Development and validation of the Mentalizing Emotions Questionnaire: A self-report measure for mentalizing emotions of the self and other.

Mentalizing describes the ability to imagine mental states underlying behavior. Furthermore, mentalizing allows one to identify, reflect on, and make sense of one's emotional state as well as to communicate one's emotions to oneself and others. In existing self-report measures, the process of mentalizing emotions in oneself and others was not captured. Therefore, the Mentalizing Emotions Questionnaire (MEQ; current version in German) was developed. In Study 1 (N = 510), we explored the factor structure of the MEQ with an Exploratory Factor Analysis. The factor analysis identified one principal (R2 = .65) and three subfactors: the overall factor was mentalizing emotions, the three subdimensions were self, communicating and other. In Study 2 (N = 509), we tested and confirmed the factor structure of the 16-items MEQ in a Confirmatory Factor Analysis (CFI = .959, RMSEA = .078, SRMR = .04) and evaluated its psychometric properties, which showed excellent internal consistency (α = .92 - .95) and good validity. The MEQ is a valid and reliable instrument which assesses the ability to mentalize emotions provides incremental validity to related constructs such as empathy that goes beyond other mentalization questionnaires.

The relationship between epistemic stance, mentalizing, paranoid distress and conspiracy mentality: an empirical investigation.

Epistemic stance, comprising epistemic trust, mistrust, and credulity, and the closely related construct of mentalizing have been related to paranoid ideation and conspiracy mentality. All phenomena are common in the general population and may become clinically and societally relevant at an extreme expression by influencing an individual's positioning towards socially transmitted information possibly as far as complete social detachment or attachment to extremist views. Herein, an individual's experienced distress may play an important role, which has however largely been neglected in empirical research. Thus, this study aims to empirically investigate the effect of epistemic stance on a clinically relevant aspect of paranoid ideation, namely paranoid distress. We assume that epistemic stance will be associated with paranoid distress, but that this association will be mediated by mentalizing. Moreover, we assume that epistemic stance will be indirectly associated with conspiracy thinking via paranoid distress. Data of 595 participants (mean age = 43.05; SD = 13.87; female = 48.32%, male = 51.18%, diverse = 0.51%) were collected via self-report questionnaires through an online-based cross-sectional study. Structural equation modeling was performed for data analysis. As expected, epistemic mistrust was associated with paranoid distress via mentalizing deficits. Unexpectedly, epistemic trust was associated with more paranoid distress. Indirectly, epistemic trust was associated with conspiracy mentality via paranoid distress. Findings partially confirmed the hypothesized associations. Mentalizing may be a target for reducing distress associated with a distrusting epistemic stance. Epistemically trusting individuals with high paranoid distress may turn to conspiracy theories for regulation.

Mentalization-based treatment for adolescents with conduct disorder (MBT-CD): a feasibility study.

Conduct disorder (CD) is a common psychiatric disorder in youth characterized by persisting norm-violating or aggressive behavior. Considering high individual and societal burden, feasible and effective psychotherapeutic treatment is desirable. Yet, treatments and research in this patient group are scarce. This study investigates the feasibility of mentalization-based treatment for adolescents with CD (MBT-CD) in terms of acceptability of MBT-CD and scientific assessments by participants as well as necessary organizational resources to conduct a consecutive randomized controlled trial (RCT). Recruitment, adherence and treatment session numbers were descriptively analyzed. Treatment evaluation interviews were qualitatively analyzed. A subset of sessions of therapists without prior MBT experience was rated for MBT adherence. Quantitative data were used to plan a consecutive RCT. Pre to post treatment changes in diagnosis and self-reported aggression, mentalizing and personality functioning were preliminarily analyzed. N = 45 adolescents with CD were recruited. 43% dropped out. Acceptance of scientific assessments was somewhat lower than therapy adherence (questionnaires filled out by ~ 80% of adolescents in treatment), and low at follow-up (25% of treatment completers). Mean session number was 30.3. Most treatment completers were satisfied with MBT-CD. Referrals mainly came from child and youth services and psychiatry. Nine of 16 sessions rated for MBT adherence were adherent. A priori sample size estimation for a prospective RCT with a drop-out rate of 43% yielded a sample of N = 158 to detect an effect f = .15 with 80% power in a repeated measures ANOVA. Pre-post analyses revealed diagnostic improvement in 68%. Of self-reported data, empathy pathology improved. Findings provide a sound basis for a consecutive feasibility and pilot RCT. TRIAL REGISTRATION: Clinicaltrials.gov, registration number NCT02988453, November 30, 2016, https://clinicaltrials.gov/ct2/show/NCT02988453.

Enhancing mentalization by specific interventions within mentalization-based treatment of adolescents with conduct disorder.

Objective: Mentalization is discussed as a mechanism of change in psychotherapy due to its positive effects on psychological functioning. In order to specifically apply mentalization-based interventions, a better understanding of the relationship between interventions and in-session mentalization is needed. The study aimed to explore the association between interventions and effective mentalizing. Method: Fifteen therapy sessions of three therapies with male adolescents with conduct disorder were transcribed and rated with the Reflective Functioning (RF) Scale and a newly developed Mentalization-based Treatment (MBT) intervention coding manual. The coded interventions were categorized into intervention levels according to the MBT manual. Fisher's exact tests were performed to test differences in frequencies of interventions in high-RF sequences (RF score ≥ 4) compared with remaining therapy sequences (RF score ≤ 3). Results: Specific MBT interventions such as demand questions, affectelaboration, empathic validation, change of subject, challenge, patienttherapist relation and mentalizing for the patient were related to effective mentalizing. Moreover, intervention levels such as supportive & empathic, basic- mentalizing & affect mode and relational mentalizing were positively associated with effective mentalizing. Conclusion: MBT interventions seem to promote effective mentalizing at various intervention levels. Interventions that enhance effective mentalizing seem to be patient specific. In line with MBT theory, their effect on effective mentalizing might depend on various variables, such as the patients' arousal and pre-mentalizing mode.

Improving working relationships with families in German early childhood interventions home visitors: a quasi-experimental training study.

BACKGROUND: Home visitation services within German Early Childhood Interventions (ECI) for families with a child aged 0-3 are mainly provided by frontline pediatric nurses and family midwifes. Home visitors are often challenged by difficult interactions with families. Mentalizing, the ability to understand mental states of oneself and others, is a key skill for building effective working relationships, which in turn positively affect intervention outcomes. The aim of this study was to investigate if a mentalizing skills training offered to home visitors active in German ECI contributes to continued professional development. We investigated, whether the training positively affected the quality of the working relationships with families as well as home visitors' empathy, self-efficacy, and mentalizing. METHODS: To test the effects of a single day mentalizing skills training on the working relationship in N = 73 ECI home visitors, we used a quasi-experimental design with repeated measures (T0, T1, T2, T3) across seven weeks in order to assess immediate change from baseline (T0) after the training (T2) and stability of changes at follow up (T3). A literature-based intervention was implemented before the training to estimate possible repeated measurement and expectational effects (T1). Primary outcome was the quality of the working relationship experienced by the home visitors. Secondary outcome criteria were empathy, work-related self-efficacy, self-reported and observer-rated mentalizing. RESULTS: Significant positive change in the working relationship quality was observed at T2 and at T3. Results on the secondary outcomes were less consistent, with data indicating improvement in empathy and increase on some but not all components of mentalizing. CONCLUSIONS: This study provides preliminary evidence that brief mentalizing skills trainings may be an effective method for continuous professional qualification in frontline ECI home visitors who afterwards, experience better working relationships with families. Thus, training participation may positively impact efficacy and implementation of home visitations in ECI.

[Bifocal perspective in the work with families with mentally ill parents]. / Bifokale Perspektive in der Arbeit mit Familien mit psychisch erkrankten Eltern: Training zur Verbesserung von Einstellungen, Wissen und Fertigkeiten für medizinische Fachkräfte.

BACKGROUND: Mentally ill parents pose a risk factor for the transgenerational transmission of mental disorders. Contemporary psychiatry mainly focuses on the individual and patients are not always recognized as being parents. OBJECTIVE: The development and evaluation of a training program for mental health professionals to support a family orientation in psychiatric treatment by using a bifocal perspective, which keeps an eye on the index patient and the family with a focus especially on children, are presented. METHODS: In order to establish the bifocal perspective in attitudes, knowledge and skills, a half-day training program, consisting of a lecture and a seminar was developed. This was carried out as part of the Children of Mentally Ill Parents -Research Network (CHIMPS-NET) consortium at seven locations in Germany in the respective adult, pediatric and adolescent departments of psychiatry. The needs were evaluated before the training using an online questionnaire. The implementation was accompanied by a qualitative analysis of memory protocols of the trainers. RESULTS AND DISCUSSION: The training could be successfully carried out with 120 participants, whereby the target of a comprehensive training of the complete personnel across occupational groups could not be realized, also partly due to the pandemic, and the exercising elements of training could not all be utilized. The evaluation of the questionnaire, which was completed by approximately 50% of the participants showed that the group of participating psychologists and physicians already had a strong family orientation. The qualitative analysis of protocols from all locations documented a strong need for networking across institutions and clear standard procedures, e.g. in dealing with child maltreatment.

Neural response to aggressive and positive interactions in violent offenders and nonviolent individuals.

BACKGROUND: Due to its severe negative consequences, human violence has been targeted by a vast number of studies. Yet, neurobiological mechanisms underlying violence are still widely unclear and it seems necessary to aim for high ecological validity to learn about mechanisms contributing to violence in real life. METHODS: The present functional magnetic resonance imaging (fMRI) study investigated the neurofunction of individuals with a history of violent offenses compared with that of controls using a laboratory paradigm requesting individuals to empathically engage in videos depicting provocative aggressive and positive social interactions from a first-person perspective. RESULTS: The contrast of aggressive vs. positive scenarios revealed midbrain activation patterns associated with caudal periaqueductal gray (PAG) in violent offenders; In controls, the rostral PAG was involved. Additionally, only in controls, this contrast revealed an involvement of the amygdaloidal complex. Moreover, in violent offenders the contrast of positive vs. aggressive situations revealed an involvement of areas in the insula, post-central gyrus and anterior cingulate cortex. CONCLUSIONS: Our results support findings on the differential role of PAG subdivisions in response to threat and point to altered processing of positive social interactions in violent offenders. They further support the notion that changes in PAG recruitment might contribute to violent individuals "taking action" instead of freezing in case of threatening situations.

Epistemic Trust and the Emergence of Conduct Problems: Aggression in the Service of Communication.

Fonagy and colleagues have recently proposed that deficits in the capacity for epistemic trust (i. e., the expectation that interpersonal communication is relevant to the addressee) are fundamental to psychopathology. In this paper, we consider the implications of this hypothesis for understanding the role of aggression in conduct disorder and conduct problems more generally. Our main proposal is to view conduct problems not only as reflecting dysregulation, but as an adaptation that allows communication with others who are (or are perceived to be) unreliable. Our formulation hinges on two propositions. The first one is to view aggression as a modality of communication adapted to scenarios in which the communicator expects the audience to have low epistemic trust in the communicator. The second idea is to conceptualize the failed "unlearning of aggression" as reflecting a lack of interest in maintaining one's reputation as a communicator, which in turn stems from a lack of epistemic trust in other communicators. In this paper, we discuss these ideas and examine how they may account for the developmental pathways that lead young people to develop conduct problems.

Mentalization-based treatment for adolescents with conduct disorder (MBT-CD): protocol of a feasibility and pilot study.

BACKGROUND: Conduct disorder (CD) is a complex mental disorder characterized by severe rule-breaking and aggressive behavior. While studies have shown that several therapeutic interventions are effective in treating CD symptoms, researchers call for treatments based on etiological knowledge and potential patho-mechanisms. Mentalization-based treatment (MBT) may represent such a treatment approach: Studies have shown that individuals with CD show mentalizing deficits and that mentalizing might represent a protective factor against the development of the disorder. As MBT focuses on the understanding of social behavior in terms of mental states, fostering mentalizing might help CD individuals to (re)gain an adaptive way of coping with negative emotions especially in social interactions and thus reduce aggressive behavior. For this purpose, MBT was adapted for adolescents with CD (MBT-CD). This is a protocol of a feasibility and pilot study to inform the planning of a prospective RCT. The primary aim is to estimate the feasibility of an RCT based on the acceptability of the intervention and the scientific assessments by CD individuals and their families indicated by quantitative and qualitative data, as well as based on necessary organizational resources to conduct an RCT. The secondary aim is to investigate the course of symptom severity and mentalizing skills. METHODS: The bi-center study is carried out in two outpatient settings associated with university hospitals (Heidelberg and Mainz) in Germany. Adolescents aged between 11 and 18 years with a CD or oppositional defiant disorder (ODD) diagnosis are included. Participants receive MBT-CD for 6 to 12 months. The primary outcome of the feasibility study (e.g., recruitment and adherence rates) will be descriptively analyzed. Multilevel modeling will be used to investigate secondary outcome data. DISCUSSION: Fostering the capacity to mentalize social interactions triggering non-mentalized, aggressive behavior might help CD individuals to behave more adaptively. The feasibility trial is essential for gathering information on how to properly conduct MBT-CD including appropriate scientific assessments in this patient group, in order to subsequently investigate the effectiveness of MBT-CD in an RCT. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02988453 . November 30, 2016 SOURCES OF MONETARY SUPPORT: Dietmar Hopp Stiftung, Heidehof Stiftung RECRUITMENT STATUS: Recruitment complete and intervention complete, follow-up assessments ongoing (Heidelberg). Recruitment and assessments ongoing (Mainz). PRIMARY SPONSOR, PRINCIPAL INVESTIGATOR, AND LEAD INVESTIGATOR IN HEIDELBERG: Svenja Taubner is responsible for the design and conduct of MBT-CD intervention and feasibility and pilot study, preparation of protocol and revisions, and publication of study results. SECONDARY SPONSOR AND LEAD INVESTIGATOR IN MAINZ: Esther Sobanski is responsible for the recruitment and data collection in the collaborating center Mainz RECRUITMENT COUNTRY: Germany HEALTH CONDITION STUDIED: Conduct disorder, oppositional defiant disorder INTERVENTION: Mentalization-based treatment for conduct disorder (MBT-CD): MBT-CD is an adaptation of MBT for Borderline Personality Disorder. This manualized psychodynamic psychotherapy focuses on increasing mentalizing, i.e., the ability to understand behavior in terms of mental states, in patients. MBT-CD includes weekly individual sessions with the patient and monthly family sessions. KEY INCLUSION AND EXCLUSION CRITERIA: Included are adolescent individuals with a diagnosis of conduct disorder or oppositional defiant disorder aged between 11 and 18 years. STUDY TYPE: Feasibility and pilot study (single-group) DATE OF FIRST ENROLLMENT: 19.01.2017 STUDY STATUS: The trial is currently in the follow-up assessment phase in Heidelberg and in the recruitment and treatment phase in Mainz. PRIMARY OUTCOMES: Acceptability of MBT-CD intervention (as indicated by recruitment rates, completion rates, drop-out rates, treatment duration, oral evaluation), acceptability of scientific assessments (as indicated by adherence, missing data, oral evaluation), and necessary organizational resources (scientific personnel, recruitment networks, MBT-CD training and supervision) to estimate feasibility of an RCT SECONDARY OUTCOMES: Adolescents' symptom severity and mentalizing ability PROTOCOL VERSION: 20.08.2020, version 1.0.

[What Did You Like About the Therapy? - A Qualitative Study on the Evaluation of Mentalization-Based Treatment for Adolescents with Conduct Disorder]. / Was hat dir an der Therapie gefallen? ­ Eine qualitative Studie zur Evaluation der Mentalisierungsbasierten Therapie für Jugendliche mit Störungen des Sozialverhaltens.

Psychotherapeutic treatment for adolescents with conduct disorder (CD) is considered difficult for various reasons. On the one hand, patients frequently lack psychological strain, and striving for autonomy is part of typical adolescent development. On the other hand, therapists can react aversively to delinquent and violent behavior, and insufficient psychological models explaining aetiology and maintenance of symptoms can impede treatment of adolescents with CD. Mentalization-Based Therapy for adolescents with CD (MBT-CD) was developed with the aim of addressing these difficulties and improving psychotherapeutic treatment for this patient group. MBT-CD focuses on the promotion of the adolescents' autonomy by increasing their scope of action via an improvement of mentalizing ability. The aim of this qualitative study is to investigate the acceptance of MBT-CD by the adolescents in terms of their experience with MBT-CD and thus obtain information about aspects which enhance therapy motivation for this group of patients. For this purpose, we conducted semi-structured interviews with twelve adolescents after completion of therapy assessing their subjective therapy evaluation. Qualitative content analysis was used to analyze the data. The results show both helpful and hindering aspects of the mentalization-based interventions. In addition, the monthly family sessions included in the therapy were regarded as important. Adolescents also regarded emotion regulation strategies as helpful. Implications for the treatment of adolescents with CD are discussed.

A negative bias in decoding positive social cues characterizes emotion processing in patients with symptom-remitted Borderline Personality Disorder.

BACKGROUND: Impairments in the domain of interpersonal functioning such as the feeling of loneliness and fear of abandonment have been associated with a negative bias during processing of social cues in Borderline Personality Disorder (BPD). Since these symptoms show low rates of remission, high rates of recurrence and are relatively resistant to treatment, in the present study we investigated whether a negative bias during social cognitive processing exists in BPD even after symptomatic remission. We focused on facial emotion recognition since it is one of the basal social-cognitive processes required for successful social interactions and building relationships. METHODS: Ninety-eight female participants (46 symptom-remitted BPD [r-BPD]), 52 healthy controls [HC]) rated the intensity of anger and happiness in ambiguous (anger/happiness blends) and unambiguous (emotion/neutral blends) emotional facial expressions. Additionally, participants assessed the confidence they experienced in their own judgments. RESULTS: R-BPD participants assessed ambiguous expressions as less happy and as more angry when the faces displayed predominantly happiness. Confidence in these judgments did not differ between groups, but confidence in judging happiness in predominantly happy faces was lower in BPD patients with a higher level of BPD psychopathology. CONCLUSIONS: Evaluating social cues that signal the willingness to affiliate is characterized by a negative bias that seems to be a trait-like feature of social cognition in BPD. In contrast, confidence in judging positive social signals seems to be a state-like feature of emotion recognition in BPD that improves with attenuation in the level of acute BPD symptoms.

Mentalization-Based Treatment for Personality Disorders: Efficacy, Effectiveness, and New Developments.

PURPOSE OF THE REVIEW: This review aims to outline the most recent evidence on the efficacy and effectiveness of mentalization-based treatment (MBT) for personality disorders (PD) from 2015 to 2018 and to describe new treatment developments. RECENT FINDINGS: Since 2015, 14 new-primarily effectiveness-MBT trials have been published. The main body of studies investigated adult populations (n = 11), patients with a borderline personality disorder (BPD) diagnosis (n = 8), and compared MBT with another psychotherapeutic treatment (n = 6). The majority of studies suggest that MBT has the potential to improve the clinical outcomes for adolescents and adults with a PD diagnosis, particularly BPD, and also with comorbid diagnoses and there are indications for changes in mentalizing being a specific mechanism of change promoted by MBT. Despite promising findings, there is an urgent need for methodological sound and sufficiently powered studies to investigate both the efficacy and effectiveness of MBT, especially beyond BPD.

[Strengthening Attachment Competencies in Parents with Mental Illness: Adaptation and Pilot Testing of the Mentalization-Based Lighthouse Parenting Program]. / Bindungskompetenzen psychisch kranker Eltern stärken: Adaptation und Pilottestung des mentalisierungsbasierten Leuchtturm-Elternprogramms.

Strengthening Attachment Competencies in Parents with Mental Illness: Adaptation and Pilot Testing of the Mentalization-Based Lighthouse Parenting Program Mentalizing describes the imaginative ability to understand human behaviour in terms of mental states. Parents with mental illnesses and experiences of early maltreatment frequently show impairments in mentalizing, which negatively impact their caregiving competences for the child. A number of mentalization-based programs to strengthen parental competences have been developed and most of them have been positively evaluated with regard to their efficacy. However, approaches which specifically aim to reach highly impaired families with children from different age groups and which can be implemented in psychiatric settings are currently lacking. The newly adapted mentalization-based Lighthouse-Parenting Program aims to fill this gap and strengthen competences of parents with a mental illness. The specific MBT-based stance, the structure and content of this new program are outlined and first results of a pilot test are presented. The program is a promising approach, which can easily be trained and implemented in existing mental health care systems. The Lighthouse-Parenting Program aims to improve the relationship between parent and child, to reduce parental stress and in the long-term to promote the child's development. A randomized controlled trial to evaluate the program's effectiveness is currently being planned.

[From Pretending to Play to Playing Pretend: The Role of Epistemic Trust in Mentalization-Based Therapy with Children]. / Vom Tun, als würde man spielen, zum Spielen, als würde man tun: Die Rolle epistemischen Vertrauens in der Mentalisierungsbasierten Therapie mit Kindern.

From Pretending to Play to Playing Pretend: The Role of Epistemic Trust in Mentalization-Based Therapy with Children Although all forms of psychotherapy encourage the patient to focus on their mental states and those of other people, it is a distinguishing characteristic of Mentalization-Based Therapy (MBT; Fonagy u. Bateman, 2006; Bateman u. Fonagy, 2016) to place such focus at the center of treatment. In MBT-Child there is the added element of play, which is considered a primary vehicle for enhancing mentalization (Midgley, Ensink, Lindqvist, Malberg, Muller, 2017). However, pre-mentalizing modes during play are developmentally normative in children. Thus, it can be difficult to distinguish between play as a goal of treatment, and the psychic equivalence and pretend modes. This paper presents some thoughts about how we can unravel the relationships between restoring mentalizing and the process by which children in therapy "learn to play". We begin by introducing the theoretical principles that underlie MBT and MBT-C, with particular focus on defining the pre-mentalizing modes. Then, we discuss recent innovations in thinking about the role of epistemic trust in psychotherapy and present a possible use of this concept in understanding pre-mentalizing modes during playing. We suggest ways in which mentalization-based techniques used when children are in pre-mentalizing modes may restore epistemic trust and act as a mechanism of change in child psychotherapy, opening up the child's capacity to both play and mentalize in relation to their social environment. Finally, we present a clinical case of a mentalization focused treatment with a 9-year old child to illustrate our views.

[Mentalizing as a Mechanism of Change in the Therapy of Conduct Disorder. A Controlled Case Study]. / Mentalisieren als Veränderungsmechanismus in der Behandlung von Störungen des Sozialverhaltens. Eine kontrollierte Fallstudie.

Mentalizing as a Mechanism of Change in the Therapy of Conduct Disorder. A Controlled Case Study This controlled case study is dedicated to mentalizing as a mechanism of change in the course of a mentalization-based therapy for the treatment of conduct disorder. Following an introduction to conduct, oppositional defiant disorder and the concept of mentalizing, the case study of a 17-year-old male patient is presented. The patient's mentalizing is measured with the Reflective Functioning Scale and assessed prior to and after treatment as well as in therapy sessions at three time points through the course of therapy. Analyses show that the capacity for mentalizing fluctuates noticeably within but also between the coded therapy sessions. During the course of therapy first an increase and then a slight decrease in mentalizing qualities become apparent. The comparison of the pre- and post-measurement shows a slight increase in the patient's mentalizing abilities. Additionally the patient no longer fulfilled the criteria of a conduct disorder. The results are discussed and implications for clinical practice are formulated.

Difficulties with being socially accepted: An experimental study in borderline personality disorder.

Anxious preoccupation with real or imagined abandonment is a key feature of borderline personality disorder (BPD). Recent experimental research suggests that patients with BPD do not simply show emotional overreactivity to rejection. Instead, they experience reduced connectedness with others in situations of social inclusion. Resulting consequences of these features on social behavior are not investigated yet. The aim of the present study was to investigate the differential impact of social acceptance and rejection on social expectations and subsequent social behavior in BPD. To this end, we developed the Mannheim Virtual Group Interaction Paradigm in which participants interacted with a group of computer-controlled avatars. They were led to believe that these represented real human coplayers. During these interactions, participants introduced themselves, evaluated their coplayers, assessed their social expectations and received feedback signaling either acceptance or rejection by the alleged other participants. Subsequently, participants played a modified trust game, which measured cooperative and aggressive behavior. Fifty-six nonmedicated BPD patients and 56 healthy control participants were randomly and double-blindly assigned to either the group-acceptance or group-rejection condition. BPD patients showed lower initial expectations of being socially accepted than healthy controls. After repeated presentation of social feedback, they adjusted their expectations in response to negative, but not to positive feedback. After the experience of social acceptance, BPD patients behaved less cooperatively. These experimental findings point to a clinically relevant issue in BPD: Altered cognitive and behavioral responses to social acceptance may hamper the forming of stable cooperative relationships and negatively affect future interpersonal relationships. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Behavioural mimicry and loneliness in borderline personality disorder.

INTRODUCTION: Interpersonal problems together with feelings of intense loneliness constitute a core symptom domain in borderline personality disorder (BPD). Mimicry is one social behaviour that serves the forming of social affiliation and building a sense of belonging. In the present study, we investigated whether behavioural mimicry is altered in BPD and whether it is linked to the patient's feeling of loneliness. METHODS: Individuals with BPD (N = 26) and healthy participants (HC, N = 25) performed a finger tapping task with a congruent or incongruent finger movement displayed preceding the presentation of the task relevant stimulus. Additional trials showing an immobile hand were used as a control condition. Mimicry strength was estimated as response facilitation after congruent and response interference after incongruent cues. RESULTS: Both HC and BPD patients showed facilitated responses after congruent finger movements. Only BPD patients exhibited interference by incongruent cues. The lonelier the BPD patients felt, the weaker was the interference of the incongruent cues. In contrast, interference increased with the level of loneliness in the HC group. CONCLUSIONS: Behavioural mimicry was increased in BPD. However, this effect was less pronounced in those BPD patients who reported the highest levels of loneliness. Our findings emphasize that mimicry is a complex construct and only some of the involved processes are altered in BPD. Future studies must further disentangle the contribution of cognitive and social cognitive processes, address a potential causality in the link between loneliness and mimicry in BPD, and relate alterations of mimicry to interpersonal dysfunction during every-day life.

Borderline Personality Disorder Features and Sensitivity to Injustice.

Hypersensitivity to injustice has been proposed to contribute to interpersonal dysfunction in borderline personality disorder (BPD). We investigated whether BPD features are related to sensitivity to injustice and whether justice sensitivity mediates the relationship between BPD features and aggressive behavior. In an online survey, subjects reported justice sensitivity from the perspective of a victim, an observer, a beneficiary, and a perpetrator as well as BPD features and their own aggressive behavior. Justice sensitivity was higher in participants with a clinically relevant degree of BPD features when they evaluated injustice from the perspective of a victim or an observer. Victim sensitivity partially mediated the relationship between BPD features and the frequency of aggressive behavior. The present study provides first data on the important role of sensitivity to injustice in those with marked BPD features. Particularly, victim sensitivity with its close link to angry reactions may contribute to interpersonal problems in BPD.

Generalisation of fear in PTSD related to prolonged childhood maltreatment: an experimental study.

BACKGROUND: Fear responses are particularly intense and persistent in post-traumatic stress disorder (PTSD), and can be evoked by unspecific cues that resemble the original traumatic event. Overgeneralisation of fear might be one of the underlying mechanisms. We investigated the generalisation and discrimination of fear in individuals with and without PTSD related to prolonged childhood maltreatment. METHODS: Sixty trauma-exposed women with (N = 30) and without (N = 30) PTSD and 30 healthy control participants (HC) underwent a fear conditioning and generalisation paradigm. In a contingency learning procedure, one of two circles of different sizes was associated with an electrical shock (danger cue), while the other circle represented a safety cue. During generalisation testing, online risk ratings, reaction times and fear-potentiated startle were measured in response to safety and danger cues as well as to eight generalisation stimuli, i.e. circles of parametrically varying size creating a continuum of similarity between the danger and safety cue. RESULTS: The increase in reaction times from the safety cue across the different generalisation classes to the danger cue was less pronounced in PTSD compared with HC. Moreover, PTSD participants expected higher risk of an aversive event independent of stimulus types and task. CONCLUSIONS: Alterations in generalisation constitute one part of fear memory alterations in PTSD. Neither the accuracy of a risk judgement nor the strength of the induced fear was affected. Instead, processing times as an index of uncertainty during risk judgements suggested a reduced differentiation between safety and threat in PTSD.

Loneliness, social networks, and social functioning in borderline personality disorder.

Persistent loneliness is often reported by patients with borderline personality disorder (BPD). However, empirical studies investigating this aspect of BPD psychopathology are sparse. Studies from social psychology revealed that social isolation and low social functioning contribute to loneliness, that is, the subjective feeling of being alone. The aim of the present study was to contribute to the understanding of loneliness in BPD by investigating its relation to social isolation and functioning in different domains of life. Subjective experience of loneliness was measured in 80 women (40 BPD patients, 40 healthy controls) with the UCLA Loneliness Scale. Social isolation and social functioning were assessed with the Social Network Inventory and the Social Functioning Scale. In addition, we assessed global functioning with the Global Assessment of Functioning. BPD patients reported stronger feelings of loneliness compared to healthy participants. In general, the level of loneliness was linked to network size, social engagement, and prosocial behavior. Diversity of social networks and functioning in the domain of interpersonal communication were associated with the level of loneliness only in BPD. A reduced variety of roles in social life together with impairments in interpersonal communication were particularly relevant for the experience of loneliness in BPD, suggesting an indirect path to target this psychopathological feature in therapeutic interventions. However, both social isolation and social functioning were not sufficient to explain the severely increased loneliness experienced by these patients, stressing the need for further investigation of determinants of loneliness in this clinical population. (PsycINFO Database Record