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Lai W, Wu H, Yang L, Chen R, Xin Z, Zhang X, Wang W, Guo L, Huang G, Lu C. Prevalence of unhealthy behaviors and their associations with non-suicidal self-injury, suicidal ideation and suicide attempt among Chinese adolescents. Child Adolesc Psychiatry Ment Health 2024; 18:61. [PMID: 38812024 PMCID: PMC11137955 DOI: 10.1186/s13034-024-00742-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/23/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Unhealthy lifestyle behaviors among adolescents have emerged as a significant public health concern worldwide, however, there is little investigation on the impact of unhealthy behaviors on non-suicidal self-injury (NSSI), suicidal ideation (SI) and suicide attempt (SA). This study aimed to investigate the prevalence of seven unhealthy behaviors as well as their associations with NSSI, SI and SA, and to explore whether the aforementioned associations differ across sex. METHODS A total of 74,152 adolescents were included in this study via a multi-stage, stratified cluster, random sampling method in 2021. Information about unhealthy behaviors (insufficient physical activity, current smoking, current drinking, excessive screen time, long homework time, insufficient sleep and unhealthy BMI), NSSI, SI, SA and other demographics was collected. Sampling weights were used to estimate the prevalence, and the weighted logistic regression models were performed. Stratified analyses by sex and sensitive analyses were conducted. RESULTS Overview, the weighted prevalence of adolescents had more than five unhealthy behaviors were 5.2%, with boys showing a higher prevalence than girls (6.5% vs.3.8%). Current smoking, current drinking, excessive screen use, long homework time, insufficient sleep, and unhealthy BMI were significantly associated with NSSI, SI and SA. Moreover, adolescents with high lifestyle risk scores were associated with an increased risk of NSSI (5-7 vs. 0: OR 6.38, 95% CI 5.24-7.77), SI (5-7 vs. 0: OR 7.67, 95% CI 6.35-9.25), and SA (5-7 vs. 0: OR 9.57, 95% CI 6.95-13.17). Significant sex differences were found in the associations of unhealthy behaviors with NSSI, SI and SA. CONCLUSION Unhealthy behaviors are quite common among Chinese adolescents. Adolescents with multiple unhealthy behaviors are associated with increased risks of NSSI, SI, and SA. The implementation of school and family-based interventions to promote healthy lifestyles is recommended as a preventive measure against self-injurious behavior and suicidality in adolescents.
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Affiliation(s)
- Wenjian Lai
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen university, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Herui Wu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen university, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Liwen Yang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen university, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Ruiying Chen
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen university, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Zhiyao Xin
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen university, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Xiaojuan Zhang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen university, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen university, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen university, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Guoliang Huang
- Center for Adverse Drug Reaction Monitoring of Guangdong, 753 Dongfeng East Road, Guangzhou, 510080, China.
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen university, 74 Zhongshan Rd 2, Guangzhou, 510080, China.
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Riedl D, Kampling H, Nolte T, Kirchhoff C, Kruse J, Sachser C, Fegert JM, Gündel H, Brähler E, Grote V, Fischer MJ, Lampe A. Utilization of Mental Health Provision, Epistemic Stance and Comorbid Psychopathology of Individuals with Complex Post-Traumatic Stress Disorders (CPTSD)-Results from a Representative German Observational Study. J Clin Med 2024; 13:2735. [PMID: 38792277 PMCID: PMC11121826 DOI: 10.3390/jcm13102735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/02/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Complex post-traumatic stress disorder (CPTSD) is a severely debilitating recently added symptom cluster in the International Classification of Diseases (ICD-11). So far, only limited information on mental health treatment-uptake and -satisfaction of individuals with CPTSD is available. The aim of this study is to investigate these aspects in a representative sample of the German general population. Methods: Participants completed the International Trauma Questionnaire (ITQ) to identify participants with CPTSD, as well as questionnaires on mental health treatment uptake and satisfaction, adverse childhood experiences, anxiety, depression, working ability, personality functioning, and epistemic trust. Results: Of the included n = 1918 participants, n = 29 (1.5%) fulfilled the criteria for CPTSD. Participants with CPTSD had received mental health treatment significantly more often than participants with PTSD or depression (65.5% vs. 58.8% vs. 31.6%; p = 0.031) but reported significantly less symptom improvement (52.9% vs. 78.0% vs. 80.0%; p = 0.008). Lower levels of epistemic trust were associated with higher CPTSD symptoms (p < 0.001). Conclusions: Our study shows that while the vast majority of individuals with CPTSD had received mental health treatment, subjective symptom improvement rates are not satisfactory. CPTSD was associated with a broad number of comorbidities and impairments in functioning. Lower levels of epistemic trust may partially explain worse treatment outcomes.
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Affiliation(s)
- David Riedl
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria; (V.G.); (M.J.F.)
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, 35392 Giessen, Germany
| | - Tobias Nolte
- Anna Freud National Centre for Children and Families, London N1 9JH, UK
- Research Department for Clinical, Educational and Heath Psychology University College London, London WC1E 6BT, UK
| | - Christina Kirchhoff
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, 35392 Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, 35037 Marburg, Germany
| | - Cedric Sachser
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, 89075 Ulm, Germany
- German Center for Mental Health (DZPG), Partner Site Ulm, 89075 Ulm, Germany
| | - Jörg M. Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, 89075 Ulm, Germany
- German Center for Mental Health (DZPG), Partner Site Ulm, 89075 Ulm, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, University Ulm Medical Center, 89081 Ulm, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, 55131 Mainz, Germany
- Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria; (V.G.); (M.J.F.)
| | - Michael J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria; (V.G.); (M.J.F.)
- VAMED Rehabilitation Center Kitzbuehel, 6370 Kitzbuehel, Austria
| | - Astrid Lampe
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria; (V.G.); (M.J.F.)
- VAMED Rehabilitation Montafon, 6780 Schruns, Austria
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Kasper LA, Hauschild S, Berning A, Holl J, Taubner S. Development and validation of the Mentalizing Emotions Questionnaire: A self-report measure for mentalizing emotions of the self and other. PLoS One 2024; 19:e0300984. [PMID: 38709789 PMCID: PMC11073734 DOI: 10.1371/journal.pone.0300984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/07/2024] [Indexed: 05/08/2024] Open
Abstract
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.
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Affiliation(s)
- Lea A. Kasper
- Psychological Institute, University Heidelberg, Heidelberg, Germany
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
| | - Sophie Hauschild
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna Berning
- Psychological Institute, University Heidelberg, Heidelberg, Germany
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Holl
- Psychological Institute, University Heidelberg, Heidelberg, Germany
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
| | - Svenja Taubner
- Psychological Institute, University Heidelberg, Heidelberg, Germany
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
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Lassri D, Gewirtz-Meydan A, Nolte T. Transdiagnostic factors in the COVID-19 pandemic: Examining the role of childhood abuse and neglect in establishing latent profiles of risk and resilience. CHILD ABUSE & NEGLECT 2024:106808. [PMID: 38693009 DOI: 10.1016/j.chiabu.2024.106808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 04/01/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Ample studies have focused on the negative consequences of COVID-19 on mental well-being, but fewer have explored the specific role of childhood abuse and neglect in the context of risk and resilience during this unprecedented crisis. OBJECTIVE We aimed to identify distinct profiles of individuals based on their experiences of childhood abuse and neglect, coping strategies, and psycho-social transdiagnostic risk and protective factors, using a person-centered approach. PARTICIPANTS AND SETTING A convenience sample of 914 Israelis completed self-report questionnaires during the second wave of COVID-19. METHODS Latent Profile Analysis was employed based on levels of childhood abuse and neglect, coping strategies, and established factors underpinning risk and resilience in mental health: dissociation, self-criticism, self-efficacy, self-compassion, attachment insecurity, psychological resilience, mentalizing, distress disclosure, psychopathology, and relationship satisfaction. Profiles were compared in COVID-19-related distress and well-being using ANOVAs. RESULTS A four-profile solution was found to be optimal for describing individuals with different profiles of risk and resilience: "risk" (5.1 %)-individuals with meaningfully high levels of childhood abuse and neglect and dissociation; "vulnerable" (14.2 %)-individuals high in risk factors and low in protective factors; "moderately resilient" (47.6 %)-those with moderate levels of protective and risk factors; "highly resilient" (33.1 %)-individuals high in protective factors and low in risk factors; groups differed in mental well-being and COVID-19-related distress. CONCLUSIONS Results highlight the importance of childhood abuse and neglect in differentiating between the two distinct profiles of at-risk individuals. Implications for risk assessment and treatment in the context of potential traumatic stress are discussed.
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Affiliation(s)
- Dana Lassri
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Israel; Research Department of Clinical, Educational, and Health Psychology, University College London (UCL), United Kingdom.
| | - Ateret Gewirtz-Meydan
- School of Social Work, Faculty of Social Welfare & Health Sciences, University of Haifa, Israel. agewirtz-@univ.haifa.ac.il
| | - Tobias Nolte
- Research Department of Clinical, Educational, and Health Psychology, University College London (UCL), United Kingdom; Anna Freud, United Kingdom.
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Lampe A, Riedl D, Kampling H, Nolte T, Kirchhoff C, Grote V, Fischer MJ, Kruse J. Improvements of complex post-traumatic stress disorder symptoms during a multimodal psychodynamic inpatient rehabilitation treatment - results of an observational single-centre pilot study. Eur J Psychotraumatol 2024; 15:2333221. [PMID: 38577992 PMCID: PMC11000601 DOI: 10.1080/20008066.2024.2333221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
Background: Complex post-traumatic stress disorder (CPTSD) describes chronic disturbances in self-organization (i.e. affect dysregulation; negative self-concept; severe difficulties in relationships) which are frequently observed in survivors of prolonged, repeated or multiple traumatic stressors. So far, evidence of psychodynamic treatment approaches for CPTSD is scarce.Methods: In this single-centre observational pilot study, symptom change during a 6-week psychodynamic inpatient treatment in a multimodal psychosomatic rehabilitation centre was evaluated using repeated measures analyses of variance (ANOVAs). Patients completed questionnaires on PTSD and CPTSD symptoms (ITQ), anxiety, depression and somatization (BSI-18), functional impairment (WHODAS) and epistemic trust, mistrust and credulity (ETMCQ) before (T1) and at the end of treatment (T2). A hierarchical linear regression analysis was calculated to identify factors associated with improved CPTSD symptoms.Results: A total of n = 50 patients with CPTSD were included in the study, of whom n = 40 (80%) completed treatment. Patients reported a significant reduction of CPTSD symptoms during treatment with a large effect size (-3.9 points; p < .001; η2 = .36), as well as a significant reduction of psychological distress (p < .001; η2 = .55) and functional impairment (p < .001; η2 = .59). At the end of treatment, 41.0% of patients no longer fulfilled the diagnostic criteria for CPTSD. Changes in epistemic stance included improved epistemic trust (β = -.34, p = .026) and decreased epistemic credulity (β = .37, p = .017), which together with lower age (β = .43, p = .012) and lower depression levels at baseline (β = .35, p = .054) were significantly associated with baseline adjusted mean change of CPTSD symptoms during therapy and explained 48% of its variance.Discussion: In our study, patients reported a significant reduction of CPTSD symptoms and comorbid symptoms during a multimodal psychodynamic inpatient rehabilitation treatment. Improved epistemic trust may facilitate the establishment of a trusting therapeutic relationship, thus fostering an environment of openness for knowledge transfer (i.e. social learning) and the exploration of diverse viewpoints and perspectives in the therapeutic process.
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Affiliation(s)
- A. Lampe
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- VAMED Rehabilitation Montafon, Schruns, Austria
| | - D. Riedl
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - H. Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - T. Nolte
- Anna Freud National Centre for Children and Families, London, UK
- Research Department for Clinical, Educational and Heath Psychology, UCL, London, UK
| | - C. Kirchhoff
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - V. Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - M. J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- VAMED Rehabilitation Center Kitzbuehel, Kitzbuehel, Austria
| | - J. Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany
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Phillips AR, Hiller RM, Halligan SL, Lavi I, Macleod JAA, Wilkins D. A qualitative investigation into care-leavers' experiences of accessing mental health support. Psychol Psychother 2024. [PMID: 38456637 DOI: 10.1111/papt.12525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/06/2024] [Accepted: 02/18/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION People who grew up under the care of children's social services are a highly vulnerable group, with 50% of this population meeting the criteria for a mental health problem at any one time. Emerging evidence suggests that there is a disparity between the number of people who require support, and those that receive it, and that they face several barriers to accessing timely and effective mental health support. We have a limited understanding of how to support the mental health of this group as they 'age out' of children's social services, and the transition to independence, which occurs around the age of 18. We aimed to explore how care-leavers understand their experiences of help-seeking from formal mental health services. METHODS We used qualitative interviews, and Interpretative Phenomenological Analysis with 9 care-experienced young people aged between 18 and 25 years old. This work was co-produced by a team of care-experienced adults, from the conception of the study to write-up. RESULTS Qualitative analysis revealed several themes which centred around: (1) taking reluctant steps towards recovery, (2) challenges with being understood and the importance of gaining an understanding of yourself, (3) navigating trust and (4) the legacy of not having your mental health needs met. CONCLUSIONS We identified several important implications for health and social care practice, across primary and secondary health care settings. This work highlights ways to better support this highly vulnerable group in accessing evidence-based mental health support, and how to maintain engagement.
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Affiliation(s)
| | - Rachel M Hiller
- Division of Psychology & Language Sciences, University College London, London, UK
- Anna Freud Centre for Children and Families, London, UK
| | | | - Iris Lavi
- Department of Psychology, University of Bath, Bath, UK
| | - John A A Macleod
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Centre for Academic Primary Care, Bristol Medical School, The University of Bristol, Bristol, UK
| | - David Wilkins
- Children's Social Care Research and Development Centre, School of Social Sciences, Cardiff University, Cardiff, UK
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Asgarizadeh A, Ghanbari S. Iranian adaptation of the Epistemic Trust, Mistrust, and Credulity Questionnaire (ETMCQ): Validity, reliability, discriminant ability, and sex invariance. Brain Behav 2024; 14:e3455. [PMID: 38451001 PMCID: PMC10918607 DOI: 10.1002/brb3.3455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Epistemic trust, or trust in transmitted knowledge, has been proposed as a critical factor in psychopathology and psychotherapy. This study aimed at evaluating the psychometric properties of the Epistemic Trust, Mistrust, and Credulity Questionnaire (ETMCQ) in Iran. METHOD Data were collected from 906 participants. Along with the ETMCQ, measures of mentalizing, mindfulness, perspective-taking, attachment, emotion dysregulation, and borderline personality disorder were administered. Confirmatory factor analysis and exploratory structural equation modeling (ESEM) were used to determine factorial structure. RESULTS The ESEM model showed an acceptable fit and outperformed the confirmatory model. A 14-item version of the ETMCQ was retained after examining item performance. Our findings also established criterion-related validity for mistrust and credulity, an acceptable internal consistency for credulity, discriminant power for mistrust and credulity in detecting positive screens for borderline personality disorder, and measurement invariance across sexes. CONCLUSION This study provides evidence for the cross-cultural applicability of the ETMCQ. Nonetheless, the validity of the trust and internal consistency of the mistrust subscale require particular attention in future research.
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Affiliation(s)
- Ahmad Asgarizadeh
- Faculty of Education and PsychologyShahid Beheshti UniversityTehranIran
| | - Saeed Ghanbari
- Faculty of Education and PsychologyShahid Beheshti UniversityTehranIran
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Luyten P, Campbell C, Moser M, Fonagy P. The role of mentalizing in psychological interventions in adults: Systematic review and recommendations for future research. Clin Psychol Rev 2024; 108:102380. [PMID: 38262188 DOI: 10.1016/j.cpr.2024.102380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 12/20/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
Mentalizing is the human capacity to understand actions of others and one's own behavior in terms of intentional mental states, such as feelings, wishes, goals and desires. Mentalizing is a transtheoretical and transdiagnostic concept that has been applied to understanding vulnerability to psychopathology and has attracted considerable research attention over the past decades. This paper reports on a pre-registered systematic review of evidence concerning the role of mentalizing as a moderator and mediator in psychological interventions in adults. Studies in adults were reviewed that address the following questions: (a) does pre-treatment mentalizing predict treatment outcome; (b) do changes in mentalizing across treatment predict outcome; (c) does adherence to the principles or protocol of mentalization-based treatment predict outcome; and (d) does strengthening in-session mentalizing impact the therapeutic process via improved alliance, alleviated symptoms, or improved interpersonal functioning? Results suggest that mentalizing might be a mediator of change in psychotherapy and may moderate treatment outcome. However, the relatively small number of studies (n = 33 papers based on 29 studies, totaling 3124 participants) that could be included in this review, and the heterogeneity of studies in terms of design, measures used, disorders included, and treatment modalities, precluded a formal meta-analysis and limited the ability to draw strong conclusions. Therefore, theoretical and methodological recommendations for future research to improve the quality of existing research in this area are formulated.
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Affiliation(s)
- Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, Pobox 3722, Leuven 3000, Belgium; Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Max Moser
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
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Drake G, Drewek K. "I Hate Sim!"-Using Psychotherapeutic Concepts to Help Educators Attend to Challenging States of Mind During Simulation Prebriefs. Simul Healthc 2024:01266021-990000000-00110. [PMID: 38421370 DOI: 10.1097/sih.0000000000000781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
SUMMARY STATEMENT This article outlines the theoretical development of an approach to simulation prebriefing that we have adopted at Great Ormond Street Children's Hospital. Many educators struggle with anxious or reticent learners during simulation. This reticence often becomes apparent first during the simulation prebrief. Previous work highlights key points to cover in a prebrief. Less work has been done on the dilemma of how to engage such learners while also attempting to maintain a pedagogically effective stance for the entire group. This article pulls together current best practice guidance on prebriefing before exploring pertinent concepts from psychotherapeutic and pedagogical domains-the therapeutic setting, the therapeutic stance, and epistemic trust-which we believe can usefully and practically be applied to simulation practice in the service of engaging reticent learners while enhancing the psychological safety of both learners and educators.
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Affiliation(s)
- Gareth Drake
- From the DClinPsy (G.D.), Great Ormond Street Children's Hospital, London, UK; and BMBS BMedSci (K.D.), St George's Hospital, London, UK
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Fonagy P, Luyten P, Allison E, Campbell C. Taking stock to move forward: Where the field of developmental psychopathology might be heading. Dev Psychopathol 2024:1-10. [PMID: 38389294 DOI: 10.1017/s0954579424000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
In this paper, dedicated to Dante Cicchetti's contributions and enduring influence, we explore the prospective directions of developmental psychopathology. Our focus centers on key domains where Cicchetti's significant achievements have continually shaped our evolving thinking about psychological development. These domains include (a) the concepts of equifinality and multifinality, along with the challenges in predicting developmental trajectories, (b) the imperative to integrate wider sociocultural viewpoints into developmental psychopathology frameworks, (c) the interplay of genetic and environmental influences in developmental courses, (d) the significance of mental state language, and (e) the progress, or its absence, in the development of prevention and intervention tactics for children, adolescents, and their caregivers. While many of our forecasts regarding the future of developmental psychopathology may not materialize, we maintain optimistic that the essential ideas presented will influence the research agenda in this field and contribute to its growth over the next fifty years.
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Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Elizabeth Allison
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Karagiannopoulou E, Milienos FS, Desatnik A, Rentzios C, Athanasopoulos V, Fonagy P. A short version of the reflective functioning questionnaire: Validation in a greek sample. PLoS One 2024; 19:e0298023. [PMID: 38319928 PMCID: PMC10846711 DOI: 10.1371/journal.pone.0298023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/17/2024] [Indexed: 02/08/2024] Open
Abstract
This study aims to validate the Greek version of the 54-item Reflective Functioning Questionnaire (RFQ), a measure designed to assess an individual's capacity for understanding themselves and others based on internal mental states. This capacity, also known as Reflective Functioning (RF) or mentalizing, is believed to play a significant role in both typical and atypical development. The validation process examined the factor structure of the RFQ and its relationship with a variety of psychosocial and clinical constructs that have theoretical and empirical links to RF. Additionally, this research investigated the factor structure's invariance across gender and age groups to determine the robustness of the instrument. A unique contribution of this work lies in examining the application of the RFQ to attachment classifications through the use of cluster analysis. The sample consisted of 875 Greek adults from the general community with a mean age of 28.5 and a median age of 22. Participants completed the Greek RFQ along with a series of self-report questionnaires assessing psychosocial constructs, including attachment, epistemic trust, emotion regulation, and psychological mindedness, as well as clinical variables such as anxiety, depression, and borderline personality traits. Our findings suggest that a shorter, 31-item version of the questionnaire provides a robust three-factor structure across a non-clinical Greek adult population. The three identified subscales are (a) excessive certainty, (b) interest/curiosity, and (c) uncertainty/confusion, all demonstrating satisfactory reliability and construct validity. The uncertainty subscale was found to be associated with insecure attachment styles, epistemic mistrust and credulity, emotional suppression, and low psychological mindedness. In contrast, the certainty and curiosity subscales were linked to secure attachment, epistemic trust, emotion reappraisal, and psychological mindedness. Uncertainty was further shown to differ significantly across probable clinical and non-clinical groups, as distinguished by cut-off scores for anxiety, depression, and borderline personality disorder (BPD). However, the certainty and interest/curiosity subscales only varied between the two BPD groups. Our results provide the first evidence supporting the use of a 31-item version of the RFQ with three validated subscales to reliably assess reflective functioning in the Greek population, demonstrating stronger psychometric properties compared to other RFQ versions reported in previous studies. Findings suggest that impaired mentalizing capacity, as measured by the RFQ, is linked to insecure attachment, epistemic mistrust and credulity, poor emotion regulation, and low psychological mindedness, and potentially plays a role in adult mental health symptoms.
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Affiliation(s)
- Evangelia Karagiannopoulou
- Department of Psychology, University of Ioannina, Ioannina, Greece
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Fotios S. Milienos
- Department of Sociology, Panteion University of Social and Political Sciences, Athens, Greece
| | - Alex Desatnik
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Anna Freud National Centre for Children and Families, London, United Kingdom
- Open Door Young People Service, London, United Kingdom
| | | | | | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Anna Freud National Centre for Children and Families, London, United Kingdom
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Fonagy P, Campbell C, Allison E, Luyten P. Commentary: Special Issue on Interpersonal Trust. J Pers Disord 2024; 38:10-18. [PMID: 38324249 DOI: 10.1521/pedi.2024.38.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
This commentary reviews the Journal of Personality Disorders special issue "Interpersonal Trust and Borderline Personality Disorder: Insights From Clinical Practice and Research," published in Volume 37, Number 5, October 2023.
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Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London, London
| | - Elizabeth Allison
- Research Department of Clinical, Educational and Health Psychology, University College London, London
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
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13
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De Coninck D, Matthijs K, Van Bavel J, Luyten P. To be a freshman during the COVID-19 pandemic: A cross-lagged model of depression, mentalizing, and epistemic trust. Personal Ment Health 2024; 18:80-89. [PMID: 37960987 DOI: 10.1002/pmh.1598] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/14/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023]
Abstract
Research has shown that severity of depression increased in freshmen during their first months at university due to increased social and academic pressures. Since the start of the COVID-19 pandemic, several cross-sectional studies have suggested that levels of depression in university students are higher than before the pandemic, but longitudinal data are largely lacking. This study investigated severity of depression and negative affect linked to the pandemic among freshmen during their first semester at a large university in Flanders, Belgium. We also investigated whether epistemic trust predicted severity of depression and pandemic-related negative affect and whether problems with reflective functioning (or mentalizing) mediated these relations. Participants in this two-wave prospective study were 289 first-year students of the Faculty of Psychology and Educational Sciences of a large Belgian university. We conducted paired samples t-tests and cross-panel analysis to answer the research question. The number of students at risk of clinical depression increased by 41% between T1 (early October 2020) and T2 (late December 2020). Epistemic mistrust at T1 was prospectively associated with an increase in the prevalence and severity of depression at T2. Problems with mentalizing and negative COVID-19-related affect were positively associated with severity of depression at T2 and mediated the association between epistemic mistrust and severity of depression at T2. The findings highlight the key role of epistemic trust in the development of depression among freshmen, with the COVID-19 pandemic presenting an additional source of uncertainty.
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Affiliation(s)
| | - Koen Matthijs
- Centre for Sociological Research, KU Leuven, Leuven, Belgium
| | - Jan Van Bavel
- Centre for Sociological Research, KU Leuven, Leuven, Belgium
| | - Patrick Luyten
- Psychoanalysis Unit, University College London, London, UK
- Clinical Psychology, KU Leuven, Leuven, Belgium
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14
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Fisher S, Guralnik T, Fonagy P, Zilcha-Mano S. The development of the Epistemic Trust Rating System (ETRS). Psychother Res 2024:1-12. [PMID: 38185139 DOI: 10.1080/10503307.2023.2299213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/19/2023] [Indexed: 01/09/2024] Open
Abstract
OBJECTIVE The present study introduces and validates the Epistemic Trust Rating System (ETRS), an observer-based measure designed to assess epistemic trust (ET) within psychotherapy. ET in psychotherapy has gained much theoretical attention as a critical component in the therapeutic context, given its inherent link to social communication. However, its empirical validation remains pending, largely due to the absence of a refined instrument to gauge ET levels within the therapy environment. Therefore, this study aimed to translate ET's theoretical construct into tangible markers within the therapeutic context. METHOD One hundred eighteen patients enrolled in a randomized controlled trial received psychodynamic psychotherapy for depression. Incorporating top-down theoretical considerations with bottom-up empirical observations yielded an overall ETRS score accompanied by three distinct sub-scales, each assessing a singular ET element: one gauges the patient's propensity to share; another measures the degree to which "we-mode" moments are achieved within the session; and the third evaluates the patient's receptiveness to learning. RESULTS The findings demonstrate the psychometric robustness of the ETRS, with good internal consistency, interrater reliability (ICC(1,8) = .86-.90), and convergent (r = .23-.29) and discriminant validity (r = -.10). CONCLUSION The current study highlights the ETRS as a promising tool bridging theory and empirical exploration, enhancing our understanding of epistemic trust in psychotherapy.
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Affiliation(s)
- Shimrit Fisher
- The Department of Psychology, University of Haifa, Haifa, Israel
| | - Timur Guralnik
- The Department of Psychology, University of Haifa, Haifa, Israel
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Dlugatch R, Georgieva A, Kerasidou A. AI-driven decision support systems and epistemic reliance: a qualitative study on obstetricians' and midwives' perspectives on integrating AI-driven CTG into clinical decision making. BMC Med Ethics 2024; 25:6. [PMID: 38184595 PMCID: PMC10771643 DOI: 10.1186/s12910-023-00990-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 11/24/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Given that AI-driven decision support systems (AI-DSS) are intended to assist in medical decision making, it is essential that clinicians are willing to incorporate AI-DSS into their practice. This study takes as a case study the use of AI-driven cardiotography (CTG), a type of AI-DSS, in the context of intrapartum care. Focusing on the perspectives of obstetricians and midwives regarding the ethical and trust-related issues of incorporating AI-driven tools in their practice, this paper explores the conditions that AI-driven CTG must fulfill for clinicians to feel justified in incorporating this assistive technology into their decision-making processes regarding interventions in labor. METHODS This study is based on semi-structured interviews conducted online with eight obstetricians and five midwives based in England. Participants were asked about their current decision-making processes about when to intervene in labor, how AI-driven CTG might enhance or disrupt this process, and what it would take for them to trust this kind of technology. Interviews were transcribed verbatim and analyzed with thematic analysis. NVivo software was used to organize thematic codes that recurred in interviews to identify the issues that mattered most to participants. Topics and themes that were repeated across interviews were identified to form the basis of the analysis and conclusions of this paper. RESULTS There were four major themes that emerged from our interviews with obstetricians and midwives regarding the conditions that AI-driven CTG must fulfill: (1) the importance of accurate and efficient risk assessments; (2) the capacity for personalization and individualized medicine; (3) the lack of significance regarding the type of institution that develops technology; and (4) the need for transparency in the development process. CONCLUSIONS Accuracy, efficiency, personalization abilities, transparency, and clear evidence that it can improve outcomes are conditions that clinicians deem necessary for AI-DSS to meet in order to be considered reliable and therefore worthy of being incorporated into the decision-making process. Importantly, healthcare professionals considered themselves as the epistemic authorities in the clinical context and the bearers of responsibility for delivering appropriate care. Therefore, what mattered to them was being able to evaluate the reliability of AI-DSS on their own terms, and have confidence in implementing them in their practice.
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Affiliation(s)
- Rachel Dlugatch
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
- Usher Institute, Old Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Antoniya Georgieva
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Level 3 Women's Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Angeliki Kerasidou
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
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Kampling H, Riedl D, Hettich N, Lampe A, Nolte T, Zara S, Ernst M, Brähler E, Sachser C, Fegert JM, Gingelmaier S, Fonagy P, Krakau L, Kruse J. To trust or not to trust in the thrall of the COVID-19 pandemic: Conspiracy endorsement and the role of adverse childhood experiences, epistemic trust, and personality functioning. Soc Sci Med 2024; 341:116526. [PMID: 38169177 DOI: 10.1016/j.socscimed.2023.116526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/27/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024]
Abstract
RATIONALE Conspiracy endorsement is a public health challenge for the successful containment of the COVID-19 pandemic. While usually considered a societal phenomenon, little is known about the equally important developmental backdrops and personality characteristics like mistrust that render an individual prone to conspiracy endorsement. There is a growing body of evidence implying a detrimental role of adverse childhood experiences (ACEs) - a highly prevalent developmental burden - in the development of epistemic trust and personality functioning. This study aimed to investigate the association between ACEs and conspiracy endorsement in the general population, specifically questioning a mediating role of epistemic trust and personality functioning. METHODS Based on cross-sectional data from a representative German survey collected during the COVID-19 pandemic (N = 2501), we conducted structural equation modelling (SEM) where personality functioning (OPD-SQS) and epistemic trust (ETMCQ) were included as mediators of the association between ACEs and conspiracy endorsement. Bootstrapped confidence intervals (5000 samples, 95%-CI) are presented for all paths. RESULTS ACEs were significantly associated with conspiracy endorsement (β = 0.25, p < 0.001) and explained 6% of its variance. Adding epistemic trust and personality functioning as mediators increased the explained variance of conspiracy endorsement to 19% while the direct association between ACEs and conspiracy endorsement was diminished (β = 0.12, p < 0.001), indicating an indirect effect of personality functioning and epistemic trust in the association between ACEs and conspiracy endorsement. Fit indices confirmed good model fit. CONCLUSIONS Establishing an association between ACEs and conspiracy endorsement further increases the evidence for early childhood adversities' far-reaching and detrimental effects. By including epistemic trust and personality functioning, these findings contribute to a deeper understanding of the underlying mechanisms in the way that ACEs may be associated with conspiracy endorsement.
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Affiliation(s)
- Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany.
| | - David Riedl
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria; Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Nora Hettich
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Astrid Lampe
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria; VAMED Rehabilitation Center, Schruns, Austria
| | - Tobias Nolte
- Anna Freud National Centre for Children and Families, London, United Kingdom; Wellcome Trust Centre for Neuroimaging, Institute of Neurology, UCL, London, United Kingdom
| | - Sandra Zara
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Mareike Ernst
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of Clinical Psychology, Psychotherapy and Psychoanalysis, Institute of Psychology, University of Klagenfurt, Klagenfurt Am Wörthersee, Austria
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Integrated Research and Treatment Center for Adiposity Diseases, Behavioral Medicine Research Unit, University Medical Center Leipzig, Germany
| | - Cedric Sachser
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Stephan Gingelmaier
- Psychology and Diagnostics for Emotional and Social Development for the Emotionally Impaired, University of Education Ludwigsburg, Germany
| | - Peter Fonagy
- Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Lina Krakau
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany; Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany
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Parolin L, Milesi A, Comelli G, Locati F. The interplay of mentalization and epistemic trust: a protective mechanism against emotional dysregulation in adolescent internalizing symptoms. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:707. [PMID: 38189488 PMCID: PMC10849069 DOI: 10.4081/ripppo.2023.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/05/2023] [Indexed: 01/09/2024]
Abstract
Mentalization is the ability to interpret actions as caused by intentional mental states. Moreover, mentalization facilitates the development of epistemic trust (ET), namely, the ability to evaluate social information as accurate, reliable, and relevant. Recent theoretical literature identifies mentalization as a protective factor, contrasting psychopathology and emotional dysregulation. However, few investigations have explored the concurrent associations between mentalization, ET and emotion dysregulation in the context of internalizing problems in adolescence. In the present study, 482 adolescents from the general population aged between 12 and 19 were assessed with the epistemic trust mistrust credulity questionnaire, the reflective functioning questionnaire- youth, the difficulties in emotion regulation scale, and the youth self-report. We tested the relationship between the variables through serial mediation models. Results showed that mentalization reduces internalizing problems via emotional dysregulation; ET is positively associated with mentalization but not symptomatology. Finally, both epistemic mistrust and epistemic credulity are significantly associated with internalizing symptomatology; those effects are mediated differently by difficulties in emotional regulation. In conclusion, the present study confirms mentalization's role as a protective factor in developmental psychopathology. Nevertheless, exploring the role of the different epistemic stances guarantees a better understanding of psychopathological pathways in adolescence.
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Affiliation(s)
- Laura Parolin
- Department of Psychology, University of Milano-Bicocca, Milan.
| | - Alberto Milesi
- Department of Psychology, University of Milano-Bicocca, Milan.
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18
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Liotti M, Fiorini Bincoletto A, Bizzi F, Tironi M, Charpentier Mora S, Cavanna D, Giovanardi G, Jurist E, Speranza AM, Lingiardi V, Tanzilli A. The catcher in the mind: validation of the brief-mentalized affectivity scale for adolescents in the Italian population. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:709. [PMID: 38189462 PMCID: PMC10849075 DOI: 10.4081/ripppo.2023.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/03/2023] [Indexed: 01/09/2024]
Abstract
The concept of mentalized affectivity (MA) encompasses the dimensions of identifying, processing, and expressing emotions and describes the process of making sense of and reevaluating one's affects in light of autobiographical memory. This construct was developed within the theoretical framework of mentalization and, due to its interpersonal nature, added further complexity to the emotion regulation construct. This research aimed to examine the factor structure and psychometric properties of the Brief-Mentalized Affectivity Scale for adolescents (B-MAS-A) on an Italian sample of young people (aged 13-19 years). Data were collected using non-probabilistic sampling and an online survey. Participants were asked to complete a large battery of instruments, including the B-MAS-A, the Toronto Alexithymia Scale, the Reflective Functioning Questionnaire, the Epistemic Trust, Mistrust, and Credulity Questionnaire, the Strengths and Difficulties Questionnaire, and the General Self-Efficacy Scale. In study 1, factor analyses carried out on a total sample of 566 adolescents identified 3 distinct dimensions of the same components of MA found in the adult population: i) identifying; ii) processing; iii) expressing emotions. The subscales showed excellent internal consistency. Study 2 (involving a subsample of 288 participants) demonstrated good levels of construct and criterion validity. These results confirm that the B-MAS-A represents a valid and robust instrument for assessing the complex and multifaceted characteristics of MA in adolescents. The B-MAS-A can make a significant contribution to clinical practice and research and encourage systematic studies on MA in psychotherapy, taking into account the developmental stage of adolescence.
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Affiliation(s)
- Marianna Liotti
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome.
| | | | - Fabiola Bizzi
- Department of Educational Sciences, University of Genoa.
| | - Marta Tironi
- Department of Educational Sciences, University of Genoa.
| | | | | | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome.
| | - Elliot Jurist
- Department of Psychology, City College of the City University of New York.
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome.
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome.
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome.
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Brauner F, Fonagy P, Campbell C, Griem J, Storck T, Nolte T. "Trust me, do not trust anyone": how epistemic mistrust and credulity are associated with conspiracy mentality. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:705. [PMID: 38156557 PMCID: PMC10782893 DOI: 10.4081/ripppo.2023.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/30/2023] [Indexed: 12/30/2023]
Abstract
Previous research shows that the propensity to endorse conspiracy theories is associated with disrupted forms of epistemic trust, i.e., the appropriate openness towards interpersonally communicated information. There are associations, first, with an increased mistrust in several actors and institutions responsible for the communication of information in society, and second, with a pronounced credulity in unreliable sources and implausible phenomena (e.g., superstition, astrology). This study aims to investigate whether these phenomena are associated with specific personality-related disruptions of epistemic trust. Based on selfreported data of 417 individuals (mean = 33.28; standard deviation = 11.11) from a UK population sampled online, the potential relationships between disruptions in epistemic trust and the endorsement of a conspiracy mentality are explored. The epistemic stances characterized by mistrust and credulity (independent variables) are measured with the epistemic trust, mistrust, and credulity questionnaire (ETMCQ), and conspiracy mentality (dependent variable) is measured with the conspiracy mentality questionnaire. In a multiple linear regression model, mistrust is associated with the endorsement of a conspiracy mentality, even when accounting for other contributing factors (e.g., individual narcissism, attachment avoidance and anxiety, authoritarianism, loneliness). In a bootstrapped mediation model controlling for other relevant predictors, the association between credulity and conspiracy mentality is fully mediated by mistrust. In future research, the impact of disrupted epistemic trust on conspiracy beliefs should be investigated in terms of the specific epistemic stances of mistrust and credulity. In this respect, the ETMCQ represents a highly promising instrument to assess individual differences in factors underpinning aspects of conspiracy endorsement.
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Affiliation(s)
- Felix Brauner
- Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin.
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London.
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London.
| | - Julia Griem
- Institute of Psychiatry, Psychology and Neuroscience, King's College London.
| | - Timo Storck
- Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin.
| | - Tobias Nolte
- Research Department of Clinical, Educational and Health Psychology, University College London.
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Hauschild S, Kasper LA, Berning A, Taubner S. The relationship between epistemic stance, mentalizing, paranoid distress and conspiracy mentality: an empirical investigation. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:706. [PMID: 38156598 PMCID: PMC10782896 DOI: 10.4081/ripppo.2023.706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/04/2023] [Indexed: 12/30/2023]
Abstract
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.
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Affiliation(s)
- Sophie Hauschild
- Institute for Psychosocial Prevention, University Hospital Heidelberg.
| | - Lea A Kasper
- Institute for Psychosocial Prevention, University Hospital Heidelberg; Psychological Institute, University Heidelberg.
| | - Anna Berning
- Institute for Psychosocial Prevention, University Hospital Heidelberg; Psychological Institute, University Heidelberg.
| | - Svenja Taubner
- Institute for Psychosocial Prevention, University Hospital Heidelberg; Psychological Institute, University Heidelberg.
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Riedl D, Kampling H, Kruse J, Nolte T, Labek K, Kirchhoff C, Grote V, Fischer MJ, Knipel A, Lampe A. Epistemic Trust Is a Critical Success Factor in Psychosomatic Rehabilitation-Results from a Naturalistic Multi-Center Observational Study. J Clin Med 2023; 13:177. [PMID: 38202184 PMCID: PMC10780285 DOI: 10.3390/jcm13010177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
Knowledge about critical success factors underpinning beneficial treatment outcomes in psychosomatic inpatient rehabilitation is scarce. The aim of this study was to evaluate the influence of patients' epistemic stance in relation to the improvement of psychological distress during rehabilitation. In this naturalistic longitudinal observational study, n = 771 patients completed routine assessments for psychological distress (BSI-18), health-related quality of life (HRQOL; WHODAS), and epistemic trust (ETMCQ) before (T1) and after (T2) psychosomatic rehabilitation. Patients were grouped as best, average, and worst responders based on their mean BSI-18 changes during treatment, and their mean change in epistemic trust, mistrust, and credulity was compared using repeated measures analyses of variance (rANOVAs). No associations of performance with sex (p = 0.09), age (p = 0.11), or relationship status (p = 0.58) were found. Best responders reported significantly improved epistemic trust (p = 0.001) and reduced epistemic mistrust (p < 0.001), whereas worst responders reported a significant increase in epistemic mistrust (p < 0.001) and credulity (p < 0.001). Average responders did not change for either epistemic trust (p = 0.11), mistrust (p > 0.99), or credulity (p = 0.96). Our results underscore the role of the epistemic stance in psychosomatic and psychotherapeutic treatments. These results help to better understand what might determine psychosomatic rehabilitation outcomes and indicate the role of epistemic trust as a critical success factor.
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Affiliation(s)
- David Riedl
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, 35390 Giessen, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, 35390 Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, 35037 Marburg, Germany
| | - Tobias Nolte
- Anna Freud National Centre for Children and Families, London N1 9JH, UK
- Research Department for Clinical, Educational and Heath Psychology, University College London, London WC1E 6BT, UK
| | - Karin Labek
- Institute of Psychology, University of Innsbruck, 6020 Innsbruck, Austria
| | - Christina Kirchhoff
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria
| | - Michael J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria
- VAMED Rehabilitation Center Kitzbuehel, 6370 Kitzbuehel, Austria
| | | | - Astrid Lampe
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria
- VAMED Rehabilitation Center Montafon, 6780 Schruns, Austria
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22
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Li E, Campbell C, Midgley N, Luyten P. Epistemic trust: a comprehensive review of empirical insights and implications for developmental psychopathology. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:704. [PMID: 38156560 PMCID: PMC10772859 DOI: 10.4081/ripppo.2023.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/27/2023] [Indexed: 12/30/2023]
Abstract
Originally rooted in philosophy and sociology, the concept of epistemic trust has recently transitioned to developmental psychopathology, illuminating social-cognitive processes in psychopathology. This narrative review synthesizes empirical evidence on epistemic trust to inform future research. A literature search highlighted 3 areas: i) the development of selective trust in children; ii) epistemic trust in non-clinical adults; iii) its link to mental health. Young children demonstrate selective learning from reliable sources using epistemic cues. Empirical studies beyond childhood were greatly facilitated in the last 2 years with the introduction of the Epistemic Trust, Mistrust and Credulity Questionnaire, a self-report scale measuring epistemic stance. Cross-sectional studies pinpointed dysfunctional epistemic strategies as factors in mental health vulnerability, and some qualitative work offered initial evidence linking restored epistemic trust to effective psychotherapy. For future research, we propose focusing on 3 primary areas. First, empirical investigations in adolescent samples are needed, as adolescence seems to be a pivotal phase in the development of epistemic trust. Second, more experimental research is required to assess dysfunctional and functional epistemic stances and how they relate to vulnerability to mental health disorders. Finally, intervention studies should explore the dynamics of epistemic stances within and between therapy sessions and their impact on therapeutic outcomes.
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Affiliation(s)
- Elizabeth Li
- Research Department of Clinical, Educational and Health Psychology, University College London; Anna Freud Centre, London.
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London; Anna Freud Centre, London.
| | - Nick Midgley
- Research Department of Clinical, Educational and Health Psychology, University College London; Anna Freud Centre, London.
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom; Anna Freud Centre, London, United Kingdom; Faculty of Psychology and Educational Sciences, University of Leuven.
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Benzi IMA, Carone N, Parolin L, Martin-Gagnon G, Ensink K, Fontana A. Different epistemic stances for different traumatic experiences: implications for mentalization. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:708. [PMID: 38156583 PMCID: PMC10772857 DOI: 10.4081/ripppo.2023.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/04/2023] [Indexed: 12/30/2023]
Abstract
Traumatic experiences may impair reflective functioning (RF), making it difficult for individuals to understand their own and others' mental states. Epistemic trust (ET), which enables evaluating social information as reliable and relevant, may vary in association with RF. In this study, we explored the implications of different ET stances (i.e., trust, mistrust, and credulity) in the relation between different childhood traumatic experiences (i.e., emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and different types of RF impairments (uncertainty and certainty about mental states). A non-clinical community sample of 496 cisgender emerging adults (mage = 24.91, standard deviation = 2.66, 71.85% assigned female at birth, 63.63% heterosexual) reported on their childhood traumatic experiences, ET, and RF. We used structural equation models to examine direct and indirect associations. The results showed significant indirect effects between emotional abuse and uncertainty about mental states through credibility. We also observed significant indirect effects between emotional abuse and certainty about mental states through mistrust and credibility. The findings suggest that a lack of discrimination when evaluating knowledge from others (i.e., credulity) might promote increased uncertainty in RF when emerging adults have experienced emotional abuse in their childhood. Conversely, a tendency to view all information sources as unreliable or ill-intentioned (i.e., mistrust) may foster greater certainty in RF as a protective mechanism against an unreliable and potentially harmful world when combined with childhood emotional abuse. The implications for clinical practice and intervention are discussed.
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Affiliation(s)
| | - Nicola Carone
- Department of Brain and Behavioral Sciences, University of Pavia.
| | - Laura Parolin
- Department of Psychology, University of Milano-Bicocca, Milan.
| | | | - Karin Ensink
- Department of Psychology, Laval University, Quebec.
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24
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Damnjanović K, Ilić S, Kušić M, Lazić M, Popović D. Psychological Factors of Vaccination Intent among Healthcare Providers, Parents, and Laypeople. Vaccines (Basel) 2023; 11:1816. [PMID: 38140220 PMCID: PMC10748119 DOI: 10.3390/vaccines11121816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
The interrelatedness of social-structural aspects and psychological features with vaccination intention provides the context to explore personal psychological features related to vaccination. Specifically, we focused on general decision making and vaccine-related dispositions, and their contribution to the intention to vaccinate, within post-pandemic circumstances, after the imposed possibility of choosing a vaccine brand. Our study aimed to map the function (promotive, protective, risk, vulnerability) of a set of personal psychological aspects in the intention to vaccinate among people holding different social roles regarding the vaccination. We surveyed three samples of people: healthcare providers (HPs), parents, and laypeople, within the post-pandemic context. Negative vaccine attitudes lower intention to vaccinate in all regression models (all βs ranging from -0.128 to -0.983, all ps < 0.01). The main results indicate that, regardless of the sample/social role, there is a shared attitudinal core for positive vaccination intention. This core consists of [high] trust in large corporations, government, and healthcare systems, as well as perceived consensus on vaccine safety/efficacy and experience of freedom (protective factors), and [low] vaccination conspiracy beliefs, trust in social media, and choice overload (risk and vulnerability factors, respectively). There are no common promotive factors of intention to vaccinate: for parents, perceived consensus on vaccines, and trust in corporations and the healthcare system, play such roles; for HPs, the experience of freedom is obtained as a unique promotive factor. In contrast, for laypeople, no unique promotive factors were found. Our findings provide insights into the function of psychological factors of vaccination intention across different social roles, particularly healthcare providers, parents, and laypeople, and emphasize the need for tailored immunization interventions in the post-pandemic landscape.
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Affiliation(s)
- Kaja Damnjanović
- Laboratory for Experimental Psychology, Department of Psychology, Institute of Philosophy, Faculty of Philosophy, University of Belgrade, 11000 Beograd, Serbia
| | - Sandra Ilić
- Laboratory for Experimental Psychology, Department of Psychology, Faculty of Philosophy, University of Belgrade, 11000 Beograd, Serbia;
| | - Marija Kušić
- Laboratory for Research of Individual Differences, Department of Psychology, Faculty of Philosophy, University of Belgrade, 11000 Beograd, Serbia;
| | - Milica Lazić
- Faculty of Philosophy, University of Novi Sad, 21000 Novi Sad, Serbia;
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25
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Locati F, Benzi IMA, Milesi A, Campbell C, Midgley N, Fonagy P, Parolin L. Associations of mentalization and epistemic trust with internalizing and externalizing problems in adolescence: A gender-sensitive structural equation modeling approach. J Adolesc 2023; 95:1564-1577. [PMID: 37500187 DOI: 10.1002/jad.12226] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/27/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Mentalization, operationalized as reflective functioning (RF), allows individuals to interpret actions as caused by intentional mental states. Previous research highlighted the gender-specific associations between adolescents' internalizing and externalizing difficulties and mentalizing impairments. In addition, research suggested that mentalizing facilitates the creation of epistemic trust (ET) to evaluate social information as accurate, reliable, and relevant. However, few investigations explored the concurrent associations between RF, ET, and adolescent psychopathology. METHODS A sample of 447 Italian cisgender adolescents (57% assigned females at birth; age range 12-19 years old; Mage = 15.54, SD = 1.98) self-reported RF (RFQY-5), ET towards mother, father, and peers (IPPA) and mental health problems (YSR-112). Gender-specific structural equation modeling explored the associations between RF, ET, and internalizing/externalizing problems. RESULTS Results suggested an excellent fit for the theoretical model and revealed gender-related associations. In females, findings suggest that ET mediates the association between RF and psychopathology, with indirect associations from RF through ET to lower internalizing and externalizing problems. However, in males, RF and ET display independent associations with psychopathology. CONCLUSION Overall, findings suggest that ET might be a transdiagnostic factor playing different roles associated with adolescent psychopathology. Indeed, links between RF and ET might help to explore gender differences in mental health problems in this developmental phase.
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Affiliation(s)
| | | | - Alberto Milesi
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Chloe Campbell
- Research Department of Clinical, Educational, and Health Psychology, UCL London, and the Anna Freud Centre, London, UK
| | - Nicholas Midgley
- Research Department of Clinical, Educational, and Health Psychology, UCL London, and the Anna Freud Centre, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational, and Health Psychology, UCL London, and the Anna Freud Centre, London, UK
| | - Laura Parolin
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
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26
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Knapen S, Swildens WE, Mensink W, Hoogendoorn A, Hutsebaut J, Beekman ATF. The development and psychometric evaluation of the Questionnaire Epistemic Trust (QET): A self-report assessment of epistemic trust. Clin Psychol Psychother 2023. [PMID: 37947067 DOI: 10.1002/cpp.2930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
Epistemic trust (ET) refers to the predisposition to trust information as authentic, trustworthy and relevant to the self. Epistemic distrust - resulting from early adversity - may interfere with openness to social learning within the therapeutic encounter, reducing the ability to benefit from treatment. The self-report Questionnaire Epistemic Trust (QET) is a newly developed instrument that aims to assess ET. This study presents the first results on the psychometric properties of the QET in both a community and a clinical sample. Our findings indicate that the QET is composed of four meaningful subscales with good to excellent internal consistency. The QET shows relevant associations with related constructs like personality functioning, symptom distress and quality of life. QET scores clearly distinguish between a clinical and community sample and are associated with the quality of the therapeutic alliance. The QET provides a promising, brief and user-friendly instrument that could be used for a range of clinical and research purposes. Future studies with larger samples are needed to strengthen construct validity and to investigate the value of the QET to predict differential treatment responses or to study mechanisms of change.
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Affiliation(s)
- Saskia Knapen
- Altrecht Mental Health Care, Utrecht, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wilma E Swildens
- Altrecht Mental Health Care, Utrecht, Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | - Wendy Mensink
- Altrecht Mental Health Care, Utrecht, The Netherlands
| | - Adriaan Hoogendoorn
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Joost Hutsebaut
- Tilburg University and Viersprong Institute for the Study on Personality Disorders, Halsteren, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
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27
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Benzi IMA, Compare A, Tona AL, Di Nuovo S, Lazzari D, Lingiardi V, Coco GL, Parolin L. PsyCARE study: assessing impact, cost-effectiveness, and transdiagnostic factors of the Italian ministry of health's "psychological bonus" policy. BMC Psychol 2023; 11:306. [PMID: 37798802 PMCID: PMC10557166 DOI: 10.1186/s40359-023-01345-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The prevalence of anxiety and depression disorders is surging worldwide, prompting a pressing demand for psychological interventions, especially in less severe cases. Responding to this need, the Italian government implemented the "Psychological Bonus" (PB) policy, allotting 25 million euros for mental health support. This policy entitles individuals to a minimum of four to twelve psychological sessions. In collaboration with the National Board of Italian Psychologists, our study assesses this policy's effectiveness. Indeed, the PsyCARE study aims to examine the utilization of the Psychological Bonus, evaluate its impact on adult and adolescent participants' psychological well-being through pre- and post-intervention assessments and six-month follow-up, and conduct a longitudinal cost-effectiveness analysis of this policy. A secondary aim is to investigate the influence of these interventions on transdiagnostic factors, including emotion regulation and epistemic trust. METHODS The study involves licensed psychotherapists and their patients, both adults and adolescents, benefiting from the Psychological Bonus. Data collection is underway and set to conclude in December 2023. Psychotherapists will provide diagnostic information and assess patient functioning. In addition, patients will be evaluated on mental health aspects such as clinical symptoms, emotion regulation, epistemic trust, and quality of life. We will employ linear mixed-effects models to analyze the outcomes, accounting for both fixed and random effects to capture the hierarchical structure of the data. DISCUSSION We anticipate the study's findings will highlight reduced psychological distress and improved quality of life for participants and demonstrate the Psychological Bonus policy's cost-effectiveness. The study will gather data on the role of specific versus nonspecific therapeutic factors in psychotherapy while adopting a patient-tailored approach to identify effective therapeutic elements and examine transdiagnostic factors. Overall, this study's findings will guide future measures within the Italian healthcare system, fostering a psychological health culture and providing valuable insights to the broader public. STUDY REGISTRATION https://osf.io/6zk2j.
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Affiliation(s)
- Ilaria M A Benzi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Angelo Compare
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Antonino La Tona
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Santo Di Nuovo
- Department of Science of Education, University of Catania, Catania, Italy
| | - David Lazzari
- National Board of Italian Psychologists (CNOP), Rome, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Laura Parolin
- National Board of Italian Psychologists (CNOP), Rome, Italy.
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, Milan, 20126, Italy.
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28
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Malcorps S, Vliegen N, Luyten P. Childhood adversity and adolescent acting-out behaviors: the mediating role of mentalizing difficulties and epistemic vigilance. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02302-9. [PMID: 37787820 DOI: 10.1007/s00787-023-02302-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Abstract
Childhood adversity is a well-established risk factor for adolescent acting-out behaviors such as self-harm, bingeing, substance abuse, and aggressive behavior. From a mentalizing perspective, acting-out behaviors are understood as resulting from a combination of impairments in mentalizing and epistemic vigilance that are a consequence of childhood adversity. Yet, few studies have investigated these assumptions. The current study investigated the potential mediating role of mentalizing impairments and epistemic vigilance in the relationship between childhood adversity and acting-out behaviors in adolescents, oversampled for risk status for psychopathology (N = 451, mean age = 15.40 years). Structural equation modeling showed a strong, direct relationship between childhood adversity and acting-out behaviors, confirming the importance of traumatic childhood experiences for adolescent acting-out behaviors. This relationship was partially mediated by both mentalizing difficulties and epistemic vigilance, explaining about 40% of the total variance. These results support the importance of focusing on strengthening mentalizing abilities and lowering epistemic hypervigilance in psychotherapeutic work with adolescents who have experienced childhood trauma.
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Affiliation(s)
- Saskia Malcorps
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, PO Box 3720, 3000, Leuven, Belgium.
| | - Nicole Vliegen
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, PO Box 3720, 3000, Leuven, Belgium
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, PO Box 3720, 3000, Leuven, Belgium
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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29
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Asgarizadeh A, Hunjani M, Ghanbari S. Do we really need "trust"? the incremental validity of epistemic trust over epistemic mistrust and credulity in predicting mentalizing-related constructs. Asian J Psychiatr 2023; 87:103688. [PMID: 37413922 DOI: 10.1016/j.ajp.2023.103688] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Ahmad Asgarizadeh
- Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran.
| | - Mahsa Hunjani
- Family Research Institute, Shahid Beheshti University, Tehran, Iran.
| | - Saeed Ghanbari
- Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran.
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30
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Fiorini Bincoletto A, Zanini L, Spitoni GF, Lingiardi V. Negative and positive ageism in an Italian sample: how ageist beliefs relate to epistemic trust, psychological distress, and well-being. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:676. [PMID: 37503673 PMCID: PMC10483480 DOI: 10.4081/ripppo.2023.676] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/04/2023] [Indexed: 07/29/2023]
Abstract
Ageism is a social issue of growing concern; ageist beliefs can shape the individual and collective experience of aging. The present study aimed to explore positive and negative ageism in young adults (YA) (18-30 years) and adults (AD) (31-60 years) and their relationship with epistemic trust, psychological distress, and psychological well-being. 301 Italian adult participants completed an online survey that included the following self-report questionnaires: attitudes towards older people scale, epistemic trust, mistrust and credulity questionnaire, depression anxiety stress scale-21, and Warwick-Edinburgh mental wellbeing scale. Negative ageism was significantly higher in YA compared to AD; on the contrary, AD presented more positive ageism than YA. When considering the entire sample, negative ageism was correlated with various dimensions of psychological distress and epistemic trust. A mediation model revealed that epistemic mistrust fully mediated the relationship between age and negative ageism, suggesting that changes in ageist beliefs that seem to occur with age are mediated by a mistrustful epistemic stance. Future research should focus on further exploring the link between epistemic trust, mental health, and holding ageist beliefs. The results are also discussed in terms of their implications for the treatment of older patients.
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Affiliation(s)
| | - Ludovica Zanini
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome.
| | - Grazia Fernanda Spitoni
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome.
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome.
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31
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Howieson JA. A framework for the evidence-based practice of therapeutic jurisprudence: A legal therapeutic alliance. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 89:101906. [PMID: 37451069 DOI: 10.1016/j.ijlp.2023.101906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
This paper provides a theoretical rationale for using the constructs of procedural justice, trust and self-determination as a framework to guide the evidence-based practice of therapeutic jurisprudence (TJ). The overarching purpose of TJ is to provide therapeutic outcomes to all participants in the legal system. This paper proposes that in legal decision-making, running a procedurally just process that generates trust amongst participants and allows the parties to experience self-determination, creates a dynamic akin to the therapeutic alliance, which, in therapy, is a reliable predictor of therapeutic outcomes. The paper argues that when a legal therapeutic alliance forms in a legal decision-making process then positive therapeutic outcomes are possible, and the process can be classified as one that accords with the philosophy of TJ. A subsequent argument is that a therapeutic court can be defined as one that enacts such a process. The paper concludes by explaining how the framework can provide both a guide to courts in designing TJ processes and an assessment framework to analyse legal decision-making processes for their therapeutic value.
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Affiliation(s)
- Jill A Howieson
- Law School, University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia.
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32
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Riedl D, Rothmund MS, Grote V, Fischer MJ, Kampling H, Kruse J, Nolte T, Labek K, Lampe A. Mentalizing and epistemic trust as critical success factors in psychosomatic rehabilitation: results of a single center longitudinal observational study. Front Psychiatry 2023; 14:1150422. [PMID: 37252135 PMCID: PMC10213326 DOI: 10.3389/fpsyt.2023.1150422] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Background Inpatient psychosomatic rehabilitation is a key treatment for patients with mental health issues. However, knowledge about critical success factors for beneficial treatment outcomes is scarce. The aim of this study was to evaluate the association of mentalizing and epistemic trust with the improvement of psychological distress during rehabilitation. Methods In this naturalistic longitudinal observational study, patients completed routine assessments of psychological distress (BSI), health-related quality of life (HRQOL; WHODAS), mentalizing (MZQ), and epistemic trust (ETMCQ) before (T1) and after (T2) psychosomatic rehabilitation. Repeated measures ANOVA (rANOVAs) and structural equation models (SEMs) were calculated to investigate the association of mentalizing and epistemic trust with the improvement in psychological distress. Results A total sample of n = 249 patients were included in the study. Improvement in mentalizing was correlated with improvement in depression (r = 0.36), anxiety (r = 0.46), and somatization (r = 0.23), as well as improved cognition (r = 0.36), social functioning (r = 0.33), and social participation (r = 0.48; all p < 0.001). Mentalizing partially mediated changes in psychological distress between T1 and T2: the direct association decreased from β = 0.69 to β = 0.57 and the explained variance increased from 47 to 61%. Decreases in epistemic mistrust (β = 0.42, 0.18-0.28; p < 0.001) and epistemic credulity (β = 0.19, 0.29-0.38; p < 0.001) and increases in epistemic trust (β = 0.42, 0.18-0.28; p < 0.001) significantly predicted improved mentalizing. A good model fit was found (χ2 = 3.248, p = 0.66; CFI = 0.99; TLI = 0.99; RMSEA = 0.000). Conclusion Mentalizing was identified as a critical success factor in psychosomatic inpatient rehabilitation. A key component to increase mentalizing in this treatment context is the improvement of epistemic mistrust.
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Affiliation(s)
- David Riedl
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Maria Sophie Rothmund
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Michael J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- VAMED Rehabilitation Center Kitzbuehel, Kitzbuehel, Austria
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany
| | - Tobias Nolte
- Anna Freud National Center for Children and Families, London, United Kingdom
- Research Department for Clinical, Educational and Heath Psychology, University College London, London, United Kingdom
| | - Karin Labek
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Astrid Lampe
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- VAMED Rehabilitation Center, Schruns, Austria
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33
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Campbell C, Fonagy P. Epistemic trust and unchanging personal narratives. Behav Brain Sci 2023; 46:e87. [PMID: 37154118 DOI: 10.1017/s0140525x22002540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Focusing on imagination and the social context in the generation of conviction narratives, we propose that these elements are dynamically related to one another, and crucially that it is the nature of this relationship that determines individuals' level of epistemic openness and capacity to respond adaptively to update their narratives in a way that increases the possibility of more successful decision-making.
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Affiliation(s)
- Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, UK https://www.ucl.ac.uk/psychoanalysis/people/chloe-campbell
| | - Peter Fonagy
- Division of Psychology and Language Sciences, University College London, London WC1H 0AP, UK. https://www.ucl.ac.uk/pals/people/peter-fonagy
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34
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Locati F, Milesi A, Conte F, Campbell C, Fonagy P, Ensink K, Parolin L. Adolescence in lockdown: The protective role of mentalizing and epistemic trust. J Clin Psychol 2023; 79:969-984. [PMID: 36256870 PMCID: PMC9874639 DOI: 10.1002/jclp.23453] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/14/2022] [Accepted: 10/03/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Mentalizing is the ability to interpret one's own and others' behavior as driven by intentional mental states. Epistemic trust (openness to interpersonally transmitted information) has been associated with mentalizing. Balanced mentalizing abilities allow people to cope with external and internal stressors. Studies show that social isolation imposed by the COVID-19 pandemic was highly stressful for most people, especially for adolescents. Here we examine whether mentalizing and epistemic trust were protective factors in relation to emotional distress during the lockdown. METHOD A total of 131 nonclinical adolescents, aged between 12 and 18 years, were evaluated during the lockdown using the Reflective Functioning Questionnaire for Youth, Inventory of Parent and Peer Attachment, Perceived Stress Scale, and Difficulties in Emotion Regulation Scale. RESULTS Results from network analysis showed that epistemic trust and mentalizing were negatively associated with perceived stress and emotion dysregulation. Epistemic trust in fathers was associated with level of perceived stress, and epistemic trust in mothers with emotion dysregulation. CONCLUSION These findings suggest that epistemic trust and the capacity to mentalize were low in adolescents during lockdown, and this was associated with high levels of stress. However, robust levels of epistemic trust and mentalizing may have acted as protective factors that buffered individuals from the risk of emotional dysregulation during the lockdown.
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Affiliation(s)
| | - Alberto Milesi
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Federica Conte
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Chloe Campbell
- Psychoanalysis Unit, University College London and Anna Freud National Centre for Children and Families, London, UK
| | - Peter Fonagy
- Psychoanalysis Unit, University College London and Anna Freud National Centre for Children and Families, London, UK
| | - Karin Ensink
- Faculté des sciences sociales, Université Laval, Québec, Canada
| | - Laura Parolin
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
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35
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Fonagy P, Campbell C, Luyten P. Attachment, Mentalizing and Trauma: Then (1992) and Now (2022). Brain Sci 2023; 13:brainsci13030459. [PMID: 36979268 PMCID: PMC10046260 DOI: 10.3390/brainsci13030459] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023] Open
Abstract
This article reviews the current status of research on the relationship between attachment and trauma in developmental psychopathology. Beginning with a review of the major issues and the state-of-the-art in relation to current thinking in the field of attachment about the impact of trauma and the inter-generational transmission of trauma, the review then considers recent neurobiological work on mentalizing and trauma and suggests areas of new development and implications for clinical practice.
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Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
- Correspondence:
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
- Faculty of Psychology and Educational Sciences, KU Leuven, B-3000 Leuven, Belgium
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Chevalier V, Simard V, Achim J. Meta-analyses of the associations of mentalization and proxy variables with anxiety and internalizing problems. J Anxiety Disord 2023; 95:102694. [PMID: 36905852 DOI: 10.1016/j.janxdis.2023.102694] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/15/2022] [Accepted: 02/28/2023] [Indexed: 03/13/2023]
Abstract
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.
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Affiliation(s)
- Valérie Chevalier
- Department of Psychology, Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil J4K 0A8, QC, Canada
| | - Valérie Simard
- Department of Psychology, Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil J4K 0A8, QC, Canada; Charles-Le Moyne Research Center, 150 Place Charles-Le Moyne, Suite 200, Longueuil J4K 0A8, QC, Canada; Research Center of the Sainte-Justine University Hospital, 3175 Côte-Sainte-Catherine Road, Montréal, QC H3T 1C5, Canada.
| | - Julie Achim
- Department of Psychology, Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil J4K 0A8, QC, Canada; Charles-Le Moyne Research Center, 150 Place Charles-Le Moyne, Suite 200, Longueuil J4K 0A8, QC, Canada; Research Center of the Centre intégré universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montréal Sacré-Coeur Hospital, 5400, Gouin Blvd West, Montreal H4J 1C5, QC, Canada
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Kwon M, Lawn S, Kaine C. Understanding Men's Engagement and Disengagement When Seeking Support for Mental Health. Am J Mens Health 2023; 17:15579883231157971. [PMID: 36880329 PMCID: PMC9996733 DOI: 10.1177/15579883231157971] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Men are less likely to utilize health care services compared with women. When it comes to mental health, men have been reported to hold more reluctant attitudes toward engaging with mental health services. Current studies have predominantly been quantitative and focused on understanding effective strategies to promote men's engagement and why men may avoid help-seeking or may not seek help early; few studies exist of men's disengagement from services. Much of this research has been undertaken from the services' perspective. The study reported here attempts to gain better insight into the reasons men give for their disengagement from mental health services and what men say will reengage them back into the system. This research was a secondary analysis of data collected by a national survey conducted by Lived Experience Australia (LEA). Responses of 73 male consumers were gathered and analyzed. Analysis of the responses was split into two themes with associated subthemes: (1) Why men disengage: (1.1) Autonomy; (1.2) Professionalism; (1.3) Authenticity; and (1.4) Systemic Barriers; and (2) What will help men reengage: (2.1) Clinician-driven reconciliation, (2.2) Community and Peer Workers; and (2.3) Ease of reentry. Findings highlight strategies to prevent disengagement such as creating open and honest therapeutic environments and improving men's mental health literacy while providing care. Evidence-based approaches to reengage male consumers are suggested along with an emphasis on men's strong preferences for community-based mental health services and peer workers.
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Affiliation(s)
- Minjoo Kwon
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Lived Experience Australia, Adelaide, South Australia, Australia
| | - Christine Kaine
- Lived Experience Australia, Adelaide, South Australia, Australia
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Lai W, Li W, Guo L, Wang W, Xu K, Dou Q, Shi J, Teopiz KM, McIntyre RS, Lu C. Association between bullying victimization, coping style, and mental health problems among Chinese adolescents. J Affect Disord 2023; 324:379-386. [PMID: 36587905 DOI: 10.1016/j.jad.2022.12.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 12/10/2022] [Accepted: 12/18/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND This study aimed to examine the association of bullying victimization with anxiety and depressive symptoms among Chinese adolescents and explored the role of coping styles in the foregoing associations. METHOD Data were drawn from the 2019 School-based Chinses Adolescents Health Survey (n = 19,809). Information about bullying victimization, coping styles, anxiety symptoms, and depressive symptoms were measured. Linear mixed-effects models were performed. RESULTS After adjusting for covariates, verbal victimization (β = 1.94 for anxiety symptoms; β = 4.62 for depressive symptoms), relational victimization (β = 3.40 for anxiety symptoms; β = 8.37 for depressive symptoms), physical victimization (β = 2.63 for anxiety symptoms; β = 6.07 for depressive symptoms) and cyber victimization (β = 4.68 for anxiety symptoms; β = 10.72 for depressive symptoms) were associated with anxiety and depressive symptoms. Moreover, the severity of anxiety and depressive symptoms tended to increase with the number of victimization types. The interaction effects between bullying victimization and coping style on anxiety and depressive symptoms were significant. Further stratified analyses by coping styles indicated that the association of relational and cyber victimization on anxiety and depressive symptoms were significantly stronger in adolescents with negative coping style than in those with positive coping style. LIMITATIONS Causal inference is limited due to the cross-sectional design. CONCLUSION Bullying victimization is associated with anxiety and depressive symptoms, and coping styles may play a moderate role in these associations. Interventions to promote mental health could focus on developing positive coping styles, particularly among adolescents with bullying victimization.
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Affiliation(s)
- Wenjian Lai
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Wenyan Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Ke Xu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Qiufen Dou
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Jingman Shi
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Kayla M Teopiz
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.
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Ollinheimo A, Hakkarainen K. Critical thinking as cooperation and its relation to mental health and social welfare. NEW IDEAS IN PSYCHOLOGY 2023. [DOI: 10.1016/j.newideapsych.2022.100988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Liotti M, Milesi A, Spitoni GF, Tanzilli A, Speranza AM, Parolin L, Campbell C, Fonagy P, Lingiardi V, Giovanardi G. Unpacking trust: The Italian validation of the Epistemic Trust, Mistrust, and Credulity Questionnaire (ETMCQ). PLoS One 2023; 18:e0280328. [PMID: 36701301 PMCID: PMC9879475 DOI: 10.1371/journal.pone.0280328] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/27/2022] [Indexed: 01/27/2023] Open
Abstract
The construct of epistemic trust has received much consideration in recent psychological literature, even though mainly from a theoretical perspective. The overall aim of this study was to validate the first self-report measure of epistemic trust-the Epistemic Trust, Mistrust, and Credulity Questionnaire (ETMCQ)-in an Italian sample. Our primary goal was to test the factorial validity of the instrument, also exploring the influence of age, gender, and level of education on epistemic trust (Study 1, n = 843). Secondarily, we investigated the associations between epistemic trust, mistrust, credulity, and other aspects of psychological functioning, as well as with the presence of adverse childhood experiences in a smaller number of participants (Study 2, n = 445). Besides the ETMCQ, the survey included an ad hoc questionnaire investigating socio-demographic characteristics and self-report measures of reflective functioning, mentalized affectivity, traumatic experiences, attachment, and psychological symptoms. Statistical analysis showed a three-factor hierarchical structure similar to the model proposed in the original validation, with some differences that suggest an influence of cultural factors in determining individuals' epistemic stance. Our results corroborate previous theoretical contributions regarding the association between epistemic trust and psychological wellbeing, and between epistemic disruptions and higher levels of psychological suffering. Both Mistrust and Credulity were significantly related to the presence of childhood traumatic experiences, attachment avoidance and anxiety, lower levels of mentalization, lower abilities in emotional regulation, and higher levels of psychopathological symptoms. The ETMCQ represents an easily administered and time-effective tool. Its use could pave the way for interesting clinical and theoretical findings.
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Affiliation(s)
- Marianna Liotti
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Lazio, Italy
- * E-mail: (ML); (AM)
| | - Alberto Milesi
- Department of Psychology, University of Milano-Bicocca, Milan, Lombardia, Italy
- * E-mail: (ML); (AM)
| | - Grazia Fernanda Spitoni
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Lazio, Italy
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Lazio, Italy
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Lazio, Italy
| | - Laura Parolin
- Department of Psychology, University of Milano-Bicocca, Milan, Lombardia, Italy
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London, London, England, United Kingdom
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, England, United Kingdom
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Lazio, Italy
| | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Lazio, Italy
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Nimbi FM, Giovanardi G, Baiocco R, Tanzilli A, Lingiardi V. Monkeypox: New epidemic or fake news? Study of psychological and social factors associated with fake news attitudes of monkeypox in Italy. Front Psychol 2023; 14:1093763. [PMID: 36874830 PMCID: PMC9981651 DOI: 10.3389/fpsyg.2023.1093763] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/30/2023] [Indexed: 02/19/2023] Open
Abstract
Objective Starting from May 2022, a growing number of monkeypox cases have been identified in several countries in Europe and the United States. To date, information on social reaction to the news circulating about monkeypox is limited. Assessing psychological and social elements related to the tendency to misinterpret monkeypox information is urgent and useful in setting up tailored education and prevention programs for specific populations. The present study aims to explore the association of selected psychological and social variables to monkeypox attitudes as fake news. Methods Three hundred and thirty-three participants (212 women, 110 men, and 11 other genders) from the general Italian population completed nine self-report measures. Results Results showed that people that were more likely to believe that monkeypox was a hoax were: older, heterosexual, politically conservative, and more religious. Moreoverm they were more likely to show more negative attitudes toward gay men, higher levels of sexual moralism, less knowledge and fear about monkeypox, no previous infections of COVID-19, lower number of COVID-19 vaccine doses, and being closer to no-vax theories. On the psychological side, participants that were more likely to believe that the monkeypox was a hoax were associated with lower levels of epistemic trust and order traits, with higher levels of epistemic mistrust, close-mindedness, and ability to process emotions. A full mediation model which explores the relationships between the main variables related to fake news attitudes toward monkeypox was tested, reporting good fit indices. Conclusion Results from the current study could be helpful to improve the effectiveness of health communication, design targeted education, and support people to engage in healthier behaviors.
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Affiliation(s)
- Filippo Maria Nimbi
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Roberto Baiocco
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Rome, Italy
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Tanzilli A, Cibelli A, Liotti M, Fiorentino F, Williams R, Lingiardi V. Personality, Defenses, Mentalization, and Epistemic Trust Related to Pandemic Containment Strategies and the COVID-19 Vaccine: A Sequential Mediation Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114290. [PMID: 36361183 PMCID: PMC9656964 DOI: 10.3390/ijerph192114290] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/10/2022] [Accepted: 10/27/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND The COVID-19 pandemic has considerably influenced all domains of people's lives worldwide, determining a high increase in overall psychological distress and several clinical conditions. The study attempted to shed light on the relationship between the strategies adopted to manage the pandemic, vaccine hesitancy, and distinct features of personality and mental functioning. METHODS The sample consisted of 367 Italian individuals (68.1% women, 31.9% men; M age = 37, SD = 12.79) who completed an online survey, including an instrument assessing four response styles to the pandemic and lockdown(s), the Personality Inventory for DSM-5-Brief Form, the Defense Mechanisms Rating Scales-Self-Report-30, the Reflective Functioning Questionnaire, and the Epistemic Trust, Mistrust, Credulity Questionnaire. RESULTS Maladaptive response patterns to pandemic restrictions were related to dysfunctional personality traits, immature defense mechanisms, poor mentalization, and epistemic mistrust or credulity. Moreover, more severe levels of personality pathology were predictive of an extraverted-maladaptive response style to health emergency through the full mediation of low overall defensive functioning, poor certainty of others' mental states, and high epistemic credulity. CONCLUSIONS Recognizing and understanding dysfunctional psychological pathways associated with individuals' difficulties in dealing with the pandemic are crucial for developing tailored mental-health interventions and promoting best practices in healthcare services.
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Schultz-Venrath U. On- oder Offline? Mentalisieren des Körpers unter Pandemiebedingungen. DIE PSYCHOTHERAPIE 2022. [PMCID: PMC9263034 DOI: 10.1007/s00278-022-00611-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Technologische Innovationen und gesellschaftliche Krisen gehen mit einer Reihe von Phänomenen einher, die mit den prämentalistischen Modi des Mentalisierungsmodells und seinem Konzept des „epistemischen Vertrauens“ bzw. „Misstrauens“ erklärt werden können. Die „severe acute respiratory syndrome coronavirus 2“ (SARS-CoV-2)-Pandemie führte zu prämentalistischen Modi mit spezifischen Störungen der Wahrnehmungen des Körpers und des Denkens. Hierzu gehören Verschwörungsglauben (dass mit der Impfung „Chips“ in den Körper eingeschleust würden), Leugnung des Virus (selbst bei vorliegender „coronavirus disease 2019“ [COVID-19]) und Verkennung der politischen Verhältnisse („Diktatur“) bis hin zu verbalen und tätlichen Angriffen auf Wissenschaftler. Letztere fanden in einem rechtzeitig aufgedeckten Entführungsszenario des Gesundheitsministers Anfang Mai 2022 ihren bisherigen Höhepunkt.
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Affiliation(s)
- Ulrich Schultz-Venrath
- Institut für Gruppenanalyse & Mentalisieren in Gruppen – Praxis für Psychosomatische Medizin & Psychotherapie & Psychoanalyse, Johannes Müller Str. 61, 50735 Köln, Deutschland
- Universität Witten-Herdecke, Witten, Deutschland
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Kampling H, Kruse J, Lampe A, Nolte T, Hettich N, Brähler E, Sachser C, Fegert JM, Gingelmaier S, Fonagy P, Krakau L, Zara S, Riedl D. Epistemic trust and personality functioning mediate the association between adverse childhood experiences and posttraumatic stress disorder and complex posttraumatic stress disorder in adulthood. Front Psychiatry 2022; 13:919191. [PMID: 36032256 PMCID: PMC9399466 DOI: 10.3389/fpsyt.2022.919191] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background Adverse childhood experiences (ACEs) are associated with posttraumatic and complex posttraumatic stress disorder symptoms in adulthood (PTSD/cPTSD), as well as reduced epistemic trust (trust in the authenticity and personal relevance of interpersonally transmitted information) and impaired personality functioning. The present work aims to investigate the predictive value of epistemic trust-the capacity for social learning-on the mediating effect of personality functioning in the association of ACEs and PTSD/cPTSD. Methods We conducted structural equation modeling (SEM) based on representative data of the German population (N = 2,004). Personality functioning (OPD-SQS) was applied as a mediator between ACEs and PTSD/cPTSD (ITQ), while epistemic trust (ETMCQ) was added as predictor for OPD-SQS. TLI, CFI, and RMSEA (95%-CI) determined the models' fit. Results N = 477 (23.8%) participants reported at least one ACE and n = 218 (10.9%) reported ≥4 ACEs. Fit indices were good for both PTSD (TLI = 0.96; CFI = 0.99; RMSEA = 0.06; 95%CI: 0.041-0.078) and cPTSD (TLI = 0.96; CFI = 0.99; RMSEA = 0.06; 95%CI: 0.043-0.081). ACEs were significantly associated with cPTSD (β = 0.44, p < 0.001) and PTSD (β = 0.29, p < 0.001), explaining 20 and 8% of its variance. Adding personality functioning as a mediator increased the explained variance of cPTSD and PTSD to 47 and 19% while the direct association between ACEs and cPTSD/PTSD decreased (β = 0.21/β = 0.17), thus, indicating a partial mediation. Including epistemic trust substantially increased the explained variance for personality functioning (41%) compared to ACEs as a single predictor (16%). Conclusion We add to previous research emphasizing the association between ACEs and PTSD/cPTSD symptoms. Offering insights on underlying mechanisms, we show that epistemic trust and personality functioning are relevant mediators. Since both are modifiable by psychotherapy, knowledge about the role of these constructs can inform research on psychotherapeutic interventions and prevention.
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Affiliation(s)
- Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany
| | - Astrid Lampe
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- VAMED Rehabilitation Center, Schruns, Austria
| | - Tobias Nolte
- Anna Freud National Centre for Children and Families, London, United Kingdom
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, United Kingdom
| | - Nora Hettich
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Behavioral Medicine Research Unit, Integrated Research and Treatment Center for Adiposity Diseases, University Medical Center Leipzig, Leipzig, Germany
| | - Cedric Sachser
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Jörg M. Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Stephan Gingelmaier
- Psychology and Diagnostics for Emotional and Social Development for the Emotionally Impaired, University of Education Ludwigsburg, Ludwigsburg, Germany
| | - Peter Fonagy
- Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Lina Krakau
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sandra Zara
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - David Riedl
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
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Barnby J, Dean R, Burgess H, Kim J, Teunisse A, Mackenzie L, Robinson G, Dayan P, Richards L. Increased persuadability and credulity in people with corpus callosum dysgenesis. Cortex 2022; 155:251-263. [DOI: 10.1016/j.cortex.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 05/04/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022]
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Zara S, Kruse J, Leveling AM, Schmitz J, Hempler I, Kampling H. Capturing Diabetes-Related Distress and Burden From the Perspective of Patients With Type 1 or Type 2 Diabetes: Protocol for an Explorative Mixed Methods Study. JMIR Res Protoc 2022; 11:e38477. [PMID: 35916703 PMCID: PMC9379798 DOI: 10.2196/38477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diabetes is one of the most common diseases worldwide and is associated with increased morbidity, mortality, and reduced quality of life. Many patients experience high diabetes-related distress as well as depression and anxiety symptoms, which are associated with poor diabetes self-management. As disease management is a central component in diabetes treatment, poor management enhances the occurrence of micro- and macrovascular complications. This emphasizes the relevance of reducing diabetes-related distress and providing adequate treatment options addressing the individual psychosocial burden of patients with diabetes. Since patients' perspectives diverge significantly from those of practitioners in terms of relevant treatment aspects, the patient perspective on, for example, barriers to and facilitators of diabetes treatment is crucial for adequate and effective treatment as well as improvements to self-management and therefore, needs to be further explored. OBJECTIVE This study aims to examine diabetes-related distress, the course of distress throughout diabetes management, as well as barriers and facilitating factors in dealing with diabetes from the individual perspective of patients with type 1 and type 2 diabetes. METHODS The study employs a mixed methods design combining qualitative and quantitative data. Semistructured interviews (N=40) will be conducted with patients with type 1 diabetes (n=20) and patients with type 2 diabetes (n=20). The primary outcomes comprise (1) diabetes-related distress, (2) the severity of distress, (3) the course of distress throughout diabetes management, (4) barriers, and (5) facilitating factors. Questionnaires will provide data on the following secondary outcomes: diabetes-related emotional distress (the Problem Areas in Diabetes scale), symptoms of depression and anxiety (Patient Health Questionnaire, German version), personality functioning (Operationalized Psychodynamic Diagnosis-Structure Questionnaire), mentalizing capacities (Mentalization Questionnaire), epistemic trust (Epistemic Trust, Mistrust and Credulity Questionnaire) and experiences of child maltreatment (Childhood Trauma Questionnaire), and the overall health status of the patient (routine medical data). RESULTS As of April 2022, the conceptualization phase of the study was finalized. Ethics approval was received in January 2022 from the local ethics committee of the Justus Liebig University Giessen - Faculty of Medicine (AZ 161/21). CONCLUSIONS This study will provide insights into the individual perspective of patients with type 1 and type 2 diabetes regarding their experiences with diabetes management and what they perceive to be relevant, obstructive, or beneficial. The insights gained could help further tailor diabetes treatment to the individual needs of patients with diabetes and therefore optimize diabetes self-management. TRIAL REGISTRATION German Clinical Trial Register DRKS00024999; https://tinyurl.com/2wb4xdh8. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/38477.
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Affiliation(s)
- Sandra Zara
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany.,Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany
| | - Anna Maria Leveling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Jana Schmitz
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Isabelle Hempler
- Institute of General Practice / Family Medicine, Medical Center - University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
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Campbell C, Allison E. Mentalizing the modern world. PSYCHOANALYTIC PSYCHOTHERAPY 2022. [DOI: 10.1080/02668734.2022.2089906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Elizabeth Allison
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
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48
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Belonging to the World through Body, Trust, and Trinity: Climate Change and Pastoral Care with University Students. RELIGIONS 2022. [DOI: 10.3390/rel13060527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
This article explores how pastoral care is performed in an age of climate change. University students suffer from a wide range of stresses, reducing their well-being. Climate change compounds these stress reactions, even where students are not directly affected. As climate change affects concrete, material matters, human reactions to it may no longer be viewed and treated as purely inner psychic states. Thus, climate change disrupts usual divisions of material, social, and mental features as separate categories, underscoring instead the close-knit relations between them. Given the far-reaching ways climate change affects mental health, the article presents an ethnographical-theologically-driven model for basic conversation in pastoral care with students in the midst of escalating climate events. Making use of theories from anthropology, psychology, and theology, this article builds on in-depth interviews with Danish university chaplains about their pastoral care with students. The model extrapolates from these theories how pastoral care may support students in the era of climate change through a triad of organizing themes that come to the fore in the interviews: “Mothering the Content”, “Loving Vital Force”, and “Befriending the Environment”.
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Abstract
Early identification of "patients at risk" for not completing regular treatment or not benefitting (sufficiently) from treatment might be among the most cost-effective strategies in mental health care. The recently introduced concept of epistemic trust (ET) may have the potential value to predict patients at risk and therefore act as a marker of treatment outcome. We argue that ET may be the final common pathway through which aversive relational experiences in the past result in interpersonal dysfunctioning, which in turn result in dysfunctional therapeutic relationships, rendering it difficult for patients to trust whatever is offered to learn in therapy. Hence, the concept of ET can play an essential role in personalized medicine, allowing for a more tailored treatment assignment to specific patients' characteristics, which may improve treatment outcomes. In this brief report, we define the clinical features of ET by describing its core domains based on consensus of expert opinion on the concept. The response rate was high, and there was a high level of agreement across experts, demonstrating a strong consensus between experts on the definition and clinical features of ET and mistrust and its significance to the understanding of personality disorders.By means of having a clear definition of the clinical features of ET, we hope to make it accessible for assessment.
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50
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Folmo EJ, Langjord T, Myhrvold NCS, Stänicke E, Lind M, Kvarstein EH. Pedagogical stance in mentalization-based treatment. J Clin Psychol 2022; 78:1764-1784. [PMID: 35263445 PMCID: PMC9543465 DOI: 10.1002/jclp.23335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 01/04/2022] [Accepted: 02/12/2022] [Indexed: 11/17/2022]
Abstract
Background A common aspect of evidence‐based treatments for people with borderline personality disorder (BPD) is pedagogical interventions and formats. In mentalization‐based treatment (MBT) the introductory course has a clear pedagogical format, but a pedagogical stance is not otherwise defined. Methods Treatment integrity was quantitatively assessed in a sample of 346 individual MBT sessions. Nine group sessions and 24 individual MBT sessions were qualitatively subjected to interpretative phenomenological analysis (IPA). Results The dominating intervention type was MBT Item 16—therapist checking own understanding (31% of the interventions). IPA unveiled the following: (1) a pervasive, but hidden/implicit psychopedagogical agenda, (2) psychopedagogical content seemed precious for the patients, and (3) four tentative strategies for pedagogical interventions in MBT (a) independent reasoning; (b) epistemic trust; (c) mental flexibility; and (d) application of verified insights, knowledge, or strategies. Conclusion Development and clarification of the pedagogical stance in MBT could further improve the quality of therapists' interventions.
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Affiliation(s)
- Espen J Folmo
- Department for National and Regional Functions, Division of Mental Health & Addiction, Norwegian National Advisory Unit on Personality Psychiatry, Section for Personality Psychiatry & Specialized Treatments, Oslo University Hospital, Oslo, Norway
| | - Tuva Langjord
- Department for National and Regional Functions, Division of Mental Health & Addiction, Section for Personality Psychiatry & Specialized Treatments, Oslo University Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Erik Stänicke
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Majse Lind
- Department of Psychology, University of Florida, Gainesville, Florida, United States
| | - Elfrida H Kvarstein
- Department for National and Regional Functions, Division of Mental Health & Addiction, Section for Personality Psychiatry & Specialized Treatments, Oslo University Hospital, Oslo, Norway.,Adult Psychiatry Unit, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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