Mentalisation-based online intervention for psychologically distressed parents: protocol of a non-randomised feasibility trial of the Lighthouse Parenting Programme-Online (LPP-Online).

INTRODUCTION: Online-based interventions provide a low-threshold way to reach and support families. The mentalisation-based Lighthouse Parenting Programme is an established intervention aimed at preventing psychopathological development in children. The objective of this study is to examine the feasibility of an online adaptation of the Lighthouse Parenting Programme (LPP-Online), evaluating (a) recruitment capability, compliance, acceptability and satisfaction with the intervention; (b) the psychometric properties of and the acceptability regarding the adjunct psychological evaluation; and (c) the employed materials and resources. The study will also obtain a preliminary evaluation of participants' responses to the intervention. METHOD AND ANALYSIS: In this monocentric, one-arm, non-randomised feasibility trial, n=30 psychologically distressed parents with children aged 0 to 14 years will participate in the LPP-Online for a duration of 8 weeks. The intervention consists of online group sessions and individual sessions, 38 smartphone-based ecological momentary interventions (EMI), and psychoeducational materials (website, booklet). At baseline (T0) and the end of the intervention (T1), parents complete self-report questionnaires as well as 7-day ecological momentary assessments (EMA) via smartphone. During the intervention, additional EMA are completed before and after the daily EMI. An interview regarding parents' subjective experience with the intervention will be conducted at T1. The feasibility of the intervention, the psychological evaluation and the resources will be examined using descriptive and qualitative analyses. The preliminary evaluation of the parents' response to the intervention will be conducted by analysing pre-post changes in questionnaire measures and the 7-day EMA as well as data of additional EMA completed before and after the daily EMI. ETHICS AND DISSEMINATION: Ethical approval of the study has been obtained from the local ethics board (Faculty of Behavioural and Cultural Studies, University of Heidelberg). Consent to participate will be obtained before starting the assessments. Results will be disseminated as publications in peer-reviewed scientific journals and at international conferences. REGISTRATION DETAILS: German Clinical Trials Register (DRKS00027423), OSF (https://doi.org/10.17605/OSF.IO/942YW).

Towards an informed research agenda for the field of personality disorders by experts with lived and living experience and researchers.

BACKGROUND: We describe a collection of themes for a research agenda for personality disorders that was originally formulated for the ESSPD Borderline Congress in 2022. METHODS: Experts with lived and living experience (EE), researchers and clinicians met virtually, exchanged ideas and discussed research topics for the field of personality disorders. The experts - patients, relatives, significant others - named the topics they thought most relevant for further research in the field. These topics were presented at the ESPPD conference in October 2022. RESULTS: The five top themes were: 1. Prevention, early detection and intervention, 2. Recovery beyond symptom improvement, 3. Involvement of relatives in treatment, 4. Gender dysphoria, and 5. Stigma. CONCLUSIONS: In general, the topics reflect current issues and changes in societal values. Overarching aims of research on these topics are the improvement of social participation and integration in society, better dissemination of research, and better information of the general public and political stakeholders.

Übersichtsarbeiten / Review Articles. Die Entwicklung von epistemischerWachsamkeit und epistemischem Vertrauen über die Lebensspanne: Perspektive aus der empirischen Forschung zum selbstregulierenden sozialen Lernen / The Development of Epistemic Vigilance and Epistemic Trust Across the Lifespan: Perspectives from Empirical Research on Self-Regulatory Social Learning.

The Development of Epistemic Vigilance and Epistemic Trust Across the Lifespan: Perspectives from Empirical Research on Self-Regulatory Social Learning This article examines what we know about the development of epistemic vigilance and epistemic trust between early infancy and adolescence.With this brief review, we intend to help put into perspective the hypotheses advanced by Fonagy and his colleagues within the socio-epistemic theory of psychopathology, according to which psychopathology reflects a closure to interpersonal communication resulting from unfavorable learning experiences in early development. Here, we will discuss how children become sensitive to overt interpersonal communication, and what cognitive skills underpin such sensitivity. Next, we shall discuss the empirical evidence that children in the second year of life already possess a rudimentary capacity for epistemic vigilance: they seem to evaluate the competence of different adult informants and appear to seek information and learn from adults based on such evaluations. Third, we will outline studies showing that in the third year of life children appear to increasingly trust ostensive communication, up to the point of becoming (at least apparently) less sensitive to the possibility of being misinformed or deceived. Finally, we will discuss how, between late childhood and adolescence, children first learn to distinguish lies, then irony, and increasingly engage in complex communication ecologies. Our review simultaneously supports the basic principles of the socio-epistemic theory of psychopathology and suggests that the theory needs further refinement of its ontogenetic predictions.

Originalarbeiten / Original Articles. Skills Lab Pädiatrie: Stärken kommunikativer Fertigkeiten für das Gespräch mit psychosozial belasteten Familien / Pediatric Skills Lab: Strengthening Communication Skills for the Conversations with Psychologically burdened Families.

Pediatric Skills Lab: Strengthening Communication Skills for the Conversations with Psychologically burdened Families To identify psychosocially burdened families early and motivate them to seek further assistance is a central aspect of pediatric preventivemedicine.The aim of the feasibility study was to develop the Pediatric Skills Lab to promote methods for identifying and addressing psychosocially burdened families, and to evaluate it. Thirteen primary care pediatricians participated in two trials of the Pediatric Skills Lab, an interdisciplinary developed two-part digital training.They answered questions regarding their work with psychosocially burdened families and their satisfaction with the Pediatric Skills Lab. Overall, there was a high level of satisfaction reported with the Pediatric Skills Lab. Specifically, the presentation of results on the effects of psychosocial stressors, the practical exercises, and the exchange with colleagues during the interactive webinar were highly praised. Criticisms included, for example, the short duration of practical exercises and the lack of sufficient examples and live demonstrations. The Pediatric Skills Lab is a training concept tailored to meet the existing needs. With widespread implementation, it could enhance psychosocial care provision. Consideration should be given to extending the duration of the training to allow formore practical exercises. Future studies building upon this feasibility study should examine the effects of the training. Additionally, ways to integrate the Pediatric Skills Lab into existing curricula formedical education should be explored.

Development and validation of the Mentalizing Emotions Questionnaire: A self-report measure for mentalizing emotions of the self and other.

Mentalizing describes the ability to imagine mental states underlying behavior. Furthermore, mentalizing allows one to identify, reflect on, and make sense of one's emotional state as well as to communicate one's emotions to oneself and others. In existing self-report measures, the process of mentalizing emotions in oneself and others was not captured. Therefore, the Mentalizing Emotions Questionnaire (MEQ; current version in German) was developed. In Study 1 (N = 510), we explored the factor structure of the MEQ with an Exploratory Factor Analysis. The factor analysis identified one principal (R2 = .65) and three subfactors: the overall factor was mentalizing emotions, the three subdimensions were self, communicating and other. In Study 2 (N = 509), we tested and confirmed the factor structure of the 16-items MEQ in a Confirmatory Factor Analysis (CFI = .959, RMSEA = .078, SRMR = .04) and evaluated its psychometric properties, which showed excellent internal consistency (α = .92 - .95) and good validity. The MEQ is a valid and reliable instrument which assesses the ability to mentalize emotions provides incremental validity to related constructs such as empathy that goes beyond other mentalization questionnaires.

Within- and between-session changes of in-session reflective functioning of mothers in dyadic parent-infant psychotherapy.

This study investigated if in-session reflective functioning (RF) of mothers improved between and within sessions of brief dyadic focused parent-infant psychotherapy (fPIP) for the treatment of regulatory disorders in infants.In-session RF was coded for 44 therapy sessions from N = 11 mothers randomly selected from a RCT on the efficacy of fPIP as part of secondary analyses. A new rating system distinguished self-focused and child-focused in-session RF. Cumulative ordinal regression models were applied to analyze the dynamics of in-session RF within and across sessions, controlling for word count of each statement.While in-session RF improved significantly within sessions, between-session RF improved significantly only in the second session compared to the first with a significant decrease observed in the last session. Child-focused in-session RF was significantly lower than self-focused in-session RF at the beginning of the sessions but improved significantly stronger than self-focused in-session RF during sessions.In-session RF (particularly in child-focused statements) can be regarded as a dynamic change process relevant within each session of dyadic fPIP. Improvements made on a session-by-session basis may not be maintained until the next session. Implications for practitioners and in-session RF research are discussed.

Mediators of Outcome in Trauma-Focused Psychotherapy with Youth: A Systematic Review.

This article aimed to provide a systematic narrative synthesis of existing studies on the mediators of change in psychotherapy with adolescents (10-19 years) and transition age youth (TAY) (20-29 years) who have experienced trauma-related symptoms or posttraumatic disorder. Additionally, we were interested in identifying psychotherapy-, trauma type-, and clients' age- and gender-specific mediators of treatment outcome. Following the preferred reporting items for systematic reviews and meta-analyses, a total of 3,723 studies published in PubMed and PsycINFO databases were screened against inclusion criteria, revealing 15 eligible studies. No studies with only TAY were found; therefore, all results were limited to therapy with adolescents. Cognitive mediators were tested in 66% of selected studies, followed by parents/family-related, mental-health-related, therapy-related, and behavioral mediators. Moderate evidence was found for posttraumatic cognitions, whereas therapeutic alliance seemed to be a promising candidate for future research. Striking absence of non-cognitive-behavioral therapy interventions, emotional and adolescent-specific mediators, as well as studies with males and in non-Western societies was evident. Future original studies would benefit from applying methodological rigor in respect to mediation testing.

A follow-up study of the "Lighthouse" mentalization-based parenting program: Mentalization as a mediator of change.

This paper reports follow-up findings for an Mentalization based treatment (MBT) parenting intervention delivered to a community mental health sample. Parents completed the 12-week version of the Lighthouse Parenting Program (LPP) and were evaluated on parenting practices, parent-child relationships, parental mental health indicators, and child problem behaviour levels. We evaluated the extent to which improvements in mentalizing at follow-up mediated changes in parenting, parental adjustment, mental health, and child outcomes. Results included a reduction in parental coercive behaviours and child problems, improved parent-child relationship, and better parental psychological adjustment and mental health. Improvement in self-focused mentalizing were observed. Self-focused mentalizing mediated the changes in most outcomes from baseline to 3-month follow-up. These results provide strong preliminary evidence that the LPP improves parent and child outcomes.

["IThink it's Good that they Choose who they want to be Stroked by" -The Support Quality of Animal-BasedTherapy]. / "Ich finde es gut, dass sie sich aussuchen, von wem sie gestreichelt werden wollen" ­ Die Unterstützungsqualität tiergestützter Therapie.

For Adolescents with personality impairments it's often difficult to accept therapy offers. Personality impairment may be preceded by (early childhood) trauma, which undermines trust in others.Thus, adolescents with traumatic experience often have limited motivation to start psychotherapy, also due to the greater need for autonomy and the process of detachment in this age phase. However, adolescence is a particularly sensitive period, as personality impairments may consolidate and personality disorders (PD) develop. To address low trust and lowmotivation in adolescents with high risk for or already full PD an animal-assisted group therapy adjunct to individual mentalization-based therapy was developed and piloted. Two groups with a total of eleven patients each were conducted, four of whom agreed to talk about their experiences with animal-assisted therapy in an interview after completion of therapy. Interviews were analyzed qualitatively and evaluated with regard to the aspects of what the adolescents liked and disliked, what expectationsweremet or unmet, andwhat effects the adjunct intervention had on the adolescents' therapeutic success.The categorized statements are discussed related to the theories of human-animal interaction according to Hediger et al. (2019) and a new hypothesis about animals as teambuilding catalysts could be established. In sum, alpacas were perceived suitable as therapy animals for adolescents with personality impairments.

The relationship between epistemic stance, mentalizing, paranoid distress and conspiracy mentality: an empirical investigation.

Epistemic stance, comprising epistemic trust, mistrust, and credulity, and the closely related construct of mentalizing have been related to paranoid ideation and conspiracy mentality. All phenomena are common in the general population and may become clinically and societally relevant at an extreme expression by influencing an individual's positioning towards socially transmitted information possibly as far as complete social detachment or attachment to extremist views. Herein, an individual's experienced distress may play an important role, which has however largely been neglected in empirical research. Thus, this study aims to empirically investigate the effect of epistemic stance on a clinically relevant aspect of paranoid ideation, namely paranoid distress. We assume that epistemic stance will be associated with paranoid distress, but that this association will be mediated by mentalizing. Moreover, we assume that epistemic stance will be indirectly associated with conspiracy thinking via paranoid distress. Data of 595 participants (mean age = 43.05; SD = 13.87; female = 48.32%, male = 51.18%, diverse = 0.51%) were collected via self-report questionnaires through an online-based cross-sectional study. Structural equation modeling was performed for data analysis. As expected, epistemic mistrust was associated with paranoid distress via mentalizing deficits. Unexpectedly, epistemic trust was associated with more paranoid distress. Indirectly, epistemic trust was associated with conspiracy mentality via paranoid distress. Findings partially confirmed the hypothesized associations. Mentalizing may be a target for reducing distress associated with a distrusting epistemic stance. Epistemically trusting individuals with high paranoid distress may turn to conspiracy theories for regulation.

[German S3 guidelines on borderline personality disorder]. / S3-Leitlinie Borderline-Persönlichkeitsstörung.

Research on the understanding and especially on the treatment of borderline personality disorder (borderline PD) has made considerable progress in recent years, so that evidence-based German treatment guidelines have now been produced for the first time. This article highlights the development as well as the main content priorities and recommendations of the guidelines: first, the recommendations on the diagnostics are presented and in this context the upcoming changes to the International Classification of Diseases 11th reversion (ICD-11) are also explained. Subsequently, the most important recommendations on guideline-compliant psychotherapy, pharmacotherapy and treatment settings are presented. Finally, the recommendations concerning relatives (or other significant persons for people with borderline PD) as well as parenthood and borderline PD are presented.

Is parental depression related to parental mentalizing? A systematic review and three-level meta-analysis.

This systematic review and meta-analysis is aimed to summarize the state of research on the relation between parental depression and parental mentalizing. To account for the multifaceted nature of parental mentalizing, several conceptualizations and measures were included and compared. The last database search was conducted on March 13, 2023. Using three-level meta-analytic modelling, we analyzed a total of 12,665 participants from 63 studies with 233 effect sizes. Taken together, higher depression was only weakly associated with lower mentalizing (r = -0.06). Specifically, parents with higher depression scored lower on questionnaire measures of parental reflective functioning (r = -0.11). No significant correlations were found for interview measures of parental reflective functioning, the observational and interview measure of mind-mindedness, or insightfulness. The data showed substantial heterogeneity. The mean effect size for self-reported pre-mentalizing (r =  -0.23 for reverse-coded subscale scores) was significantly stronger compared to other self-report subscales. In studies including parents with diagnosis and controls, there was limited evidence suggesting a larger negative correlation between depression, mind-mindedness, and insightfulness. Therefore, more research is needed in clinical samples. Due to their correlational nature, our results do not allow causal inferences. Future studies should target moderators that explain variability (e.g., comorbid psychological problems, coparenting, child behavior).

[On the State of Training in Parent-Infant/Toddler Psychotherapy in Germany]. / Zum Stand der Aus- undWeiterbildung in Säuglings-/Kleinkind-Eltern-Psychotherapie in Deutschland.

Regulation disorders in early childhood and postpartum mental disorders of parents can be effectively treated by interventions that involve parents and child (so-called parent-infant psychotherapy, PIP). Availability of PIP in routine care remains low, even though the intervention is in high demand. This study aims to map the current situation of psychotherapy training in PIP in Germany, to record existing obstacles from the perspective of the institutes, and to obtain indications for improving training. Contact persons of training institutes all over Germany were invited to participate in an online survey. N = 95 persons answered questions about possible training in PIP and related advantages and hurdles as well as conditions for a future implementation. Nineteen (22.4 %) of the institutions indicated that PIP was part of their training concept. In 84.2 % of the cases this was aimed at child and adolescent psychotherapists. In 63.6 % of the institutes PIP was treated comprehensively. On average, 2.55 barriers were perceived, most frequently of an organizational nature. 75.9 % of the institutes that did not yet offer PIP would be willing to do so in the future under at least one condition. Among those conditions, information on PIP curricula and specific training content was most frequent (40.7 %).The low implementation of PIP in training seems to be mainly due to barriers of an organizational nature that can be overcome by some simple means, such as the dissemination of model curricula.

Mediators of outcome in adolescent psychotherapy and their implications for theories and mechanisms of change: a systematic review.

Psychotherapeutic treatment of adolescents requires age-specific approaches and thus plausibly also involves different change mechanisms than adult psychotherapy. To guide further research and improve therapeutic outcomes for adolescents, we reviewed all RCTs investigating mechanisms of change in the psychological treatment of adolescents to identify the most promising age-, disorder- or treatment-specific mediators. Following the preferred reporting items for systematic reviews (PRISMA), 106 studies were included that reported 252 statistical mediation tests assessed with 181 different measures. Most often studied and significant mediators were cognitive, followed by family-related, and behavioral variables. Several mediators were identified to be promising for future investigations: changes in negative thoughts, dysfunctional beliefs and metacognitive skills; family functioning and parenting skills; as well as successful engagement in therapy activities and increased impulse control. Symptom change during therapy was least often a mediator for other therapeutic changes. Relational and emotional mediators were largely understudied, whereas peer-influence appeared a promising mediator for intervention outcomes. Adolescence-specific mediators were most commonly investigated. Majority of studied mediators were not disorder-specific. There was a tendency to mainly test change mechanisms of specific theoretical models without considering other possible change theories. Further, virtually no studies fulfilled all criteria for rigorously investigating mediation and only nine were classified with an overall good study quality. While bearing in mind the current limitations in study designs, methodological rigor and reporting, there appears to be substantial evidence for transdiagnostic age-specific change models in the psychological treatment of adolescents. For future research, need for consensus on a core set of transdiagnostic and transtheoretical mediators and measures is highlighted. These should address likely core mechanisms of change, as well as take into account age-relevant developmental challenges and biological markers.

Transactional Relations between Child Functioning and Parenting Stress in the First Years of Life: A Longitudinal Study among Psychosocially Burdened Families.

INTRODUCTION: Previous research reported transactional relations between child functioning and parenting stress. There is limited evidence whether a transactional developmental model also fits children below the age of 12 months, especially in psychosocially burdened families. This study aims to test the fit of a transactional model during the first 3 years of life and examines whether the model differs between families with low and high psychosocial burden. METHODS: A total of 302 psychosocially burdened families were observed over 3 years at age 4, 12, 24, and 36 months. Child behavioral problems and parenting stress were assessed via self-report while psychosocial burden was assessed via external rating at baseline. Cross-lagged panel analysis was used to investigate the fit of a transactional model. RESULTS: A transactional model fitted the data significantly better (Δχ2 = 81.87, p < 0.001) than an autoregressive model reaching acceptable to good fit indices (CFI = 0.96, RMSEA = 0.09). The model indicated moderate stability within and reciprocal effects between child behavioral problems and parenting stress from age 12 to 36 months. From age 4 to 12 months, parenting stress predicted child behavioral problems but not vice-versa. Model fit indices and transactional relations did not substantially differ between families with low and high psychosocial burden, except for child effects on parenting stress during the first year of life, which were only evident in higher burdened families. CONCLUSION: Transactional relations among child and parent variables are evident in the first 3 years of life. Child effects in the first year of life may be restricted to highly psychosocially burdened families. Future research may focus on potential mediating variables such as parental sensitivity or contextual variables like significant life events. Targeted prevention strategies should be adapted to the level of psychosocial burden to account for the differing transactional relations.

Mentalization-enhancing therapeutic interventions in the psychotherapy of anorexia nervosa: An analysis of use and influence on patients' mentalizing capacity.

OBJECTIVE: Improvement in patients' mentalizing capacities is considered a possible mechanism of change in psychotherapy. This improvement might take place via mentalization-enhancing interventions (MEIs) performed by psychotherapists. The study aimed to explore the use of MEIs in two evidence-based psychotherapeutic treatments for patients with anorexia nervosa (enhanced cognitive-behavior therapy, focal psychodynamic therapy) and their association with the patients' capacity to mentalize in sessions ("in-session reflective functioning" / in-session RF). Additionally, it was explored, if the amount of MEIs used could either predict change in in-session RF or outcome (end of treatment, one year follow-up). METHOD: 84 audiotapes from psychotherapy sessions of 28 patients of the ANTOP-study (three sessions per patient) were transcribed and rated with both the MEI Rating Scale and the In-Session RF Scale by trained raters. RESULTS: MEIs were applied in both treatments. A moderate correlation between the amount of MEIs and patients' in-session RF as well as its change over the course of treatment was found, but no relation to change in BMI or eating disorder symptoms. CONCLUSION: A greater use of MEIs was related to patients' in-session-mentalizing. However, there seems to be no simple relation between RF as shown in sessions and symptom change.

Mentalization-based treatment for adolescents with conduct disorder (MBT-CD): a feasibility study.

Conduct disorder (CD) is a common psychiatric disorder in youth characterized by persisting norm-violating or aggressive behavior. Considering high individual and societal burden, feasible and effective psychotherapeutic treatment is desirable. Yet, treatments and research in this patient group are scarce. This study investigates the feasibility of mentalization-based treatment for adolescents with CD (MBT-CD) in terms of acceptability of MBT-CD and scientific assessments by participants as well as necessary organizational resources to conduct a consecutive randomized controlled trial (RCT). Recruitment, adherence and treatment session numbers were descriptively analyzed. Treatment evaluation interviews were qualitatively analyzed. A subset of sessions of therapists without prior MBT experience was rated for MBT adherence. Quantitative data were used to plan a consecutive RCT. Pre to post treatment changes in diagnosis and self-reported aggression, mentalizing and personality functioning were preliminarily analyzed. N = 45 adolescents with CD were recruited. 43% dropped out. Acceptance of scientific assessments was somewhat lower than therapy adherence (questionnaires filled out by ~ 80% of adolescents in treatment), and low at follow-up (25% of treatment completers). Mean session number was 30.3. Most treatment completers were satisfied with MBT-CD. Referrals mainly came from child and youth services and psychiatry. Nine of 16 sessions rated for MBT adherence were adherent. A priori sample size estimation for a prospective RCT with a drop-out rate of 43% yielded a sample of N = 158 to detect an effect f = .15 with 80% power in a repeated measures ANOVA. Pre-post analyses revealed diagnostic improvement in 68%. Of self-reported data, empathy pathology improved. Findings provide a sound basis for a consecutive feasibility and pilot RCT. TRIAL REGISTRATION: Clinicaltrials.gov, registration number NCT02988453, November 30, 2016, https://clinicaltrials.gov/ct2/show/NCT02988453.