Bridging the transmission gap: An end to an important mystery of attachment research?

Girls and Gangs: A Decade on From the Firmin Report and What Has Changed?

Presenting data from the first phase of a U.K.-based 5-year mixed-methods study, we restart a decade-long conversation into Girls and Gangs and Violence Against Women and Girls (VAWG). The relationship between the two is not mutually exclusive and coupled with the recent optics surrounding youth violence and gendered violence, we discuss how the needs of women are being somewhat hindered as a result of U.K. governmental vacillation. We therefore consider the serious impact of VAWG and the concomitancy with youth violence/gangs. By drawing on contemporary feminist criminological theorizing, we aim to galvanize governmental responses to prioritize the needs of women at a time when policymakers are arguably poised to listen.

Relationship focused mother-infant groups: Preliminary evaluation of improvements in maternal mental health, parenting confidence, and parental reflective functioning

We report on two preliminary evaluations of a group intervention, targeting vulnerable infants and their mothers within the first 6-months postpartum. The Mother-Baby Nurture® program aims to strengthen the developing infant-mother attachment relationship by increasing maternal mentalizing. These studies were undertaken with pre-post evaluations with the mothers of infants under 10-months of age. The mother-infant dyads participated in ten 2-h group sessions. Study one (N = 69 dyads) included self-reported maternal depression, anxiety, and parenting confidence. In study two (N = 27 dyads), parenting stress and reflective functioning were measured by self-report, and reflective functioning coded on the 5 min speech sample (completed by N = 22). Results from study one confirmed a decrease in depression (p < .001, d = .79) and anxiety (p < .001, d = .72) symptoms, and an increase in mothers' scores for parenting confidence (p < .001, d = -.98). Results from Study Two demonstrated a significant decrease in parenting stress (p < .001, d = .94) and significant improvement in measures of self-report reflective functioning (p = .007, .024; d = .56, .61). These findings are preliminary yet promising indications that this program could be effective in alleviating parenting stress, depression, and anxiety, and improving mother's reflective functioning and parenting confidence. Further research is needed, with a control group and long-term follow-up assessments.

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.

Safe haven in adolescence: Improving parental reflective functioning and youth attachment and mental health with the Connecting and Reflecting Experience

Attachment security provides a well-documented protective developmental function for children exposed to individual- and community-level trauma, yet the effectiveness of prevention and intervention efforts targeting attachment during adolescence has been relatively underexplored. The Connecting and Reflecting Experience (CARE) program is a transdiagnostic, bi-generational, group-based, mentalizing-focused parenting intervention developed to dismantle the intergenerational transmission of trauma and support secure attachment relationships across the developmental spectrum within an under-resourced community. This exploratory study evaluated outcomes among caregiver-adolescent dyads (N = 32) in the CARE condition of a nonrandomized clinical trial at an outpatient mental health clinic within a diverse, urban U.S. community with disproportionate trauma exposure exacerbated by COVID-19. Caregivers predominantly identified as Black/African/African American (47%), Hispanic/Latina (38%), and/or White (19%). At pre- and post-intervention, caregivers completed questionnaires regarding parental mentalizing and their adolescents' psychosocial functioning. Adolescents completed scales regarding attachment and psychosocial functioning. Results showed a significant decrease in caregivers' prementalizing on the Parental Reflective Functioning Questionnaire, improvement in adolescent psychosocial functioning on the Youth Outcomes Questionnaire, and an increase in adolescents' reports of attachment security on the Security Scale. These preliminary findings suggest that mentalizing-focused parenting interventions may be effective in fostering improved attachment security and psychosocial functioning during adolescence.

Perinatal Depression and Anxiety Symptoms, Parental Bonding and Dyadic Sensitivity in Mother-Baby Interactions at Three Months Post-Partum

The quality of the early parent-infant relationship is crucial for the child's optimal development, and parental sensitivity plays a key role in early interactions. The purpose of the study was to evaluate the influence of maternal perinatal depression and anxiety symptoms on dyadic sensitivity at three months post-partum, also considering a large set of maternal and infant variables. At the third trimester of pregnancy (T1) and at three months postpartum (T2), 43 primiparous women filled in a set of questionnaires evaluating symptoms of depression (CES-D) or anxiety (STAI), the woman's parental bonding experiences (PBI), alexithymia (TAS-20), maternal attachment to the baby (PAI, MPAS) and the perceived social support (MSPSS). At T2 mothers also completed a questionnaire on infant temperament and took part in the CARE-Index videotaped procedure. Dyadic sensitivity was predicted by higher maternal trait anxiety scores in pregnancy. In addition, the mother's experience of being cared for by her father in childhood was predictive of her infant's lower compulsivity, while paternal overprotection predicted higher unresponsiveness. The results highlight the influence of perinatal maternal psychological well-being and maternal childhood experiences on the quality of the dyadic relationship. The results may be useful to foster mother-child adjustment during the perinatal period.

Reflective functioning in mothers with addictions: Differential relationships involving family history of mental illness and substance use

Parental reflective functioning (RF) is often cited as an important domain in which mothers with addictions struggle in their roles as parents, though the links between addiction and RF remain unclear. Exposure to attachment trauma associated with parental mental illness and substance use is commonly associated with both addiction and lower RF. We thus examined how family history of parental mental illness and substance use may relate to the RF of mothers with addictions. One hundred ninety-four mothers in outpatient substance use treatment completed the Parent Development Interview and provided information about whether their mothers and fathers experienced mental illness or problems with substance use. Univariate ANOVAs revealed an interaction between family history of maternal mental illness and maternal substance use. Among mothers with a history of maternal substance use, those with a history of maternal mental illness had higher RF than those who had no history of maternal mental illness. Among mothers who did not report a family history of maternal mental illness, mothers who had a family history of maternal substance use exhibited significantly lower RF than mothers with no family history of maternal substance use. Exposure to paternal mental illness or substance use was not associated with mothers' RF. These findings highlight the importance of disentangling the contributions of attachment trauma to mothers' RF and utilizing interventions that support mothers' capacity to reflect about how their early experiences of being cared for by a mother with a mental illness or addiction may impact their current caregiving behaviors.

A Systematic Review of Barriers and Facilitators to Implementing Assisted Dying: A Qualitative Evidence Synthesis of Professionals' Perspectives

Assisted dying is a divisive topic and draws both lamenting and approving commentary from political, medical, legal, and philosophical domains. This systematic review and qualitative evidence synthesis aims to identify the factors that healthcare professionals experience when working within assisted dying frameworks. PRISMA guidelines for systematic reviews were followed. Search results yielded 15,426 papers with 39 papers meeting inclusion criteria for this review. Remaining papers were subjected to critical appraisal and a thematic synthesis. Eight themes fell under the domain of 'barrier' and represented different personal and professional factors that hinder professionals from delivering assisted dying healthcare. Five themes came under the domain of 'facilitators' and represent factors that contribute to the smooth implementation and delivery of assisted dying services. Health professionals experience a range of factors that both impede and propel delivery of assisted dying frameworks.

Psychometric properties of the parental reflective functioning questionnaire in Iranian mothers

This study aims to examine the psychometric properties of the Persian version of the Parental Reflective Functioning Questionnaire (PRFQ) in mothers, a brief self-report measure that assesses parental mentalization capacity. To examine the factor structure and construct validity of the PRFQ, 430 mothers of 3-6-year-old children completed the Persian version of the PRFQ (Persian-PRFQ) along with the Emotion Regulation Checklist (ERC) and the Strengths and Difficulties Questionnaire (SDQ). Exploratory and confirmatory factor analyses supported the three-factor structure of the PRFQ. Convergent validity was confirmed for the three subscales of the PRFQ, while divergent validity was only confirmed for the PM and IC. Furthermore, the mean score of the certainty of mental states (CMS) in this sample was higher than in other studies, and contrary to the theoretical foundations, the CMS was positively related to interest and curiosity in mental states (IC). In conclusion, our results provided initial evidence for the use of the Persian-PRFQ in the Iranian population.

Self-report measures of secure attachment in adulthood: A systematic review

BACKGROUND

Secure attachment in adulthood is associated with many markers of adaptive functioning. Valid and reliable self-report measures of attachment security could provide a practical tool to help advance strengths-based research and clinical work. Previous reviews have not specifically examined the psychometric properties of self-report instruments with respect to secure attachment or systematically appraised the methodological quality of relevant validation studies.

METHOD

A systematic review was completed in accordance with the COSMIN guidelines for reviews of patient-reported outcome measures. The methodological quality of individual studies was evaluated, and results were rated against criteria for good measurement properties.

RESULTS

A total of 40 studies were included in the review, which collectively reported on 24 self-report instruments. The methodological quality of individual studies was variable, and no single instrument was identified as having sufficient evidence of a range of psychometric properties. However, the Attachment Style Questionnaire-Short Form (ASQ-SF), the Cartes-Modèles Individuels de Relations (CAMIR), Cartes-Modèles Individuels de Relations-Reduced (CAMIR-R), and the Psychological Treatment Inventory-Attachment Style Scales (PTI-ASS) had the most robust evidence for the properties assessed.

CONCLUSION

Existing self-report measures assessing adult secure attachment have limited psychometric support. More methodologically robust studies of content validity, reliability, measurement invariance, and construct validity in particular are needed.

The mediating role of parental embodied mentalizing in the longitudinal association between prenatal spousal support and toddler emotion recognition

Emotion recognition is an important developmental achievement in early childhood. Grounded in theoretical concepts of family systems theory and the spillover effect, the goal of the current study was to examine whether prenatal spousal support predicts toddler emotion recognition at 24 months, and whether this association is mediated by parental embodied mentalizing (PEM) at 6 months. PEM refers to the parent's capacity to understand the infant's mental states from his or her whole-body kinesthetic expressions and adjust their own kinesthetic patterns accordingly. One hundred and five families expecting their first child were included in the study. Results indicated that maternal PEM mediated the relationship between prenatal dyadic positive and overall support and toddler emotion recognition. Paternal PEM was not found to be related to either dyadic support or to toddler emotion recognition, and it did not mediate the relationship between the two. The findings of the current study support the importance of including both parents' embodied mentalizing and a systemic approach to illuminate child development. A significant clinical implication from this study is the usefulness of prenatal couple interventions to improve mutual support and communication as it can promote parents' parental mentalizing and ultimately the child's emotion recognition capacity.

Reflecting Before, During, and After the Heat of the Moment: A Review of Four Approaches for Supporting Health Staff to Manage Stressful Events

Being a healthcare professional in both paediatric and adult hospitals will mean being exposed to human tragedies and stressful events involving conflict, misunderstanding, and moral distress. There are a number of different structured approaches to reflection and discussion designed to support healthcare professionals process and make sense of their feelings and experiences and to mitigate against direct and vicarious trauma. In this paper, we draw from our experience in a large children's hospital and more broadly from the literature to identify and analyse four established approaches to facilitated reflective discussions. Each of the four approaches seeks to acknowledge the stressful nature of health professional work and to support clinicians from all healthcare professions to develop sustainable skills so they continue to grow and thrive as health professionals. Each approach also has the potential to open up feelings of uncertainty, frustration, sorrow, anguish, and moral distress for participants. We argue, therefore, that in order to avoid unintentionally causing harm, a facilitator should have specific skills required to safely lead the discussion and be able to explain the nature, scope, safe application, and limits of each approach. With reference to a hypothetical but realistic clinical case scenario, we discuss the application and key features of each approach, including the goals, underpinning theory, and methods of facilitation.

Traumatized Refugees in Psychotherapy: Long-Term Changes in Personality, Mental Health, Well-Being, and Exile Life Functioning

ABSTRACT

This pre- and posttreatment study of 22 severely traumatized adult refugees spanned a mean of 6.5 years. Changes in personality functioning, mental health, and well-being were examined using the Rorschach Performance Assessment System, Harvard Trauma Questionnaire, Hopkins Symptom Checklist-25, and the World Health Organization's Quality of Life-BREF questionnaire. A paired samples t-test revealed significant improvement after psychotherapy in traumatic ideation and initial severe disruptions in thought processes, reality testing, perception, self and other representations, and relational capacity (Cohen's d = 0.46-0.59). Symptoms of anxiety, depression, and posttraumatic stress were significantly reduced (d = 0.54-0.84), quality of life in the physical health and psychological health domains increased significantly (d = 0.87 and 0.97), and percentage of participants with exile language proficiency and work/study status increased significantly. The findings demonstrate the potential of psychotherapy to contribute to normalizing perceptual, cognitive, and relational capacities in severely traumatized refugees, paramount to well-being and functioning in exile.

Reflective Practices to Study Group Dynamics: Implement Empowerment and Understand the Functioning of Groups

Introduction: Individual and group reflection practices are qualitative methods useful in a group context to develop group skills and more awareness of the dynamics that take place within the group to which one belongs. Aim: The aim of this work is to highlight how individual reflective practices and group reflections contribute to the development of group skills. More specifically, the effectiveness of relevant group dynamics is investigated, with the aim of creating a space for reflection, and activation for individual and group empowerment. Participants: The participants were 130 university students (86% female), resided in northwestern Italy, and had a mean age of 27.5 years (SD = 7.52). They were randomly divided into 23 groups (ranged from four to nine members). Method: The participants engaged in several online training activities and at the end of every activity they completed individual reflection practice in which they presented both positive and negative aspects related to the group experiences. Then they participated in online group reflections that allowed them to reflect on the group dynamics, particular attention given to factors such as climate, participation and roles played by each participant in a variety of training activities. This study analyzes 130 individual reflective practices and 23 group reflections. The data collected through individual reflective practices and the transcripts of the group reflections were analyzed using grounded theory. Two independent judges analyzed and categorized the data and then identified the main common categories that emerged by the support of Nvivo software. Results: From the analysis of the content, it is determined that the participants, based on the construction of the individual and group reflections, paid greater attention to the dynamics that occurred within the group during the various activities in which they participated, thus allowing them to be more aware of the various factors that affected the importance attributed to the different roles, the climate, and their active participation. Conclusion: Combined, these factors allowed participants to strengthen their relationships with each other and enhance the cohesion of the group.

Effectiveness of a Preventive Parenting Program Combining Attachment and Behavioral Approaches in an Arab Context: a Cluster-Based Randomized Control Trial

Parenting programs aim to help parents and carers enhance their skills and ameliorate infants' and toddlers' wellbeing. In Lebanon and other Arab countries, contextualized group-based parenting programs addressing parents' mental wellbeing, parenting styles, and child development are quite rare. Therefore, a Preventive Parenting Program consisting of 7 sessions has been designed by local experts for the local cultural context. This study aims to assess its effectiveness. Thirty-three sites were identified in Great Beirut: private firms, primary healthcare centers, and child daycares. Sixteen agreed to take part in the study and were randomly assigned to intervention and control arms. From these clusters, 191 mothers of typically developed children younger than three years were recruited to intervention (106) or control (85) groups. The Mental Health Inventory, Caregiver Knowledge about Child Development Inventory, Parent Authority Questionnaire, and a Demographic questionnaire were completed at pre-intervention and post-intervention and 3 months later by both groups of mothers. There were no significant differences between clusters with respect to all scales' scores at baseline as well as the 2 other data collection points. Despite the positive feedback collected from mothers who attended the sessions, no significant effects were detected. The design of the program, the expected outcomes, and the characteristics of the participants may have contributed to the limited results, hence the need for further research.

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 (β=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.

Mentalizing Glasses: Multifocal Attention in Mentalization-Based Treatment and the Role of the Supervision

Bifocal attention has been conceptualized differently by various scholars; however, all converge in the idea that the therapeutic process includes the need for the therapist to focus his attention on more than one aspect of the therapeutic setting. We propose a novel view in the application of bifocal attention within the mentalizing framework (MBT) of working with children, adolescents, and their families. We start by providing a short history of the evolution of the construct of bifocal attention, followed by a brief description of the structure of MBT for children and adolescents, emphasizing the crucial role of bifocal and multiple attentions in the mentalizing therapist. We close by discussing the importance of continued supervision in facilitating the maintaining of mentalizing glasses in therapy.

Mothering from the Inside Out: Addressing the Intersection of Addiction, Adversity, and Attachment with Evidence-Based Parenting Intervention

Purpose of Review

Mothers with substance use disorders are often referred for parenting support, though commonly available programs may miss the mark for families impacted by addiction. This may be related to a lack of attention to children's emotional needs, mothers' histories of adversity, and the neurobiological differences seen in mothers with addictions. We review the implications of addiction, adversity, and attachment for parenting interventions. We then describe Mothering from the Inside Out (MIO), an evidence-based parenting intervention designed specifically for mothers with addictions.

Recent Findings

Evidence from clinical trials suggests that MIO improves outcomes for two generations: both mothers with addictions and their children. Recent trials demonstrate that MIO may be delivered effectively by community-based clinicians and may be beneficial for parents with other chronic stressors.

Summary

Addressing addiction, adversity, and attachment simultaneously may have a positive synergistic effect. Future research should study the implementation of MIO in real-world settings and examine the impact of MIO on maternal neurobiology.

Parental reflective functioning and theory of mind acquisition: A developmental perspective

This study investigated theory of mind (ToM) development in 83 children aged 3-5 years and its associations with parental reflective functioning (PRF), using a multidimensional and developmental approach. Results showed that ToM dimensions (i.e., affective, belief-desire, and cognitive) gradually increased with age. All dimensions of PRF (i.e., prementalizing modes, certainty about mental states, and interest and curiosity in mental states) were associated with ToM dimensions, with different dimensions being differentially related to ToM, including age-related effects.

Learning Through Shared Care : Allomaternal Care Impacts Cognitive Development in Early Infancy in a Western Population

This study investigates how allomaternal care (AMC) impacts human development outside of energetics by evaluating relations between important qualitative and quantitative aspects of AMC and developmental outcomes in a Western population. This study seeks to determine whether there are measurable differences in cognitive and language outcomes as predicted by differences in exposure to AMC via formal (e.g., childcare facilities) and informal (e.g., family and friends) networks. Data were collected from 102 mothers and their typically developing infants aged 13-18 months. AMC predictor data were collected using questionnaires, structured daily diaries, and longitudinal interviews. Developmental outcomes were assessed using the Cognitive, Receptive Language, and Expressive Language subtests of the Bayley III Screening Test. Additional demographic covariates were also evaluated. Akaike Information Criterion (AIC)-informed model selection was used to identify the best-fitting model for each outcome across three working linear regression models. Although AMC variables had no significant effects on Receptive and Expressive Language subtest scores, highly involved familial AMC had a significant medium effect on Cognitive subtest score (β = 0.23, p < 0.01, semi-partial r = 0.28). Formal childcare had no effect on any outcome. This study provides preliminary evidence that there is a measurable connection between AMC and cognitive development in some populations and provides a methodological base from which to assess these connections cross-culturally through future studies. As these effects are attributable to AMC interactions with networks of mostly related individuals, these findings present an area for further investigation regarding the kin selection hypothesis for AMC.

A Further Look at Reading the Mind in the Eyes-Child Version: Association With Fluid Intelligence, Receptive Language, and Intergenerational Transmission in Typically Developing School-Aged Children

A number of tasks have been developed to measure the affective theory of mind (ToM), nevertheless, recent studies found that different affective ToM tasks do not correlate with each other, suggesting that further studies on affective ToM and its measurement are needed. More in-depth knowledge of the tools that are available to assess affective ToM is needed to decide which should be used in research and in clinical practice, and how to interpret results. The current study focuses on the Reading the Mind in the Eyes Test (RMET) primarily to investigate in a sample of 112 children the currently unexplored relationships in middle childhood between performance on the RMET and fluid intelligence. Relationships with receptive vocabulary, age, and sex were also investigated. Moreover, because studying the family's influence on children mentalization could have important implications in developing prevention and treatment interventions, this study offers a novel contribution to the field by exploring the family's influence on children's RMET performance. Although significant positive correlations were found among RMET-C performance, fluid intelligence, and receptive language, regression analysis revealed that fluid intelligence was the only predictor. No family influence was found on children's RMET performance. On the whole, results from the current study offer some support to the hypothesis that RMET-C is not a “pure” ToM task, specifically the effect of fluid intelligence on RMET performance should be taken into account when RMET is used both in research and in the clinical setting.

Representations of attachment security, attachment avoidance, and gender in Ugandan children

Researchers returned to the home of Mary Ainsworth's original attachment study to explore the contributions of Ugandan children's representations of attachment interactions with their caregivers to their perceptions about gender. Researchers administered the Attachment Story-Completion Task (ASCT) and applied three attachment narrative coding systems and a gender stereotypes typology to the ASCT stories of 51 Ugandan children ages 5-7. Nine attachment narrative variables were applied to the children's responses to a series of five attachment story stems told using a family of dolls. The narratives emerging from the children's responses to these story stems were also coded independently for 14 masculine and 14 feminine gender stereotypes. Empathic relations among the dolls and narrative coherence were positively correlated with counterstereotypical gender representations only in girls. Attachment representations of a rejecting father were positively correlated with stereotypical gender representations only in boys. Representations of attachment avoidance were negatively correlated with counterstereotypical gender representations in both boys and girls. The findings suggested two different trajectories for the development of gender representation flexibility in boys and girls. This study contextualizes these findings against the backdrop of a country with rigid sex roles and a fast-growing child population.

The μ-opioid receptor gene A118G polymorphism is associated with insecure attachment in children with disruptive mood regulation disorder and their mothers

BACKGROUND

The A118G single nucleotide polymorphism (SNP) of the μ-opioid receptor gene, with high expression of the A allele and low expression of the G allele, has been associated with emotional/behavioral dysregulation and depressive disorders and is recognized as a mediator of affiliative behavior. No study has thus far investigated this SNP in school-age children with disruptive mood regulation disorder (DMDD). This study compared a sample of healthy children and their mothers with a sample of children with DMDD and their mothers, evaluating whether insecure attachment and psychopathological symptoms are associated with A allele- or G allele-carrying mothers and children and whether caregiving capacities are associated with A allele- or G allele-carrying mothers.

METHODS

For evaluation of their psychopathological symptoms and attachment styles, mothers filled out the CBCL/6-18, the SCL-90-R, and the ECR. To evaluate the types of relationship children were experiencing with their mothers, children filled out the ECR-revised child version and the PBI. Genotypic analyses were conducted on DNA samples obtained by buccal swabbing from children and mothers.

RESULTS

An insecure attachment style was more frequent in mothers and children carrying the G allele (G/G + A/G genotypes). In the clinical sample, G allele-carrying children scored higher than homozygous A/A ones on the subscales of Withdrawal and Conduct Problems. G-carrying mothers showed higher interpersonal sensitivity, depression, hostility, and paranoid ideation and provided less care than A/A mothers.

CONCLUSIONS

This study offers new insights into the associations between the A118G SNP of the μ-opioid receptor gene and emotional/behavioral functioning, attachment style in children, and psychopathology and caregiving ability in mothers.

Newborn Behavioral Observation, maternal stress, depressive symptoms and the mother-infant relationship: results from the Northern Babies Longitudinal Study (NorBaby)

BACKGROUND

Families can experience the postpartum period as overwhelming and many report a special need for support. The Newborn Behavioral Observation (NBO) aims to promote a positive parent-infant relationship by sensitising parents to the infant's signals. This article evaluates the NBO as a universal preventive intervention within the regular well-baby clinic service on measures of maternal depressive symptoms, parental stress, the mother-infant relationship and satisfaction/benefit of the postpartum follow-up.

METHODS

This investigation is part of a larger longitudinal study comprising 220 women and 130 of their partners recruited between 2015 and 2017. The study had a non-randomised cluster-controlled design with 6 measurement points. This article is based on a sample of 196 women using data from T1 (gestational weeks 13-39), T4 (5-15 weeks postpartum) and T5 (3-9 months postpartum). Participants were allocated to a group receiving the NBO (n = 82) and a care as usual comparison group (n = 114). We measured maternal depressive symptoms and parental stress using the Edinburgh Postnatal Depression Scale (EPDS) and the Parenting Stress Index (PSI). The mother-infant relationship was assessed with the Parental Reflective Functioning Questionnaire (PRFQ), the Maternal Postnatal Attachment Scale (MPAS) and the Maternal Confidence Questionnaire (MCQ). Participants also answered questions about satisfaction/benefit of the postpartum follow-up.

RESULTS

A Mann-Whitney U test indicated that participants in the NBO-group learned significantly more than the comparison group from the follow-up about the baby's signals in relation to sleep/sleep patterns, social interaction and crying/fuzziness. Multivariate analyses of covariance (MANCOVA) and repeated measures ANCOVA found no significant differences between the groups for the mother-infant relationship domain and few differences in depressive symptoms and parental stress. The repeated measures ANCOVA found that participants in the NBO-group scored slightly higher on parental stress, although the difference was small.

CONCLUSIONS

The results indicate that the NBO-group learned more than the comparison group about reading their child's signals in important everyday situations. However, the benefits of the NBO were limited for depressive symptoms, parental stress and self-reported mother-infant relationship. The study sample was generally well-functioning, and the results indicate that the benefits of the NBO may be limited within a well-functioning sample.

TRIAL REGISTRATION

ClinicalTrials, NCT02538497, Registered 2 September 2015.

Reflective Functioning of Refugee Mothers with Children Born of Conflict-Related Sexual Violence

The ability of a parent to step back from their own experiences in order to understand those of their child, reflective functioning (RF), can be impacted by myriad factors. We explored RF among refugee mothers in the context of having a child born of sexual violence (CBSV). A sample of 10 mothers now residing in the Netherlands, both with (n = 5) and without (n = 5) a CBSV, were interviewed, seeking to explore parents’ representations of their children, themselves as parents, and their relationship with their children. After deriving a score of RF, interview narratives were qualitatively analyzed using thematic analysis. An ordinary level of reflective functioning was identified in this sample overall (average score 4.5); which was reduced in the group with CBSV (average score 3.0). Trends within the qualitative analyses indicated that emotion regulation and ambivalence as well as parenting challenges are factors that affect RF capabilities for mothers with CBSV. Wider findings show that the asylum process and mental well-being also impinge on RF capabilities. Experiences of having a CBSV as well as those pertaining to being a refugee appear to interact and impact reflective functioning for some mothers. Further investigation would add weight to this pilot data.

Childhood abuse and neglect experiences, Hostile-Helpless attachment, and reflective functioning in mentally ill filicidal mothers

The present study represents the first empirical investigation of the mechanisms - a Hostile-Helpless (HH) attachment and reflective functioning (RF) - through which childhood abuse and neglect (CA&N) experiences may impact a mother's likelihood to commit filicide. The sample was comprised of 46 mentally ill mothers. Differences in attachment-derived risk variables between filicidal mothers (FM) and non-filicidal mothers (NFM) were also examined. FM (n = 23) reported lower RF, higher HH attachment, and a more severe history of CA&N, compared to NFM (n = 23), but did not differ on the severity of childhood experiences of loss of and/or separation from attachment figures. Bayesian analysis indicated that the mediated effect of more severe CA&N on the likelihood of committing filicide through higher HH attachment was significantly amplified by lower RF. A developmental interpretation of filicide is proposed and clinical implications for prevention and attachment-based interventions with at-risk mother-child dyads are discussed.

Do early parental postnatal depression, attachment style and perceived social support affect neurodevelopmental outcomes of premature infants?

BACKGROUND

The birth of a premature infant is both a stressful event for both parents and associated with an increased rate of postnatal depression (PND). Additionally some mothers may have delayed feelings of attachment to their babies because of the medical procedures or possible medical complications. Social support is known as an important factor for well-being in the postnatal period. However there is scarce data about these factors for fathers. We aimed to identify the impact of parental PND, attachment style and social support on premature infant development considering the prematurity degree and risk groups.

METHODS

This prospective study was conducted by including 96 infants who were born preterm. Mothers and fathers were given Edinburgh Postnatal Depression Scale (EPDS), Adult Attachment Style Scale (AASS), and Multidimensional Scale of Perceived Social Support (MSPSS) to fill out when their infants' corrected age was 3 months. The developmental evaluation was conducted with Bayley III at the corrected 6 months and 18 months of age.

RESULTS

Postnatal depression scores were more in mothers than fathers, the rates of secure attachment and social support were similar between mothers and fathers. Factors associated with the neurodevelopmental outcomes including prematurity degree and risk groups, EPDS, AASS and MSPSS scores were analyzed for both parents. In multivariate analysis, fathers' depression scores were inversely associated with cognitive development (p = 0.030, R² = 0.080, B=-0.283) and mothers' anxious/ambivalent attachment style was inversely associated with language development (p = 0.011, R² = 0.108, B=-0.329) at the age of corrected 6 months old.

CONCLUSIONS

Our findings underscore that the efforts to improve developmental outcomes of premature infants should include parental well-being taking into account new fathers' depressive symptomatology and maternal anxious/ambivalent attachment.

Individual differences in attachment anxiety shape the association between adverse childhood experiences and adult somatic symptoms

BACKGROUND

Although prior research has documented the link between adverse childhood experiences (ACEs) and somatic symptoms, it remains unclear why some individuals exposed to ACEs developed somatic symptoms while others did not.

OBJECTIVE

Framed by a biopsychosocial perspective, this study investigated the role of attachment anxiety in the association between ACEs and somatic symptoms in adulthood.

PARTICIPANTS AND SETTING

A total of 662 emerging adults attending college were recruited to respond to an online survey in a computer lab.

METHOD

The computer-based survey included demographic form, the Adverse Childhood Experience Scale, the Experience in Close Relationship Scale-Short Form, and the Somatization Scale of the Symptom Checklist-90-Revised for somatic symptoms. Multivariate regression analyses were used to examine the role of attachment anxiety in the association between ACEs and somatic symptoms.

RESULTS

The results indicated that ACEs positively correlated with attachment anxiety and somatic symptoms; and attachment anxiety and somatic symptoms were positively correlated. Moreover, the results indicated a significant effect of interaction between ACEs and attachment anxiety on somatic symptoms, suggesting a moderating role of attachment anxiety. Subsequent simple slope test revealed that attachment anxiety intensified the strength of relation between ACEs and somatic symptoms; but when the level of attachment anxiety was low, ACEs and somatic symptoms were not related.

CONCLUSION

Individual differences in attachment anxiety shape the association of adverse childhood experiences with somatic symptoms. Targeting and reformulating anxious working models of attachment may help ameliorate vulnerability to somatic symptoms in individuals exposed to ACEs.

Attachment and Epigenetics: A Scoping Review of Recent Research and Current Knowledge

Background

Epigenetic research has pointed to that the interaction between genetics and environmental factors may play a role in making some individuals more vulnerable than others.

Aim

The aim of this article was to present a broad perspective on the current state of knowledge in a relatively new and complex field of “attachment and epigenetic processes.”

Method

We conducted a scoping review based on a systematic literature search in PsycINFO, PubMed, and Embase databases for relevant abstracts using the terms attachment and epigenet*.

Results

In total, 11 studies were included. Research predating 2009 and animal studies were excluded in order to review the current state of research in humans.

Conclusion

Overall, there seems to be a consistency in the literature, pointing to a link between early childhood adversity, attachment processes, and epigenetic changes. However, research in human subjects is still limited.

Influence of maternal reflective functioning on mothers' and children's weight: A follow-up study

Based on cross-sectional research linking poor reflective functionining (RF) to eating disorders, the current follow-up study tested whether maternal RF would explain the variance of mothers' and children's weight beyond the effects of maternal emotional dysregulation. During pregnancy (Time 1 [T1]), 51 women were administered the Difficulties in Emotion Regulation Scale (DERS) and interviewed using the Adult Attachment Interview (AAI). Seven months after delivery (Time 2 [T2]), mother-baby dyads who remained in the study (n = 44) were videotaped (Feeding Scale) during their feeding interaction. Last (Time 3 [T3]), the weight of the 34 children who were still in the study was collected at 3 years of age. Maternal AAI-RF at T1 did not correlate with the DERS at T1 nor with the quality of the feeding interacions at T2. However, it correlated, significantly, with maternal body mass index (BMI) at T1, r = -.298, P = .034, and marginally significantly with baby's BMI at T3, r = -.296, P = .089. Moreover, multiple regression models showed a trend indicating that maternal AAI-RF might explain the variance of mothers' and children's weight beyond the effects of maternal emotional dysregulation. These findings suggest that working on maternal mentalization might contribute to helping prevent childhood obesity from pregnancy.

The Analysis of Self-Mutilation in Adolescence Based on the Theory of Mentalization: From Sukhvinder in the Novel 'Casual Vacancy'

Objectives:

Adolescence involves a number of developmental processes, as well as unique psychological characteristics and behaviors. An increased rate of internet and game addictions, school violence, and suicide may either represent aspects of adolescence or a psychopathological phenomenon. There is an urgent need to develop software programs that can prevent and resolve adolescent behavioral problems. We applied the mentalization theory to interpret and find solutions for problems faced by adolescent characters in literature.

Methods:

In Joan Rowling’s novel “Casual Vacancy,” Sukhvinder is a girl with problems representative of those encountered by modern adolescents; she is a victim of bullying and engages in self-mutilation. We targeted her problematic behaviors as representative of a prementalized state.

Results:

Born into an upper-class English family with Pakistani origins, Sukhvinder, unlike her siblings, fails her parents’ expectations. Whenever she faces a psychological crisis, she regresses into the teleological mode (the most primitive pre-mentalization stage) and regains her sense of self by cutting herself. After her friend’s suicide, however, she begins to communicate with her parents and moves toward mentalization.

Conclusion:

By analyzing Sukhvinder’s behavior, we assessed patterns of attachment, empathy, and mentalization, and identified corrective approaches for problematic behaviors. We believe that the presented interpretation may serve as a foundation for the development of models for understanding adolescent deviant behaviors.

Patterns of Romantic Pathways among 23 Year Olds and their Adolescent Antecedents

Observation of the romantic lives of the majority of young people shows that they might move between transitory and inconsistent states, being in and out of a relationship. The present study aims to better understand the meaning of these fluctuations. For this purpose, and employing a multi-method design, 144 Israeli adolescents (59.7% females) were followed from age 16 to 23. At age 23 in-depth interviews were conducted with the participants, focusing on their romantic histories. Analyses of interviews at age 23 yielded four distinctive romantic pathways differing in stability and the ability to progress toward intimacy: Sporadic and Casual Encounters, Sporadic Encounters in Response to a Stressful Romantic Experience, Steady Non-Intimate Involvements, and Progression toward Steady Intimate Involvements. The findings showed that more than half of participants belonged to the Progression toward Steady Intimate Involvements pathway, suggesting that romantic fluctuations served as means to progress toward intimate involvements. Progression toward steady intimate involvement was explained by greater secure attachment, greater capacity to face tension and to express one's views, and greater parental support measured seven years earlier. In contrast, lower earlier intra- and interpersonal assets during adolescence were more likely to associate with a variety of romantic experiences during emerging adulthood that are characterized by romantic instabilities and difficulty to progress toward intimacy. The findings are discussed within the framework of the Developmental Systems Theory.

Video feedback intervention to enhance parental reflective functioning in primary caregivers of inpatient psychiatric children: protocol for a randomized feasibility trial

Background

Children requiring hospitalization for psychiatric care have serious disorders, high use of psychotropic medication, and frequent readmissions. The development and implementation of therapies focused on incorporating primary caregivers or attachment figures is necessary for working with children with severe psychiatric disorders. Mentalization or parental reflective functioning (PRF) is the ability of parents to understand their children’s behaviors as an expression of internal emotional states and act accordingly to help them regulate their emotions; in this way mentalizing is a key component of sensitive parenting. Video-assisted therapies have proven to be effective in promoting change in parent–child relationships. The majority of studies have been carried out with mothers of pre-school children and in an outpatient setting. Video intervention therapy (VIT) is a flexible manualized therapy, which allows the intervention to be individualized to the context where it is applied, according to the needs and resources of the people who participate in it. The objective of the study is to evaluate the feasibility and acceptability of applying VIT to improve the PRF of the parents as primary carers of children hospitalized in a psychiatric service.

Methods

This is a pilot randomized, single-masked (outcome assessor) study with a qualitative component. It will involve a block randomization procedure to generate a 2:1 allocation (with more people allocated to the intervention arm). The intervention consists of four modules; every module has both one video-recorded play session and one VIT session per week. People assigned to the control group will receive treatment as usual plus weekly play sessions. Feasibility and acceptability of the study will be quantitatively and qualitatively assessed. Evaluation of the caregivers will include assessments of PRF, wellbeing and personality structure; assessments of children will include parent-ratings and clinician-ratings of symptomatology and general functioning. After every video feedback (VF) session, PRF, the caregiver’s wellbeing and children’s general functioning will be reassessed.

Discussion

This study will contribute to the currently scarce evidence on how to provide family attachment-based interventions in a child inpatient psychiatric unit. It will also inform the design and implementation of a future randomized clinical trial.

Trial registration

ClinicalTrials.gov, NCT03374904. Registered on 14 December 2017 (retrospectively registered).

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3310-y) contains supplementary material, which is available to authorized users.

Defensive patterns in reflective group supervisions at Child Health Centres

Reflective group supervision with infant healthcare workers has been described in several publications. It aims to enhance their ability to help distressed families, and to comprehend and relieve themselves of the distress that they encounter in such work. The ultimate aim has been formulated as an effort at increasing the professional's reflective function. The present article adds to the literature by applying an ego-psychological perspective on the group process and investigating defensive patterns in such supervisions. This approach includes a critical discussion of the place of the reflective function concept in psychoanalytic metapsychology. The article also suggests a Bionian perspective to account for skewed communicative patterns in groups, so-called basic assumptions. Some technical recommendations are provided on the frame in group supervision. They aim to disarm such defenses and facilitate the group participants' possibilities of understanding and thus helping their colleague's problematic relationship with the family. To illustrate the discussion, and to help readers form an image of the supervision process, brief detailed accounts of such work are submitted.

Maternal reflective functioning, interpersonal violence-related posttraumatic stress disorder, and risk for psychopathology in early childhood

The aim of this study was to examine associations between maternal mentalization, interactive behavior, and child symptoms in families in which mothers suffer from interpersonal violence-related posttraumatic stress disorder (IPV-PTSD). Fifty-six mothers and children (aged 12-42 months) including mothers with a diagnosis of IPV-PTSD were studied. Mentalization was measured by the Parental Reflective Functioning (PRF) Scale. Interactive behavior during free-play was measured via the CARE-Index. Child symptoms were measured by the Infant-Toddler Social and Emotional Assessment (ITSEA). Data analyses included non-parametric correlations and multiple linear regression. Results showed that lower IPV-PTSD and higher Maternal Reflective Functioning (MRF) were related to greater maternal sensitivity. Lower MRF and greater controlling behavior were related to child dysregulation. MRF was found to be lower in the subgroup of IPV-PTSD when the child's father was the perpetrator of IPV. Both MRF and interactive behavior are thus likely to be important targets for intervention during sensitive periods of early social-emotional development.

A developmental model of addictions: integrating neurobiological and psychodynamic theories through the lens of attachment

Although substance use and abuse may impact brain and behavior, it is still unclear why some people become addicted while others do not. Neuroscientific theories explain addiction as a series of between- and within-system neuroadaptations that lead to an increasingly dysregulating cycle, affecting reward, motivation, and executive control systems. In contrast, psychoanalysis understands addiction through a relational perspective wherein there is an underlying failure in affect regulation, a capacity shaped early developmentally. Considering recent findings suggesting the neurobiological overlap of addiction and attachment, it may be possible to integrate both perspectives into a developmental model through the lens of attachment. The goal of the present review is to evaluate the value of neurobiological and psychodynamic perspectives to inform our understanding of addiction, particularly substance-use disorders.

A qualitative exploration of the experiences of adoptive parents attending 'Nurturing Attachments', a dyadic developmental psychotherapy informed group

Children who are adopted have frequently experienced a range of aversive experience which impact on their ability to form secure attachments. Dyadic Developmental Psychotherapy (DDP) is an intervention designed to develop and promote secure attachments with children who have experienced developmental trauma. Eight adoptive parents participated in semi-structured interviews regarding their experiences of attending the 'Nurturing Attachment' group informed by DDP. The transcripts of their interviews were explored using Interpretative Phenomenological Analysis. The analysis revealed five inter-connected superordinate themes which were as follows: A supportive group, A shift in perspective, 'Turning trauma into secure attachment', 'Am I doing it right?' and Continuing the adoption journey. Themes are considered in relation to the theoretical underpinnings and practice of DDP. Some further implications for clinical and research practice are also discussed.

Exploring adverse parent-child relationships from the perspective of convicted child murderers: A South African qualitative study

Child homicide is the most extreme form of violence against children. Within South Africa, children face the highest risk of homicide by parents/caregivers. It is suggested that prolonged exposure to adverse relationships with one’s own parents may be linked to committing child homicide as it may lead to psychological damage and disturb neurological functioning. This paper explores the adverse parent-child relationships of 22 men and women incarcerated for the murder of either a biological child, a stepchild or a child in their care and draws on 49 in-depth interviews with these participants. We illustrate that traumatic parent-child experiences in the form of absent parents, neglect and abuse have a profound impact on establishing unhealthy attachment styles and emphasize the importance of early adverse parent-child bonds in setting the tone for future bonds as adults. The pathway to adopting an adverse attachment with one’s own child is argued to be influenced by these early traumatic emotional experiences within the home. This study highlights the need to acknowledge the impact that adverse parent-child experiences have on the formation of violent forms of parental behavior. It is imperative to reduce children’s emotional vulnerabilities by implementing strategies to strengthen current parenting practices, to promote the development of less violent parent-child relationships and to work towards resolving parents’ experiences of trauma in reducing child homicide.

Mentalizing in the presence of another: Measuring reflective functioning and attachment in the therapy process

Objective: In this paper, we test the reliability and validity of two novel ways of assessing mentalizing in the therapy context: the Reflective Functioning scale (RF) applied to code psychotherapy transcripts (In-session RF), and the Exploring scale of the Patient Attachment Coding System (PACS), which measures in-session autonomy and is linked with secure attachment in psychotherapy. Method: Before treatment, 160 patients in different types of psychotherapy and from three different countries were administered the Adult Attachment Interview (AAI), which was rated with the RF scale. One early psychotherapy session for each patient was independently rated with the In-session RF scale and with the PACS Exploring scale. Results: Both scales were found to be reliable and to have concurrent validity with the RF scale rated on the AAI, with the PACS Exploring scale found to be a better predictor of RF on the AAI. Conclusions: These results suggest that the PACS Exploring scale might be a practical method for assessing RF in psychotherapy research and a way for researchers and clinicians to track patients' RF on an ongoing basis. These results also provide information regarding the ways in which differences in RF manifest during psychotherapy sessions. Clinical or methodological significance of this article Researchers and clinicians can assess patients' mentalizing based on any single psychotherapy transcript, in many therapeutic modalities The Exploring scale of the Patient Attachment Coding System can yield a reliable measure of reflective functioning based on any single psychotherapy transcript, in many therapeutic modalities Client differences in mentalizing manifest in part independently of the therapist's contributions.