attachment and to provide recommendations for future research, clinical practice and intervention. METHOD: Using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach, five electronic databases were searched for peer-reviewed empirical studies, published in English. Articles were considered for inclusion if data was collected on adult attachment, child attachment, and a domain of parent mental health/wellbeing. No date parameters were applied to the search strategy. The review was registered with PROPSERO (registration number: CRD42020157247). RESULTS: Eleven studies examining the impact on parent mental health and wellbeing on the intergenerational transmission of attachment were identified for inclusion in this review. Our review found preliminary evidence that parent mental health and wellbeing play a role in the intergenerational transmission of attachment. Other key findings from the review were: evidence quality is mixed due to variable measurement of attachment and mental health; studies have mostly included correlational analysis or do not utilise contemporary methodological approaches to testing mediating or moderating relationships; and literature is largely focused on psychopathology and negative factors of mental health. CONCLUSIONS: The limited scope of parent mental health and wellbeing constructs examined in the literature, the sparse use of robust statistical analyses, and the lack of literature in general makes it difficult to draw conclusions on how and why parent mental health impacts attachment transmission. Addressing these limitations will further progress attachment-related literature and may have particular implications for attachment-informed interventions with clinical populations.

Assessing the efficacy of a stepped-care group treatment programme for borderline personality disorder: study protocol for a pragmatic trial.

BACKGROUND: Borderline personality disorder (BPD) is a high prevalence and serious mental health disorder that has historically challenged the finite resources of health services. Despite empirical evidence supporting structured psychological therapy as the first line of treatment, there remains significant barriers in providing timely access to evidence-based treatment for this population. The primary aim of this study is to evaluate the effectiveness of providing a stepped-care structured psychological group treatment to individuals with BPD within local mental health services. The secondary aims of the study are to identify the variables that predict the need to step up or down in care and the effectiveness of treatment on psychosocial functioning. METHODS: Participants seeking treatment at two community mental health services will be invited to participate. Randomised controlled trial assignment will be to either (i) group skills treatment or (ii) treatment as usual. Group treatment will be offered via a stepped-care pathway with participants initially attending a 12-week group with the option of a subsequent 16-week group. The criteria for inclusion in continuing treatment includes meeting > 4 BPD diagnostic criteria or severity on GAF (< 65) at the completion of the 12-week group. Data will be collected at baseline and at five follow-up time points over a 12-month period. DISCUSSION: This pragmatic trial will provide valuable information regarding the effectiveness of a progressive stepped-care group treatment for individuals with BPD in the real-world setting of a community mental health service. It will further the current understanding of variables that predict treatment dose and duration. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618000477224 . Registered on 3 April 2018.

Maternal perinatal mental health: Associations with bonding, mindfulness, and self-criticism at 18 months' postpartum.

The perinatal period is a time of significant transition for women, with changes in maternal mental health from pregnancy to 18 months' postpartum. This study specifically analyzes maternal self-criticism and mindfulness during pregnancy and at 18 months' postpartum, and their associations with bonding. A longitudinal study (30 weeks' gestation-18 months' postpartum) assessed 32 mother-infant dyads, examining changes in maternal depression, anxiety, self-criticism, and mindfulness. In addition, associations between maternal variables during pregnancy and bonding were investigated. Maternal depression and self-criticism significantly increased from pregnancy to postpartum. Maternal anxiety, self-criticism, and facets of mindfulness during pregnancy were also associated with mother-infant bonding at 18 months. Maternal mental health during pregnancy is subject to change postchildbirth. The lack of control and autonomy accompanying motherhood may result in an increase in self-criticism during this period. Such feelings may elevate a woman's vulnerability to postpartum depression and have consequences for later maternal bonding. Early identification of at-risk mothers is important to increase likelihood of positive outcomes.

Trasfondo: el período perinatal es un momento de significativa transición para las mujeres, con cambios en la salud mental materna a partir del embarazo hasta los 18 meses después del parto. Este estudio específicamente analiza la auto-crítica y la plena atención maternas durante el embarazo y a los 18 meses después del parto y sus asociaciones con la vinculación afectiva. Método: un estudio longitudinal (gestación de 30 semanas a 18 meses después del parto) evaluó a 32 díadas madre-infante por medio de examinar cambios en cuanto a depresión materna, ansiedad, auto-crítica y plena atención. Adicionalmente, se investigaron las asociaciones entre las variables maternas durante el embarazo y la vinculación afectiva. Resultados: la depresión materna y la auto-crítica aumentaron significativamente desde el embarazo hasta después del parto. También se asociaron la ansiedad materna, la auto-crítica y facetas de la plena atención durante el embarazo con la vinculación afectiva entre madre e infante a los 18 meses. Discusión: la salud mental materna durante el embarazo está sujeta a cambiar después del nacimiento del niño. La falta de control y autonomía que acompaña a la maternidad pudiera resultar en un aumento en la auto-crítica durante este período. Tales sentimientos pudieran incrementar la vulnerabilidad de una mujer con respecto a la depresión posterior al parto y tener consecuencias más tarde en la vinculación afectiva materna. Es importante la temprana identificación de madres bajo riesgo para aumentar la probabilidad de resultados positivos.

Contexte: La période périnatale est un moment de transition importante pour les femmes, avec des changements dans la santé mentale maternelle de la grossesse à 18 mois après la naissance. Cette étude analyse plus spécifiquement l'autocritique maternelle et la pleine conscience durant la grossesse et à 18 mois après la naissance, ainsi que leur lien avec la connexion. Méthode: Une étude longitudinale (30 semaine de grosses à 18 mois après la naissance) a évalué 32 dyades mère-nourrisson, en examinant les changements dans la dépression maternelle, l'anxiété, l'autocritique et la pleine conscience. De plus les liens entre les variables maternelles durant la grossesse et la connexion ont fait l'objet de la recherche. Résultats : La dépression maternelle et l'autocritique ont fortement augmenté de la grossesse à la période postpartum. L'anxiété maternelle, l'autocritique et les facettes de pleine conscience durant la grossesse étaient également liées à la connexion mère-nourrisson à 18 mois. Discussion: La santé mentale maternelle durant la grossesse peut changer après la naissance de l'enfant. Le manque de contrôle et d'autonomie qui accompagne la maternité peut résulter en une augmentation de l'autocritique durant cette période. De tels sentiments peuvent élever la vulnérabilité d'une femme à la dépression postpartum et avoir des conséquences sur la connexion maternelle ultérieure. Une identification précoce des mères à risque est importante afin d'augmenter les chances de résultats positifs.

Illawarra Born cross-generational health study: feasibility of a multi-generational birth cohort study.

BACKGROUND: There is a strong interest in the concept of developmental origins of health and disease and their influence on various factors "from cradle to grave". Despite the increasing appreciation of this lifelong legacy across the human life course, many gaps remain in the scientific understanding of mechanisms influencing these formative phases. Cross-generational susceptibility to health problems is emerging as a focus of research in the context of birth cohort studies.The primary aim of the Illawarra Born study is to make scientific discoveries associated with improving health and wellbeing across the lifespan, with a particular focus on preventable chronic diseases, especially mental health. This birth cohort study will follow and collect data from three cohorts representing different stages across the lifespan: infants, adults (parents) and older adults (grandparents). The multi-generational, cross-sectional and longitudinal design of this birth cohort study supports a focus on the contributions of genetics, environment and lifestyle on health and wellbeing. The feasibility of conducting a multi-generational longitudinal birth cohort project was conducted through a small pilot study. METHODS/DESIGN: The purpose of this paper is to report on the feasibility and acceptability of the research protocol for a collaborative cross-generation health study in the community and test recruitment and outcome measures for the main study. This feasibility study included pregnant women who were intending to give birth in the Illawarra-Shoalhaven region in Eastern Australia. The area includes a large, regional referral hospital, with capacity to treat specialist and complex cases. Pregnant women were asked to participate in five data collection waves beginning at 22 weeks gestation and ending with a 6-month post-partum appointment. Recruitment was then extended, via the pregnant women, to also include fathers and maternal grandmothers. DISCUSSION: This feasibility study focused on the perinatal period and collected data across three multi-disciplinary domains including mental health, diet, exposures to toxins and the role of these in maternal and infant outcomes. Forty-one families participated in extensive data collection from 22 weeks gestation to 6-months post-partum. Factors impacting on viability and feasibility including recruitment solutions provide the basis for a large-scale study.

TOP-DOWN AND BOTTOM-UP: THE ROLE OF SOCIAL INFORMATION PROCESSING AND MINDFULNESS AS PREDICTORS IN MATERNAL-INFANT INTERACTION.

The cross-generational transmission of attachment appears to reflect a complex interplay of factors, which have been challenging to identify. The current longitudinal study explored the maternal cognitive model of relationships through language use, maternal mindfulness, and attachment style assessed prenatally, as predictors of maternal response to distress and infant behavior at 6 months' postpartum. Infant behavior to the mother also was examined to provide an understanding of the evolving relationship. Thirty-two females were interviewed prenatally regarding social and family experiences. At 6 months' postpartum, each mother participated in a video-recorded session where she was asked to teach her infant a developmentally appropriate task. Videos were analyzed using the NCAST Teaching Protocol. Language use prenatally as well as the mindfulness facets (acting with awareness and describing) predicted the mothers' ability to respond to infant distress, indicating greater attunement. Infant's response to mother and clarity of cues also were predicted by maternal pronoun use. The study highlights the role of internal working models reflective of interpersonal beliefs, cognitive models, and current-moment awareness in maternal behavior. The effect of maternal language on infant behavior arguably indicates the infant's integration of maternal internal working models.

OBSERVING THE INFLUENCE OF MINDFULNESS AND ATTACHMENT STYLES THROUGH MOTHER AND INFANT INTERACTION: A LONGITUDINAL STUDY.

The cross-generational influence of attachment security or insecurity on caregiving is well-established. Recently, research has focused on mindfulness as a potential variable to interrupt the transmission of insecure attachment and disrupt its effect across generations. Thirty-six pregnant female participants completed the Five Facets Mindfulness Questionnaire and Relationship Questionnaire-Clinical Version at 30 weeks' gestation. Following the infant's birth, mothers and their babies participated in a video-recorded feeding session at 7 to 10 weeks' postpartum. It was predicted that a secure attachment style and higher levels of mindfulness measured prenatally would be associated with greater maternal responsiveness postpartum. The hypothesis was supported for both the secure and insecure (fearful and profoundly distrustful) attachment styles. Mindfulness did not mediate the relationship between attachment and maternal distress. The mindfulness subscale Non-Reacting was significantly associated with maternal response to distress. These findings support the role of prenatal mindfulness skills and attachment security for later postnatal maternal sensitivity to baby.