Improvements in mentalization predict improvements in interpersonal distress in patients with mental disorders

Hayden, Markus; Müllauer, Pia K; Gaugeler, Richard; Senft, Birgit; Andreas, Sylke

doi:10.1002/jclp.22673

Cited by 30 publications

(28 citation statements)

References 44 publications

(64 reference statements)

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“…For example, Herpertz and Bertsch (2014) considered impairments in social cognition (i.e., facial emotion recognition, cognitive and emotional empathy, and theory of mind) to be a core concept that characterizes PDs. Other authors (Antonsen et al, 2016; Hayden et al, 2018) found an association between Reflective Function (RF) and the intensity of symptom distress and psychosocial impairment. Semerari et al (2014) supported evidence that (1) metacognition is specifically impaired in PDs if compared to a clinical sample of non-PD patients, (2) the dysfunction is significantly correlated to the severity of personality pathology (measured as the number of criteria met in the SCID II) and (3) difficulties in metacognition are specific to different PDs (Semerari et al, 2007), for example in BPD (Semerari et al, 2005, 2015) and in Avoidant PD (AvPD) patients Pellecchia et al (2018).…”

Section: Discussionmentioning

confidence: 98%

Metacognition as a Predictor of Improvements in Personality Disorders

Carcione¹,

Riccardi²,

Bilotta³

et al. 2019

Front. Psychol.

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Personality Disorders (PDs) are particularly hard to treat and treatment drop-out rates are high. Several authors have agreed that psychotherapy is more successful when it focuses on the core of personality pathology. For this reason, therapists dealing with PDs need to understand the psychopathological variables that characterize this pathology and exactly what contributes to maintaining psychopathological processes. Moreover, several authors have noted that one key problem that characterizes all PDs is an impairment in understanding mental states – here termed metacognition – which could also be responsible for therapy failures. Unfortunately, a limited number of studies have investigated the role of mentalization in the process of change during psychotherapy. In this paper, we assume that poor metacognition corresponds to a core element of the general pathology of personality, impacts a series of clinical variables, generates symptoms and interpersonal problems, and causes treatment to be slower and less effective. We explored whether changes in metacognition predicted an improvement among different psychopathological variables characterizing PDs; 193 outpatients were treated at the Third Center of Cognitive Psychotherapy in Rome, Italy, and followed a structured path tailored for the different psychopathological variables that emerged from a comprehensive psychodiagnostic assessment that considered patients’ symptoms, metacognitive abilities, interpersonal relationships, personality psychopathology, and global functioning. The measurements were repeated after a year of treatment. The results showed that changes in metacognitive abilities predicted improvements in the analyzed variables.

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Section: Discussionmentioning

confidence: 98%

Metacognition as a Predictor of Improvements in Personality Disorders

Carcione¹,

Riccardi²,

Bilotta³

et al. 2019

Front. Psychol.

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“…However, we also took into consideration that the severity of psychiatric symptoms can have a serious impact on inner psychic processes [29, 30]. Previous studies have demonstrated that this may affect research regarding the aforementioned concepts as well [27, 31, 32]. Therefore, we also included this variable in our research.…”

Section: Introductionmentioning

confidence: 99%

“…In another study, affect regulation – an important component of mentalization – turned out to mediate the association between attachment insecurities and interpersonal problems [17]. Furthermore, one study reported stable patterns of intercorrelation between measures of adult attachment, interpersonal problems, and mentalization over the course of inpatient psychotherapy [27], and one study revealed specific patterns of attachment-deactivating and -hyperactivating strategies, an impairment in reflective functioning, and an increase in interpersonal problems [28]. …”

Section: Introductionmentioning

confidence: 99%

Mentalization as Mediator between Adult Attachment and Interpersonal Distress

Hayden

Müllauer

Gaugeler³

et al. 2019

Psychopathology

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Background: The aim of this study was to investigate the mediating role of mentalization in the association between adult attachment and interpersonal problems. Methods: The sample consisted of 89 patients with different types of mental disorders who were at the beginning of treatment in one of two medical centers. Both mediational analysis and path analysis were used to test the model. Results: The proposed model revealed a good model fit. The data indicate that mentalization fully mediates the effect of attachment on interpersonal distress. Symptom severity proved to be a strong confounding variable that influenced all other variables and reduced existing effects. Conclusion: We conclude that both mentalization and symptom distress are key components in the association of adult attachment and interpersonal problems. Therefore, we recommend research on integrative psychotherapy concepts rather than unilateral approaches.

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“…Mentalization is positively intercorrelated with mental stability and attachment security. A growing number of studies have emphasized the importance of mentalization as a protective factor against mental disorders (10)(11)(12). On the other hand, impairments in the ability to mentalize are predictors of psychopathology and mental instability (3,8).…”

Section: Introductionmentioning

confidence: 99%

“…Both disorders are characterized by a lack of mentalization, and both disorders are characterized by the predominance of immature defense mechanisms ( 34 , 35 ). Furthermore, both the enhancement of reflective functioning and the maturation of defense mechanisms are associated with mental stability and with progress in psychotherapy, e.g., in the treatment of personality disorders ( 11 , 28 , 36 , 37 ). Since mentalization enables humans to reflect upon their own actions and, in particular, to reflect upon the mental processes that cause their own actions, an association of mentalization with the use of various kinds of defense mechanisms seems plausible.…”

Section: Introductionmentioning

confidence: 99%

Increasing Mentalization to Reduce Maladaptive Defense in Patients With Mental Disorders

et al. 2021

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Background: There are indications of associations between the ability to mentalize and psychological defense mechanisms. However, only a few studies have focused on these associations, and even fewer have included empirical analyses. In the present study, we aimed to fill this research gap by analyzing the link between the ability to mentalize and psychological defense mechanisms in patients with mental disorders. We examined whether changes in defense mechanisms are predicted by an increase in mentalization or whether such changes are only related to reductions in psychopathology and interpersonal problems.Methods: A clinical sample of N = 89 patients was studied during and after inpatient psychiatric rehabilitation. Repeated-measures analyses of variance were performed to determine changes in mentalization, psychological defense, psychopathology, and interpersonal problems over the course of therapy and post-treatment. Linear regression analyses were used to predict the change in defense patterns based on an increase in mentalization.Results: Maladaptive defense mechanisms were significantly reduced during inpatient therapy and remained low until follow-up, whereas neurotic and adaptive defense mechanisms did not change significantly. The results of the regression analyses indicated that mentalization played an important role in the reduction in maladaptive defense during and after inpatient rehabilitation for mental disorders, whereas reductions in psychopathology and interpersonal distress were only partially associated with a reduction in maladaptive defense.Conclusion: We conclude that mentalization is vital for reducing maladaptive defense mechanisms, which are commonly associated with mental disorders. In therapy, an increase in patients' capacity to mentalize may be a practicable approach to diminish maladaptive defense mechanisms.

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Improvements in mentalization predict improvements in interpersonal distress in patients with mental disorders

Cited by 30 publications

References 44 publications

Metacognition as a Predictor of Improvements in Personality Disorders

Metacognition as a Predictor of Improvements in Personality Disorders

Mentalization as Mediator between Adult Attachment and Interpersonal Distress

Increasing Mentalization to Reduce Maladaptive Defense in Patients With Mental Disorders

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