Mentalizing article (lecture 4) Flashcards
(77 cards)
1
Q
What is Mentalizing?
A
The human ability to understand to understand the self and others in terms of intentional mental states, e.g. feelings, desires, wishes, attitudes, goals etc.
2
Q
Is mentalizing observed in other animals except humans?
A
No, it is a species-specific capacity.
Only a lesser version of it is observed in our nearest primate relatives
3
Q
What are the 4 main approaches of the mentalizing approach in psychopathology?
(We’ll get into each one in more detail)
A
- Neuroscience shows that mentalizing is an evolutionary pre-wired capacity
- Considerable environmental input is needed to fully develop the ability to mentalize
- Mentalizing is a transdiagnostic concept that is implied in a wide range of psychological problems and disorders
- Also, mentalizing is a common factor found to be important in recovery in psychotherapies
4
Q
NEUROBIOLOGY OF MENTALIZING
A
5
Q
What have findings from neurobiology demonstrated about mentalizing?
(We’ll get into each one into more detail)
A
- Highly specialized, species-specific neural circuits are involved in mentalizing
- Mentalizing is a multidimensional capacity
-> Imbalances/problems in different dimensions of mentalizing underlie different characteristics of mental disorders (See Flashcard 10) - Mentalizing is an umbrella concept
6
Q
Highly specialized, species-specific neural circuits are involved in men
What is some basic evidence of mentalizing being a pre-wired innate ability of humans?
A
- Infants have the capability for shared intentionality and attention
- 3 year old’s develop collective intentionality, the ability to function in a group based on shared principles, norms and conventions
7
Q
What is the advantage/importance of mentalizing?
A
It provides us with flexibility to adapt to a constantly changing, complex environment
- enables communication an cooperation not seen in any other species
- permits the transmission of shared goals, motives, morals and knowledge across generations through social learning (since we have joint intentionality, we can acquire knowledge shared by a culture very quickly)
- facilitates meaningful interactions
8
Q
What are some problems that arise from mentalizing?
A
- It can sometimes lead to aggressive and competitive behavior
- Enables us to use other techniques to compete with others that other animals don’t have, such as deception and manipulation
9
Q
Mentalizing is multidimensional
How many dimensions does mentalizing have and what are they?
A
Four.
- Automatic vs Controlled
- Mentalizing with regard to self and others
- Mentalizing based on external vs internal features of the self and others
- Cognitive vs Affective
10
Q
Automatic vs Controlled
A
Automatic: Fast, parallel, reflexive, requires little effort.
- Rely mainly on sensory info
- older brain regions
Controlled: Conscious, verbal, reflective
- Rely on linguistic/symbolic processing
- newer brain regions
- allows for the evolutionary leap for humans
11
Q
What is the relationship between automatic and controlled mentalizing with stress?
A
As stress increases, there is a switch from controlled mentalizing to automatic mentalizing.
- Makes sense -> The fight/flight response relies on fast and automatic processing of info
12
Q
What is the problem with this relationship in our modern, complex world?
A
Our world requires a lot more controlled mentalizing than automatic, so automatic mentalizing and processes are often problematic.
- Automatic mentalizing typically implies nonreflective, simplistic and biased assumptions about the self and others (e.g. activation of biased views towards people of other ethnicities)
- Given the complex demands of our modern world, having a “low switch point” from controlled to automatic mentalizing when under stress can be problematic
13
Q
Mentalizing based on external vs internal features of the self and others
A
- Externally based mentalizing recruits frontotemporal parietal networks that involves more reflexive processing
- Internally based mentalizing relies on a medial frontoparietal network that involves more active and controlled, reflective processes
14
Q
Mentalizing with regard to self and others - What are the two mentalizing systems that have evolved in humans?
A
- Shared representation system (SR system) -> the more basic one
- Mental state attribution system (MSA system)
-> the more advanced one
15
Q
SR system
A
!!! Mentalize and understand other through motor-simulation mechanisms (Bodily based) !!!
- Doesn’t require high-level processing
- Based on the similarity of neural activation while experiencing and observing others experiencing their own states of mind
- Important for social empathy in humans and other animals
16
Q
MSA system
A
!!! Mentalize and understand others through in abstract and symbolic ways !!!
- Develops fully in adolescence
- Provides top-down regulation of the SR system (controls it, and is a high-level processing function)
17
Q
Based on the above two systems, what can be a possible problem with mentalizing?
A
We might possibly conflate our own and other’s mental states.
This is built in our neurology since we tend to understand others based only on our own embodied simulation of other’s experiences
(This is a key realization in MBT)
18
Q
Cognitive vs Affective
A
- Cognitive: Perspective taking, belief-desire reasoning
- Affective: Felt reality and emotions
19
Q
Which two basic mentalizing systems does cognitive/affective utilize (Automatic/controlled)?
A
- Cognitive: controlled mentalizing
- Affective: Automatic mentalizing
20
Q
What happens to these two systems of mentalizing over the course of life?
A
They become more integrated together
-> In line with the notion that empathy has a basic “emotional contagion” aspect and amore advanced perspective taking aspect
21
Q
Mentalizing is an umbrella concept
Why do we say that mentalizing is an umbrella concept?
A
It refers to many processes involved in reflective functioning about self-other and cognition-affect based on internal and external features
- It also refers to context- and state-dependent processes rather than to a trait
22
Q
What are some concept that fall under this umbrella of mentalizing?
A
Empathy, ToM, insightfulness, alexithymia, mindfulness, psychological mindedness and more
- Empathy: Focuses on mentalizing others and affective aspects of mentalizing
- Mindfulness: Focuses on mentalizing regarding the self and affective aspects of mentalizing
- ToM: Focuses on mentalizing others and cognitive aspects of mentalizing
- Alexithymia: Focuses on mentalizing regarding the self
23
Q
Given that mentalizing involves many different processes, what does effective mentalizing consist of?
A
A balance between the different dimensions and types of mentalizing
24
Q
DEVELOPMENTAL APPRACH TO MENTALIZING
A
25
Given that mentalizing involves many different processes, what are it's implications in psychopathology?
Different types of psychological problems can be related to different types of imbalances between the different dimensions and types of mentalizing
26
Why is PRF so important for the child?
- PRF fosters the development of secure attachment and reflective functioning in children. This in turn leads to healthy emotion regulation and interpersonal functioning
- Enables the child to develop second-order representations of others' subjective experiences
!!! In simple words, crucial for the development of mentalizing in the child !!!
(See figure 1 as well)
27
# Initial (Mentalizing) Approach
What is Parental Reflective Functioning (PRF)?
It's the caregivers capacity to reflect upon his/her own internal mental experiences as well as those of the child
(It can be described as a socializing context between child and parent that focuses on mental states)
28
Based on everything said previously, is mentalizing relationship and context dependent?
YES.
- The capacity to mentalize develops in the context of interactions with others
- It is constantly influenced by the mentalizing capacity of those others
29
What are attachment hyperactivating and deactivating strategies?
These are strategies used by the child to cope with the fact that the caregiver/parent doesn't provide a secure attachment.
!!! Play a key role in the relationship between stress/arousal and mentalizing in different interpersonal contexts !!!
30
What do these strategies influence?
- The threshold at which the switch from controlled to automatic mentalizing occurs
- The strength of the relationship between the severity of stress/arousal and the activation of automatic/controlled mentalizing processes
31
What are the three modes that reflect ineffective mentalizing based on the initial approach?
- Psychic equivalence mode: Thoughts and feelings become too real, can't consider other's perspectives other than your own
-> Domination of self over other, external over internal, affective over cognition
- Teleological mode: Only observable, goal-directed behavior and events that stop you from obtaining goals are observed
-> Extreme external over interior, loss of controlled
- Pretend mode: Thoughts and feelings are severed from reality, entangled in different narratives that have no connection to reality (thinking wrongly what others think, a bit psychotic), in extreme forms leads to dissociation
-> Implicit mentalizing over explicit mentalizing
-> Commonly used in BPD
!!! All the above explain many externalizing problems/disorders (e.g. ED, SUD and more), especially the teleological mode !!!
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# Evidence for initial approach
What is the evidence for the stability of mentalizing?
Has both state and trait features.
More research is needed to understand the factors involved in explaining stability and changes in mentalizing
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Child's attachment and mentalizing?
They're correlated -> impairments in childhood lead to a wide array of problems.
More research is needed to understand the role of child men. and att. in the development of psychopathology
- Possible factors influencing this:
-> Context
-> Interaction with other child features (e.g. temperament)
-> Biological vulnerability
-> Resilience
34
Why are the above findings on parental mentalizing and child attachment impressive?
- There are 3 main types of research in this domain:
-> Meins et al. = emphasized distinction between appropriate mind-related comments and non-attuned mind-related comments
-> Oppenheim et al.= Termed the concept of parental insightfulness, which refers to the caregivers tendency to perceive intentions underlying the child's behavior
-> Fonagy et al. = termed PRF
All the above studies overlap (they all assess mentalizing one way or the other), and with the above findings (4th research which is the cherry on top) we can say that all these types of research show and confirm that parent's mentalizing is crucial for the quality of the child-parent relationship
- Parental mentalizing then can also be a predictor of the development of attachment in a child
- Parental mentalizing also plays a role then in social skills
35
Parental mentalizing and child attachment?
r = 0.3
Important here is parental sensitivity, which is assessed through observable behavior
-> Sensitivity and mentalizing influence child attachment independently
-> A small part of parental mentalizing influences child attachment through sensitivity (sensitivity acts as a mediator)
36
Parental mentalizing and child mentalizing?
Parental mentalizing positively predicts child mentalizing
- Effect sizes for par. men. and child att. are around d = 0.2
- Effect sizes for par. men. and child men. are around d = 0.5-0.8
(Effect of par. men. on child men. is stronger than that of par. men. on child att.)
37
What is the effect of complex trauma on mentalizing?
Can severely impair it
- High level of caregiver's reflective functioning, especially with regard to their own traumatic experiences can buffer the effect of trauma on mentalizing
38
In insecure attachment, what does the synchronous activity of the mentalizing and reward systems lead to?
It means that interpersonal relationships for such people are not rewarding and might even be aversive.
- If attachment figures weren't available = dismissive patterns of others
- If attachment figures were available only intermittently = hyperactivating strategies and dependency on others, but always afraid others won't be available
39
What is the role of attachment and mentalizing in stress regulation?
(First, are the attachment and mentalizing systems overlapping or distinct? = They're distinct, yet they show functional connectivity at the behavioral and brain level)
HEALTHY ATT. AND MEN. -> Secure attachment -> synchronous functioning of attachment and mentalizing systems -> effect on HPA axis, leads to hypoactivity of it -> Resilience to stress
-> In such infants, way of attaching to parent generalize to other relationships as well, but the way of attaching does weaken a bit (isn't exactly the same)
INSECURE ATT. AND MEN. -> Insecure attachment -> impaired development of att. and men. systems -> hyperactivity of HPA axis and REWARD SYSTEM (Synchronicity of reward system mentalizing system)
40
# Limitations of the initial approach
What is the main criticism of the initial approach to mentalizing?
Parental attachment isn't the only thing that plays a role in the development of the child's mentalizing, but also context and environment
41
What benefits does cultural knowledge provide to humans?
This knowledge is intergenerational and can be transmitted fast
42
What are the six major challenges for Bowlby's (contemporary) attachment theory?
1. evocative person-environment relationships play a major role in the development of mentalizing
2. The relationship between attachment in childhood and developmental outcomes is less strong than may be expected
3. Meta-analyses suggest only
show that the stability of attachment across development is moderate. Stability of attachment is largely a function of the stability of the environment. This also clashes with key assumptions of attachment approaches
4. Historical, sociocultural, and environmental factors may determine the role and function of the attachment-behavioral system (challenges Bowlby’s original beliefs of attachment as an innate, universal behavioral system)
5. A recent study showed that parental sensitivity actually explains only a small proportion of the variance
6. There's increasing evidence for the roles of genes in the development of attachment. Thus gene-environment interaction can lead to different phenotypes and thus different types of attachments
43
# Modern, alternative approach, based on pedagogy
What concepts distinguish the modern approach to mentalizing from the initial apprach?
- Cultural knowledge
- Epistemic trust (or vigilance)
- Ostensive cueing
- Salutogenesis
44
What is epistemic trust?
The capacity to identify knowledge conveyed by others as personally relevant and generalizable to other contexts
45
What is the relationship between the above two concepts?
Instead of having to try and figure out cultural knowledge by yourself (time-consuming, near impossible) through epistemic trust we can rely on other people to provide us quickly with this info, which is achievable through epistemic trust.
This is a species-specific type of learning
46
Is Epistemic trust the default mode of functioning in humans?
NO. We're born with epistemic vigilance (opposite of epistemic trust) (Showcased by how infants show skepticism and distrust towards knowledge conveyed by others early on)
- Secure attachment provides the best context in which a child can develop epistemic trust
47
What is the importance of ostensive cueing?
- They prime the infant that upcoming communications are important
- They make the infant feel as a subjective agentive self
!!! These lead to epistemic trust and the possibility for quick transmission of cultural knowledge, as well as salutogenesis !!!
48
What is ostensive cueing?
Cueing in which the parent directs the attention of the infant somewhere or signals that something is important.
- Examples: Eye contact, infant directed speech, hearing your name being called
- Infants pay close attention to such cues
49
What is salutogenesis?
The capacity to benefit from positive influences in one's environment
50
What is the relationship between secure attachment and ostensive cueing?
Secure attachment provides the most ostensive cueing
51
What is the general model of the modern approach to mentalizing?
See Figure 2
52
So based on all the above concepts, what is the relationship between all of them?
Secure attachment -> Ostensive cueing -> Epistemic trust -> Salutogenesis
53
Based on the modern approach, how can we now view specific attachment styles?
They're contexts for social communication that the familial setting is promoting about the most effective way to function in an environment
54
Based on the modern approach, how can we conceptualize psychopathology?
Psychopathology is different manifestations of communicative strategies that arise from social learning to ensure adequate adaptation to changing social situations
55
What are these three communication systems?
- System 1 (lowering of epistemic vigilance): Epistemic vigilance lowers and trust grows. This creates the potential for learning and change
-> Importance of mentalizing in this system: Therapist needs to tailor the specific intervention to the patient, and patient needs to be able to recognize that the therapist considers his/her perspective
- System 2 (enabling mechanisms of social learning). As stated previously, increase in epistemic trust increases mentalizing and that in turn increases epistemic trust even further.
!!! Aim of therapy isn't to increase mentalizing in itself, but rather to open up the patient's potential for learning through increase in mentalizing and help the patient benefit from communications with the therapist (in other words, leads to salutogenesis)
- System 3 (reengaging with the social world). Once the person learns how to mentalize he/she is freed from their state of temporary social isolation and the capacity to learn is re-activated (as stated previously)
-> Allows the person to be able to grow outside of therapy
56
Based on the modern approach, how do we can we view effective treatments?
Effective treatments are a form of social re-learning fostered by changes in what we have conceptualized as three communication systems
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# Empirical Evidence for the modern approach
What is the empirical evidence for the modern approach?
- Significant evidence for the
species-specific nature of social learning based on joint intentionality and mentalizing
- Evidence showing that the quality of the relationship of a child and the communicator determines in large part the extent to which the child will acquire and generalize information from that communicator
-> Evidenced by the “hard-to-reach” character of individuals with a history of early adversity and deprivation that
we see as leading to epistemic distrust
- The association between the p factor and a family history of psychiatric problems, childhood adversity, and adult life impairment suggests that the p factor
may be related to problems with epistemic trust and salutogenesis.
- The equal effectiveness of common psychological interventions similarly points to a final common pathway involving social learning and salutogenesis.
- The prevalence of mental health disorders is highly associated with levels of distrust in social institutions
58
MENTALIZING IN PERSONALITY DISORDERS
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# BPD
What attachment strategies can be seen in BPD?
- High levels of hyperactivating attachment strategies (expressed as high levels of preoccupied attachment)
- Disorganized/unresolved patterns of attachment
!!! In general, those with BPD have an insecure attachment !!!
60
How is patients' insecure attachment expressed in terms of mentalizing?
Overly simplistic or over analytic/hyperactive accounts of their own mental states and those of others
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What is the relationship between trauma and BPD?
Very high rates of complex trauma in patients with BPD:
- Prevalence is up to 90%
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What is the relationship between genes and BPD?
Gene-environment interactions might play an important role in the etiology of BPD
- Heritability estimates are 40-50%
63
What is the relationship between maltreatment and BPD?
Maltreatment is highly associated with BPD, but only in those with a family history of psychopathology as an index of genetic vulnerability.
- Those without a history of psychopathology -> maltreatment in only 7% of patients
- Those with a history of psychopathology -> maltreatment in 50% of patients
64
What are the characteristic patterns of mentalizing on patients with BPD?
- Overly simplistic or over analytic/hyperactive accounts of their own mental states and those of others
- Rapid loss of controlled mentalizing and overreliance on fast, automatic mentalizing, followed by problems with cognitive mentalizing, particularly in complex interpersonal situation
- Overreliance on affective and external mentalizing at the expense of internal mentalizing
- Tendency to conflate mental states of self and others which results in susceptibility to emotional contagion -> Results from easy activation of automatic mentalizing system
!!! In general those with BPD tend to hyper-mentalize and this might make it seem that they have superior mentalizing to controls !!!
65
What is the neurobiology of mentalizing in those with BPD?
- Overactivation of the SR system
- Deficits in MSA system
66
What deficits do people with BPD showcase regarding epistemic trust?
- Showcase epistemic trust
- Takes decades even after successful therapy for such trust to develop
67
# Other personality disorders
In ASPD, what are the two main developmental pathways?
- One pathway leads to high levels of anxiety, hypervigilance to emotional states, and high levels of reactive aggression
-> Characterized by fast switches to automatic mentalizing
- Second pathway leads to so-called callous–unemotional features: hypo-reactivity to stress, severe deficits in affective mentalizing, and the use of instrumental aggression.
68
How can ASPD be conceptualized (similar to what was said above)?
As adaptation strategies
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# Mentalizing in other disorders
In depression, what role does attachment play?
Attachment disruptions have been shown to lead to vulnerability to these disorders.
70
In depression, what is the relationship between the disorder and mentalizing?
Mentalizing can be a cause, a consequence, or both
- Mentalizing impairments also increase the chance of relapse
!!! Mentalizing is an important target for treatment then !!!
71
What is the relationship between anxiety disorders and mentalizing?
Problems in reflecting on anxiety symptoms and their relation to personal events
72
What is the relationship between ED and mentalizing?
- In more dysregulated people with EDs, studies have typically found a pattern of severe impairments in mentalizing as well as affective hyper-mentalizing
- In higher-functioning, perfectionistic patients, there's a combination of hypo--mentalizing and cognitive hyper-mentalizing.
73
What is the relationship between somatoform disorders and mentalizing?
Attachment disruptions -> Mentalizing impairments and stress dysregulation -> hyperreactivity to stress -> constant stress on HPA axis and sympathetic nervous system leads to a biopsychosocial crash, which leads to anxiety, depression fatigue, as well associated pain and problems in immune regulation systems
- All of the above lead to further impairments in mentalizing which in turn then leads the person to experience his/her own body as an alien object that threatens the self from within
74
What other disorders has mentalizing problems been showcased in?
PTSD and ASD
75
MNETLIZATION BASED TREATMENT INTERVENTIONS
76
What are the 3 common features of all mentalizing approaches?
- MBT interventions focus on improving mentalizing capacities through a focus on the patient’s mental states as they are experienced moment by moment, and
by emphasizing the therapeutic alliance with the active repair of ruptures in the patient–therapist relationship
- Second, MBT interventions are structured, manualized interventions that focus on delivering treatments that are coherent, consistent, and continuous (The Three "C's", which are common in all evidence-based psychotherapies)
- Increasingly emphasizing and fostering of the capacity for salutogenesis and thus resilience in patients.
77
What are some general findings regarding MBT treatments?
- As effective as a high-intensity day-hospitalization treatment for BPD
- As effective as other EBT's (probably due to the 3 C's)
- Has low dropout rates
- Might be more effective than nonspecialized interventions in patients whose symptoms are more severe
- Quality of implementation may have a large impact on the effects of MBT (compared to others EBT's)
- More evidence regarding how it can be applied to the family and broader social context
