Post-traumatic-stress in the context of childhood maltreatment: pathways from attachment through mentalizing during the transition to parenthood.

Introduction: This study aimed to clarify the role of mentalizing in pathways from attachment to Post Traumatic Stress Symptoms (PTSS) in survivors of childhood maltreatment (CM). We focused on the transition to parenting, a critical period for reworking parenting representations to reduce intergenerational maltreatment cycles. Method: Study participants included 100 pregnant CM survivors. We assessed PTSS with the SCID and attachment and mentalizing with the Adult Attachment Interview (AAI), which was rated for Attachment and Reflective Functioning (RF). Results: Regarding Re-experiencing trauma symptoms, the results of the path analysis were consistent with mediation. CM survivors' mentalizing about their early relationships with their parents (RF-Other) directly impacted Re-experiencing trauma symptoms, and attachment had an effect on Re-experiencing trauma symptoms through mentalizing (RF-Other). Regarding Arousal/Reactivity symptoms, the results of the pathways analysis were consistent with partial mediation by mentalizing about early relationships with parents (RF-Other). In addition to the pathway from attachment via mentalizing (RF-Other) to Arousal/Reactivity, the pathway between attachment and Arousal/Reactivity also remained significant. Discussion: This study provides new evidence of a mentalizing and attachment model of PTSS in CM survivors. The findings indicate that increased mentalizing about early relationships with parents is an important process associated with lower PTSS. Finally, we discuss the implications of developing interventions for CM survivors to reduce PTSS. Scaffolding the development of mentalizing regarding attachment relationships in which CM occurred may help CM survivors reduce the intrusion of traumatic memories and decrease trauma-related arousal and reactivity symptoms. Interventions to help CM survivors mentalize regarding parents and attachment relationships in which trauma occurred may be particularly important during the transition to parenting when activation of representations of parenting can trigger PTSS.

Mothers' Self-focused Reflective Functioning Interacts with Childhood Experiences of Rejection to Predict Current Romantic Relationship Quality and Parenting Behavior.

Parents exposed to rejection in their childhood could experience bonding disturbances in their current relationships. Reflective functioning (RF), the capacity to understand one's own and others' behavior through the lens of underlying mental states (cognitions, emotions), has been identified as a potential protective process. The aim of this longitudinal study was to examine whether RF moderates the effect of parents' experiences of rejection in childhood on later relationship functioning with partners and infants. Pregnant women with experiences of abuse and neglect were recruited and completed the Adult Attachment Interview, which was coded for RF and experiences of childhood rejection. During two follow-up assessments, when their infants were 5 and 17 months old, the mothers in our sample who had partners reported on dyadic cohesion with these partners. Further, at 5 months postnatal, mothers completed interaction tasks with their infants, which were later assessed using observational measures (i.e., CARE-Index). Results of mothers with partners (N = 93) indicated that RF moderated the relationship between dyadic cohesion with partners at 17 months only. Additionally, results with all mothers in the sample (N = 108) indicated that RF moderated the relationship between retrospectively reported experiences of rejection and controlling and unresponsive behaviors with infants. Adequate-to-high RF was associated with lower unresponsiveness and higher relationship satisfaction in the context of rejection, while being associated with higher levels of control. These findings have important clinical implications, as RF is amenable to change and can therefore be more prominently implemented within various interventions.

Los padres expuestos al rechazo en su infancia podrían tener problemas de vinculación en sus relaciones actuales. El funcionamiento reflexivo (FR), la capacidad de comprender la conducta propia y de los demás mediante la perspectiva de los estados mentales subyacentes (cogniciones, emociones) se ha identificado como posible proceso de protección. El objetivo de este estudio longitudinal fue analizar si el FR modera el efecto de las experiencias de rechazo de los padres durante la infancia en el funcionamiento posterior de las relaciones con las parejas y los bebés. Se incluyó a mujeres embarazadas con experiencias de abuso y abandono, quienes completaron la Entrevista de Apego en los Adultos (Adult Attachment Interview), la cual se codificó para el FR y las experiencias de rechazo en la infancia. Durante dos evaluaciones de seguimiento, cuando sus bebés tenían cinco meses y diecisiete meses, las madres de nuestra muestra que tenían pareja informaron sobre la cohesión diádica con estas parejas. Además, a los cinco meses después del parto, las madres completaron tareas de interacción con sus bebés, que después se evaluaron usando instrumentos de evaluación observacionales (p. ej., CARE-Index). Los resultados de las madres con las parejas (N = 93) indicaron que el FR moderó la relación entre la cohesión diádica con las parejas a los 17 meses solamente. Además, los resultados con todas las madres de la muestra (N = 108) indicaron que el FR moderó la relación entre las experiencias de rechazo informadas retrospectivamente y las conductas dominantes e indiferentes con los bebés. El FR entre adecuado y alto se asoció con una indiferencia más baja y una satisfacción con la relación más alta en el contexto del rechazo, y a su vez se lo asoció con niveles más altos de control. Estos resultados tienen consecuencias clínicas importantes, ya que el FR es susceptible de cambios y puede, por ende, implementarse de manera más prominente dentro de diferentes intervenciones.

Incidentaloma Discoveries in the Course of Neuroimaging Research.

ABSTRACTAmong healthy volunteers in psychiatric brain functional magnetic resonance imaging (fMRI) research studies, the prevalence of incidentalomas can be as high as 34%, of which 10% show clinical significance. An incidentaloma is a lesion found by coincidence without clinical symptoms or suspicion. Like lesions and other types of accidental findings, it is found in healthy individuals recruited to take part in psychiatric studies. The prevalence of these accidental findings among specific psychiatric populations remains unknown. However, a precise understanding of cerebral neuroanatomy, neuroradiological expertise, and an appropriate choice of fMRI exploration sequences will increase the sensitivity of identifying these accidental findings and enable researchers to address their clinical relevance and nature. We present recommendations on how to appropriately inform patients or participants of the accidental findings. Additionally, we propose specific suggestions pertaining to the clinical research setting aimed for investigators and psychiatrists. Unlike current articles pertaining to incidentaloma, the current report provides a distinct focus on psychiatric issues and specific recommendations for studies involving psychiatric patients.

Intergenerational transmission of attachment in abused and neglected mothers: the role of trauma-specific reflective functioning.

There are still important gaps in our knowledge regarding the intergenerational transmission of attachment from mother to child, especially in mothers with childhood histories of abuse and neglect (CA&N). This study examined the contributions of reflective function concerning general attachment relationships, and specifically concerning trauma, as well as those of maternal attachment states of mind to the prediction of infant attachment disorganization in a sample of mothers with CA&N and their infants, using a 20-month follow-up design. Attachment and reflective functioning were assessed during pregnancy with the Adult Attachment Interview. Infant attachment was evaluated with the Strange Situation Procedure. The majority (83%) of infants of abused and neglected mothers were classified as insecure, and a significant proportion (44%) manifested attachment disorganization. There was a strong concordance between mother and child attachment, indicative of intergenerational transmission of attachment in parents with CA&N and their infants. Both unresolved trauma and trauma-specific reflective function made significant contributions to explaining variance in infant attachment disorganization. The findings of this study highlight the importance of trauma-specific mentalization in the intergenerational transmission of attachment by mothers with a history of childhood maltreatment, and provide new evidence of the importance of the absence of mentalization regarding trauma for infant attachment.

Another step closer to measuring the ghosts in the nursery: preliminary validation of the Trauma Reflective Functioning Scale.

The aim of this study was to examine preliminary evidence of the validity of the Trauma Reflective Functioning Scale and to investigate reflective functioning (RF) and attachment in pregnant women with histories of trauma, with a particular focus on the capacity to mentalize regarding trauma and its implications for adaptation to pregnancy and couple functioning. The Adult Attachment Interview was used to assess attachment, unresolved trauma and mentalization (measured as RF) regarding relationships with attachment figures (RF-G) and trauma (RF-T) in 100 pregnant women with histories of abuse and neglect. The majority (63%) of women had insecure attachment states of mind and approximately half were unresolved regarding trauma. Furthermore, the majority of women manifested deficits specific to RF-T. Their RF-T was significantly lower than their RF-G; the findings indicate that women with histories of childhood abuse and neglect do not manifest a generic inhibition of reflectiveness, but a collapse of mentalization specific to trauma. Low RF-T, indicative of difficulty in considering traumatic experiences in mental state terms, was associated with difficulty in investment in the pregnancy and lack of positive feelings about the baby and motherhood. In addition, low RF-T was also associated with difficulties in intimate relationships. Results of a regression analysis with RF indicated that RF-T was the best predictor of investment in pregnancy and couple functioning. In sum, the study provides preliminary evidence that RF-T can be reliably measured and is a valid construct that has potential usefulness for research and clinical practice. It highlights the importance of mentalization specifically about trauma and suggests that it is not the experience of trauma per se, but the absence of mentalization regarding trauma that is associated with difficulties in close relationships and in making the transition to parenthood.

[The implementation of the Quebec Mental Health Action Plan: hands-on experience at the Maisonneuve-Rosemont hospital in Montreal]. / La mise en place du Plan d'action en santé mentale au Québec : l'expérience concrète de l'Hôpital Maisonneuve-Rosemont à Montréal.

The Mental Health Action Plan maps out the reorganization of mental health services in the province of Quebec. Accordingly, this paper presents the transformation process of the mental health program at the Maisonneuve-Rosemont hospital in Montreal. The authors discuss, on the one hand, the challenges that were met and, on the other hand, the model of care and organisational choices that were adopted. This article is divided in three parts. The first part describes the two main guiding principles underlying the Mental Health Action Plan. The second part examines the context surrounding the arrival of the Action Plan at the Maisonneuve-Rosemont Hospital. The third part describes the hospital transformation process that evolved in relation with: 1- the new centralized access points for mental health services; 2- the support for first line (or primary care) services; 3- the second line services for the specialized treatment of complex mental health problems.

Assessing psychosocial risk in pregnant/postpartum women using the Contextual Assessment of Maternity Experience (CAME)--recent life adversity, social support and maternal feelings.

BACKGROUND: The Contextual Assessment of Maternity Experience (CAME) interview was developed to characterise the psychosocial context relevant to the maternity experience by providing a detailed picture of women's lives during the transition to motherhood. More specifically, it was designed to enable the assessment of major risk factors for emotional disturbances in pregnant and postpartum women, especially depression, within the same instrument and using a coherent methodological framework. METHOD: The CAME assesses three domains relevant to motherhood: 1) recent life adversity or stressors; 2) the quality of social support and key relationships including partner relationship; and 3) maternal feelings towards pregnancy, motherhood and the baby. Two high-risk samples of inner-city London women were used to test the psychometric qualities of the CAME components. RESULTS: Overall, the internal consistencies of the relevant components were high in both samples examined. The validity of the three components of the measure was evidenced by their association with either maternal characteristics or parenting assessments. CONCLUSION: It was concluded that the CAME shows promise as a measure of the psychosocial risk factors involved in the maternity experience for future research in this field.

Motherhood as a vulnerability factor in major depression: the role of negative pregnancy experiences.

Adverse pregnancy experiences were examined retrospectively in relation to adult lifetime experience of clinical depression to see whether such experience conferred long-term risk for women. The sample consisted of just under 200 community-based women, half of whom were selected for high depressive-risk on the basis of adverse childhood experience. Over two-thirds of these women had experienced pregnancy. Adverse pregnancies were classified either in terms of loss (adverse non-live pregnancy/births) or in terms of live births in difficult circumstances (adverse live pregnancy/births). Intensive life history interviews collected details of all pregnancies, childhood neglect/abuse, marital adversity and a history of episodes of clinical depression. Both adverse non-live and live pregnancy experiences were significantly related to lifetime depression. The relationship remained for depression in different time periods and for those episodes unrelated to maternity experience. Both types of adverse pregnancy/birth experiences were associated with increased rates of marital problems. While adverse live pregnancy/births related to prior childhood neglect/abuse, this did not hold for those non-live. Logistic regression showed that only adverse non-live pregnancy/births together with marital adversity and childhood neglect/abuse provided the best model for lifetime depression. The findings are discussed in terms of lifetime trajectories linking difficult environments, close relationships and issues of loss.