A meta-analysis of mentalizing in anxiety disorders, obsessive-compulsive and related disorders, and trauma and stressor related disorders.

BACKGROUND: The number of studies that have researched the ability to mentalize in individuals with anxiety and related disorders is limited. Often, no distinction is made between different anxiety and related disorders in the examination of mentalization. OBJECTIVE: The goal of this study was to obtain insight into mentalization in anxiety and related disorders, and to compare this ability between these disorders. METHOD: A systematic literature search was performed to identify studies in which performance on a mentalization task was compared between a patient group diagnosed with an anxiety or a related disorder, and a control group. Meta-analyses were performed on the included articles. RESULTS: The initial search yielded 2844 articles, of which 26 studies on 1056 patients were included. Patients diagnosed with anxiety and related disorders showed a deficit in mentalization when compared to healthy controls (SMD = -0.60, p 0.001). A deficit was found in all patient groups: Patients with anxiety disorders (SMD = -0.39, p = 0.007), obsessive-compulsive and related disorders (SMD = -0.78, p = 0.01), and trauma and stressor related disorders showed significant deficits (SMD = -0.77, p = 0.02) as compared to healthy controls. CONCLUSION: The results indicated impaired mentalization in anxiety and related disorders, with specific deficiencies in posttraumatic stress disorder, social anxiety, and obsessive-compulsive disorders. Mentalization could provide a clinical target in treatment of these disorders.

Social cognitive performance in posttraumatic stress disorder: A meta-analysis.

BACKGROUND: Social support represents a key factor in the development of post-traumatic stress disorder (PTSD). Social cognition - the ability to perceive, interpret, and respond to other people - is considered fundamental in making use of social support. Gaining knowledge on the link between PTSD and social cognition is therefore essential. Whilst social cognitive difficulties in patients with PTSD are documented, an understanding of which particular social cognitive processes might be affected more than others, is lacking. The current meta-analysis was therefore aimed to examine social cognitive functioning in four underlying social cognitive domains (mentalization, emotion recognition, social perception, and attributional style) in PTSD diagnosed patients versus controls. METHODS: Meta-analyzes were conducted on studies examining performance on at least one social cognitive domain in PTSD diagnosed patients compared to controls. RESULTS: 19 studies were included, involving 565 patients and 641 controls. Relative to controls, the PTSD group scored lower on overall social cognitive functioning (SMD = -0.42), specifically on mentalization (SMD = -0.81) and social perception (SMD = -0.30), whilst the latter should be interpreted with caution as only one study was found pertaining to this domain. No emotion recognition and attributional style differences were found. LIMITATIONS: There was evidence of moderate heterogeneity in the results of the included studies for overall social cognition and attributional style. CONCLUSIONS: Findings indicate that social cognition represents a potential important clinical factor in PTSD and underscore the importance of differentiating between underlying social cognitive processes in research and treatment of PTSD.

Feasibility of narrative exposure therapy in an outpatient day treatment programme for refugees: improvement in symptoms and global functioning.

BACKGROUND:  Refugees are at high risk for developing post-traumatic stress disorder (PTSD). Narrative exposure therapy (NET) is an evidence-based treatment of PTSD, designed for patients exposed to (multiple) traumatic events and recommended for patients with culturally diverse backgrounds. In clinical practice, adherence to the NET-protocol has been challenged because of psychosocial complexities and comorbid disorders. . OBJECTIVE: The current study investigated the feasibility of NET embedded in an outpatient day treatment programme for refugees and examined reduction in PTSD symptoms and improvement of global functioning as well as correlates of change. . METHOD: Participants were patients who consecutively entered an outpatient daytreatment programme from 2013-2017. The majority had a history of prior unsuccessful treatment. PTSD was assessed with the Clinically Administered PTSD Scale (CAPS) before and after finishing NET. Global Assessment of Functioning (GAF) was used to examine changes in functioning. Changes in PTSD scores and functioning were analyzed using paired t-tests and reliable change indices. Patients showing significant improvement were compared to those who did not, on patient and treatment characteristics, including sex, age, region of origin, childhood trauma and treatment duration and dosage of NET. . RESULTS: Of 97 patients, 76 (78.4%) completed NET. Completers had a longer residency and were more likely to have a partner. Significant reductions in PTSD symptoms and improvements in global functioning were observed. Twenty-eight percent showed reliable improvement with large effect sizes. Four patients did no longer meet the criteria for PTSD. No strong moderators for changes were found. Patients who did not improve more often had a history of childhood trauma. CONCLUSIONS: NET embedded in an outpatient day treatment programme appears to be feasible. In those who improved, a substantial decline in symptoms and improvement of functioning were observed. The findings suggest that a socially supportive living environment enhances acceptability of trauma-focused treatment in refugees.

Antecedentes: Los refugiados están en alto riesgo de desarrollar trastorno de estrés postraumático (TEPT). La terapia de exposición narrativa (NET) es un tratamiento basado en evidencia del TEPT, diseñado para pacientes expuestos a eventos traumáticos (múltiples) y recomendado para pacientes con antecedentes culturalmente diversos. En la práctica clínica, la adherencia al protocolo NET ha sido desafiada debido a las complejidades psicosociales y los trastornos comórbidos.Objetivo: El estudio actual investigó la factibilidad de NET incluido en un programa de tratamiento diurno ambulatorio para refugiados y examinó la reducción de síntomas de TEPT y la mejora del funcionamiento global, así como correlatos de cambio.Método: Los participantes fueron pacientes que ingresaron consecutivamente a un programa de tratamiento diurno ambulatorio entre 2013­2017. La mayoría tenía antecedentes de tratamiento previo sin éxito. El TEPT se evaluó con la Escala de TEPT administrada clínicamente (CAPS, por sus siglas en ingles) antes y después de finalizar NET. La Evaluación Global del Funcionamiento (GAF) se utilizó para examinar los cambios en el funcionamiento. Los cambios en los puntajes y el funcionamiento del TEPT se analizaron mediante t-test pareados e índices de cambio confiables. Los pacientes que mostraron una mejoría significativa fueron comparados con aquellos que no lo hicieron, en cuanto a las características del paciente y tratamiento, incluidos sexo, edad, región de origen, trauma infantil y duración del tratamiento, y dosificación de NET.Resultados: De 97 pacientes, 76 (78.4%) completaron NET. Los que completaron tenían un periodo de residencia más largo y tenían más probabilidades de tener una pareja. Se observaron reducciones significativas en los síntomas de TEPT y mejoras en el funcionamiento global. Veintiocho por ciento mostró una mejora confiable con grandes tamaños de efecto. Cuatro pacientes ya no cumplían los criterios para TEPT. No se encontraron fuertes moderadores para los cambios. Los pacientes que no mejoraron con mayor frecuencia tenían antecedentes de trauma infantil.Conclusiones: NET integrado en un programa de tratamiento ambulatorio diurno se muestra factible. En aquellos que mejoraron, se observó disminución sustancial de los síntomas y una mejoria del funcionamiento. Los hallazgos sugieren que un entorno de vida de apoyo social aumenta la aceptabilidad del tratamiento centrado en el trauma en los refugiados.