La video intervención terapéutica: una psicoterapia de apego y mentalización en la asistencia pública / La videointervenció terapèutica: una psicoteràpia d’aferrament i mentalització en l’assistència pública / Video Intervention Therapy: attachment and mentalization psychotherapy in public care

La VideoIntervención Terapéutica (VIT), de George Downing, tiene evidencia científica y, a diferencia de otros métodosútiles para niños pequeños, puede aplicarse a lo largo de la infancia y adolescencia. Es flexible y puede indicarsecomo tratamiento único o como parte de un plan de tratamiento. Estas cualidades lo hacen idóneo para incluirseen la cartera de servicios de la asistencia pública. En la primera parte de este artículo, se describe el método VIT,su procedimiento, características, conceptos operativos esenciales y algunas aplicaciones clínicas. En la segundaparte, se presenta un estudio retrospectivo de la aplicación VIT en un Centro de Salud Mental Infanto-juvenil.(AU)

George Downing’sVideo Intervention Therapy (VIT) has scientific evidence and, unlike other methods useful for young children, itcan be applied throughout childhood and adolescence. It is flexible and can be used as a stand-alone treatmentor as part of a treatment plan. These qualities make it suitable for inclusion in the public health care portfolio. Inthe first part of this article, the VIT method, its procedure, characteristics, essential operational concepts, andsome clinical applications are described. In the second part, a retrospective study of the VIT application in aChild and Adolescent Mental Health Centre is presented.(AU)

Lavideointervenció terapèutica (VIT), de George Downing, té evidència científica i, a diferència d’altres mètodesútils per a nens petits, es pot aplicar al llarg de la infància i adolescència. És flexible i es pot indicar com atractament únic o com a part d’un pla de tractament. Aquestes qualitats la fan idònia per incloure-la en la carterade serveis de l’assistència pública. A la primera part d’aquest article, es descriu el mètode VIT, el procediment,característiques, conceptes operatius essencials i algunes aplicacions clíniques. A la segona part, es presentaun estudi retrospectiu de l’aplicació VIT en un centre de salut mental infantil i juvenil.(AU)

The Primary Care-Video Intervention Therapy for Growth-Vulnerable Infants. A Case Study.

Perinatal growth vulnerability (e.g., Small for Gestational Age, SGA) poses the goal to not overlook subtle developmental susceptibilities and their impact on the parent-infant relationship. In this case study, we examined the application of a video-feedback intervention program to support parenting, the Primary Care-Video Intervention Therapy (PC-VIT), specifically developed to fit pediatric care characteristics. The case presentation details the principal steps of the intervention with the family of an SGA infant from birth up to toddlerhood. Findings for this family highlighted initial worries about the infant's growth. Along sessions, PC-VIT held maternal anxiety and sustained parents' abilities to recognize and talk about the infant's developmental skills and regulatory abilities. The PC-VIT shows the powerful opportunity to limit the impact of infant growth vulnerability on the parent-child relationship and socio-emotional development. Pediatricians can prevent vulnerable developmental milestones from clinical outcomes by implementing timely and effective strategies embracing mental health and parenting-related issues.

Video feedback intervention to enhance parental reflective functioning in primary caregivers of inpatient psychiatric children: protocol for a randomized feasibility trial.

BACKGROUND: Children requiring hospitalization for psychiatric care have serious disorders, high use of psychotropic medication, and frequent readmissions. The development and implementation of therapies focused on incorporating primary caregivers or attachment figures is necessary for working with children with severe psychiatric disorders. Mentalization or parental reflective functioning (PRF) is the ability of parents to understand their children's behaviors as an expression of internal emotional states and act accordingly to help them regulate their emotions; in this way mentalizing is a key component of sensitive parenting. Video-assisted therapies have proven to be effective in promoting change in parent-child relationships. The majority of studies have been carried out with mothers of pre-school children and in an outpatient setting. Video intervention therapy (VIT) is a flexible manualized therapy, which allows the intervention to be individualized to the context where it is applied, according to the needs and resources of the people who participate in it. The objective of the study is to evaluate the feasibility and acceptability of applying VIT to improve the PRF of the parents as primary carers of children hospitalized in a psychiatric service. METHODS: This is a pilot randomized, single-masked (outcome assessor) study with a qualitative component. It will involve a block randomization procedure to generate a 2:1 allocation (with more people allocated to the intervention arm). The intervention consists of four modules; every module has both one video-recorded play session and one VIT session per week. People assigned to the control group will receive treatment as usual plus weekly play sessions. Feasibility and acceptability of the study will be quantitatively and qualitatively assessed. Evaluation of the caregivers will include assessments of PRF, wellbeing and personality structure; assessments of children will include parent-ratings and clinician-ratings of symptomatology and general functioning. After every video feedback (VF) session, PRF, the caregiver's wellbeing and children's general functioning will be reassessed. DISCUSSION: This study will contribute to the currently scarce evidence on how to provide family attachment-based interventions in a child inpatient psychiatric unit. It will also inform the design and implementation of a future randomized clinical trial. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03374904 . Registered on 14 December 2017 (retrospectively registered).

Effectiveness of an Attachment-Based Intervention Program in Promoting Emotion Regulation and Attachment in Adolescent Mothers and their Infants: A Pilot Study.

This pilot study examined the effectiveness of an attachment-based intervention program, PRERAYMI, based on video technique, psychological counseling and developmental guidance in improving the style of interaction and emotion regulation of adolescent mothers and their infants after 3 and 6 months of intervention. Analyses revealed that adolescent mothers who participated in the intervention (vs. control group adolescent mothers) increased their Sensitivity and reduced their Controlling style after both 3 and 6 months of treatment. Infants who participated in the intervention (vs. control group infants) increased their Cooperative style and reduced their Passive style from 3 to 9 months. Moreover, the intervention group dyads (vs. control group dyads) increased the amount of time spent in affective positive coordination states (matches), decreased the amount of time spent in affective mismatches, and had a greater ability to repair mismatches from 3 to 9 months. Furthermore, the intervention group dyads (vs. control group dyads) increased the amount of time spent in reciprocal involvement in play with objects from 3 to 9 months. The quality of maternal attachment did not affect the intervention effect.

Pediatricians, Well-Baby Visits, and Video Intervention Therapy: Feasibility of a Video-Feedback Infant Mental Health Support Intervention in a Pediatric Primary Health Care Setting.

This case series study evaluated the feasibility and acceptability of a behavioral/cognitive psychological intervention in a pediatric primary health care setting during standard well-baby visits. The aim of the intervention was to support caregivers' sensitivity and mentalization in order to promote infant mental health (IMH). Four neonates from birth to 8 months were consecutively enrolled to test a short video-feedback intervention (Primary Care - Video Intervention Therapy, an adaptation of George Downing's Video Intervention Therapy to primary care) conducted by a pediatrician. The 5 min interaction recording and the video-feedback session were performed during the same well-baby visit and in the same pediatrician's office where the physical examination was conducted. During the study period, six video-feedback sessions were performed for each baby at different ages (1, 2, 3, 4, 6, 8 months). A series of different interactional situations were filmed and discussed: touch, cry, affective matching, descriptive language, feeding, separation and autonomy. The intervention was easily accepted and much appreciated by all four families enrolled. This study aimed to answer a dilemma which pediatric providers generally face: if the provider wishes to respond not only to physical but also IMH issues, how on a practical level can this be done? This case series study indicates that Primary Care - Video Intervention Therapy can be a promising new tool for such a purpose.

Interactive coordination of currently depressed inpatient mothers and their infants during the postpartum period.

In healthy mother-infant dyads, interactions are characterized by a pattern of matching and mismatching interactive states with quick reparation of mismatches into matches. In contrast, dyads in which mothers have postpartum depression show impaired mother-infant interaction patterns over the first few months of the infant's life. The majority of studies that have examined such interaction patterns have drawn on community samples rather than on depressed inpatient samples of mothers who were in a state of current depression at the time of assessment. To date, no study has investigated specific microanalytic patterns of interactive coordination between depressed German mothers and their infants using the Face-to-Face Still-Face paradigm (FFSF). The primary goal of this study was to evaluate specific patterns of dyadic coordination and the capacity for repairing states of miscoordination in an inpatient sample of postpartum currently depressed mothers and their infants as compared with a healthy control group. A sample of 28 depressed inpatient German mothers and their infants (age range = 1-8 months, M age = 4.06 months) and 34 healthy dyads (range = 1-8 months, M age = 3.89 months) were videotaped while engaging in the FFSF. A focus was placed on the play and reunion episodes. Compared with healthy dyads, dyads with depressed mothers showed less coordination of positive matched states and longer latencies when repairing interactive mismatching states into positive matched states. Clinical implications are discussed.

Interfaces between intersubjectivity and attachment: Three perspectives on a mother-infant inpatient case.

Despite much new literature on clinical early intervention, background theoretical issues have received less critical attention. In this study, we look at a single mother-infant case from different perspectives. To give the discussion a viable focus, we draw upon two types of specific material: an Adult Attachment Interview (M. Main & R. Goldwyn, 1985-1998) and a video of mother-infant interaction. We elaborate some alternative conceptualizations of this material, noting similarities, contrasts, and differences in emphasis in these frameworks. A brief series of practical implications for clinical treatment is summarized in conclusion.

Interactive regulation of affect in postpartum depressed mothers and their infants: an overview.

Specific patterns of interaction emerging in the first months of life are related to processes regulating mutual affects in the mother-child dyad. Particularly important for the dyad are the matching and interactive repair processes. The interaction between postpartum depressed mothers and their children is characterized by a lack of responsiveness, by passivity or intrusiveness, withdrawal and avoidance, as well as a low level of positive expression of affect. Thus, an impaired capability to regulate the child's affect has been demonstrated in depressed mothers. Maternal aggression, neglect toward infants, infanticidal thoughts, as well as infanticidal behavior are mainly linked to severe postpartum depression, especially with psychotic symptoms. The findings on mother-child interaction reported in this paper are based on mothers with mild to moderate depressive disorders without psychotic symptoms. Considering the stability of interaction patterns in the course of depressive illness as well as the long-term consequences of these interactions, it seems surprising that there are still few systematic studies of depressed mothers interacting with their infants. In connection with an overview on these issues, treatment models for parent-infant psychotherapy are discussed.