Meta-analyses of the associations of mentalization and proxy variables with anxiety and internalizing problems.

Mentalization, the high-order function of detecting and interpreting one's own and others' mental states, has gained interest in the fields of clinical and developmental psychopathology. However, little is known about mentalization's associations with anxiety and broader internalizing problems. Using the framework of the multidimensional model of mentalization, the aim of this meta-analysis was to quantify the strength of the association between mentalization and anxiety/internalizing problems and to identify potential moderators of this association. A systematic review of the literature led to the inclusion of 105 studies (N = 19,529) covering all age groups. The global effect analysis showed a small negative association between mentalization and the overall anxious and internalizing symptomatology (r = -0.095, p = .000). Various effect sizes were found for associations between mentalization and specific outcomes (unspecified anxiety, social anxiety, generalized anxiety, and internalizing problems). The methods of assessment of mentalization and anxiety moderated their association. Findings support the presence of modest impairments in the mentalizing capacities of anxious individuals, likely influenced by their vulnerability to stress and the context in which they mentalize. Further studies are needed to draw a clear profile of mentalizing capacities with regard to specific anxious and internalizing symptomatologies.

Reflective Functioning in Children and Adolescents With and Without an Anxiety Disorder.

Reflective functioning (RF), meaning the capacity to interpret mental states (intentions, emotions, thoughts, desires, and beliefs) underlying one's own and others' behaviors, may help understand the dysfunctional self-regulation associated with anxiety disorders. However, research on anxiety and RF in clinical samples is scarce. This study aimed to assess whether mothers' and youths' RF was associated with youths' (a) anxiety disorders and symptoms and (b) internalizing symptoms. Another goal was to explore whether RF predicted anxiety and internalizing symptoms beyond the more commonly established effect of attachment. Canadian children and adolescents aged between 8 and 16years, and their mothers were recruited in an outpatient psychiatric clinic (clinical group with a diagnosed anxiety disorder, n=30, mean age=11.5±2.8years) and in the general population (non-clinical group, n=23, mean age=11.5±2.1years). The Child Attachment Interview was used to assess youths' attachment along with three dimensions of RF (global, regarding self, regarding others). Mothers' attachment and RF were assessed with the Adult Attachment Interview. Children's and adolescents' anxiety and internalizing symptoms were measured with the Behavior Assessment Scale for Children, second version. The clinical and non-clinical groups did not differ in mothers' or youths' RF. However, in the overall sample, youths' RF regarding themselves and maternal attachment preoccupation were associated with internalizing symptoms. Sequential regression analyses revealed that higher RF regarding self predicted a higher level of self-reported internalizing symptoms, beyond the effect of maternal attachment (ß=0.43, p<0.05). This study's finding suggests that clinically anxious children and adolescents have adequate RF. We propose that the sustained hypervigilance and apprehension associated with anxiety make anxious youths sensitive to their own and others' mental states. Our findings suggest that psychotherapeutic treatments for anxiety should make use of patients' RF abilities to help them make sense of their symptoms and thus reduce them.

Mentalization-Based Training Program for Child Care Workers in Residential Settings.

Most of the children placed in child welfare residential care have experienced complex traumas linked to various forms of abuse and neglect, which have many important developmental impacts. Research shows that maltreatment is associated with increased aggression and disruptive behavior, internalizing difficulties, violence towards self and others, sexualized behaviors, academic difficulties, and early drug abuse. These experiences also negatively affect the attachment system and the mentalization process of the child. Consequently, working with this population represents a challenge for child care workers. This article describes a mentalization-based training program for child care workers who care for children aged six to 12 years old. First, the general framework of the training program is presented. Then, some of the therapeutic strategies used to improve the children's mentalizing capacity are described. Those strategies are adapted to the psychic functioning level of the child. Finally, a summary of a preliminary study of the program's efficacy are presented. This work suggests that mentalization-based interventions might represent a valuable approach in child welfare residential care.

Weight Changes and Body Image in Pregnant Women: A Challenge for Health Care Professionals.

Body changes concerns and body image dissatisfaction are common during pregnancy. We aimed to examine whether health care professionals (HCPs): (i) believe that women are concerned about body image during pregnancy; (ii) consider it important to question, support, and intervene when pregnant women express body image concerns; (iii) feel comfortable enough in their abilities to question pregnant women with concerns; and (iv) have sufficient knowledge and skills to provide adequate support. A 36-item e-survey, developed by ÉquiLibre in collaboration with an expert committee, was sent to HCPs via email. HCPs believe that some situations are associated with body image concerns: postpregnancy weight loss (74.0%), perceived changes in their appearance (65.9%), excessive weight gain (65.3%), and feeling less in control of their body (36.8%). Among 321 responders, 60% considered it important to question pregnant women's concerns. One in four (25.4%) considered themselves "totally comfortable" asking about weight and body image concerns. Our study showed that HCPs need to be better supported in developing their abilities to help weight-preoccupied pregnant women. There is an urgent need to clarify HCPs' roles and to delineate the referral process as well as to ensure staff availability, in terms of time and personnel.

A Matched Cohort Study of the Association Between Childhood Sexual Abuse and Teenage Pregnancy.

PURPOSE: This matched cohort study aims to determine whether teenagers with a history of childhood sexual abuse (CSA) are at greater risk of consulting for a pregnancy and related complications than teenagers from the general population. It also aims to compare provoked abortion, live births, and fetal losses of participants who were sexually abused in childhood and those of the general population. METHODS: A total of 661 girls (aged 13-18 years) with a corroborated by Child Protection Services CSA report between 2001 and 2010 were matched to 661 girls from the general population upon age, biological sex, urban Child Protection Services area, and public drug insurance admissibility at reporting date. Pregnancy consultations and complications during pregnancy and delivery were documented using diagnoses from public health insurance administrative databases from January 1996 to March 2013. Socioeconomic status was controlled. RESULTS: Results indicate that compared with participants from the general population, those with a history of CSA were 4.6 times more likely to consult for at least one pregnancy, 5.3 times more likely to consult for at least one complication during pregnancy or delivery, and on average 5.2 and 3.3 times more likely to consult for at least one live birth and provoked abortion, respectively. There were too few observations to compare fetal losses between groups. CONCLUSIONS: Medical interventions for teenage pregnancies and related complications should take into consideration a possible history of CSA to reinforce gynecological follow-up and treatment for girls who were sexually abused and to prevent unfavorable outcomes.

[Attachment and Mentalization in Child Psychiatry: A Window Into Children and Parents Functioning]. / L'attachement et la mentalisation en pédopsychiatrie : une fenêtre sur le fonctionnement des enfants et de leurs parents.

Objectives Mental health professionals who work with children face various challenges, requiring them to consider factors that aim to promote healthy adaptation in their clients. There is a growing body of literature showing that child attachment pattern, as well as mentalizing ability in both children and their parents, are related to various indicators of well-being including mental health. However, studies assessing these constructs in clinical samples are sparse. Method Forty-nine children (2-6 years of age) and their parents were recruited through the Clinique spécialisée 0-5 ans of the Hôpital en santé mentale Albert-Prévost (HSMAP). A two-hour laboratory visit was carried out where parents and children completed individual and parent-child dyad tasks and filled out questionnaires. Various dimensions of parent and child functioning were assessed including the mother-child attachment relationship and parents' mentalization ability. Results Preliminary results indicated that child attachment pattern was related to children's behavioral and executive functioning as well as parents' psychiatric symptoms and parenting-related stress. Moreover, parents in our sample had lower levels of mentalizing abilities than those found in normative samples. Parents' mentalizing ability was related to the presence of psychiatric symptoms, parenting-related stress, and a history stressful life events. Conclusion These results highlight the need for mental health professionals working in a child psychiatric clinic to consider the child's attachment pattern and the mentalization ability of children and their parents, throughout the assessment process and subsequent implementation of interventions. In the last section of the manuscript, we present different ways we have integrated these concepts into our clinical work with children and parents referred to HSMAP.

Sofrimento nos laços pais-filhos: práticas educativas fundadas na mentalização na proteção da infância / Suffering in the parent-child relationship: mentalizing interventions in youth protection / El sufrimiento en la relación padre-hijo: intervenciones basadas en la mentalización adaptadas a la protección de la infancia

A maioria das crianças e dos adolescentes que vivem sob a proteção da juventude viveram traumas complexos ligados à negligência, aos maus tratos e às diversas formas de abusos. Sugerimos que esses jovens, bem como seus pais, apresentam dificuldades quanto à capacidade de mentalização e demonstram um funcionamento psíquico característico dos modos de pensar pré-mentalizantes. Este artigo apresenta a operacionalização dos diferentes modos de pensar (teleológico, de equivalência psíquica e fictício). São apresentados os princípios subjacentes a um programa de intervenção baseado na mentalização que poderão ser utilizados pelos educadores que trabalham com crianças e adolescentes em situação de vulnerabilidade. (AU)

Children and adolescents under the responsibility of the youth protection have experienced complex traumas concerning neglect, mistreatment, and various forms of abuse. The authors suggest that, as their parents, they show significant difficulties to mentalize as well as a pre-mentalizing mode of psychic functioning. This article presents the operationalization of the different pre-mentalizing modes of thought (teleological, psychic equivalence, and pretend-mode). This study also presents the underlying principles from a mentalizing intervention program that can be used by educators who work with vulnerable children and adolescents. (AU)

La mayoría de los niños y adolescentes bajo la custodia del servicio de protección de la infancia han vivido traumas complejos relacionados con el abandono, el maltrato y diversas formas de abuso. Los autores sugieren que éstos presentan, al igual que sus padres, deficiencias significativas en cuanto a la capacidad de mentalización y un funcionamiento característico de los modos pre-mentalizadores. Este artículo presenta una operacionalización de los diferentes modos de funcionamiento mental, teleológico, equivalente y ficticio; y expone igualmente los principios subyacentes a un programa de intervención basado en la mentalización y dirigido a los educadores que trabajan con estos niños y adolescentes. (AU)

Sofrimento nos laços pais-filhos: práticas educativas fundadas na mentalização na proteção da infância / Suffering in the parent-child relationship: mentalizing interventions in youth protection / El sufrimiento en la relación padre-hijo: intervenciones basadas en la mentalización adaptadas a la protección de la infancia

A maioria das crianças e dos adolescentes que vivem sob a proteção da juventude viveram traumas complexos ligados à negligência, aos maus tratos e às diversas formas de abusos. Sugerimos que esses jovens, bem como seus pais, apresentam dificuldades quanto à capacidade de mentalização e demonstram um funcionamento psíquico característico dos modos de pensar pré-mentalizantes. Este artigo apresenta a operacionalização dos diferentes modos de pensar (teleológico, de equivalência psíquica e fictício). São apresentados os princípios subjacentes a um programa de intervenção baseado na mentalização que poderão ser utilizados pelos educadores que trabalham com crianças e adolescentes em situação de vulnerabilidade...

Children and adolescents under the responsibility of the youth protection have experienced complex traumas concerning neglect, mistreatment, and various forms of abuse. The authors suggest that, as their parents, they show significant difficulties to mentalize as well as a pre-mentalizing mode of psychic functioning. This article presents the operationalization of the different pre-mentalizing modes of thought (teleological, psychic equivalence, and pretend-mode). This study also presents the underlying principles from a mentalizing intervention program that can be used by educators who work with vulnerable children and adolescents...

La mayoría de los niños y adolescentes bajo la custodia del servicio de protección de la infancia han vivido traumas complejos relacionados con el abandono, el maltrato y diversas formas de abuso. Los autores sugieren que éstos presentan, al igual que sus padres, deficiencias significativas en cuanto a la capacidad de mentalización y un funcionamiento característico de los modos pre-mentalizadores. Este artículo presenta una operacionalización de los diferentes modos de funcionamiento mental, teleológico, equivalente y ficticio; y expone igualmente los principios subyacentes a un programa de intervención basado en la mentalización y dirigido a los educadores que trabajan con estos niños y adolescentes...