Much is known about when children acquire an understanding of mental states, but few, if any, experiments identify social contexts in which children tend to use this capacity and dispositions that ...influence its usage. Social exclusion is a common situation that compels us to reconnect with new parties, which may crucially involve attending to those parties' mental states. Across two studies, this line of inquiry was extended to typically developing preschoolers (Study 1) and young children with and without anxiety disorder (AD) (Study 2). Children played the virtual game of toss "Cyberball" ostensibly over the Internet with two peers who first played fair (inclusion), but eventually threw very few balls to the child (exclusion). Before and after Cyberball, children in both studies completed stories about peer-scenarios. For Study 1, 36 typically developing 5-year-olds were randomly assigned to regular exclusion (for no apparent reason) or accidental exclusion (due to an alleged computer malfunction). Compared to accidental exclusion, regular exclusion led children to portray story-characters more strongly as intentional agents (intentionality), with use of more mental state language (MSL), and more between-character affiliation in post-Cyberball stories. For Study 2, 20 clinically referred 4 to 8-year-olds with AD and 15 age- and gender-matched non-anxious controls completed stories before and after regular exclusion. While we replicated the post regular-exclusion increase of intentional and MSL portrayals of story-characters among non-anxious controls, anxious children exhibited a decline on both dimensions after regular exclusion. We conclude that exclusion typically induces young children to mentalize, enabling more effective reconnection with others. However, excessive anxiety may impair controlled mentalizing, which may, in turn, hamper effective reconnection with others after exclusion.
One class of parent–child interaction that has recently received attention is a mother's engagement with her child at a mental level. The current study operationalizes this notion by asking the ...mothers of 354 7‐ to 11‐year‐old children drawn from a larger community sample (N=659) to guess the responses of their children, who, in turn, were asked to attribute thoughts to their peers in distressing peer‐related scenarios. The following predictions were made: (1) mothers would be above chance in the accuracy by which they predicted their children's overall attributional styles; (2) increased maternal accuracy would be an important correlate of reduced psychopathology symptoms in children; and (3) poor maternal accuracy would associate with a maladaptive child attributional response style characterized by unrealistic and overly positive attributions. Results suggested that maternal accuracy was normally distributed with mothers accurately guessing the responses of their children for about half of the social scenarios. Furthermore, mothers were shown to be above chance in the accuracy by which they predicted their children's overall attributional styles. Maternal accuracy was found to be related to child psychosocial adjustment (reduced scores on child psychopathology measures), whilst poor maternal accuracy was associated with ineffective social‐cognitive reasoning, as indexed by an unrealistic and overly positive child attributional style. Findings are discussed within the context of the burgeoning literature linking attachment, family talk about feelings and thoughts, and parental mind‐mindedness.
The NOURISHED study: Nice OUtcomes for Referrals with Impulsivity, Self Harm and Eating Disorders.Eating Disorders (ED) and Borderline Personality Disorder (BPD) are both difficult to treat and the ...combination presents particular challenges. Both are associated with vulnerability to loss of mentalization (awareness of one's own and others' emotional state). In BPD, Mentalization Based therapy (MBT) has been found effective in reducing symptoms. In this trial we investigate the effectiveness and cost-effectiveness of MBT adapted for Eating disorders (Mentalization Based Therapy for Eating Disorders (MBT-ED)) compared to a standard comparison treatment, Specialist Supportive Clinical Management (SSCM-ED) in patients with a combination of an Eating Disorder and either a diagnosis of BPD or a history of self-harm and impulsivity in the previous 12 months.
We will complete a multi-site single-blind randomized controlled trial (RCT) of MBT-ED vs SSCM-ED. Participants will be recruited from three Eating Disorder Services and two Borderline Personality Disorder Services in London. Participants allocated to MBT-ED will receive one year of weekly group and individual therapy and participants allocated to SSCM-ED will receive 20 sessions of individual therapy over 1 year. In addition, participants in both groups will have access to up to 5 hours of dietetic advice. The primary outcome measure is the global score on the Eating Disorders Examination. Secondary outcome measures include total score on the Zanarini BPD scale, the Object Relations Inventory, the Depression Anxiety Stress Scales, quality of life and cost-effectiveness. Measures are taken at recruitment and at 6 month intervals up to 18 months.
This is the first Randomised Controlled Trial of MBT-ED in patients with eating disorders and symptoms of BPD and will provide evidence to inform therapy decisions in this group of patients. During MBT-ED mentalization is encouraged, while in SSCM-ED it is not overtly addressed. This study will help elucidate mechanisms of change in the two therapies and analysis of therapy and interview transcripts will provide qualitative information about the conduct of therapy and changes in mentalization and object relations.
ISRCTN51304415.
Associations are reported among classifications of Adult Attachment Interviews (AAIs) obtained from expectant parents and subsequent classifications of their infants in the Strange Situation ...Procedure (SSP). Mothers' AAIs predicted infant-mother SSPs (χ 2 = 41.87, N = 96, df = 9, p ≤ .0001), and fathers' AAIs predicted infant-father SSPs (χ 2 = 18.94, N = 90, df = 6, p ≤ .005). Associations between parents' AAIs and infant-parent SSPs were lessened by the failure to predict the insecure-resistant pattern with mother and the absence of this pattern with father. Counter to expectation, infant-father SSPs were associated with infant-mother SSPs (χ 2 = 3.78, N = 90, df = 1, p ≤ .05), which could not be accounted for in terms of an overlap between parental AAIs. A secondary analysis of the data suggested that this dependency effect of SSPs may be explained by the influence of maternal AAIs upon child-father SSPs. Results are discussed in terms of intergenerational and relationship-specific influences upon attachment during infancy, the possible influence of infant temperament, and the relative influence of mother and father upon the child's evolving representations of attachments within the family.
The effectiveness of hospital-based treatment models for personality disorder is still uncertain.
To compare effectiveness of two models of psychosocial intervention for personality disorder.
Two ...samples of people with personality disorder allocated to a one-stage treatment model (in-patient treatment with no after care) and to a two-stage model (shorter in-patient admission followed by outreach therapy) are prospectively compared.
Subjects in the two-stage sample did significantly better on global assessment of mental health (according to the Global Assessment Score (GAS)) at 6 and 12 months and on social adjustment (according to the Social Adjustment Scale (SAS)) at 12 months. Significant differences in rates of reliable improvement on the GAS (43% v. 17%) and SAS (39% v. 15%) in favour of the two-stage condition were found at 12 months. Subjects with borderline personality disorder (BPD) allocated to the two-stage model improved significantly more than such patients in the one-stage model.
A long-term phased model which combines hospital-based and community-based strategies has advantages over a purely in-patient model for the treatment of BPD.
PDF
