Luyten et al. (2020). The Mentalizing Approach to Psychopathology: State of the Art and Future Directions Flashcards
a parentified child
someone who is given to much responsibility, in the absence of parental support. they are often overregulating their emotions, need to stay in control,staying away from everything.
some observations about manon and julia
➢ The outcomes for each child are markedly different even though they are twins(monozygotic or dizygotic?).
➢ In the absence of parental support children find ways to take care of themselves and each other. And of their parents (parentification).
➢ This is certainly not simply a story of an individual with a disorder – it is a system.
➢ Neither is it simply a story of ‘blame the parent’. It is also a story of very young parents who have not been cared for themselves. And of a society that did not sufficiently care.
➢ In terms of emotion regulation an absence of well-regulated, reflected, ‘mentalized’ emotions seems to occur in both twins.
➢ In one of them underregulated, overwhelming emotions dominate. In the other overregulation and staying away from
emotions.
the interpersonal field
both self & other have an self system and affect system. they are connected through perception & behaviour
kijken in schrift
early maladaptive schema: defectiveness/shame
the belief that one is defective, bad, unwanted, inferior, or unworthy. this includes the fear of insecurities being exposed to significant others, accompanied by hypersensitivity to criticism, rejection and blame
the self as agent
to make choices and move forward in life in a self-determined and goal-directed manner. human agency suggests intention, volition, will, purpose, and some modicum of personal control in life.
in other words, even though infants can be seen to express agency, human beings do not consciously and reflexively understand themselves as agents, in a full sense until much later
mentalization=
the assumption that others and oneself have a mental live with intentions that give reasons for actions.
- understandings that self and others are agents
- need to first learn about ourselves and world
- allows to navigate social world
- it’s species-specific -> only in humans and primates
the possibility for mentalization is genetically coded, but the full skill is not present at birth
cause-effect
acts are not just behaviours. intentionality is involved within our actions.
waar is mentalizing in disturbed
BDP en autism en soms trauma
parental mentalizing:
attribute attention and meaning to what the child is doing. then the child learns that it has a mind and others have that too
four assumptions of mentalization
- neuroscience -> mentalization is evolutionary prewired capacity
- developmental -> needs environmental inputs to develop
- transdiagnostic/transtheoretical -> common in many psychological problems/disorders
- recovery -> mentalization = associated with successful therapy for many disorders (but not specifically targeted)
safe attachment is needed for good mentalization:
because making sense of the world and others is very difficult if you have been in unsafe/traumatic environments
neurobiology of mentalizing
- mentalizing has specific neural circuits/is evolutionary prewired
- is a multidimensional capacity
- its an umbrella concept
mentalizing has specific neural circuits/is evolutionary prewired=
- the first signs are already visible as an infant -> they have joint attention and intentionality.
- at 3 years -> collective intentionality
collective intentionality=
ability to function in a group based on shared principles, norms + conventions
- capacity underlined by capacity to mentalize
- allows vision of others’ goals + collaboration to get to shared ones
- both mitigates and enhances competition (allows to manipulate/deceive ppl)
4 dimensions of mentalizing
- automatic vs controlled
- self vs others
- internal vs external focus
- cognitive vs affective
automatic mentalization
- fast, reflexive, little effort needed
- older neural circuits
- role in stress + emotional regulation -> switch to automatic mentalization
- usually adaptive, but overrelying on it -> biased assumptions of self or others
controlled mentalization
- conscious, verbal, reflective
- newer brain circuits
- involves symbols and abstractions
external focused mentalization
- inter emotional states of others based on face, posture
- lateral frontotemporal circuits (less reflective)
internally-focused mentalization
- inferring mental states by taking perspective of the others
- based on the context
- medial frontoparietal networks (active and controlled)
circuits to know the self and other
1.shared representation system (SR) -> empathy based on shared representations of the others mental states. implicit/visceral/body-based mirror neurons. understand others by mechanically repeating the movements (no high level of cognition needed)
2. mental state attribution system (MSA) -> more abstract, shaped by interpersonal relationships. fully develops in adolescence. vmPFC, dmPFC, TPJ, medial temporal lobe
wat is er met die 2 systemen
the systems are mutually inhibitory: SMA down-regulates SR if it’s conflating our mental states
mentalizing involves 2 features
- cognitive features: perspective-taking, belief-desire reasoning… -> controlled mentalizing
- affective features: automatic
umbrella concept of mentalizing
involves theory of mind, mindfulness, perspective taking, empathy
hoe definieer je attachment in mentalization
attachment is the context in which we start to acquire mentalization
parental reflective functionin
caregiver’s ability to reflect on own experiences + those of the child
kijken naar model parental reflective functioning
oke
high levels of PRF=
more affection to the child
- socializing context that focuses on mental states: secure attachment + reflective functioning -> virtuous cycle of emo regulation and socioemotional development
- parent’s mentalizing capacities fluctuate tho: but no disruption of secure attachment if already created
mentalizing is interactive: develops by interacting with others + continually influenced by others’ capacity to
mentalize
oke
modes of ineffective mentalizing=
- psychic equivalence (own thoughts or feelings become too real, no others perspectives are considered)
- teleological (person only recognizes real or observable goals and actions. extreme focus on exterior. no controlled mentalizing)
- pretend (thoughts and feelings are detached from reality (hyper-mentalizing) and narratives become overwhelming. kan leiden tot depersonalization/derealisation. internal focus, poor belief-desire reason, risk of fusing with others, vaak bij BPD)
common factor between the 3 ways of ineffective mentalization
tendency to externalize aspects of self that are not mentalized yet. these are alien-self parts (expressed in attempts to dominate others minds, self injury etc.)
dus conclusie attachment en mentalizing
early adversities and complex trauma have a negative effect on the ability to mentalize. high levels of parental reflective functioning is a buffer.
strategies to hyperactivate and deactivate attachment influence:
- threshold to switch from controlled to automatic mentalizing
- strength of relationship severity of stress/arousal + activation of neural circuits underlying controlled/
vs automatic mentalizing - time to recover controlled mentalizing
research supports these main points about mentalization
- mentalizing = stable, only fluctuates in contexts of stress/arousal
- there is a relationship between parental mentalizing + child’s attachment (more mentalizing = secure)
- parental mentalizing is related to child’s mentalizing -> stronger association that association with attachment.
- early adversities + complex trauma = negative impact on mentalizing
- high levels of PRF = buffer - child’s attachment style is associated to mentalizing (secure = high)
- there is relationship between child’s mentalizing and cognitive + socioemotional development
- there is association attachment, mentalizing and stress/arousal regulation
- secure attachment = synchronicity in behavioral systems that coordinate stress response
- high functional connectivity attachment + mentalizing systems
- insecure attachment = dysregulation of HPA axis -> vulnerability to stress - re-emergence of pre-mentalizing modes + externalization of alien-self
- impairments in mentalizing -> regress to teleological mode
- BPD = pretend mode
limitations of mentalizing approach
- relationships childhood attachment + developmental outcomes is weaker than thought
- attachment is moderately stable in development BUT risk status (conflict, separation…) lowers it
- attachment = interpersonal strategy to optimize adaptation to particular environment - historical, sociocultural + environmental factors determine function of attachment-behavioral system (not innate/universal as posited by Bowlby)
- parental sensitivity only explains small % of variance in association parent + infant attachment
- genetic factors determine course of attachment -> role in resetting developmental trajectories
what do we need for the transmission of cultural knowledge
epistemic trust
epistemic trust=
the capacity to identify knowledge conveyed by others as personally relevant and generalizable to other contexts
children left alone in room may show random preference for a toy BUT when trusting other show clear preference for another (with facial expression) -> child’s preference is switched
mentalization needs trust
ostensive cues
prime the recipient that whats about to be communicated is personally relevant (gazing, pointing). both verbal and nonverbal
2 sources for whats good and bad
- own experience
- feelings or knowledge transmitted by trusted others
what is a consequence of epistemic trust
salutogenesis
salutogenesis=
ability to benefit from positive influences of the environment
BUT epistemic trust is not the default mode of functioning. what is?
epistemic vigilance.
capacity to identify + filter info conveyed by others when perceived to be misleading/deceitful
wat gebeurt er als iemand te vaak teleurgesteld wordt
we develop a mode where we don’t learn much from others, but base only on rudimentary experiences (feeling of alientation also from culture)
importance of epistemic trust
- need to learn about self and others in development
- epistemic trust allows us to do it quickly - when epistemic trust = disrupted -> hard to learn to understand oneself + others
- self, other and world become misunderstood and scary
when does epistemic trust develop
before language develops (symbols and language are introduced in the stage of epistemic trust)
new conception of attachment styles:
contexts for social communication that family is promoting about most effective way to function in one’s environment
in this view: insecure attachment + PDs + other psychopathologies are communicative strategies that underlie social learning to ensure adequate adaptation to changing social situations
social learning is promoted by 3 communication channels:
- channel 1: lowering epistemic vigilance
- channel 2: enabling mechanisms of social learning
- channel 3: re-engaging with social world
channel 1: lowering epistemic vigilance
treatments provide patients with a model of mind that seems personally relevant to them. patients should recognize good intentions. key is mutual mentalizing: therapist should tailor the intervention to the client
channel 2: enabling mechanisms of social learning
activated by epistemic trust. mentalizing capacity of the patient is re-activated through trust and modelling of the therapists mentalizing. this facilitates further increase in epistemic trust
channel 3: re-engaging with social world
being mentalized by another person -> patient freed from isolation + re-activation of capacities to learn and grow outside therapy. seeking new experiences, reconstructing relationships, improve adaptation
therefore aim of therapy (in context of mentalization)
increasing mentalization to open patient’s potential for social learning -> patient gains salutogenesis
welke attachment styles hebben mensen met BPD
- anxious/preoccupiedp
- disorganized
prevalence complex trauma in BPD
90%
hoe zie je deficiencies in mentalizing in BPD patients
These impairments are typically expressed in terms of patients’ overly simplistic or overanalytic/hyperactive accounts of their own mental states and those of others
empathy paradox in BPD
The characteristic pattern of mentalizing in BPD is a rapid loss of controlled mentalizing and overreliance on fast, automatic mentalizing, followed by problems with cognitive mentalizing, particularly in complex interpersonal situations; there is also an overreliance on affectively dominated and highly externally based mentalizing at the expense of mentalizing that is directly focused on mental interiors, and a tendency to conflate mental states of the self and others (so-called identity diffusion), leading to increased susceptibility to emotional contagion.Hence, the presumed superiority of mentalizing of BPD patients in some circumstances appears to be largely based on a tendency toward hypermentalizing—an attempt to make sense of others’ external cues (such as their facial expressions or posture) based on fast, automatic processing of such information. As a result, BPD patients often might “get it right,” but the flip side is that they often jump to conclusions about others’ internal mental states. This is also shown by findings concerning a negativity bias in BPD patients, which has been observed, for instance, in their interpretation of neutral faces (Herpertz & Bertsch 2015) or when they are presented with short silent video clips (Barnow et al. 2009). When presented with such material, BPD patients typically see characters as more negative and more aggressive
role of epistemic trust in BPD
people with BPD have a bias in their perception of others as being hostile and untrustworthy; they tend to expect that others will reject, hurt, abandon, criticize, or neglect them or treat them dishonestly (for a recent review, see Fertuck et al. 2018). From a neurobiological perspective, the lack of trust in others typical of BPD patients appears to be mediated by the reward system, which is also centrally implicated in attachment
in welke andere PDs ook deficiencies in mentalizing
- narcissism
- antisocial
- avoidant
antisocial and mentalizing: 2 routes of development
- high anxiety cluster: hypervigilance + aggression
- fast switch to automatic + affect-dominated mentalizing - callous-unemotional features: hyporeactivity to stress + instrumental aggression
- difficulties in affective mentalizing
wat voor adaptation strategies zijn ASPD en conduct disorder
ASPD + conduct disorder = adaptation strategies in abusive social environments
welke andere mentale stoornissen hebben deficiencies in mentalizing
- anxiety and depression
- eating disorders
- somatoform disorders
- autism
eating disorders and mentalizing
intrinsic association attachment disruptions + mentalizing impairments
- in dysregulated patients -> + mentalizing impairments and affective mentalizing
- higher-functioning patients -> hypomentalizing + cognitive hypermentalizing
somatoform and mentalization
causal sequence attachment disruptions à mentalizing problems + stress
dysregulation à hyperreactivity to stress
- hyperreactivity à chronic dysregulation of bio stress system + pain/immune regulation system (also depressed mood, anxiety + fatigue)
which disorders are dominated by teleological functioning
- SUD, gambling, ADHD and psychotic
- recent studies -> deficits in PTSD
