I'm with you, baby: Using parental embodied mentalizing in a pilot study to capture change following the circle of security parenting intervention.

Supported by a large body of work demonstrating the impact of infant attachment representations on subsequent development, numerous therapeutic programs have been developed to promote secure attachment, with increasing focus on parental mentalizing. Nonetheless, empirical evidence supporting their effectiveness has yet to be fully established. The current pilot study (N = 24) was designed to evaluate whether and to what extent parents' shifts in parental mentalizing following a brief attachment-based group intervention, namely circle of security parenting (COSP; Cooper, Hoffman & Powell, 2009) can be captured using the parental embodied mentalizing instrument (PEM; Shai & Belsky, 2017). Compared to a waiting list-control group, this small-scale study examined whether community-based low-risk mothers of infants aged 5-48 months show an increase in their observed PEM capacities following the intervention. Secondary self-reported outcome variables parental stress, feeling of competence, and self-compassion. Findings show that PEM ratings improved significantly over time in the COSP group, but not in the control group. Intervention group mother-infant dyads also presented significantly longer embodied interactions communication post intervention compared to the control group. No effects of the COSP on parental stress, competence, or self-compassion were found. Despite the small sample size, these results tentatively suggest that COSP can improve embodied mentalizing abilities.

Trust me! Parental embodied mentalizing predicts infant cognitive and language development in longitudinal follow-up.

Children's cognitive and language development is a central aspect of human development and has wide and long-standing impact. The parent-infant relationship is the chief arena for the infant to learn about the world. Studies reveal associations between quality of parental care and children's cognitive and language development when the former is measured as maternal sensitivity. Nonetheless, the extent to which parental mentalizing - a parent's understanding of the thoughts, feelings, and attitudes of a child, and presumed to underlie sensitivity - contributes to children's cognitive development and functioning, has yet to be thoroughly investigated. According to the epistemic trust theory, high mentalizing parents often use ostensive cues, which signal to the infant that they are perceived and treated as unique subjective beings. By doing so, parents foster epistemic trust in their infants, allowing the infant to use the parents a reliable source of knowledge to learn from. Until recently, parental mentalizing has been limited to verbal approaches and measurement. This is a substantial limitation of the construct as we know that understanding of intentionality is both non-verbal and verbal. In this investigation we employed both verbal and non-verbal, body-based, approaches to parental mentalizing, to examine whether parental mentalizing in a clinical sample predicts children's cognitive and language development 12 months later. Findings from a longitudinal intervention study of 39 mothers and their infants revealed that parental embodied mentalizing in infancy significantly predicted language development 12 months later and marginally predicted child cognitive development. Importantly, PEM explained unique variance in the child's cognitive and linguistic capacities over and above maternal emotional availability, child interactive behavior, parental reflective functioning, depression, ethnicity, education, marital status, and number of other children. The theoretical, empirical, and clinical implications of these findings are discussed.

Parental embodied mentalizing: Associations with maternal depression, anxiety, verbal mentalizing, and maternal styles of interaction.

BACKGROUND: Maternal depression and anxiety in the perinatal period affect the quality of maternal sensitivity and mentalizing abilities. Few studies analyzed implicit mentalizing in relation to maternal distress. The aims of the study were: to examine the relation between nonverbal mentalizing - parental embodied mentalizing (PEM) - and maternal depression and anxiety, verbal mentalizing, and maternal styles of interaction; and to test PEM as a mediator of the effect of maternal distress on styles of interaction. METHOD: 81 mother-infant dyads have been recruited. At infant three months, maternal depression was assessed using the Edinburgh Postnatal Depression Scale, anxiety with State Trait Anxiety Inventory, and reflective functioning with Reflective Functioning Scale. Mother-infant interactions were coded with various approaches: PEM for nonverbal mentalizing, Mind-mindedness coding system for Mind-mindedness, and CARE-Index for maternal styles of interaction. RESULTS: Maternal depression and state anxiety were negatively correlated with PEM. PEM was also negatively correlated to maternal controlling style. Mothers with psychopathological problems (vs. mothers with no psychopathological problems) had lower PEM and sensitivity and more controlling style. Moreover, maternal depression and anxiety had direct effects on maternal sensitivity and had indirect effects mediated by PEM on controlling style. LIMITATIONS: The study evaluates interactions at three months; longitudinal studies will be able to examine maternal mentalizing and sensitivity in various stages and identify the effect on the child's attachment. CONCLUSIONS: PEM is associated to maternal anxiety and depression and mediates the effects of depression and anxiety on mother controlling style. These results emphasize the importance of early prevention programs for mothers focused also on implicit mentalizing.

Associations of maternal sensitivity and embodied mentalizing with infant-mother attachment security at one year in depressed and non-depressed dyads.

Parental Embodied Mentalizing (PEM) captures the parent's capacity to extrapolate the child's mental states from movement and respond on a nonverbal level. Little is known about PEM's relation to other established measures of parent-child interactive behavior, such as maternal sensitivity and attachment. This is investigated in a sample of four months old infants and mothers with (n = 27) and without a diagnosis of postpartum depression (n = 44). Video-recorded infant-mother interactions were coded independently using PEM and Coding Interactive Behavior. Attachment was assessed at 13 months using the Strange Situation Procedure. Sensitivity and PEM was positively associated, but only sensitivity predicted attachment security and only the nonclinical group. This indicates that PEM and sensitivity are moderately related as well as capturing different aspects of infant-mother interactions. The study confirms previous findings of sensitivity predicting attachment in nonclinical groups. More research is required to further understand predictors of attachment in clinical samples.

High Burden of COVID-19 among Unvaccinated Law Enforcement Officers and Firefighters

Law Enforcement Officers (LEOs), firefighters, and other first responders are at increased risk of SARS-CoV-2 infection compared to healthcare personnel but have relatively low COVID-19 vaccine uptake. Resistance to COVID-19 vaccine mandates among first responders has the potential to disrupt essential public services and threaten public health and safety. Using data from the HEROES-RECOVER prospective cohorts, we report on the increased illness burden of COVID-19 among unvaccinated first responders. From January to September 2021, first responders contributed to weekly active surveillance for COVID-19-like illness (CLI). Self-collected respiratory specimens collected weekly, irrespective of symptoms, and at the onset CLI were tested by Reverse Transcription Polymerase Chain Reaction (RT-PCR) assay for SARS-CoV-2. Among 1415 first responders, 17% were LEOs, 68% firefighters, and 15% had other first responder occupations. Unvaccinated (41%) compared to fully vaccinated (59%) first responders were less likely to believe COVID-19 vaccines are very or extremely effective (17% versus 54%) or very or extremely safe (15% versus 54%). From January through September 2021, among unvaccinated LEOs, the incidence of COVID-19 was 11.9 per 1,000 person-weeks (95%CI=7.0-20.1) compared to only 0.6 (95%CI=0.2-2.5) among vaccinated LEOs. Incidence of COVID-19 was also higher among unvaccinated firefighters (9.0 per 1,000 person-weeks; 95%CI=6.4-12.7) compared to those vaccinated (1.8 per 1,000; 95%CI=1.1-2.8). Once they had laboratory-confirmed COVID-19, unvaccinated first responders were sick for a mean{+/-}SD of 14.7{+/-}21.7 days and missed a mean of 38.0{+/-}46.0 hours of work. These findings suggest that state and local governments with large numbers of unvaccinated first responders may face major disruptions in their workforce due to COVID-19 illness.

Neutralizing Antibody Response to Pseudotype SARS-CoV-2 Differs between mRNA-1273 and BNT162b2 COVID-19 Vaccines and by History of SARS-CoV-2 Infection

BackgroundData on the development of neutralizing antibodies against SARS-CoV-2 after SARS-CoV-2 infection and after vaccination with messenger RNA (mRNA) COVID-19 vaccines are limited. MethodsFrom a prospective cohort of 3,975 adult essential and frontline workers tested weekly from August, 2020 to March, 2021 for SARS-CoV-2 infection by Reverse Transcription- Polymerase Chain Reaction (RT-PCR) assay irrespective of symptoms, 497 participants had sera drawn after infection (170), vaccination (327), and after both infection and vaccination (50 from the infection population). Serum was collected after infection and each vaccine dose. Serum- neutralizing antibody titers against USA-WA1/2020-spike pseudotype virus were determined by the 50% inhibitory dilution. Geometric mean titers (GMTs) and corresponding fold increases were calculated using t-tests and linear mixed effects models. ResultsAmong 170 unvaccinated participants with SARS-CoV-2 infection, 158 (93%) developed neutralizing antibodies (nAb) with a GMT of 1,003 (95% CI=766-1,315). Among 139 previously uninfected participants, 138 (99%) developed nAb after mRNA vaccine dose-2 with a GMT of 3,257 (95% CI = 2,596-4,052). GMT was higher among those receiving mRNA-1273 vaccine (GMT =4,698, 95%CI= 3,186-6,926) compared to BNT162b2 vaccine (GMT=2,309, 95%CI=1,825-2,919). Among 32 participants with prior SARS-CoV-2 infection, GMT was 21,655 (95%CI=14,766-31,756) after mRNA vaccine dose-1, without further increase after dose- 2. ConclusionsA single dose of mRNA vaccine after SARS-CoV-2 infection resulted in the highest observed nAb response. Two doses of mRNA vaccine in previously uninfected participants resulted in higher nAb to SARS-CoV-2 than after one dose of vaccine or SARS- CoV-2 infection alone. Neutralizing antibody response also differed by mRNA vaccine product. Main Point SummaryOne dose of mRNA COVID-19 vaccine after previous SARS-CoV-2 infection produced the highest neutralizing antibody titers; among those without history of infection, two doses of mRNA vaccine produced the most robust response.

Studying the process of psychoanalytic parent-infant psychotherapy: Embodied and discursive aspects.

This paper presents findings from an intensive, mixed methods case study of one session of psychoanalytic parent-infant psychotherapy (PPIP) addressing early relational trauma, and aims to shed light on the multimodal interactive processes that take place in the moment-to-moment exchanges comprising the therapeutic encounter. Different research methods were used on video material from PPIP sessions, including microanalysis of adult-infant interactions, discourse analysis of talk, and coding systems developed to study parent-infant interaction. These different perspectives were brought together with the clinical narrative to illuminate the complex, dynamic processes of parent-infant-therapist interaction. More specifically, the detailed analysis of one interactive episode revealed brief behavioral manifestations of fearful and disoriented states of mind, reflecting dysregulated interaction between mother and infant, which also powerfully affected the therapist. The processes through which the therapist gradually resolves this rupture are also described in detail. Through this pilot study, we were able to show that it is possible to systematically study the process of PPIP. The study contributes to the growing psychotherapy research literature that takes into account both the verbal domain and implicit, interactional processes in therapeutic practice, and underscores the therapist's comprehensive engagement in the therapeutic process.

Este ensayo presenta resultados de un intensivo estudio de caso, con métodos mixtos, de una sesión de sicoterapia sicoanalítica de progenitor e infante (PPIP) dirigida al temprano trauma en la relación, y se propone arrojar luz sobre los procesos interactivos multimodales que se llevan a cabo en los intercambios de momento a momento que componen el encuentro terapéutico. Se usaron diferentes métodos de investigación en el material de video de las sesiones de PPIP, incluyendo el micro-análisis de las interacciones adulto-infante, análisis discursivos del habla y sistemas de codificación desarrollados para estudiar la interacción progenitor-infante. Estas diferentes perspectivas se pusieron juntas con la narrativa clínica para dar luz a los complejos, dinámicos procesos de interacción progenitor-infante-terapeuta. Más específicamente, los análisis detallados de un episodio interactivo revelaron breves manifestaciones de conducta de estados mentales de miedo y desorientación, lo cual refleja la interacción desregulada entre la madre y el bebé, lo que también afecta poderosamente al terapeuta. También se describen en detalle los procesos a través de los cuales el terapeuta gradualmente resuelve esta ruptura. Por medio de este estudio piloto, pudimos mostrar que es posible estudiar sistemáticamente el proceso de sicoterapia sicoanalítica de progenitor e infante. El estudio contribuye al creciente cuerpo investigativo sobre sicoterapia que toma en cuenta tanto el dominio verbal como los implícitos procesos interactivos en la práctica terapéutica y subraya la participación comprensiva del terapeuta en el proceso terapéutico. Palabras claves: sicoterapia progenitor-infante, comunicación multimodal, dominio implícito, investigación de procesos, trauma en la relación.

Studying the process of psychoanalytic parent-infant psychotherapy: Embodied and discursive aspects Cet article présente les résultats d'une étude de cas intensive par méthodes mixtes d'une session de psychothérapie psychanalytique parent-bébé adressant un trauma relationnel précoce. Il se donne pour but de mettre en lumière les processus interactifs multimodaux qui prennent place dans les échanges de moment-à-moment que comprend la rencontre thérapeutique. Différentes méthodes de recherches ont utilisé du matériel vidéo de séances PPIP, y compris des micro-analyses des interactions adulte-bébé, une analyse textuelle du dialogue et des systèmes de codage développés afin d'étudier l'interaction parent-bébé. Ces différentes perspectives ont été rassemblées avec la narration clinique afin d'illuminer les processus complexes et dynamiques de l'interaction parent-bébé-thérapeute. Plus particulièrement l'analyse détaillée d'un épisode interactif a révélé de brèves manifestations comportementales d'états d'esprit craintifs et désorientés, reflétant une interaction dys-régulée entre la mère et le bébé, qui ont aussi profondément affecté le thérapeute. Les processus au travers desquels le thérapeute a graduellement résolu cette rupture sont également décrits en détail. A travers cette étude pilote nous avons pu montrer qu'il est possible d'étudier systématiquement le processus de psychothérapie psychanalytique parent-bébé. L'étude contribue aux recherches en psychothérapie qui tiennent en compte à la fois le domaine verbal et implicite et les processus interactionnels dans la pratique thérapeutique, et souligne l'engagement total du thérapeute dans le processus thérapeutique. Mots clés: Psychothérapie parent-bébé, communication multimodale, domaine implicite, recherches processus, trauma relationn.

Does Postpartum Depression Affect Parental Embodied Mentalizing in Mothers With 4-Months old Infants?

Parental Embodied Mentalizing (PEM) regards parents' nonverbal capacity to understand the infant's bodily manifested mental states and adjust his or her own movements accordingly. Little is known about how mothers suffering from postpartum depression (PPD) mentalize the infant on an embodied level. The aims of the present study were to investigate whether mothers meeting criteria for a PPD diagnosis differ from non-clinical mothers in regard to their PEM capacities and whether the severity of depressive symptoms was associated with PEM in mothers meeting criteria for a PPD diagnosis compared to non-clinical mothers. 10-minute long lab-based face-to-face interactions were coded with the PEM coding scheme at 4-months postpartum in mother-infant dyads with mothers meeting criteria for a PPD diagnosis (n = 29) and non-clinical mothers (n = 51). Results showed that mothers with and without a PPD diagnosis differ in their capacity to mentalize on an embodied level, but only when controlling for scores on the Edinburgh Postnatal Depression Scale (EPDS). However, more depressive symptoms as measured with the EPDS was not in itself associated with lower PEM in either group. This finding may indicate the presence of a threshold effect, i.e. that maternal PEM may be affected only when a certain degree of severity and duration in depressive symptoms is beyond a certain threshold. The importance of the findings in regard to the assessment of depression as well as more clinical perspectives are discussed.