Improvements in mentalization predict improvements in interpersonal distress in patients with mental disorders

Markus C Hayden, Pia K Müllauer, Richard Gaugeler, Birgit Senft, Sylke Andreas, Markus C Hayden, Pia K Müllauer, Richard Gaugeler, Birgit Senft, Sylke Andreas

Abstract

Objectives: Associations between interpersonal problems and mentalization have rarely been investigated. In this study, we explored patterns of interpersonal problems, mentalization, symptom severity, and attachment during inpatient treatment and at follow-up. Additionally, we investigated whether mentalization predicts a decrease in interpersonal distress.

Method: We analyzed time-series data from patients with mental disorders. Data were collected at the beginning and at the end of inpatient treatment, and approximately 6 months after discharge from hospital.

Results: Patterns of correlations were stable from admission to the hospital until follow-up. Treatment significantly increased the levels of mentalization and decreased the levels of interpersonal problems and symptom severity, whereas attachment was only partially targeted. Improvements in mentalization significantly predicted reduction in interpersonal distress at each point in time.

Conclusion: Results revealed characteristic patterns of interpersonal problems, mentalization, symptom severity, and attachment. Mentalization was found to play a key role in the reduction of interpersonal distress.

Keywords: adult attachment; interpersonal problems; mental disorders; mentalization; symptom severity.

© 2018 The Authors. Journal of Clinical Psychology published by Wiley Periodicals, Inc.

References

    1. Arcelus, J. , Haslam, M. , Farrow, C. , & Meyer, C. (2013). The role of interpersonal functioning in the maintenance of eating psychopathology: A systematic review and testable model. Clinical Psychology Review, 33(1), 156–167. 10.1016/j.cpr.2012.10.009
    1. Bateman, A. , & Fonagy, P. (2004). Mentalization‐based treatment of BPD. Journal of Personality Disorders, 18(1), 36–51. 10.1521/pedi.18.1.36.32772
    1. Bateman, A. , & Fonagy, P. (2008). 8‐Year follow‐up of patients treated for borderline personality disorder: Mentalization‐based treatment versus treatment as usual. American Journal of Psychiatry, 165(5), 631–638. 10.1176/appi.ajp.2007.07040636
    1. Bateman, A. , & Fonagy, P. (2009). Randomized controlled trial of outpatient mentalization‐based treatment versus structured clinical management for borderline personality disorder. American Journal of Psychiatry, 166(12), 1355–1364. 10.1176/appi.ajp.2009.09040539
    1. Berry, K. , Barrowclough, C. , & Wearden, A. (2008). Attachment theory: A framework for understanding symptoms and interpersonal relationships in psychosis. Behaviour Research and Therapy, 46(12), 1275–1282. 10.1016/j.brat.2008.08.009
    1. Brennan, K. A. , Clark, C. , & Shaver, P. (1998). Self‐report measurement of adult romantic attachment: An integrative overview In Simpson J. & Rholes W. (Eds.), Attachment theory and close relationships (pp. 46–76). New York, NY: Guilford Press.
    1. Choi‐Kain, L. W. , & Gunderson, J. G. (2008). Mentalization: Ontogeny, assessment, and application in the treatment of borderline personality disorder. American Journal of Psychiatry, 165(9), 1127–1135. 10.1176/appi.ajp.2008.07081360
    1. Classen, C. , Field, N. P. , Koopman, C. , Nevill‐Manning, K. , & Spiegel, D. (2001). Interpersonal problems and their relationship to sexual revictimization among women sexually abused in childhood. Journal of Interpersonal Violence, 16(6), 495–509. 10.1177/088626001016006001
    1. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd. ed.). New Jersey: Lawrence Erlbaum Associates.
    1. Conradi, H. J. , Gerlsma, C. , Duijn, M. Van , & Jonge, P. De (2006). Internal and external validity of the experiences in close relationships questionnaire in an American and two Dutch samples. The European Journal of Psychiatry, 20(4), 258–269. 10.4321/S0213-61632006000400006
    1. De Meulemeester, C. , Lowyck, B. , Vermote, R. , Verhaest, Y. , & Luyten, P. (2017). Mentalizing and interpersonal problems in borderline personality disorder: The mediating role of identity diffusion. Psychiatry Research, 258, 141–144. 10.1016/j.psychres.2017.09.061
    1. Fjeldstad, A. , Høglend, P. , & Lorentzen, S. (2017). Patterns of change in interpersonal problems during and after short‐term and long‐term psychodynamic group therapy: A randomized clinical trial. Psychotherapy Research, 27(3), 350–361. 10.1080/10503307.2015.1102357
    1. Fonagy, P. , & Bateman, A. W. (2006). Mechanisms of change in mentalization‐based treatment of BPD. Journal of Clinical Psychology, 62(4), 411–430. 10.1002/jclp.20241
    1. Fonagy, P. , & Luyten, P. (2009). A developmental, mentalization‐based approach to the understanding and treatment of borderline personality disorder. Development and Psychopathology, 21(4), 1355–1381. 10.1017/S0954579409990198
    1. Fonagy, P. , Steele, M. , Steele, H. , Moran, G. S. , & Higgitt, A. C. (1991). The capacity for understanding mental states: The reflective self in parent and child and its significance for security of attachment. Infant Mental Health Journal, 12(3), 201–218. 10.1002/1097-0355(199123)12:3<201::AID-IMHJ2280120307>;2-7
    1. Fonagy, P. , & Target, M. (2006). The mentalization‐focused approach to self pathology. Journal of Personality Disorders, 20(6), 544–576. 10.1521/pedi.2006.20.6.544
    1. Fraley, R. C. , Heffernan, M. E. , Vicary, A. M. , & Brumbaugh, C. C. (2011). The experiences in close relationships—Relationship structures questionnaire: A method for assessing attachment orientations across relationships. Psychological Assessment, 23(3), 615–625. 10.1037/a0022898
    1. Franke, G. H. (2000). BSI. Brief Symptom Inventory ‐ Deutsche version. manual. Göttingen, Germany: Beltz Test.
    1. Girden, E. (1992). ANOVA: Repeated measures. Newbury Park, CA: SAGE Publications; 10.4135/9781412983419
    1. Haggerty, G. , Hilsenroth, M. J. , & Vala‐Stewart, R. (2009). Attachment and interpersonal distress: Examining the relationship between attachment styles and interpersonal problems in a clinical population. Clinical Psychology & Psychotherapy, 16(1), 1–9. 10.1002/cpp.596
    1. Hartmann, A. , Zeeck, A. , & Barrett, M. S. (2010). Interpersonal problems in eating disorders. International Journal of Eating Disorders, 43(7), 619–627. 10.1002/eat.20747
    1. Hausberg, M. C. , Schulz, H. , Piegler, T. , Happach, C. G. , Klöpper, M. , Brütt, A. L. , … Andreas, S. (2012). Is a self‐rated instrument appropriate to assess mentalization in patients with mental disorders? Development and first validation of the mentalization questionnaire (MZQ). Psychotherapy Research, 22(6), 699–709. 10.1080/10503307.2012.709325
    1. Hayden, M. C. , Müllauer, P. K. , & Andreas, S. (2017). A systematic review on the association between adult attachment and interpersonal problems. Journal of Psychology & Psychotherapy, 7(2), 296 10.4172/2161-0487.1000296
    1. Horowitz, L. M. , Dryer, D. C. , & Krasnoperova, E. N. (1997). The circumplex structure of interpersonal problems In Plutchik R. & Conte H. R. (Eds.), Circumplex models of personality and emotions. Washington: American Psychological Association; 10.1037/10261-000
    1. Huynh, H. , & Feldt, L. S. (1976). Estimation of the box correction for degrees of freedom from sample data in randomized block and split‐plot designs. Journal of Educational Statistics, 1(1), 69 10.2307/1164736
    1. Katznelson, H. (2014). Reflective functioning: A review. Clinical Psychology Review, 34(2), 107–117. 10.1016/j.cpr.2013.12.003
    1. Levene, H. (1960). Robust tests for equality of variances In Olkin I., Ghurye S. G., Hoeffding W., Madow W. G., & Mann H. B. (Eds.), Contributions to probability and statistics: Essays in honor of harold hotelling (pp. 278–292). Palo Alto, CA: Stanford University Press.
    1. Liebherz, S. , & Rabung, S. (2014). Do Patients’ symptoms and interpersonal problems improve in psychotherapeutic hospital treatment in Germany? ‐ A systematic review and meta‐analysis. PLoS One, 9(8), e105329 10.1371/journal.pone.0105329
    1. Locke, K. D. (2005). Interpersonal problems and interpersonal expectations in everyday life. Journal of Social and Clinical Psychology, 24(7), 915–931. 10.1521/jscp.2005.24.7.915
    1. Lorentzen, S. , Fjeldstad, A. , Ruud, T. , & Høglend, P. A. (2015). Comparing short‐ and long‐term group therapy: Seven‐year follow‐up of a randomized clinical trial. Psychotherapy and Psychosomatics, 84(5), 320–321. 10.1159/000381751
    1. Maling, M. , Gurtman, M. , & Howard, K. (1995). The response of interpersonal problems to varying doses of psychotherapy. Psychotherapy Research, 5(1), 63–75. 10.1080/10503309512331331146
    1. Markowitz, J. C. , & Weissman, M. M. (2004). Interpersonal psychotherapy: Principles and applications. World Psychiatry, 3(3), 136–139.
    1. National Research Council . (2010). The prevention and treatment of missing data in clinical trials. panel on handling missing data in clinical trials. The National Academy Of Sciences. Washington, DC: The National Academies Press; 10.1056/NEJMsr1203730
    1. Newman, M. G. , Jacobson, N. C. , Erickson, T. M. , & Fisher, A. J. (2017). Interpersonal problems predict differential response to cognitive versus behavioral treatment in a randomized controlled trial. Behavior Therapy, 48(1), 56–68. 10.1016/j.beth.2016.05.005
    1. Puschner, B. , Bauer, S. , Horowitz, L. M. , & Kordy, H. (2005). The relationship between interpersonal problems and the helping alliance. Journal of Clinical Psychology, 61(4), 415–429. 10.1002/jclp.20050
    1. Ravitz, P. , Maunder, R. , Hunter, J. , Sthankiya, B. , & Lancee, W. (2010). Adult attachment measures: A 25‐year review. Journal of Psychosomatic Research, 69(4), 419–432. 10.1016/j.jpsychores.2009.08.006
    1. Renner, F. , Jarrett, R. B. , Vittengl, J. R. , Barrett, M. S. , Clark, L. A. , & Thase, M. E. (2012). Interpersonal problems as predictors of therapeutic alliance and symptom improvement in cognitive therapy for depression. Journal of Affective Disorders, 138(3), 458–467. 10.1016/j.jad.2011.12.044
    1. Salzer, S. , Pincus, A. L. , Winkelbach, C. , Leichsenring, F. , & Leibing, E. (2011). Interpersonal subtypes and change of interpersonal problems in the treatment of patients with generalized anxiety disorder: A pilot study. Psychotherapy, 48(3), 304–310. 10.1037/a0022013
    1. Slade, A. (2005). Parental reflective functioning: An introduction. Attachment & Human Development, 7(3), 269–281. 10.1080/14616730500245906
    1. Spitzer, C. , Hammer, S. , Löwe, B. , Grabe, H. J. , Barnow, S. , Rose, M. , … Franke, G. H. (2011). Die Kurzform des Brief Symptom Inventory (BSI‐18): Erste Befunde zu den psychometrischen Kennwerten der deutschen Version. Fortschritte Der Neurologie Psychiatrie, 79(9), 517–523. 10.1055/s-0031-1281602
    1. Taubner, S. , Hörz, S. , Fischer‐Kern, M. , Doering, S. , Buchheim, A. , & Zimmermann, J. (2013). Internal structure of the reflective functioning scale. Psychological Assessment, 25(1), 127–135. 10.1037/a0029138
    1. Taylor, P. , Rietzschel, J. , Danquah, A. , & Berry, K. (2015). Changes in attachment representations during psychological therapy. Psychotherapy Research, 25(2), 222–238. 10.1080/10503307.2014.886791
    1. Thomas, A. , Brähler, E. , & Strauß, B. (2011). IIP‐32: Entwicklung, validierung und normierung einer kurzform des inventars zur erfassung interpersonaler probleme. Diagnostica, 57(2), 68–83. 10.1026/0012-1924/a000034
    1. Wei, M. , Russell, D. W. , Mallinckrodt, B. , & Vogel, D. L. (2007). The Experiences in Close Relationship Scale (ECR)‐short form: Reliability, validity, and factor structure. Journal of Personality Assessment, 88(2), 187–204. 10.1080/00223890701268041
    1. World Health Organization . (1992). The ICD‐10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva, Switzerland: World Health Organization.

Source: PubMed

3
Tilaa