Martin Debbané

University of Geneva | UNIGE · Faculty of Psychology and Education Sciences (FAPSE)

Introduction: The capacity to understand one's own actions and those of others in terms of cognitive and affective mental states (i.e., reflective functioning or mentalizing) is thought to play a critical role in both typical and atypical development. To date, however, no self-report tool is available for assessing reflective functioning ability i...

Notre capacité à mentaliser - faire émerger les probables intentions, émotions, besoins qui se cachent derrière les actions d'autrui mais aussi les siennes propres - est un pilier de notre santé mentale. Sa défaillance ouvre la porte à des états psychopathologiques caractérisés par des tempêtes affectives, des ruptures relationnelles et des conduit...

In this review article, we outline the evidence linking attachment adversity to psychosis, from the premorbid stages of the disorder to its clinical forms. To better understand the neurobiological mechanisms through which insecure attachment may contribute to psychosis, we identify at least five neurobiological pathways linking attachment to risk f...

The 22q11.2 deletion syndrome (22q11DS) is characterized by high rates of psychotic symptoms and schizophrenia, making this condition a promising human model for studying risk factors for psychosis. We explored the predictive value of ultra high risk (UHR) criteria in a sample of patients with 22q11DS. We also examined the additional contribution o...

Starting from the early descriptions of Kraepelin and Bleuler, the construct of schizotypy was developed from observations of aberrations in nonpsychotic family members of schizophrenia patients. In contemporary diagnostic manuals, the positive symptoms of schizotypal personality disorder were included in the ultra high-risk (UHR) criteria 20 years...

At present, suicidal patients are still hospitalized to reduce their risk of committing a life-threatening act. Yet suicide research, long dominated by the ambition to identify people at risk, shows that the prediction model is largely ineffective. The time has come for a paradigm shift to: give up categorizing patients according to their risk; rec...

Imbalances in mentalizing – the capacity to envisage mental states in oneself and others - have consistently been associated with symptomatic and functional outcomes in people with psychosis, as well as with the transition to clinical psychosis among those who are at increased risk. Recently, applications of mentalization-based therapy (MBT) for in...

Pathological narcissism (PN) is a common psychopathological issue leading to maladaptive strategies to cope with self-esteem threats, including self-enhancement and exploitation (grandiose strategies) or internalized shame, depression, and social withdrawal (vulnerable strategies). Mentalizing is a key process for regulating self and other represen...

The concept of epistemic trust is gaining traction in the mental health field. It is thought to play a foundational role as a resilience factor against the development and maintenance of psychopathology by facilitating social learnings useful to navigate in the modern world. The primary aim of this study is to validate in French language the Episte...

Positive and negative schizotypy reflect distinct patterns of subclinical traits in the general population associated with neurodevelopmental and schizophrenia-spectrum pathologies. Yet, a comprehensive characterization of the unique and shared neuroanatomical signatures of these schizotypy dimensions is lacking. Leveraging 3D brain MRI data from 2...

Background: The transdiagnostic approach to psychopathology has emerged as an alternative to traditional taxonomic approaches. The Multidimensional Emotional Disorders Inventory (MEDI) is a specifically designed self-report to measure the transdiagnostic dimensions proposed by Brown and Barlow. This study aims to analyze the psychometric properties...

This study explores the potential of stylometric analysis in identifying Self-Defining Memories (SDMs) authored by individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) versus a control group. A sample of 198 SDMs were written by 66 adolescents and were then analysed using Support Vector Classifiers (SVC). The analysis included a variety...

Adult attention deficit hyperactivity disorder (ADHD) is often associated with personality pathology. However, only few studies have been conducted on the link between ADHD and pathological narcissism (PN), with or without a diagnosis of narcissistic personality disorder (NPD). In order to fill this gap, PN and NPD were assessed in 164 subjects suf...

Objectives Treatments for borderline personality disorder (BPD) and post‐traumatic stress disorder (PTSD) are less effective for patients with co‐occurring symptoms of both disorders, who are considered to have complex PTSD (cPTSD), compared with patients with either condition alone. Evidence suggests that co‐occurrence of symptoms indicates greate...

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common psychological neurodevel-opmental disorder among children and adolescents, with a prevalence of 5.6% in teenagers aged 12 to 18 years [1]. Its diagnosis is reliable and valid when evaluated with standard criteria for psychiatric disorders [2], but it is time consuming and req...

Impairments in mentalization—the imaginative capacity to utilize mental state information to understand oneself and others—have consistently been identified across the developmental continuum of schizotypy expression, from nonclinical trait manifestations and prodromal risk states to clinically diagnosable schizophrenia spectrum disorders (SSDs). R...

Objective Schizotypal traits and disturbances in mentalizing (the capacity to understand the mental states driving one’s own and others’ behaviors) have been implicated in increased vulnerability for psychosis. Therefore, we explored the associations linking schizotypal traits, mentalizing difficulties and their interactions to clinical high-risk f...

Background: Depression symptoms and mood disorders constitute one of the major public health challenges among youths. Thus, early prevention and intervention for depression should be a priority. The main goal of the present study was to validate the Patient Health Questionnaire-9 (PHQ-9) scores in a school-based sample of non-clinical adolescents....

Introduction: Growing, albeit heterogenous evidence questions whether attention deficit/hyperactivity disorder (ADHD) is associated with socio-cognitive impairments, especially beyond childhood. This study focuses on mentalizing - the socio-cognitive ability to attribute and reason in terms of mental states. We aimed to characterize mentalizing pe...

A complete and practical guide offering a concise overview of mentalization-based treatment (MBT) and its application in different situations and with different groups of patients to help improve the treatment of mental health disorders. Featuring an introduction to mentalizing and the evidence base to support it, followed by the principles of MBT...

Mentalization-based treatment (MBT) for psychosis focuses on the decoupling of bodily and mental experience as well as the stresses of mentalizing during social interaction. In a framework of mentalizing, psychotic phenomena can be represented as severe disturbances to the experience of oneself as a coherent unit. Clinical treatment that aims to in...

Interactive mentalizing is a problem for couples who are struggling to relate to each other constructively. Mentalization-based treatment for couples (MBT-CO) is a structured intervention that targets the ability to see things from the other person’s perspective, and the recovery of epistemic trust. Initially couples are asked to identify their own...

In MBT for families (MBT-F), psychoeducation leads to learning about mentalizing problems. Techniques that stabilize mentalizing in all family members are discussed. The stabilizing of individual and interactive mentalizing in the family is achieved through exploration of identified problems using the MBT Loop to bring the family members together s...

MBT-Children (MBT-C) targets the mentalizing of children and their families. A range of techniques that are tailored to the child’s mentalizing capacity are discussed in this chapter. MBT-C involves working not only with the child but also with the parents, to support their capacity to adopt a mentalizing stance toward their child. The mentalizing...

There is considerable evidence of mentalizing problems in patients with eating disorders, with non-mentalizing modes, especially in relation to body weight and shape, being dominant. The mentalizing model assumes the existence of developmental vulnerabilities, especially during adolescence, and that the range of different symptoms associated with e...

A mentalizing framework for understanding narcissism is outlined, and the resulting modifications of basic mentalization-based treatment (MBT) for narcissistic personality disorder are discussed. Treatment of patients with pathological narcissism requires an emphasis on empathic validation and support of the vulnerable “I-mode.” The dangers of not...

Mentalizing or “mind-wondering” is central to social interaction, culture, and morality. In our everyday life we are all philosophers of the mind, wondering what is going on in other people’s heads, and tracking our own thoughts and feelings. Several terms have been used to cover this territory of thinking about thoughts—they include, among others,...

This chapter describes the structure of mentalization-based treatment group therapy (MBT-G) for adults and adolescents, and explains how to focus on the mentalizing process in the group. Clinical examples are used for illustrative purposes throughout, and the progress of the patient who was described in Chapter 4 is discussed. The introduction of n...

The development of mentalizing and non-mentalizing is discussed along with the importance of mentalizing as a psychotherapy process in the treatment of mental health problems. A defining feature of mental disorder is the experience of “wild imagination,” and we consider that mentalizing difficulties—that is, the tendency to get caught up in unhelpf...

From a mentalizing perspective, symptoms of depression arise from reactions to threats to attachment relationships—and thus threats to the self—and associated impairments in mentalizing problems. Mentalization-based treatment (MBT) for depression targets mentalizing impairments, dominant attachment styles, and problems with epistemic trust. Depress...

From a mentalizing perspective, in attachment trauma an individual’s experience of adversity is compounded by the sense that they have to be able to bear that experience alone. An overwhelming experience cannot be calibrated and managed within an attachment relationship. Normally another mind provides the social referencing that enables an individu...

The case of a patient who is receiving mentalization-based treatment (MBT) is described. All of the stages and interventions of MBT, including interventions for suicidality and violence, are illustrated across the patient’s treatment trajectory. The formulation agreed with the patient is the focus for treatment. Clinical examples are presented to i...

MBT for avoidant personality disorder (AvPD) targets hypermentalizing and hypomentalizing modes along with the problems associated with mentalizing problems found in the polarities of self/other mentalizing which become apparent when the patient engages with their social world. Reducing overuse of the self is central to treatment. The experience of...

Antisocial personality disorder (ASPD) and violence result from a loss of mentalizing. Mentalization-based treatment for antisocial personality disorder (MBT-ASPD) is delivered primarily as a group intervention. Individuals with ASPD are more likely to learn from those whom they consider to be similar to themselves, so the task of the MBT clinician...

This chapter outlines the use of mentalizing as an essential process for unifying teams and creating a caring environment in relation to schools, fostering of children, and caring for babies in adverse circumstances. An individual’s mentalizing is strongly influenced by their social environment. Any intervention that aims to treat a person with men...

The principles of mentalization-based treatment (MBT) as they are applied in clinical practice are discussed. Both the clinician and the patient need to learn to manage their anxiety, as any stress can potentially undermine the ability to mentalize. This chapter focuses in particular on how to maintain the appropriate balance between attachment anx...

Social mentalizing informs the theory and practice of mentalization-based treatment for adolescents (MBT-A). Adolescence is, among other things, a time for establishing a self-identity and learning about how to interact effectively with a peer group. A focus on balancing mentalizing in peer and family interactions is crucial, with special attention...

Emergency care teams need to organize their response to crises around shared assessment procedures. This chapter describes how MBT can inform emergency care when a crisis is handled by the multidisciplinary team of mental health practitioners in psychiatric emergency settings. Development of the formulation according to mentalizing principles creat...

Background The COVID-19 pandemic has affected people globally both physically and psychologically. The increased demands for mental health interventions provided by clinical psychologists, psychotherapists and mental health care professionals, as well as the rapid change in work setting (e.g., from face-to-face to video therapy) has proven challeng...

People with personality disorders (PDs) are often admitted to psychiatric emergency services due to the frequent repetition of acute crises. This study drew on the ICD diagnostic records of 2,634 individuals with PDs who were admitted to a specialized inpatient psychiatric crisis unit over a 6-year period. Multiple logistic regressions and survival...

Background: The aim of the PSICE (Evidence-based Psychology in Educational Contexts) Project is to examine the effectiveness of the Unified Protocol for Transdiagnostic Treatment of Adolescents (UP-A) with symptoms of anxiety and depression in school settings. The goal is to prevent emotional problems and to improve adolescents’ socioemotional adju...

The question of whether attention-related disorders such as attention-deficit/hyperactivity disorder (ADHD) are best understood as clinical categories or as extreme ends of a spectrum is an ongoing debate. Assessing individuals with varying degrees of attention problems and utilizing novel methodologies to assess relationships between attention and...

Objective To examine whether putatively atypical neuronal activity during internal attention in ADHD yields insights into processes underlying emotion dysregulation. Methods We used a word processing paradigm to assess neural activations in adults with ADHD ( N = 46) compared to controls ( N = 43). We measured effects of valence, applied partial-l...

Background Borderline Personality Disorder (BPD) is a potentially severe personality disorder, characterized by difficulties in emotion regulation and control of behaviors. It is often associated with non-suicidal self-injuries (NSSI). Borderline personality features have also been linked to body modifications (BMs). However, the prevalence of BMs,...

Context Our team works in a psychiatric hospital unit at the University Hospitals of Geneva (Switzerland). We welcome there for 7 days people in crisis situations who have either suicidal thoughts or suicidal behavior. As factors precipitating the suicidal crisis, these people go through life events that are accompanied by intense interpersonal dif...

The practice of clinical evaluation and intervention for schizophrenia spectrum and other psychotic disorders (SSPDs) is progressively integrating a developmental perspective, targeting premorbid, clinical high-risk, and early phases along the continuum of symptom severity. Notwithstanding important progress in early intervention, clinical challeng...

Résumé Objectifs Étudier l’état des connaissances et des représentations au sujet du trouble de personnalité borderline d’un groupe de soignants francophones intéressés par ces patients. Méthodes Entre 2019 et 2020, nous avons au début d’une formation aux approches psychothérapeutiques du trouble de personnalité borderline fait passer à 126 soign...

The Pathological Narcissism Inventory (PNI) and the Narcissistic Personality Inventory (NPI) are often used to screen for pathological narcissism but have rarely been validated against a clinician-administered diagnostic interview. Our study evaluated the convergent validity of the PNI and NPI against a diagnostic interview for narcissistic persona...

The impact of emotion on executive functioning is gaining interest. It has led to the differentiation of “cool” Executive Functioning (EF) processes, such as cognitive flexibility, and “hot” EF processes, such as affective flexibility. But how does affective flexibility, the ability to switch between cognitive and affective information, vary as a f...

Given that death by suicide continues to rank among the top three causes of death during adolescence, new psychological models may contribute critical insight towards understanding the complex interactions between risk and protective factors in suicidal behaviour. The main objective of this study was to analyse the psychological network structure o...

Neuroanatomical abnormalities have been reported along a continuum from at-risk stages, including high schizotypy, to early and chronic psychosis. However, a comprehensive neuroanatomical mapping of schizotypy remains to be established. The authors conducted the first large-scale meta-analyses of cortical and subcortical morphometric patterns of sc...

Background: Our main objective was to provide estimates of the prevalence rates of psychiatric disorders and comorbidities among youths in a juvenile detention center in Geneva, Switzerland. We also aimed to investigate potential positive effects of intensive psychotherapeutic and educational services this center provides. Finally, we examined psyc...

Psychological science aims at understanding the development and interplay of hidden psychological mechanisms (cognitive, affective, and social) and their causal role in observable behaviors, both in adaptive and maladaptive contexts. It is thus relevant, though highly challenging, to develop computational models and artificial agents derived from p...

Contexte Notre équipe travaille dans une unité hospitalière psychiatrique de crise aux Hôpitaux universitaires de Genève (Suisse). Nous y accueillons pour 7 jours des personnes en situation de crise qui présentent des idées ou un comportement suicidaire. Comme facteurs précipitant la crise suicidaire, ces personnes traversent des évènements de vie...

Introduction: The mirror-gazing task (MGT) is an experimental paradigm inducing anomalous perceptions and anomalous experiences of self-face (ASEs) in the general population, ranging from changes in light and color, to face deformation, to experiencing one's specular image as another identity. Subclinical ASEs have been related to the emergence of...

22q11.2 deletion syndrome (22q11DS), also known as velo-cardio-facial syndrome (VCFS) is the most common copy number variant (CNV) in humans caused by a microdeletion on chromosome 22q11.2. The phenotype encompasses heart anomalies, cleft palate and cognitive difficulties. Alongside brain differences in VCFS, such as reduced hippocampal volume, dif...

The existing literature suggests that individual differences in attachment may be associated with differential trajectories of structural brain development. In addition to maturation during infancy and childhood, developmental trajectories are characteristic of adolescence, a period marked by increasingly complex interpersonal relationships and sig...

Background Adolescence and young adulthood is a risk period for the emergence of mental disorders. There is strong evidence that psychotherapeutic interventions are effective for most mental disorders. However, very little is known about which of the different psychotherapeutic treatment modalities are effective for whom. This large systematic revi...

Résumé La recherche scientifique a mis en évidence l’importance d’adopter une approche développementale et interactionnelle pour comprendre la complexité du fonctionnement psychique de l’être humain. Ces dernières années un intérêt particulier a été porté par la psychologie du développement à l’étude de l’émergence des compétences cognitives et émo...

Background: The empirical evidence accumulated on the efficacy, effectiveness, and efficiency of psychotherapeutic treatments in children and adolescents calls for an update. The main goal of this paper objective was to carry out a selective review of empirically supported psychological treatments for a variety of common psychological disorders and...

Mentalization-based treatment (MBT) is a psychodynamically oriented form of psychotherapy originally developed for the treatment of borderline personality disorder. The focus of MBT is on enhancing mentalizing, the imaginative capacity to reflect on the internal states (i.e. thoughts, feelings) underpinning one’s own and others’ behaviours. Disrupt...

Neuroanatomical abnormalities have been reported along a continuum from at-risk stages, including high schizotypy, to early and chronic psychosis. However, a comprehensive neuroanatomical mapping of schizotypy remains to be established. The authors conducted the first large-scale meta-analyses of cortical and subcortical morphometric patterns of sc...

Antecedentes: los tratamientos psicológicos han mostrado su eficacia, efectividad y eficiencia para el abordaje de los trastornos mentales; no obstante, considerando el conocimiento científico generado en los últimos años, no se dispone de trabajos de actualización en español sobre cuáles son los tratamientos psicológicos con respaldo empírico. El...

Evidence-Based Psychological Treatments for Adults: A Selective Review. Background: Psychological treatments have shown their effi cacy, effectiveness, and effi ciency in dealing with mental disorders. However, considering the scientifi c knowledge generated in recent years, in the Spanish context, there are no updating studies about empirically su...

Background The 22q11.2 deletion syndrome (22q11DS) is a genetic syndrome that results in a highly variable profile of affected individuals of which impairments in the social domain and increased psychopathology are the most prominent. Notably, 25–30% of affected individuals eventually develop schizophrenia/psychosis, predisposing persons with the s...

Childhood neglect is the most common type of maltreatment, ranging from minor isolated incidents to consistent failures in emotional/physical caregiving. It has been associated with developmental impairments and considered a risk factor for the emergence of psychopathology, particularly internalizing disorders. This study aimed to explore individua...

Background: Empirical evidence suggests that schizotypy is a useful construct for analyzing and understanding psychotic disorders. However, several issues remain to be resolved. Method: This selective, critical review, addresses some questions and limitations, and discusses future directions of work. Results: First, we present a conceptual out...

Antecedentes: los tratamientos psicológicos han mostrado su efi cacia, efectividad y efi ciencia para el abordaje de los trastornos mentales; no obstante, considerando el conocimiento científi co generado en los últimos años, no se dispone de trabajos de actualización en español sobre cuáles son los tratamientos psicológicos con respaldo empírico....

The relationships between borderline and schizotypal traits are still debated. Borderline traits, schizotypal traits, and several psychopathological symptoms were assessed among 2,341 college students. A factor analysis was performed on borderline and schizotypal personality measures, leading to 10 factors. Borderline factors were largely intercorr...

Suicide is a major mental health problem, particularly during youth, when it is the second leading cause of death. Since young people at risk of suicide are often cared for by the adult health system, we sought to identify the specificities and similarities between suicidal youths and adults in order to further inform the potential need for adaptat...

Background: Adolescence and young adulthood is a risk period for the emergence of mental disorders. There is strong evidence that psychotherapeutic interventions are effective for most mental disorders. However, very little is known about for whom different psychotherapeutic treatment modalities are effective. This large systematic review aims to a...