ArticlePDF Available

School-Aged Children With Higher Reflective Functioning Exhibit Lower Cardiovascular Reactivity

Frontiers
Frontiers in Medicine
Authors:
  • SDSU / UC San Diego Joint Doctoral Program in Clinical Psychology

Abstract and Figures

Despite extensive theorizing regarding the regulatory role of reflective functioning (RF), few studies have explored the links between RF and physiological indices of emotion regulation, and none have examined these associations in children. Further, while scholars contend that RF promotes resilience via enhanced ability to process emotional experiences, including those occurring in attachment relationships, this argument has seldom been tested empirically in children. In the current study, we explore the association between RF and physiological measures of emotion reactivity and regulation, as well as the interaction of RF and attachment insecurity. We test these associations by examining children's (N = 76; 8–12 years old) cardiovascular responses [respiratory sinus arrhythmia (RSA)] to a standardized paradigm designed to evoke reactions regarding the experience and expression of attachment-related needs. Children also completed a semi-structured attachment interview, which was later coded for children's attachment insecurity (operationalized as attachment dismissal and preoccupation) and RF. Our findings were largely consistent with theory and our hypotheses, suggesting that higher RF is associated with lesser cardiovascular reactivity (higher levels of RSA) during the stressor task and better recovery following the task. These links were especially strong for children with greater attachment preoccupation but did not vary as a function of children's levels of attachment dismissal. These findings contribute to developmental theory in suggesting that RF is closely linked to physiological emotion regulation in children.
This content is subject to copyright.
ORIGINAL RESEARCH
published: 06 July 2018
doi: 10.3389/fmed.2018.00196
Frontiers in Medicine | www.frontiersin.org 1July 2018 | Volume 5 | Article 196
Edited by:
Marcelo Demarzo,
Federal University of São Paulo, Brazil
Reviewed by:
Daniela Rodrigues de Oliveira,
Escola Paulista de Medicina,
Universidade Federal de Sao Paulo,
Brazil
Dana McDevitt Shai,
Academic College Tel Aviv-Yaffo, Israel
*Correspondence:
Jessica L. Borelli
jessica.borelli@uci.edu
Specialty section:
This article was submitted to
Family Medicine and Primary Care,
a section of the journal
Frontiers in Medicine
Received: 29 November 2017
Accepted: 14 June 2018
Published: 06 July 2018
Citation:
Borelli JL, Ensink K, Hong K,
Sereno AT, Drury R and Fonagy P
(2018) School-Aged Children With
Higher Reflective Functioning Exhibit
Lower Cardiovascular Reactivity.
Front. Med. 5:196.
doi: 10.3389/fmed.2018.00196
School-Aged Children With Higher
Reflective Functioning Exhibit Lower
Cardiovascular Reactivity
Jessica L. Borelli 1
*, Karin Ensink 2, Kajung Hong 1, Alexandra T. Sereno 2, Robert Drury 3,4, 5
and Peter Fonagy 6
1THRIVE Laboratory, Psychology and Social Behavior, University of California, Irvine, Irvine, CA, United States, 2Department
of Psychology, University Laval, Quebec, QC, Canada, 3Wisconsin Institute for Discovery, Bainbridge Island, WA,
United States, 4University of Wisconsin-Madison, Madison, WI, United States, 5ReThink Health, Cambridge, MA,
United States, 6Anna Freud National Centre for Children and Families & University College London, London, United Kingdom
Despite extensive theorizing regarding the regulatory role of reflective functioning (RF),
few studies have explored the links between RF and physiological indices of emotion
regulation, and none have examined these associations in children. Further, while
scholars contend that RF promotes resilience via enhanced ability to process emotional
experiences, including those occurring in attachment relationships, this argument has
seldom been tested empirically in children. In the current study, we explore the
association between RF and physiological measures of emotion reactivity and regulation,
as well as the interaction of RF and attachment insecurity. We test these associations by
examining children’s (N=76; 8–12 years old) cardiovascular responses [respiratory sinus
arrhythmia (RSA)] to a standardized paradigm designed to evoke reactions regarding
the experience and expression of attachment-related needs. Children also completed a
semi-structured attachment interview, which was later coded for children’s attachment
insecurity (operationalized as attachment dismissal and preoccupation) and RF. Our
findings were largely consistent with theory and our hypotheses, suggesting that higher
RF is associated with lesser cardiovascular reactivity (higher levels of RSA) during the
stressor task and better recovery following the task. These links were especially strong for
children with greater attachment preoccupation but did not vary as a function of children’s
levels of attachment dismissal. These findings contribute to developmental theory in
suggesting that RF is closely linked to physiological emotion regulation in children.
Keywords: reflective functioning, mentalization, children, respiratory sinus arrhythmia, attachment
INTRODUCTION
Emotion serves an important role in orienting us to attend to internal or external
stimuli (1,2). Regulation of emotions, which involves conscious and unconscious
processes (3,4), is a key developmental milestone and transdiagnostic protective
factor against psychopathology (57). Emotion is a multifaceted construct comprised
of experiential, behavioral, and physiological components, with each factor revealing
unique information (3). Measuring these different components has the potential to
give insight into those unique streams of information. Physiological measures of
emotion can be particularly useful in measuring autonomic arousal, a metric that is less
Borelli et al. RF and Children’s Cardiovascular Reactivity
susceptible to reporting biases or social desirability effects than
other assessments (e.g., self-report). Heart rate variability (HRV),
an index of the change in time invervals between heartbeats, is
a measure of physiological reactivity that reflects the interplay
of different physiological systems that enable us to adapt
to challenges in the internal and external environment (8).
Respiratory sinus arrhythmia (RSA) is a short-term measure of
HRV that reflects the vagus nerve’s influence on the slowing and
speeding of the heart. RSA captures parasympathetic nervous
system activation in response to environmental stimuli (9).
Higher levels of task-related changes in RSA indicate lower levels
of sympathetic reactivity (1012). While the initial response to a
stimulus indexes emotion reactivity, observed recovery or return
to baseline RSA can be used to infer emotion regulation, as has
been done in prior studies (13,14).
ATTACHMENT
Attachment security, or the felt sense that others will be
responsive to one’s expression of needs for comfort and support,
is thought to develop as a result of a history of receiving
sensitive care from attachment figures (15). The internal
working model, a cognitive-affective schema that emerges from
a history of interactions between infant and caregiver, contains
important beliefs regarding the experience and expression of
emotion (15): when children’s expressions of emotional need
have been met consistently with empathy and assistance in
regulating emotion, children internalize the message that painful
emotional experiences can be experienced, expressed, and
resolved, resulting in optimal self-regulation of emotion later
in development (16). In contrast, when children’s needs have
been rejected or ignored or when caregivers have responded
inconsistently or with alarm to children’s needs, children resort
to defensive emotion regulation strategies, such as deactivation
or hyperactivation, which while adaptive in the short-term, can
result in negative outcomes over the long-term (16).
Decades of research substantiate this theorizing by
documenting links between attachment security and emotion
regulation in adults [e.g., (17,18)]. Although middle childhood
remains an understudied developmental phase with respect to
attachment and its links with emotion (19), emerging evidence
suggests that school-aged children with secure attachment have
better emotion regulation than their insecure counterparts [e.g.,
(20,21)].
The association between attachment and emotion regulation
is thought to depend on early parent-child interactions involving
physical/embodied regulation by the parent (22,23). These
interactions serve to calibrate the infant’s developing stress
regulation system so that over time, physiological self -regulation
is established (24), with the presence of the parent needed and
sought only in contexts of threat or higher levels of distress.
In addition, expectancies regarding the parent’s availability to
respond to distress are reflected at a representational level.
By middle childhood, attachment processes (1) have facilitated
emotional regulation through their early physiological impact on
the development of the stress regulation system; (2) continue
to facilitate emotional regulation through the actual availability
of, support from, and protection offered by attachment figures
in times of distress (25); and (3) promote regulation at a
representational level regarding the imagined responsiveness and
trustworthiness of attachment figures and others in times of
need (26). In line with this perspective, longitudinal evidence
suggests that the quality of early parenting, through its impact
on epigenetic regulation and DNA methylation, has long term
implications on self-regulation and interpersonal processes into
adulthood (2729).
MENTALIZATION
As conceptualized by Fonagy et al. (24), mentalization refers
to the process of interpreting the reactions of others in terms
of psychological experience, imagining the mental states and
intentions that underlie behavior, and being cognizant of
one’s own emotional reactions and their impact on others.
Mentalization has been operationalized for research purposes as
reflective functioning (RF). RF includes a self-focused dimension
of one’s own mental states, as well as an other-focused dimension
concerning others’ experiences (3032).
Mentalization develops alongside attachment when infants are
treated as individuals with minds and are responded to as if their
behavior communicates something about their psychological
experience (33). Through being treated as intentional agents,
children discover their minds and come to think of themselves as
having thoughts, desires, and feelings (34). Consistent with this
argument, parental mentalization predicts school-aged children’s
own mentalization (30).
People with higher RF are more likely to have secure
attachment (35), perhaps as a result of the association between
sensitive parenting and parental mentalization, but the two
constructs are not synonymous. Evidence suggests that adults
with secure attachment are more likely to have higher RF
(3638), but the effect sizes obtained in these studies are
not large, suggesting the distinctiveness of the two constructs.
However, to date only one study has explored the links between
attachment security and RF in children, finding that lower RF is
associated with dismissing and disorganized, but not preoccupied
attachment (Bizzi et al. in press).
MENTALIZATION AND EMOTION
REGULATION
Scholars contend that there is a bidirectional association
between RF and emotion reactivity and regulation (24). Having
access to representations, metacognitive reflection, and semantic
processing regarding one’s own emotions facilitates the ability
to make sense of and modify emotional expeirence. Fonagy
et al. (24) describe a particular type of early non-verbal
communication involving marked mirroring of the infant’s
peak affects and ostensive cueing, suggesting that this type of
interaction provides the infant with an external representation
of his/her emotions that is important for the consolidation of an
early sense of self (39). Thus, mentalization is thought to serve a
Frontiers in Medicine | www.frontiersin.org 2July 2018 | Volume 5 | Article 196
Borelli et al. RF and Children’s Cardiovascular Reactivity
powerful regulatory function, helping individuals make sense of
their own and others’ behaviors, thoughts, and feelings, and in so
doing, create an environment in which emotions are viewed as
predictable, meaningful, and controllable (24). At the same time,
mentalization is impacted by emotional arousal—higher levels of
arousal may inhibit effortful and deliberate RF (31,40).
Despite the rich theorizing regarding the regulatory role of
mentalization, the links between RF and emotion have seldom
been examined empirically, and have not yet been explored
in children. Although there is no direct evidence of the link
between children’s RF and children’s emotion regulation, several
studies provide indirect support for this association. First, there
is evidence that mentalization in parents predicts parenting
behavior that is associated with better emotion regulation in
children. For instance, parents with higher RF engage in more
sensitive (4145) and less intrusive or frightening parenting
than parents with lower RF (41,46). We see this as consistent
with the theorized association, given that more sensitive or
controlled parenting may in and of itself be evidence of better
emotion regulation (47). Second, in a series of studies on parental
mentalization and school-aged children’s emotional adjustment
(48,49), Gottman and colleagues find that parents who show
greater awareness of their own and their children’s emotions
have children who exhibit better emotion regulation. Conversely,
lower RF confers risk for a variety of forms of psychopathology,
including autism, depression, psychosis, PTSD, eating disorders,
substance abuse [for a review see (5055)], as well as forms of
psychopathology chiefly characterized by emotion dysregulation
[e.g., borderline personality disorder; (56,57)], suggesting that
the two may be linked. Similarly, in adolescents, lower RF is
a general risk factor for psychopathology, including borderline
and narcissistic personality traits, as well as internalizing and
externalizing symptoms (58). Finally, in children, lower RF
is associated with more depressive, externalizing, and somatic
symptoms [Bizzi et al., under revision, (59,60)].
RF AS A RESILIENCE FACTOR IN THE
CONTEXT OF ATTACHMENT
According to theory, mentalization can assist individuals
in the processing of life experiences, including those that
occur in attachment relationships (24,61). Mentalization can
help individuals understand and make sense of their past
experiences, which is thought to be central to resilience. This
conceptualization of mentalization converges with the notion of
resilience as a “reintegration of self that includes a conscious
effort to move forward in an insightful integrated positive
manner as a result of lessons learned from an adverse experience”
[(62), p. 3].
In support of this argument, research finds that among
adolescents who report having experienced parental neglect
(adverse early experience), those with higher RF were less
likely to be classified as having insecure attachment (outcome)
compared to their lower-RF counterparts (63). Similarly, another
study found that among parents with childhood experiences of
maltreatment (adverse early experience), those with higher levels
of RF regarding trauma were less likely to have infants who
were disorganized in their attachment [outcome variable; (64)].
In the current study, we examine whether the link between RF
and RSA is stronger among children with greater attachment
insecurity (more attachment preoccupation or dismissal), who
are likely to have experienced greater distress in the context of
attachment related needs than children with lesser attachment
insecurity, thereby assessing whether RF can promote resilience
in the context of attachment experiences.
CURRENT INVESTIGATION
We pursue two central aims—first, we test the concurrent
associations between school-aged children’s RF and their
physiological reactivity to and recovery following a stressor
task related to attachment needs. Second, we explore whether
RF interacts with attachment insecurity in its associations with
physiological reactivity and recovery.
To these ends, a community sample of school-aged children
completed an attachment interview, which was later coded
by independent teams of raters naïve to study hypotheses for
attachment security and RF. Approximately 1 week later, children
completed a standardized laboratory paradigm used in previous
studies of attachment (65), in which they read hypothetical
vignettes of other children encountering situations that are
likely to evoke attachment-related needs (e.g., being sick, feeling
afraid). During and following the presentation of these vignettes,
we monitored children’s RSA, which we used as measures of
reactivity and regulation, respectively.
We tested the following hypotheses. First, consistent with
prior work, we sought to replicate the association between
higher attachment insecurity (dismissal and preoccupation) and
lower RF. Second, we predicted that higher RF would be
associated with lower reactivity and regulation (higher RSA
during and following the stressor task). We followed this
prediction with an exploratory test of the pathway between RF
and emotion regulation, testing whether RSA during the stressor
(emotion reactivity) mediates the association between RF and
RSA following the stressor (emotion regulation). Third, we tested
the theory that RF buffers the effects of attachment insecurity;
we predicted that RF and attachment insecurity would interact
in their association with RSA during (emotion reactivity) and
following the stressor (emotion regulation), such that for children
higher in attachment insecurity, higher RF would be more
strongly associated with attenuated reactivity and regulation.
Similar to above, we followed this hypothesis-driven prediction
with an exploration of a moderated mediation model in which
RF moderates the link between attachment insecurity and RSA
following the stressor, as mediated by RSA during the stressor.
METHODS
Participants
The protocol for this study was approved by the Institutional
Review Board at Pomona College. Children (N=76; 50%
boys, Mage =9.82, SDage=1.47) between the ages of 8 and
12 participated in this study of children’s development. The
principal investigator calculated the targeted sample size based
on a power analysis using effect sizes obtained from her prior
Frontiers in Medicine | www.frontiersin.org 3July 2018 | Volume 5 | Article 196
Borelli et al. RF and Children’s Cardiovascular Reactivity
work on attachment in school-aged children, which suggested
a sample size of N=70 would be sufficient to detect an effect.
The participants were recruited from the community through
advertisements posted online, flyers, and word of mouth. The
sample was racially/ethnically (40% of caregivers identified as
Hispanic, 36% Caucasian, 13% African American, 4% Other,
1% Asian, and 1% Native American) and socioeconomically
diverse (50% of families reported an annual income <$40,000;
8% >$120,000).
Procedure
The study took place over two sessions occurring 2 weeks
apart. Caregivers provided consent to participate in a study, while
children provided informed assent. Participants were informed
that they could choose to opt out of any portion of the study
at any time. Then children completed the Child Attachment
Interview [CAI; (66)], from which two non-overlapping teams
of coders scored children’s attachment security and RF. On
the second visit, children completed a laboratory stressor and
recovery task during which we monitored their cardiovascular
reactivity.
Measures
Attachment Security
Children completed the CAI, a semi-structured interview for 8–
13 year olds, designed to assess the quality of their attachment
to their caregivers. The interview consists of 19 questions about
children’s current and past experiences with their caregivers.
Responses are coded on 8 scales (e.g., Idealization, Preoccupying
Anger, Balance of positive/negative references to attachment
figures), as well as on the Overall Narrative Coherence scale,
a dimensional measure of attachment security (67). A certified
CAI coder coded all interviews, with reliability performed on 16
randomly-selected cases coded by a second certified coder. The
Intraclass Correlation Coefficients (ICC) for CAI scales ranged
from 0.72 to 0.97. The average ICC across all CAI subscales was
0.87.
The CAI manual provides guidelines for using scale scores
to place children into one of four best-fitting attachment
classifications with respect to each caregiver: secure, dismissing,
preoccupied, and disorganized. However, in line with the
argument that attachment is best reflected using dimensional,
rather than categorical, metrics (68,69), we used factor
analytically-derived scales of dismissing and preoccupied
attachment. This procedure has previously been used with
studies using the CAI (7072). The details of the factor analysis
conducted within the larger sample are reported elsewhere (73),
but in brief, the analysis revealed the presence of two factors.
Scales loading on the first factor (eigenvalue =4.83) signified
attachment dismissal, with high scores indicating high dismissal
of attachment needs and idealization of relationships with
caregivers. Scales loading on the second factor (eigenvalue =
1.86) signified preoccupation, with high scores indicating high
involving/preoccupying anger (communalities above 0.70). A
high level of inter-rater reliability was achieved on these factor
scales, dismissal ICC =0.92, preoccupation ICC =0.96.
Reflective Functioning
Children’s RF was coded from their responses to the CAI using
the Child Reflective Functioning Scale [CRFS; (30,74)]. The
CRFS is a modification of the Adult Reflective Functioning
Scale [ARFS; (75)], which is used to measure RF on the Adult
Attachment Interview [AAI; (76)]. The CRFS involves coding
children’s ability to articulate their own and others’ internal
experiences while describing current and past experiences with
their caregivers. Coders rate RF on each CAI question; these
scores are then averaged to create a global RF score. Although
relatively recently developed, the CRFS has already shown
promising psychometrics—the item-total correlations ranged
from 0.57 to 0.79, and Cronbach’s alpha was 0.94 (36). Due to our
interest in children’s general reflective capacities, in the current
study we use children’s global RF scores in analyses. In this study,
internal consistency in RF scores across items was high, α=
0.96. The coder of all of the CAIs in this sample was trained
by and was demonstrated to have excellent reliability with the
developer of the CRFS measure (ICC =0.92). The CRFS coder
was unaware of all information regarding the children in the
study (including their attachment classifications) and was not
part of the attachment coding team.
The CRFS manual contains descriptions and examples of
different levels and types of children’s RF. Children’s narratives
are coded on an 11-point scale (1–9) descriptively anchored at
six points in terms of their propensity to consider interpersonal
interactions and personal reactions in mental state terms. To
obtain a general indicator of children’s RF (CRF-G), the mean
RF of all the coded responses was used. The scale alpha was 0.94,
and item-total correlations ranged from 0.57 to 0.79, confirming
that the total score (CRF-G) could be used as a good indicator
of overall RF. Because of theoretical considerations and previous
findings with adults indicating that self- and other understanding
may have distinct implications, self and other items were treated
as separate scales. A factor analysis is not reported given that the
sample was composed in part of children with histories of sexual
abuse involving their fathers and that this may have had an effect
on their mentalization regarding fathers that may be particular
to this sample and would be unlikely to be replicated in other
samples.
Laboratory Stressor: Distress Vignettes Paradigm
Children completed a standardized laboratory stressor task in
which they were presented with multiple vignettes in text form
regarding same-sex hypothetical children experiencing mildly
emotionally and physically distressing situations (sadness, fear,
sick, and hurt) on a computer screen (65). They were asked
to reflect on their thoughts and feelings in reaction to each
vignette (e.g., [Child’s name] hurt her/his knee when (s)he was
playing basketball. It hurt all day long). We used two different
counterbalanced conditions to control for order effects of the
presentation of the different situations (Order 1: hurt, sad,
afraid, sick, neutral; Order 2: neutral, sick, hurt, sad, afraid).
For each distressing situation, three vignettes were presented
(order randomized within counterbalanced block) to represent
increasing levels of severity of distress. All stimuli were presented
using E-Prime. Prior data using this paradigm suggest that
Frontiers in Medicine | www.frontiersin.org 4July 2018 | Volume 5 | Article 196
Borelli et al. RF and Children’s Cardiovascular Reactivity
TABLE 1 | Descriptive statistics of key variables by children’s gender.
Measures Total (N=76) Boys (n=38) Girls (n=38) Gender differences t
M(SD)M(SD)M(SD)
Age 9.82 (1.47) 9.24 (1.38) 10.39 (1.33) 3.72***
Attachment dismissala0.05 (1.00) 0.36 (1.01) 0.27 (0.88) 2.89**
Attachment preoccupationb0.11 (0.98) 0.10 (0.97) 0.12 (1.00) 0.11
RF 3.09 (0.84) 2.71 (0.69) 3.47 (0.80) 4.45***
RSA-baseline 6.85 (1.24) 6.63 (1.38) 7.08 (1.05) 1.60
RSA–stressor 6.75 (0.90) 6.68 (0.94) 6.83 (0.85) 0.70
RSA–recovery 6.79 (0.90) 6.77 (0.91) 6.80 (0.90) 0.16
RF, Reflective functioning; **p<0.01. ***p<0.001.
aAttachment dismissal, Factor analytically derived dismissing attachment score (Child Attachment Interview); Higher score means highly dismissing.
bAttachment preoccupation, Factor analytically derived preoccupied attachment score (Child Attachment Interview); Higher score means highly preoccupied.
TABLE 2 | Correlation matrix for key variables.
Variable 1 2 3 4 5 6 7 8
1. Age
2. Gender 0.40***
3. Attachment dismissala0.18 0.32**
4. Attachment preoccupationb0.03 0.01 0.04
5. RF 0.40*** 0.46*** 0.58*** 0.10
6. RSA-baseline 0.01 0.18 0.02 0.07 0.05
7. RSA–stressor 0.22 0.08 0.09 0.02 0.10 0.58***
8. RSA–recovery 0.25* 0.02 0.04 0.06 0.13 0.53*** 0.84***
RF, Reflective functioning; Gender coding: 1, boys; 2, girls; *p<0.05, **p<0.01, ***p<0.001.
aAttachment dismissal, Factor analytically derived dismissing attachment score (Child Attachment Interview); Higher score means highly dismissing.
bAttachment preoccupation, Factor analytically derived preoccupied attachment score (Child Attachment Interview); Higher score means highly preoccupied.
children experience significant increases in self-reported negative
emotion in response to these vignettes (65).
Cardiovascular Physiology
RSA data were collected before, while, and after the laboratory
stressor was presented. Baseline RSA was collected while children
sat quietly and watched a 290 s nature video. During the
laboratory task, RSA-stressor was collected while each of the
vignette (“story”) and reflection periods were presented (60 s
for each vignette). Following each distress block (e.g., afraid),
which included the presentation of three separate vignettes
and reflection periods, children completed a 30 s RSA recovery
period during which they were asked to sit quietly and wait
until the next “story” appeared on the screen. Thus, for the
purposes of this study, we considered RSA recordings taken
during the vignettes to be measures of reactivity, whereas
we considered RSA measures taken during the recovery
periods following each block of vignettes to be measures of
regulation.
We collected HRV data using disposable Mindware 1.5-
in foam EKG electrodes with 7% chloride wet gel and
touchproof snap leads, which were connected to a BioNex 8
slot chassis equipped with an impedance cardiograph (Mindware
Technologies, Gahanna, OH). Data were collected using BioLab
2.5 acquisition software and were later edited for peak errors
and noise using BioLab HRV 2.0 application (Mindware
Technologies, Gahanna, OH). Prior to conducting data analysis,
we computed mean RSA across the baseline assessment, and the
reactivity and recovery sessions of the four distressing vignette
types.
Data Analytic Plan
To evaluate our hypotheses, we used hierarchical linear
regressions in which we controlled for children’s age
and gender on an initial step. For analyses involving
moderation, mediation, and moderated mediation, we
used Hayes’ PROCESS macro (77). In analyses in which
reactivity and recovery levels of RSA were the dependent
variables, we included baseline RSA as an additional
covariate.
RESULTS
Descriptive Statistics
Descriptive statistics for key variables, overall and by child
gender, are reported in Table 1. Independent samples t-tests
revealed that girls were significantly older, less dismissing, and
higher in RF than boys. Zero-order correlations indicated that
older children had higher RF (r=0.40, p<0.001) and higher
RSA-recovery (r= 0.25, p=0.03; see Table 2). Children with
Frontiers in Medicine | www.frontiersin.org 5July 2018 | Volume 5 | Article 196
Borelli et al. RF and Children’s Cardiovascular Reactivity
more dismissing attachment had lower RF (r= 0.58, p<
0.001).
Based on the results of these preliminary analyses, we
controlled for children’s age and gender in all subsequent
analyses.
Hypothesis 1. Association Between
Children’s RF and Attachment Security
After controlling for children’s age and gender (R2=0.27, p
<0.001), attachment dismissal was negatively associated with
children’s RF (1R2=0.22, b= 0.40, SE =0.08, p<0.001;
see Table 3). In a subsequent analysis, when we controlled for
attachment preoccupation (R2=0.28, p<0.001), attachment
dismissal was still negatively associated with children’s RF (1R2
=0.21, b= 0.40, SE =0.08, p<0.001), but preoccupation was
not.
Hypothesis 2. Association Between
Children’s RF and RSA
Table 4 depicts the results of two hierarchical linear regressions
testing the association between children’s RF and RSA-stressor,
as well as children’s RF and RSA-recovery. After controlling for
children’s age, gender, and baseline RSA (R2=0.38, p<0.001),
children’s RF was significantly positively associated with RSA-
stressor (1R2=0.05, b=0.28, SE =0.11, p=0.01; Hypothesis
2a). Thus, in support of Hypothesis 2, higher RF was associated
with lesser reactivity.
Second, after controlling for the same set of covariates
(R2=0.34, p<0.001), children’s RF was significantly
positively associated with children’s RSA-recovery (1R2=
0.09, b=0.37, SE =0.11, p=0.002; Hypothesis 2b).
Therefore, in support of our hypothesis, higher RF was associated
with greater parasympathetic activation during the recovery
period.
Exploratory Mediation
Figure 1 presents the results of a hierarchical regression testing
the mediation model. PROCESS Model 4 revealed that after
TABLE 3 | Child attachment dismissal associated with child RF.
Dependent variable: child RF
Step bSE βCI
Step 1 R20.27***
Constant 0.79 0.57 [0.34, 1.92]
Age 0.14* 0.06 0.25 [0.02, 0.27]
Gender 0.60** 0.18 0.36 [0.24, 0.96]
Step 2 1R20.22***
Attachment dismissala0.40*** 0.08 0.48 [0.55, 0.25]
Attachment preoccupationb0.11 0.07 0.13 [0.25, 0.04]
RF, Reflective functioning; *p<0.05; **p<0.01 ***p<0.001.
aAttachment dismissal =Factor analytically derived dismissing attachment score (Child
Attachment Interview); Higher score means highly dismissing.
bAttachment preoccupation =Factor analytically derived preoccupied attachment score
(Child Attachment Interview); Higher score means highly preoccupied.
controlling for children’s age, gender, and baseline RSA in the first
step (R2=0.43, p<0.001), children’s RSA-stressor acted as an
indirect effect in explaining the link between child RF and RSA-
recovery (point estimate =0.21, 95% CI [0.03, 0.42]). Controlling
for the indirect effect, the direct effect between child RF and
RSA-recovery was not significant (point estimate =0.16, 95% CI
[0.004, 0.33]).
Hypothesis 3. Association Between
Children’s RF and RSA Moderated by
Attachment
We tested whether attachment dismissal or preoccupation
moderated the link between children’s RF and RSA-stressor
(Hypothesis 2a) or RSA-recovery (Hypothesis 2b), after
controlling for covariates. The results of these moderation
analyses revealed that neither attachment dismissal (1R2=
0.01, b= 0.13 p=0.21), nor attachment preoccupation
(1R2=0.01, b=0.09, p=0.28), moderated the link between
children’s RF and RSA-stressor. However, after controlling
for children’s age, gender, baseline RSA, and the main effects
of attachment dismissal and preoccupation (R2=0.48, p<
0.001), attachment preoccupation moderated the link between
children’s RF and RSA-recovery (1R2=0.05, b=0.21, p=
0.01). Among children with mean (b=0.43, p=0.002), and high
levels of attachment preoccupation (b=0.63, p=0.0001), RF
was positively associated with RSA-recovery. Among children
with low attachment preoccupation, the association between
children’s RF and RSA-recovery was not significant (b=0.23,
p=0.15; see Figure 2). Attachment dismissal did not moderate
the association between child RF and RSA recovery after the
stressor task (1R2=0.004, b= 0.07, p=0.52); therefore, we
elected not to examine a moderated mediation using attachment
dismissal.
Exploratory Moderated Mediation
After controlling for children’s age, gender, baseline RSA, and
attachment dismissal (R2=0.43, p<0.001), the examination of
conditional effects revealed that among children with mean (b=
0.22, p=0.02) and high attachment preoccupation (b=0.36, p
=0.002) RSA-stressor mediated the link between children’s RF
and RSA-recovery (point estimate =0.20, 95% CI [0.003, 0.39];
see Table 5 and Figure 3). Among children with low attachment
preoccupation, there was no significant mediation effect (b=0.08
p=0.45).
DISCUSSION
Despite extensive theorizing regarding the regulatory role
of RF, prior to the current investigation, extremely few
studies had explored the links between RF and physiological
reactivity or regulation, and none had examined these
associations in children. In the current study, we tested these
associations by exploring children’s physiological responses to
a standardized paradigm designed to evoke reactions regarding
the experience and expression of attachment-related needs.
Consistent with theory and hypotheses, the key findings of
Frontiers in Medicine | www.frontiersin.org 6July 2018 | Volume 5 | Article 196
Borelli et al. RF and Children’s Cardiovascular Reactivity
TABLE 4 | Hierarchical regressions examining associations between children’s RF, RSA-stressor and RSA-recovery.
Dependent variable: RSA–stressor Dependent variable: RSA–recovery
Step b SE βCI b SE βCI
Step 1 R20.38*** 0.34***
Constant 5.22*** 0.73 [3.76, 6.67] 5.62*** 0.76 [4.10, 7.13]
Age 0.15* 0.06 0.24 [0.27, 0.02] 0.15* 0.06 0.25 [0.28, 0.02]
Gender 0.13 0.18 0.07 [0.23, 0.50] 0.04 0.19 0.02 [0.34, 0.42]
RSA–Baseline 0.41*** 0.07 0.56 [0.27, 0.54] 0.38*** 0.07 0.52 [0.24, 0.52]
Step 2 1R20.05* 0.09**
RF 0.28* 0.11 0.26 [0.06, 0.51] 0.37** 0.11 0.34 [0.14, 0.60]
RF, Reflective functioning. *p<0.05. **p<0.01. ***p<0.001.
FIGURE 1 | RSA-stressor as a mediator for the association between Child RF and RSA-recovery. Figure shows unstandardized bvalues. Analysis includes the
following covariates (not pictured here): child age, child gender, RSA-Baseline. RF, Reflective functioning; *p<0.05. ***p<0.001.
FIGURE 2 | Attachment preoccupation moderates the association between children’s RF and RSA-recovery, but not RSA-reactivity. RF, Reflective functioning;
Attachment preoccupation, Factor analytically derived preoccupied attachment.
this study were that higher RF was associated with lower
cardiovascular reactivity and better regulation, links that
were especially strong for children with greater attachment
preoccupation.
The findings of our first analysis revealed that greater
attachment dismissal was associated with lower RF, but that
attachment preoccupation was not significantly associated with
child RF. Thus, using ratings derived from independent
Frontiers in Medicine | www.frontiersin.org 7July 2018 | Volume 5 | Article 196
Borelli et al. RF and Children’s Cardiovascular Reactivity
TABLE 5 | Regressions examining the moderated mediation model: attachment
preoccupation as a moderator of the mediation of the children’s RF to
RSA-recovery by RSA-stressor.
Independent variable: children’s RF
Dependent variable: RSA–recovery
Predictor variables b SE CI
Low attachment preoccupation 0.08 0.11 [0.13, 0.30]
Mean attachment preoccupation 0.22* 0.09 [0.03, 0.41]
High attachment preoccupation 0.36** 0.11 [0.14, 0.59]
RF, Reflective functioning; Attachment preoccupation, Factor analytically derived
preoccupied attachment score (Child Attachment Interview); Higher score means highly
preoccupied. *p<0.05, **p<0.01.
FIGURE 3 | Visual depiction of the proposed moderated mediation:
Attachment preoccupation moderates the association between children’s RF
and RSA-recovery mediated by RSA-stressor. RF, Reflective functioning;
Attachment preoccupation, Factor analytically derived preoccupied
attachment score (Child Attachment Interview); Higher score means highly
preoccupied.
teams of coders, we found that children classified as having
high attachment dismissal had lower RF, demonstrating the
limitations in their abilities to hold in mind their own and
their parents’ mental states. However, our findings revealing a
unique link between dismissing attachment and RF are in line
with results from other studies finding a specific association
between dismissing attachment and lower RF in children and
parents [Bizzi et al., under revision; (73), but see (36), for an
association between lower RF with dismissal and preoccupation].
One potential reason for the lack of association between RF
and preoccupation is that preoccupied children may use more
emotion words than dismissing children, and may potentially
use comparable numbers of emotion words as secure children.
The use of emotion words constitutes part of the global RF score
and thus could inflate the RF ratings of preoccupied children,
despite their relatively infrequent use of attributions or actual
mentalization. However, for preoccupied children, the use of
mental state language may not be as emotionally regulating as it is
for secure children, or perhaps preoccupied children use mental
state language but do not achieve higher levels of mentalization
(e.g., drawing connections between mental states and behavior).
An alternate explanation is that preoccupied children, who are
likely to be more open to experiencing and expressing negative
emotion than dismissing children (16), may engage in a type
of hypermentalizing in an attempt to regulate emotion, but are
unable to use their mentalization in an organized way to regulate
and contain negative effects and anger in relation to attachment
figures (Bizzi et al., under revision).
Our central study hypotheses concerned the interrelations of
RF and physiological reactivity and regulation, operationalized
as RSA during the task and the recovery period, respectively.
RF was associated with higher RSA during the stressor and
recovery period, supporting our hypotheses and suggesting that
RF is associated with lower reactivity and better regulation.
Interpreting these findings in terms of theory would suggest
that for children with higher RF on the CAI, contemplating
attachment needs (being physically hurt, sick, sad, or frightened)
did not require as much physiological regulatory effort as this
task demanded from children with lower levels of RF. Thus, at
least in the context of the current attachment-based task, RF was
associated with superior physiological regulation. According to
mentalization theory, a child’s experience of the benign interest
of parents in their subjective experience can improve emotion
regulation, as it opens a space where they can communicate their
concerns, fears, and difficulties to their parents, allowing them to
develop a mutually elaborated understanding of themselves and
their emotions (26,33,60).
However, much remains to be understood about these effects
as, given the correlational design in which measures were
assessed at a single timepoint, causal conclusions elude us.
Further, RF could be associated with emotion reactivity and
regulation via several channels. For instance, children may
have been less reactive owing to a sense of confidence that
emotions can be safely experienced and shared. Higher RF may
in part be associated with lower stress activation because of
early experiences in which children’s subjective experience was
responded to first through marked affect mirroring when they
were young (24) and later through the parents’ creation of a
shared mental space where the children’s subjective experience
can be elaborated. Further, interactions in which the parent
actively helped the child understand affective experience could
have positively impacted the development of the child’s stress
regulation system. Alternatively, higher RF youth may not
have found the vignettes emotionally taxing, as, by virtue of
their abilities to mentalize, contemplating attachment needs
and emotions may not be as daunting. Via mentalization,
children have learned to mentally represent emotions, symbolize
subjective experience, and put these experiences into words,
a process which facilitates the understanding and regulation
of emotions. When children develop symbolic and semantic
representations of emotion, children’s neurobiological pathways
of stress regulation and mentalization may be more effectively
Frontiers in Medicine | www.frontiersin.org 8July 2018 | Volume 5 | Article 196
Borelli et al. RF and Children’s Cardiovascular Reactivity
connected, thus promoting the effective regulation of emotion.
We tentatively suggest that the outcome of interpersonally
developed mentalization about self and others, evident at the
level of physiological regulation, may reflect an integration of
symbolic and affective processes that are likely evident at the level
of neurobiology but may also be seen from the perspective of self
and identity. At this level of development, higher RF may be seen
as an index of the child’s emerging sense of self and attachment
figures, and as central to identity.
Finally, we found that attachment preoccupation, but not
attachment dismissal, moderated the link between RF and
RSA during recovery, but not RSA reactivity. Specifically, the
positive association between RF and RSA was only statistically
significant among children with mean or higher attachment
preoccupation, and not among children with low levels of
attachment preoccupation. Children who are low in attachment
preoccupation may not need RF to regulate themselves when
considering attachment needs and feelings, as contemplating
these topics may have evoked less intense reactions. On
the other hand, for preoccupied children, for whom the
contemplation of attachment needs may have caused higher
reactivity, RF appears to have helped in their recovery. We have
previously speculated whether the higher measured RF found
among preoccupied children was indicative of hypermentalizing
(repetitive, unproductive contemplating about mental states),
but the current findings suggest that RF does in fact facilitate
regulation among preoccupied children.
This finding can be understood in terms of its contribution to
the notion that RF promotes resilience—children whose mental
representations are characterized by preoccupation, who were
nonetheless simultaneously engaged in the process of making
sense of these experiences (evidenced by high RF), demonstrated
superior physiological recovery from the stressor task. As
resilience can be conceptualized as the capacity of a system to
adjust to disturbances that could threaten it, or the attempt
to continually derive meaning and insight from experiences
(62), it aptly characterizes the process of mentalization co-
occurring with preoccupied attachment. The link between RF
and physiological reactivity did not vary as a function of
dismissing attachment; at all levels of dismissing attachment,
higher RF was associated with better emotion reactivity and
regulation. Thus, no matter how low the attachment dismissal,
RF confers regulatory protection.
Strengths and Limitations
As the first empirical test of the links between RF and
physiological reactivity in children, we believe that this study
contributes to the literature in significant ways. By using robust
observational measures of attachment and RF, and by employing
a standardized laboratory stressor designed to present to children
situations in which attachment needs are evoked, we offer an
important, highly controlled examination of research hypotheses.
Further, our use of a highly racially and ethnically diverse sample
of children increases the generalizability of the findings we report.
However, it is also important to contextualize the
contributions of this study in light of its limitations. One
limitation of the study is that the assessment occurred at a single
timepoint, leaving open the possibility that lower physiological
reactivity or better regulation could cause higher levels of RF,
or that a shared third variable drives the association between
RF and emotion reactivity and regulation. Longitudinal designs
will be able to identify whether RF predicts emotion regulation
later in development, which would strengthen the argument
that children’s RF promotes resilience. Further, we examined
attachment and RF using the same instrument (CAI). Although
we used non-overlapping coders who were blind to all participant
information, the fact that these indices were derived from the
same measure may limit the extent to which we can accurately
conceptualize them as separable constructs.
Further, measuring children’s RSA in response to the distress
vignettes task did not permit us to examine the types of
negative emotion reactivity and regulation that are associated
with RF (e.g., we cannot make an argument regarding discrete
emotions), nor can we speak to children’s subjective emotional
experience more generally; this is an area ripe for future
inquiry. Relatedly, for the purposes of this study, we attempted
to distinguish between physiological measures of reactivity
(RSA measured during the presentation of the vignettes) and
regulation (RSA measured during the 30 s following each
vignette block); however, this distinction contains some error
in that children can employ regulation before and during the
presentation of the distress vignettes. Thus, it is impossible to
conclude that these measures indexed reactivity and regulation,
but we can state that they assessed early and later measures
of cardiovascular activation. In terms of the use of RSA, we
note that some researchers suggest that greater decreases in RSA
during a demanding task connote greater activation to stimuli
and thus more optimal use of coping strategies (7880), while
others suggest that higher RSA during a stressor signifies lower
emotional reactivity, which serves an adaptive function (10
12). Thus, it is important to note that our interpretation that
lower stressor- and recovery-RSA signifies greater reactivity is
consistent with one way of conceptualizing task-related changes
of RSA, but this view is not universally held.
In addition, we did not measure or control for children’s
reading or learning abilities, which leaves open the possibility
that the effects found here are biased to some extent by children’s
cognitive functioning. Finally, in future studies, it would be
informative to measure task-specific or state-like RF regarding
the laboratory task, as has been done in at least one other
investigation (46), as this would enable us to get closer to
identifying the processes occurring during the stressor task for
high RF children.
CONCLUSIONS
This study provides new physiological evidence that children’s
mentalization is associated with more efficient stress regulation,
as higher RF was associated with less physiological reactivity
during and more efficient recovery from a stressor. When
confronted with attachment stress, children with higher RF
regulated their autonomic nervous systems with less effort than
children with lower RF. Consistent with the argument that
Frontiers in Medicine | www.frontiersin.org 9July 2018 | Volume 5 | Article 196
Borelli et al. RF and Children’s Cardiovascular Reactivity
RF promotes resilience, the association between RF and higher
RSA was only significant among children with higher levels of
attachment preoccupation.
AUTHOR CONTRIBUTIONS
JB designed the study, developed the hypotheses, oversaw the
data collection, conducted data analyses, and was the chief
contributor to the writing of the manuscript. KE developed
the coding system for children’s reflective functioning, oversaw
the coding of the data, and contributed to the writing and
editing of the manuscript. KH assisted with data analyses,
editing and writing of the manuscript, and the preparation
and checking of references. ATS conducted the coding of
the reflective functioning data and assisted with the literature
review of the manuscript. RD provided conceptual guidance
regarding the framing of the manuscript. PF assisted with
the conceptual framing of the mentalization aspect of the
manuscript.
FUNDING
PF is in receipt of a National Institute for Health Research
(NIHR) Senior Investigator Award (NF-SI-0514-10157) and was
in part supported by the NIHR Collaboration for Leadership in
Applied Health Research and Care (CLAHRC) North Thames at
Barts Health NHS Trust. The views expressed are those of the
authors and not necessarily those of the NHS, the NIHR, or the
Department of Health.
REFERENCES
1. Campos JJ, Mumme DL, Kermoian R, Campos RG. A functionalist perspective
on the nature of emotion. Monogr Soc Res Child Dev. (1994) 59:284–303.
doi: 10.2307/1166150
2. Gross JJ. The emerging field of emotion regulation: an integrative review. Rev
Gen Psychol. (1998) 2:271–99. doi: 10.1037/1089-2680.2.3.271
3. Gross JJ. Handbook of Emotion Regulation. 2nd ed. New York, NY: Guilford
Press (2014).
4. Thompson RA. Emotion regulation: a theme in search of definition. Monogr
Soc Res Child Dev. (1994) 59:25–52. doi: 10.2307/1166137
5. Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies
across psychopathology: a meta-analytic review. Clin Psychol Rev. (2010)
30:217–37. doi: 10.1016/j.cpr.2009.11.004
6. Cicchetti D, Ackerman BP, Izard CE. Emotions and emotion regulation
in developmental psychopathology. Dev Psychopathol. (2009) 7:1–10.
doi: 10.1017/S0954579400006301
7. Thompson RA. Emotional regulation and emotional development. Educ
Psychol Review. (1991) 3:269–307. doi: 10.1007/BF01319934
8. Shaffer R, Ginsberg JP. An overview of heart rate variability metrics
and norms. Front Public Health (2017) 28:258. doi: 10.3389/fpubh.2017.
00258
9. Thayer JF, Hansen AL, Saus-Rose E, Johnsen BH. Heart rate variability,
prefrontal neural function, and cognitive performance: the neurovisceral
integration perspective on self-regulation, adaptation, and health. Ann Behav
Med. (2009) 37:141–53. doi: 10.1007/s12160-009-9101-z
10. Fagundes CP, Diamond LM, Allen KP. Adolescent attachment insecurity and
parasympathetic functioning predict future loss adjustment. Pers Soc Psychol
Bull. (2012) 38:821–32. doi: 10.1177/0146167212437429
11. Sbarra DA, Borelli JL. Heart rate variability moderates the association
between attachment avoidance and self-concept reorganization
following marital separation. Int J Psychophysiol. (2013) 88:253–60.
doi: 10.1016/j.ijpsycho.2012.04.004
12. Smith TW, Cribbet MR, Nealey-Moore JB, Uchino BN, Williams PG,
MacKenzie J, et al. Matters of the variable heart: respiratory sinus arrhythmia
response to marital interaction and associations with marital quality. J Pers
Soc Psychol. (2011) 100:103–19. doi: 10.1037/a0021136
13. Willemen AM, Schuengel C, Koot HM. Physiological regulation of stress
in referred adolescents: the role of the parent-adolescent relationship. J
Child Psychol Psychiatry (2009) 50:482–90. doi: 10.1111/j.1469-7610.2008.
01982.x
14. Waugh CE, Panage S, Mendes WB, Gotlib IH. Cardiovascular and
affective recovery from anticipatory threat. Biol Psychol. (2010) 84:169–75.
doi: 10.1016/j.biopsycho.2010.01.010
15. Bowlby J. Attachment and loss:Loss. Vol. 3. New York, NY: Basic Books (1980).
16. Cassidy J. Emotion regulation: influences of attachment relationships. Monogr
Soc Res Child Dev. (1994) 59:228–83. doi: 10.2307/1166148
17. Mikulincer M, Shaver PR. Adult attachment and affect regulation. In: Cassidy
J, Shaver PR, editors. Handbook of Attachment:Theory, Research, and Clinical
Applications. New York, NY: Guilford Press (2008). p. 503–31.
18. Mikulincer M, Shaver PR, Pereg D. Attachment theory and affect
regulation: the dynamics, development, and cognitive consequences
of attachment-related strategies. Motiv Emot. (2003) 27:77–102.
doi: 10.1023/A:1024515519160
19. Bosmans G, Kerns KA. Attachment in middle childhood: progress
and prospects. New Dir Child Adolesc Dev. (2015) 148:1–14.
doi: 10.1002/cad.20100
20. Borelli JL, Crowley MJ, David DH, Sbarra DA, Anderson GM, Mayes LC.
Attachment and emotion in school-aged children. Emotion (2010) 10:475–85.
doi: 10.1037/a0018490
21. Kerns KA, Abraham MM, Schlegelmilch A, Morgan TA. Mother–child
attachment in later middle childhood: assessment approaches and associations
with mood and emotion regulation. Attach Hum Dev. (2007) 9:33–53.
doi: 10.1080/14616730601151441
22. Shai D, Belsky J. When words just won’t do: introducing parental
embodied mentalizing. Child Dev Perspect. (2011) 5:173–80.
doi: 10.1111/j.1750-8606.2011.00181.x
23. Shai D, Belsky J. Parental embodied mentalizing: how the nonverbal dance
between parents and infants predicts children’s socio-emotional functioning.
Attach Hum Dev. (2017) 19:191–219. doi: 10.1080/14616734.2016.1255653
24. Fonagy P, Gergely G, Jurist EL, Target M. Affect Regulation, Mentalization,an d
the Development of the Self. New York, NY: Other Press (2002).
25. Kerns KA. Attachment in middle childhood. In: Cassidy J, Shaver PR, editors.
Handbook of Attachment: Theory, Research, and Clinical Applications. New
York, NY: Guilford Press (2008). pp. 366–82.
26. Fonagy P, Gergely G, Target M. The parent-infant dyad and the construction
of the subjective self. J Child Psychol Psychiatry (2007) 48:288–328.
doi: 10.1111/j.1469-7610.2007.01727.x
27. Caspi A, Sugden K, Moffitt TE, Taylor A, Craig IW, Harrington H, et al.
Influence of life stress on depression: moderation by a polymorphism in the
5-HTT gene. Science (2003) 301:386–9. doi: 10.1126/science.1083968
28. Meaney MJ. Maternal care, gene expression, and the transmission of
individual differences in stress reactivity across generations. Annu Rev
Neurosci. (2001) 24:1161–92. doi: 10.1146/annurev.neuro.24.1.1161
29. Naumova OY, Hein S, Suderman M, Barbot B, Lee M, Raefski A, et
al. Epigenetic patterns modulate the connection between developmental
dynamics of parenting and offspring psychosocial adjustment. Child Dev.
(2016) 87:98–110. doi: 10.1111/cdev.12485
30. Ensink K, Target M, Oandasan C, Duval J. Child and Adolescent Reflective
Functioning Scale (CRFS) scoring manual. Unpublished manuscript, School
of Psychology, Université Laval (2015).
31. Fonagy P, Luyten P. A developmental, mentalization-based approach to
the understanding and treatment of borderline personality disorder. Dev
Psychopathol. (2009) 21:1355–81. doi: 10.1017/S0954579409990198
Frontiers in Medicine | www.frontiersin.org 10 July 2018 | Volume 5 | Article 196
Borelli et al. RF and Children’s Cardiovascular Reactivity
32. Ensink K, Normandin L, Target M, Fonagy P, Sabourin S, Berthelot N.
Mentalization in children and mothers in the context of trauma: an initial
study of the validity of the Child Reflective Functioning Scale. Br J Dev Psychol.
(2015) 33:203–17. doi: 10.1111/bjdp.12074
33. Fonagy P, Target M. The mentalization-focused approach to self pathology. J
Pers Disord. (2006) 20:544–76. doi: 10.1521/pedi.2006.20.6.544
34. Ensink K, Leroux A, Normandin L, Biberdzic M, Fonagy P. Assessing
reflective parenting in interaction with school-aged children. J Pers Assess.
(2017) 99:585–95. doi: 10.1080/00223891.2016.1270289
35. Fonagy P, Bateman AW. Adversity, attachment, and mentalizing. Compr
Psychiatry (2016) 64:59–66. doi: 10.1016/j.comppsych.2015.11.006
36. Ensink K, Berthelot N, Bernazzani O, Normandin L, Fonagy P. Another
step closer to measuring the ghosts in the nursery: preliminary validation
of the Trauma Reflective Functioning Scale. Front Psychol. (2014) 5:1471.
doi: 10.3389/fpsyg.2014.01471
37. Fonagy P, Steele M, Steele H. Maternal representations of attachment during
pregnancy predict the organization of infant mother attachment at one year
of age. Child Dev. (1991) 62:891–905. doi: 10.2307/1131141
38. Fonagy P, Steele M, Steele H, Leigh T, Kennedy R, Mattoon G, et al.
Attachment, the reflective self, and borderline states: the predictive specificity
of the Adult Attachment Interview and pathological emotional development.
In: Goldberg S, Muir R, Kerr J, Goldberg S, Muir R, Kerr J, editors.
Attachment Theory:Social, Developmental, and Clinical Perspectives.Hillsdale,
NJ: Analytic Press, Inc. (1995). p. 233–78.
39. Ensink K, Mayes LC. The development of mentalisation in children
from a theory of mind perspective. Psychoanal Inq. (2010) 30:301–37.
doi: 10.1080/07351690903206504
40. Mayes LC. Arousal regulation, emotional flexibility, medial amygdala
function, and the impact of early experience: comments on the paper of Lewis
et al. Ann N Y Acad Sci. (2006) 1094:178–92. doi: 10.1196/annals.1376.018
41. Ensink K, Normandin L, Plamondon A, Berthelot N, Fonagy P.
Intergenerational pathways from reflective functioning to infant attachment
through parenting. Can J Behav Sci. (2016) 48:9–18. doi: 10.1037/cbs0000030
42. Grienenberger J, Kelly K, Slade A. Maternal reflective functioning, mother-
infant affective communication, and infant attachment: exploring the
link between mental states and observed caregiving behavior in the
intergenerational transmission of attachment. Attach Hum Dev. (2005) 7:299–
311. doi: 10.1080/14616730500245963
43. Stacks AM, Muzik M, Wong K, Beeghly M, Huth-Bocks A, Irwin JL, et al.
Maternal reflective functioning among mothers with childhood maltreatment
histories: links to sensitive parenting and infant attachment security. Attach
Hum Dev. (2014) 16:515–33. doi: 10.1080/14616734.2014.935452
44. Slade A. Parental reflective functioning: an introduction. Attach Hum Dev.
(2005) 7:269–281. doi: 10.1080/14616730500245906
45. Suchman NE, DeCoste C, Leigh D, Borelli J. Reflective functioning in
mothers with drug use disorders: implications for dyadic interactions
with infants and toddlers. Attach Hum Dev. (2010) 12:567–85.
doi: 10.1080/14616734.2010.501988
46. Borelli JL, Hong K, Rasmussen HF, Smiley PA. Reflective functioning,
physiological reactivity, and overcontrol in mothers: links with school-
aged children’s reflective functioning. Dev Psychol. (2017) 53:1680–93.
doi: 10.1037/dev0000371
47. Rutherford HJV, Wallace NS, Laurent HK, Mayes LC. Emotion regulation in
parenthood. Dev Rev. (2015) 36:1–14. doi: 10.1016/j.dr.2014.12.008
48. Gottman JM, Katz LF, Hooven C. Parental meta-emotion philosophy and the
emotional life of families: theoretical models and preliminary data. J Fam
Psychol. (1996) 10:243–68. doi: 10.1037/0893-3200.10.3.243
49. Gottman JM, Katz LF, Hooven C. Meta-Emotion:How Families Communicate
Emotionally. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc. (1997).
50. Katznelson H. Reflective functioning: a review. Clin Psychol Rev. (2014)
34:107–17. doi: 10.1016/j.cpr.2013.12.003
51. Badoud D, Luyten P, Fonseca-Pedrero E, Eliez S, Fonagy P, Debbané M.
The French version of the reflective functioning questionnaire: validity
data for adolescents and adults and its association with non-suicidal
self-injury. PLoS ONE (2015) 10:e0145892. doi: 10.1371/journal.pone.
0145892
52. Pedersen SH, Lunn S, Katznelson H, Poulsen S. Reflective functioning in
70 patients suffering from bulimia nervosa. Eur Eat Disord Rev. (2012)
20:303–10. doi: 10.1002/erv.2158
53. Pajulo M, Pyykkönen N, Kalland M, Sinkkonen J, Helenius H, Punamäki
R, et al. Substance-abusing mothers in residential treatment with
their babies: importance of pre- and postnatal maternal reflective
functioning. Infant Ment Health J. (2012) 33:70–81. doi: 10.1002/imhj.
20342
54. Schechter DS, Myers MM, Brunelli SA, Coates SW, Zeanah CJ, Davies
M, et al. Traumatized mothers can change their minds about their
toddlers: understanding how a novel use of videofeedback supports positive
change of maternal attributions. Infant Ment Health J. (2006) 27:429–47.
doi: 10.1002/imhj.20101
55. Toth SL, Rogosch FA, Cicchetti D. Attachment-theory-informed intervention
and reflective functioning in depressed mothers. In: Steele H, Steele M,
editors. Clinical Applications of the Adult Attachment Interview. New York,
NY: Guilford Press (2008). p. 154–72.
56. Chiesa M, Fonagy P. Reflective function as a mediator between childhood
adversity, personality disorder and symptom distress. Pers Ment Health (2014)
8:52–66. doi: 10.1002/pmh.1245
57. Fonagy P, Leigh T, Steele M, Steele H, Kennedy R, Mattoon G,
et al. The relation of attachment status, psychiatric classification, and
response to psychotherapy. J Consult Clin Psychol. (1996) 64:22–31.
doi: 10.1037/0022-006X.64.1.22
58. Duval J, Ensink K, Normandin L, Sharp C, Fonagy P. Measuring
reflective functioning in adolescents: relations to personality
disorders and psychological difficulties. Adolesc Psychiatry. (2018)
doi: 10.2174/2210676608666180208161619
59. Ensink K. (2004). Assessing Theory of Mind, Affective Understanding and
Reflective Functioning in Primary School-Aged Children. Doctoral dissertation.
Available online at: http://discovery.ucl.ac.uk/1446627/
60. Ensink K, Bégin M, Normandin L, Fonagy P. Maternal and child
reflective functioning in the context of child sexual abuse: pathways to
depression and externalising difficulties. Eur J Psychotraumatol. (2016)
7:30611. doi: 10.3402/ejpt.v7.30611
61. Fonagy P, Steele M, Steele H, Higgitt A, Target M. The Emanuel
Miller Memorial Lecture 1992: the theory and practice of
resilience. Child Psychol Psychiatry All Discipl. (1994) 35:231–57.
doi: 10.1111/j.1469-7610.1994.tb01160.x
62. Southwick SM, Bonanno GA, Masten AS, Panter-Brick C, Yehuda
R. Resilience definitions, theory, and challenges: interdisciplinary
perspectives. Eur J Psychotraumatol. (2014) 5:25338. doi: 10.3402/ejpt.v5.
25338
63. Borelli JL, Compare A, Snavely JE, Decio V. Reflective functioning moderates
the association between perceptions of parental neglect and attachment in
adolescence. Psychoanal Psychol. (2015) 32:23–35. doi: 10.1037/a0037858
64. Berthelot N, Ensink K, Bernazzani O, Normandin L, Luyten P, Fonagy
P. Intergenerational transmission of attachment in abused and neglected
mothers: the role of trauma-specific reflective functioning. Infant Ment Health
J. (2015) 36:200–12. doi: 10.1002/imhj.21499
65. Borelli JL, West JL, Weekes N, Crowley M. Dismissing child attachment and
discordance for subjective and neuroendocrine responses to vulnerability. Dev
Psychobiol. (2014) 56:584–91. doi: 10.1002/dev.21107
66. Target M, Fonagy P, Shmueli-Goetz Y. Attachment representations in school-
age children: the development of the Child Attachment Interview (CAI). J
Child Psychother. (2003) 29:171–86. doi: 10.1080/0075417031000138433
67. Shmueli-Goetz Y, Target M, Datta A, Fonagy P. Child Attachment Interview
(CAI) Coding and Classification Manual, Version V. Unpublished Manuscript,
The Sub-epartment of Clinical Health Psychology, University College London
(2004).
68. Fraley RC, Spieker SJ. Are infant attachment patterns continuously or
categorically distributed? A taxometric analysis of strange situation behavior.
Dev Psychol. (2003) 39:387–404. doi: 10.1037/0012-1649.39.3.387
69. Roisman GI, Fraley RC, Belsky J. A taxometric study of the Adult Attachment
Interview. Dev Psychol. (2007) 43:675–86. doi: 10.1037/0012-1649.43.
3.675
Frontiers in Medicine | www.frontiersin.org 11 July 2018 | Volume 5 | Article 196
Borelli et al. RF and Children’s Cardiovascular Reactivity
70. Borelli JL, Somers J, West JL, Coffey JK, De Los Reyes A, Shmueli-
Goetz Y. Associations between attachment narratives and self-
report measures of attachment in middle childhood: extending
evidence for the validity of the Child Attachment Interview. J
Child Fam Stud. (2016) 25:1235–46. doi: 10.1007/s10826-015-0
310-8
71. Venta A, Shmueli-Goetz Y, Sharp C. Assessing attachment in adolescence: a
psychometric study of the Child Attachment Interview. Psychol Assess. (2014)
26:238–55. doi: 10.1037/a0034712
72. Zachrisson HD, Røysamb E, Oppedal B, Hauser S. Factor structure of
the Child Attachment Interview. Eur J Dev Psychol. (2011) 8:744–59.
doi: 10.1080/17405629.2011.631293
73. Borelli JL, St. John HK, Cho E, Suchman NE. Reflective functioning in
parents of school-aged children. Am J Orthopsychiatry (2016) 86:24–36.
doi: 10.1037/ort0000141
74. Ensink K, Target M, Oandasan C. Child Reflective Functioning Scale
Scoring Manual: For Application to the Child Attachment Interview.
Unpublished manuscript, Anna Freud Centre, University College London
(2013).
75. Fonagy P, Target M, Steele H, Steele M. Reflective-Functioning Manual, Version
5.0, for Application to Adult Attachment Interviews. Unpublished manuscript,
Sub-Department of Clinical Health Psychology, University College London
(1998).
76. George C, Kaplan N, Main M. The Adult Attachment Interview. Unpublished
manuscript, Berkeley: Department of Psychology, University of California
(1985).
77. Hayes AF. PROCESS:A Versatile Computational Tool for Observed Variable
Mediation, Moderation, and Conditional Process Modeling [White paper]
(2012). Available online at: http://www.processmacro.org/index.html
78. Porges SW. The polyvagal theory: phylogenetic contributions
to social behavior. Physiol Behav. (2003) 79:503–13.
doi: 10.1016/S0031-9384(03)00156-2
79. Porges SW. The polyvagal perspective. Biol Psychol. (2007) 74:116–43.
doi: 10.1016/j.biopsycho.2006.06.009
80. Wilson BJ, Gottman JM. Attention—the shuttle between emotion and
cognition: risk, resiliency, and physiological bases. In: Hetherington EM,
Blechman EA, editors. Stress, Coping, and Resiliency in Children and Families.
Hillsdale, NJ: Lawrence Erlbaum Associates, Inc. (1996). p. 189–228.
Conflict of Interest Statement: The authors declare that the research was
conducted in the absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.
The reviewer DRO and handling Editor declared their shared affiliation.
Copyright © 2018 Borelli, Ensink, Hong, Sereno, Drury and Fonagy. This is an
open-access article distributed under the terms of the Creative Commons Attribution
License (CC BY). The use, distribution or reproduction in other forums is permitted,
provided the original author(s) and the copyright owner(s) are credited and that the
original publication in this journal is cited, in accordance with accepted academic
practice. No use, distribution or reproduction is permitted which does not comply
with these terms.
Frontiers in Medicine | www.frontiersin.org 12 July 2018 | Volume 5 | Article 196
... Moreover, studies investigating the mentalizing capacity of various occupational groups, such as daycare teachers, teachers or psychotherapists, found that occupational distress has a negative effect on well-being, while mentalizing capacity has an opposite and positive effect on health ratings (Brugnera et al., 2021;Safiye et al., 2023;Schwarzer et al., 2023). Finally, several studies found that mentalizing might function as a coping resource by improving the way in which individuals cope with distressing experiences (Borelli et al., 2018;Schwarzer et al., 2022). In summary, mentalizing seems to promote coping strategies that are adaptive with respect to environmental demands. ...
... These findings contradict results from other studies. For example, Borelli et al. (2018) reported that, in an experimental setting, faster normalization of psychophysiological arousal during a stress-inducing task was predicted by better mentalizing. This might suggest an association between effective mentalizing and adaptive emotion regulation strategies. ...
Article
Background: In recent years, mentalizing – the capacity to understand one’s own and others’ intentional mental states in social contexts – has been considered to be a protective capacity that enables adaptive processing of stress-related emotional arousal, benefits general well-being and underpins adaptive emotion regulation. Objective: Several studies using cross-sectional research designs have demonstrated the potential health-promoting effect of mentalizing in non-clinical samples. However, longitudinal evidence is scarce. The present study aimed to investigate whether mentalizing predicts well-being and emotion regulation strategies in a non-clinical sample of mainly young adults using a prospective longitudinal design. Methods: In a prospective research design, 135 participants completed questionnaires assessing well-being, psychological symptom severity and mentalizing capacity at baseline (T1). Twelve months later (T2), emotion regulation strategies (suppression and cognitive reappraisal), well-being and psychological symptom severity were assessed by self-report. The data were analyzed using multivariate linear regression analysis. Results: Impairments in mentalizing were a significant negative predictor of well-being 12 months later. Furthermore, impairments in mentalizing positively predicted suppression of emotional states at T2. No association was found between deficits in mentalizing and cognitive reappraisal of emotional states over the course of 1 year. Conclusion: The findings indicate that mentalizing is longitudinally associated with mental health indicators in a non-clinical adult sample. Specifically, ineffective mentalizing was associated with impaired psychological well-being and a tendency to suppress intense emotional states over a period of 1 year. Future research should replicate these findings using multiple measurement timepoints to etablish causality.
... The child sees each crisis as catastrophic and his/her interpretations are catastrophic [33]. The child interprets family challenges or any behavior that is not accompanied by love and attention as a reason for misery and rejection by others, as if any challenge or crisis attacks the child's integrity [34]. Children who experience complex and relationship trauma, especially if the traumatic events begun before their birth, are usually hypervigilant and restless [35]. ...
Article
Full-text available
Mentalization, operationalized as reflective functioning (RF), is the ability to understand one’s own and another’s mental world implicitly or explicitly. RF is a newly discovered research field in Iran and is largely under-studied in Eastern cultures in general, underscoring the high need for cross-cultural studies in this field of research. A qualitative method was used to examine the ability to understand, process, and respond to high-arousal attachment situations in typical and clinical populations of Iranian children recruited from a Tehran primary school. A well-known semi-structured interview commonly used to assess RF in children was used to collect data. Required information on internalizing and externalizing symptoms, demographic information, and all formal diagnoses of children were collected by parents. The results indicated the identification of four different profiles of RF in children, one of which was adaptive, while the other three were maladaptive. Also, the results showed that typically developing children and those having a high social and economic status (SES) were characterized as having a more adaptive profile of RF, while children from the clinical population and those with a low SES reported a more maladaptive profile (passive mentalizing, helpless mentalizing, narcissistic mentalizing) of RF. The present study is an important step in increasing our understanding of the development of mentalization in children and has significant educational and clinical implications.
... Verbalizing emotions when stressed is thought to help individuals downregulate physiological arousal (Torre & Lieberman, 2018) and emotion word use has consequently been seen as an implicit form of emotion regulation (e.g., Torre & Lieberman, 2018). Using emotion words may foster emotional awareness (Torre & Lieberman, 2018) and in turn go along with lower cardiovascular reactivity (Borelli et al., 2018). Supporting this view, studies that experimentally manipulated emotional language through affect or emotion labelling (for a review, see Torre & Lieberman, 2018) often found decreases in cardiovascular reactivity (e.g., heart rate) in trials where individuals verbally labeled their emotions compared to trials without labelling (Matejka et al., 2013;McRae et al., 2010). ...
Preprint
Putting feelings into words is often thought to be beneficial. Few studies, however, have examined associations between natural emotion word use and cardiovascular reactivity. This laboratory-based study examined emotion word use (i.e., from computerized text analysis) and cardiovascular reactivity (i.e., interbeat interval changes from baseline) across two interaction contexts (i.e., conflict and positive conversations) in 49 mixed-sex married couples (age: M = 43.11, SD = 9.20) from diverse socioeconomic backgrounds. We focused on both frequency (i.e., relative proportion of emotion words) and diversity (i.e., relative proportion of unique emotion words) of emotion words. Data were collected between 2015 and 2017 and analyzed treating both partners and conversations as repeated measures, resulting in 196 observations overall (four per dyad). Findings showed that (1) when spouses used more negative emotion words (especially anger), they showed higher cardiovascular reactivity. This finding was robust when controlling for covariates; generalized across gender, interaction contexts, and socioeconomic status. Moreover, (2) when spouses used a more diverse negative emotion vocabulary, they showed higher cardiovascular reactivity, but this was not robust when controlling for negative emotion word frequency. Associations between (3) positive emotion word use and cardiovascular reactivity were not statistically significant. Verbalizing negative emotions thus seems to go along with higher cardiovascular reactivity, at least in the short term. Replication is needed across other relationship types, genders, and sexual orientations. These findings highlight emotion word use as an indicator of cardiovascular reactivity, which has implications for the identification of potential health risks that emerge during marital interactions.
... Verbalizing emotions when stressed is thought to help individuals downregulate physiological arousal (Torre & Lieberman, 2018) and emotion word use has consequently been seen as an implicit form of emotion regulation (e.g., Torre & Lieberman, 2018). Using emotion words may foster emotional awareness (Torre & Lieberman, 2018) and in turn go along with lower cardiovascular reactivity (Borelli et al., 2018). Supporting this view, studies that experimentally manipulated emotional language through affect or emotion labelling (for a review, see Torre & Lieberman, 2018) often found decreases in cardiovascular reactivity (e.g., heart rate) in trials where individuals verbally labeled their emotions compared to trials without labelling (Matejka et al., 2013;McRae et al., 2010). ...
Article
Full-text available
Putting feelings into words is often thought to be beneficial. Few studies, however, have examined associations between natural emotion word use and cardiovascular reactivity. This laboratory-based study examined emotion word use (i.e., from computerized text analysis) and cardiovascular reactivity (i.e., interbeat interval changes from baseline) across two interaction contexts (i.e., conflict and positive conversations) in 49 mixed-sex married couples (age: M = 43.11, SD = 9.20) from diverse socioeconomic backgrounds. We focused on both frequency (i.e., relative proportion of emotion words) and diversity (i.e., relative proportion of unique emotion words) of emotion words. Data were collected between 2015 and 2017 and analyzed treating both partners and conversations as repeated measures, resulting in 196 observations overall (four per dyad). Findings showed that (a) when spouses used more negative emotion words (especially anger), they showed higher cardiovascular reactivity. This finding was robust when controlling for covariates; generalized across gender, interaction contexts, and socioeconomic status. Moreover, (b) when spouses used a more diverse negative emotion vocabulary, they showed higher cardiovascular reactivity, but this was not robust when controlling for negative emotion word frequency. Associations between (c) positive emotion word use and cardiovascular reactivity were not statistically significant. Verbalizing negative emotions thus seems to go along with higher cardiovascular reactivity, at least in the short term. Replication is needed across other relationship types, genders, and sexual orientations. These findings highlight emotion word use as an indicator of cardiovascular reactivity, which has implications for the identification of potential health risks that emerge during marital interactions.
... At present, few studies have shifted the lens to investigate the specific connections between child RF and mental health. In fact, research on child RF in children with mental health diagnoses has typically focused on general, self, or other RF [19,[31][32][33][34], neglecting other proposed dimensions, despite the fact that theorizing regarding mentalizing is very rich, as described above. For example, in Bizzi and colleagues' (2018) study of school-aged (8 to 15 year olds) children, they examined the links between self-focused and other-focused RF, finding that children with somatic symptom disorders and disruptive behavior disorders had significantly lower RF compared to children in the comparison group. ...
Article
Full-text available
Mentalization refers to the ability to understand the mental states of oneself and those of others that motivate action and behavior. Mentalization has generally been linked to adaptive development and healthy functioning whereas diminished mentalization has been associated with maladaptive development and psychopathology. The vast majority of research on mentalization and developmental trajectories, however, is based on Western countries. The overall aim of this study was therefore to examine mentalizing abilities in a novel sample of 153 typically developing and atypically developing Iranian children (Mage = 9.41, SDage = 1.10, Range = 8–11, 54.2% females) recruited from a primary school and health clinic in Tehran. The children completed semi-structured interviews that were later transcribed and coded for mentalization. The parents provided reports on internalizing and externalizing symptoms, demographic information, and all formal diagnoses of the children. The results pointed at general age and sex differences across the two groups. Older children showed more adaptive mentalization compared to the younger children; boys and girls used different mentalizing strategies when facing difficult situations. The typically developing children were better at mentalizing than the atypically developing children. Finally, more adaptive mentalization was associated with lower externalizing and internalizing symptoms among all children. The findings of this study contributes with expanding mentalization research to also encompass non-Western populations and the results hold crucial educational and therapeutic implications.
Article
Full-text available
Introduction Major gaps remain in our knowledge regarding childhood sexual abuse (CSA) related symptoms in adolescent psychiatric inpatients, as well as potential resilience factors like mentalizing. CSA is a risk factor for the early emergence of borderline personality features, posttraumatic stress, and sexual concerns. Mentalizing, which involves the capacity to understand our reactions and that of others in psychological terms, is a resilience factor for self and interpersonal functioning. The aim of this study was to address knowledge gaps by examining the contributions of CSA and mentalizing in a latent factor composed of borderline personality features, posttraumatic stress, and sexual concerns in a sample of adolescent psychiatric inpatients. We hypothesized that CSA and mentalizing would independently explain the variance in this latent factor. Method Participants were 273 adolescents aged 12–17 recruited from an adolescent inpatient psychiatric clinic. They completed the Reflective Function Questionnaire for Youth (RFQ-Y), the Trauma Symptom Checklist for Children (TSCC), and the Borderline Personality Features Scale for Children (BPFS-C). CSA was assessed using the Child Attachment Interview (CAI), the Computerized Diagnostic Interview Schedule for Children (C-DISC), as well as the Childhood Trauma Questionnaire (CTQ). Results 27.5% of adolescent psychiatric inpatients reported CSA. CSA and mentalizing were independently associated with a latent factor consisting of posttraumatic stress, borderline personality features, and sexual concerns. CSA explained 5.0% and RF explained 16.7% of the variance of the latent factor. When we consider both the unique and the shared contribution of CSA and mentalizing, the model explained 23.0% of the variance of this factor. Discussion CSA and mentalizing independently explained variance in a latent factor constituted of borderline personality features, posttraumatic stress, and sexual concerns. The direct effect of mentalizing was stronger and mentalizing explained comparatively more variance of trauma-related symptoms in adolescent psychiatric inpatients. The findings are consistent with the theory that mentalizing is an internal resilience factor in adolescent psychiatric inpatients. By implication, clinical interventions focused on promoting the development of mentalizing, such as Mentalization Based Treatment, may palliate mental health difficulties manifested by adolescent psychiatric inpatients including those associated with CSA.
Article
Full-text available
Introduction Since intimacy is a fundamental human need within social relationships, and recognizing that a fear of intimacy correlates with various negative consequences, it becomes crucial to examine the origins and factors that contribute to addressing this issue. This research aimed to investigate the mediating roles of mentalization and integrative self-knowledge in the link between childhood trauma and the fear of intimacy. Methods Conducted as correlational descriptive research, our study incorporates a total sample of 303 adult women and men participants aged 20 to 50 in Tehran using the convenience sampling method. They completed the Fear of Intimacy Scale (FIS), the Childhood Trauma Questionnaire (CTQ), the Mentalization Scale (MentS), and the Integrative Self-Knowledge Scale (ISK). To analyze the research data at the descriptive level, frequency, percentage, standard deviation, and Pearson’s correlation coefficient were used, while path analysis tested our hypotheses in SPSS version 26 and AMOS version 24. Fit indices were used to check the model’s fit, and the mediation test was performed using the bootstrapping method. The fit indices revealed an excellent fit of the model with the data (χ2 = 1.51, χ2/df = 1.51, p = 0.219; RMSEA = 0.05; SRMR = 0.02; CFI = 0.99; NFI = 0.99; TLI = 0.99). Results Results indicate mentalization fully mediates the childhood trauma-fear of intimacy relationship (β = 0.14, p < 0.01). However, the indirect relationship between childhood trauma and fear of intimacy through integrative self-knowledge was insignificant. The results also showed that the path coefficient from mentalization to fear of intimacy was negative and significant (β = −0.41, p < 0.001), while the path coefficient from integrative self-knowledge to fear of intimacy was not significant (β = −0.02, p > 0.05). Discussion Based on the current findings indicating the complete mediation of mentalization and the insignificance of the mediation of integrative self-knowledge, we can deduce that enhancing the capacity for mentalization holds promise in effectively addressing intimacy-related issues. Overall, the study suggests mentalization effectively predicts the relationship between childhood trauma and fear of intimacy. This, in turn, may mitigate the detrimental effects of challenging childhood experiences on an individual’s ability to engage in intimacy and cultivate emotional closeness.
Chapter
Empathy is a fundamental social ability that allows humans to infer others’ emotions and intentions. Empathy is thought to be rooted in bodily sensations coming from the autonomic nervous system. In parallel, the functionality and perceptions coming from the autonomic nervous system could be improved by practicing activities that involve mind-body interactions, such as meditation. Furthermore, perceptions from the autonomic nervous system are thought to be important in the embodiment of abstract concepts. Consequently, in the current study, we collected data online from 581 participants and explored the associations between levels of empathy and (1) the practice of meditation, music, and sports; (2) the impact of self-report measures on bodily awareness and reactivity; and (3) the embodiment of abstract concepts in interoception. In line with previous studies, Meditators were found to have higher empathy scores than Non-Meditators. In addition, lower levels of autonomic reactivity in organs above the diaphragm were associated with higher empathy. Finally, we also observed that empathy was positively associated with interoceptive components of abstract concepts in those participants with high autonomic reactivity. Taken together, the results suggest that meditation practice and having low autonomic reactivity are associated with empathy, arguably through the downregulation of autonomic responses. Implications for mind-body interaction in meditation and its role in promoting empathy are discussed.
Article
Full-text available
Introduction This study aimed to clarify the role of mentalizing in pathways from attachment to Post Traumatic Stress Symptoms (PTSS) in survivors of childhood maltreatment (CM). We focused on the transition to parenting, a critical period for reworking parenting representations to reduce intergenerational maltreatment cycles. Method Study participants included 100 pregnant CM survivors. We assessed PTSS with the SCID and attachment and mentalizing with the Adult Attachment Interview (AAI), which was rated for Attachment and Reflective Functioning (RF). Results Regarding Re-experiencing trauma symptoms, the results of the path analysis were consistent with mediation. CM survivors' mentalizing about their early relationships with their parents (RF-Other) directly impacted Re-experiencing trauma symptoms, and attachment had an effect on Re-experiencing trauma symptoms through mentalizing (RF-Other). Regarding Arousal/Reactivity symptoms, the results of the pathways analysis were consistent with partial mediation by mentalizing about early relationships with parents (RF-Other). In addition to the pathway from attachment via mentalizing (RF-Other) to Arousal/Reactivity, the pathway between attachment and Arousal/Reactivity also remained significant. Discussion This study provides new evidence of a mentalizing and attachment model of PTSS in CM survivors. The findings indicate that increased mentalizing about early relationships with parents is an important process associated with lower PTSS. Finally, we discuss the implications of developing interventions for CM survivors to reduce PTSS. Scaffolding the development of mentalizing regarding attachment relationships in which CM occurred may help CM survivors reduce the intrusion of traumatic memories and decrease trauma-related arousal and reactivity symptoms. Interventions to help CM survivors mentalize regarding parents and attachment relationships in which trauma occurred may be particularly important during the transition to parenting when activation of representations of parenting can trigger PTSS.
Article
Full-text available
Background: Reflective Functioning (RF) is considered to play a central role in risk and resilience for psychological difficulties such as borderline personality disorder (BPD) and has become an important treatment target of transdiagnostic psychosocial interventions like Mentalization Based Therapy. However, a lack of measures to assess RF in adolescents has hampered research that can further elucidate the role of RF in different types of psychopathology. Objective: The objective of the present study was to examine the validity of the Reflective Functioning Questionnaire for Youth (RFQ-Y), examine the factor structure of the french RFQ-Y, the relationship between RFQ-Y and social cognition, psychological difficulties, BPD and narcissistic personality disorders. Methods: A total of 533 adolescents and young adults (age 12 - 21) from the community completed the RFQ-Y, the Child Behaviour Checklist, the Borderline Personality Features Scale and the Pathological Narcissism Inventory. A subsample of 150 participants completed the Movie for the Assessment of Social Cognition (MASC). Results: Three factors were identified. Uncertainty/confusion was strongly positively correlated with psychological difficulties, especially symptoms of borderline personality disorder. Interest/curiosity was negatively correlated with and psychopathology and Excessive Certainty correlated significantly with grandiose narcissism. RFQ-Y factors correlated more strongly with psychopathology than the MASC scales. Conclusion: This study demonstrates the validity of self-report measures like the RFQ-Y and its utility for identifying problematic styles of mentalizing associated with increased risk of psychopathology in general, as well as difficulties like narcissism in particular.
Article
Full-text available
Healthy biological systems exhibit complex patterns of variability that can be described by mathematical chaos. Heart rate variability (HRV) consists of changes in the time intervals between consecutive heartbeats called interbeat intervals (IBIs). A healthy heart is not a metronome. The oscillations of a healthy heart are complex and constantly changing, which allow the cardiovascular system to rapidly adjust to sudden physical and psychological challenges to homeostasis. This article briefly reviews current perspectives on the mechanisms that generate 24 h, short-term (~5 min), and ultra-short-term (<5 min) HRV, the importance of HRV, and its implications for health and performance. The authors provide an overview of widely-used HRV time-domain, frequency-domain, and non-linear metrics. Time-domain indices quantify the amount of HRV observed during monitoring periods that may range from ~2 min to 24 h. Frequency-domain values calculate the absolute or relative amount of signal energy within component bands. Non-linear measurements quantify the unpredictability and complexity of a series of IBIs. The authors survey published normative values for clinical, healthy, and optimal performance populations. They stress the importance of measurement context, including recording period length, subject age, and sex, on baseline HRV values. They caution that 24 h, short-term, and ultra-short-term normative values are not interchangeable. They encourage professionals to supplement published norms with findings from their own specialized populations. Finally, the authors provide an overview of HRV assessment strategies for clinical and optimal performance interventions.
Article
Full-text available
Theorists argue that parental reflective functioning (PRF) is activated in response to emotions, potentially supporting parenting sensitivity even when arousal is high. That is, when parents become emotionally reactive when interacting with their children, those who can use PRF to understand their children's mental states should be able to parent sensitively, which, in turn, should promote children's ability to understand their own mental states. We test this theory by examining whether, in the face of physiological reactivity, mothers' PRF inhibits one form of parenting insensitivity, overcontrol (OC), and whether this process in turn predicts children's RF. A diverse sample of school-age children (N = 106, Mage = 10.27 years) completed a standardized failure paradigm while their mothers were asked to passively observe. Following the stressor, mothers and children independently completed interviews regarding the task, which were later coded for RF with respect to children's mental states. Mothers provided saliva samples before and after the stressor, and after the interview, which were later assayed for cortisol reactivity; maternal behavior during the stressor task was coded for OC. Among mothers with low levels of RF, greater increases in cortisol were associated with more displays of OC, whereas among mothers with high PRF, greater cortisol reactivity was associated with fewer OC behaviors. For low PRF mothers, higher reactivity and OC predicted lower children's PRF for their own experiences. The findings provide initial evidence for a protective function of PRF, and may point toward the importance of promoting PRF in intervention programs to reduce parental OC. (PsycINFO Database Record
Article
Full-text available
The aim of this study was to examine whether it was possible to develop a reliable and valid assessment of reflective parenting implicit in interaction with school-aged children using an adaptation of the Squiggle paradigm developed by Winnicott (1968 Winnicott, D. W. (1968). Playing: Its theoretical status in the clinical situation. International Journal of Psycho-Analysis, 49, 591–599.[PubMed], [Web of Science ®]) and a manualized coding system (Normandin, Leroux, Ensink, Terradas, & Fonagy, 2015 Normandin, L., Leroux, A., Ensink, K., Terradas, M. M., & Fonagy, P. (2015). Reflective Parenting Assessment coding manual (Unpublished manual). University Laval, Québec City, QC, Canada.). A total of 158 mother–child dyads participated when children were age 5 to 12. Of this group, 89 children had experienced sexual abuse. Interrater reliability using the manualized coding system was excellent. The factor analysis identified a reflective parenting stance factor, in addition to an affectionate support factor and a negative parenting factor. Furthermore, there was a medium strength relationship between the mother's reflective parenting stance evident in her interactions with her child and parental reflective functioning assessed using the Parent Development Interview (Slade, Aber, Bresgi, Berger, & Kaplan, 2004 Slade, A., Aber, J. L., Bresgi, I., Berger, B., & Kaplan, M. (2004). The Parent Development Interview–Revised (Unpublished protocol). The City University of New York, New York, NY.), suggesting the parental reflective stance is a good indicator of parental reflective functioning in interaction. With regard to parent reports of child internalizing and externalizing behaviors, the reflective parenting stance was the only predictor of internalizing difficulties and a significant predictor of externalizing difficulties in addition to sexual abuse.
Article
Full-text available
Parental mentalizing – the parent’s ability to envision the child’s mental states (such as desires, thoughts, or wishes) – has been argued to underlie a parent’s ability to respond sensitively to their child’s emotional needs, and thereby promote advantageous cognitive and socio-emotional development. Mentalizing is typically operationalized in terms of how parents talk to or about their infants. This work extends research on mentalizing by operationalizing parental mentalizing exclusively in terms of nonverbal, bodily based, interactive behavior, namely parental embodied mentalizing(PEM). The purpose of the current research was twofold: (1) to establish the reliability and validity of the PEM coding system; and (2) to evaluate whether such measurement predicts infant and child cognitive and socio-emotional functioning. Assessing 200 mother–infant dyads at 6 months using the coding of PEM proved both reliable and valid, including predicting child attachment security at 15 and 36 months, and language abilities, academic skills, behavior problems, and social competence at 54 months, in many cases even after taking into consideration traditional measures of parenting, namely maternal sensitivity. Conceptual, empirical, and clinical implications are discussed.
Article
Full-text available
This study attempted to establish and quantify the connections between parenting, offspring psychosocial adjustment, and the epigenome. The participants, 35 African American young adults (19 females and 16 males; age = 17–29.5 years), represented a subsample of a 3-wave longitudinal 15-year study on the developmental trajectories of low-income urban mother–offspring dyads. Mothers were assessed on their perceptions of maternal stress at each wave. Offspring were assessed on their perceptions of maternal parenting at each wave and on their adaptive and maladaptive behavior at the last wave. Genome-wide DNA methylation in peripheral T lymphocytes at the third wave was assayed using Methyl Binding Domain(MBD) sequencing. Statistically significant associations were identified between the change in offspring's perception of parenting from middle childhood to adulthood and the DNA methylation in offspring's adult genomes. Specifically, the slope of perceived parental rejection across the 3 time points was related to an increase in methylation, or a potential downregulation, of 565 genes thought to be involved in the control of a broad spectrum of biological functions generally related to cellular signaling. A subset of these epigenetic marks, clustered in 23 genes, some of which participate in the development and functioning of the CNS, were in turn associated with psychosocial adjustment as captured by interpersonal relationships and emotional self-evaluation. This appears to be one of the first investigations of the modulating role of the methylome in associations between developmental dynamics of parenting throughout the formative years of child and adolescent development and psychosocial adjustment in adulthood.
Article
Full-text available
Background: Sexual abuse is a well-recognised risk factor for child psychopathology. Little is known regarding whether child and maternal mentalization can be considered a potential resource or protective factor in this context, respectively, mediating or moderating the relationship between sexual abuse and psychopathology. Objective: The aims of this study were (1) to explore the relationships between child and maternal mentalizing, measured as reflective functioning (RF), and child depressive symptoms and externalising difficulties; and (2) to examine whether child mentalizing mediates the relationship between child sexual abuse (CSA) and psychopathology. Method: A total of 168 children aged 7-12 years and their mothers participated in the study. The sample included 74 dyads where children had experienced sexual abuse. The Child Attachment Interview was rated by using the Child Reflective Functioning Scale to assess children's mentalization, and the Child Depression Inventory was used to assess depressive symptoms. Mothers completed the Parent Development Interview to assess maternal RF and the Child Behavior Checklist to assess their child's externalising difficulties. A model involving direct and indirect paths from CSA, child and maternal RF to child psychopathology was examined using Mplus software. Results: Child mentalization partially mediated the relationships between CSA and depressive symptoms, as well as the relationship between CSA and externalising difficulties. Maternal mentalization was an independent predictor of child externalising difficulties, with higher maternal RF associated with less externalising difficulties. Discussion: The findings indicate that by ages 7-12, child mentalization is an important inner resource associated with lower depression and externalising. In addition, this study provides new evidence of the importance of the parent's mentalizing stance for the development of self-regulation and externalising difficulties in both abused and non-abused children. The clinical implications are discussed.
Article
Full-text available
The aim of this prospective study was to examine temporal pathways from mothers’ reflective functioning (RF) through parenting to infant attachment measured more than 16 months later. Participants were 88 mother–infant dyads from demographically diverse backgrounds and included a group of mothers with histories of childhood maltreatment. RF was assessed using the RF rating of the Adult Attachment Interview before the birth of the baby. Parenting was assessed when the infants were 6 months old using the Maternal Sensitivity scale, as well as when they were 16 months using the Disconnected and Extremely Insensitive Parenting scale. Infant attachment was assessed when the infants were 16 months old using the Strange Situation. As hypothesised, the study findings showed that mothers’ mentalization regarding their own early attachment relationships was associated with later parenting and infant attachment. Negative parenting behaviours explained the link between mothers’ RF about their own attachment relationships and infant attachment disorganization. The findings suggest that mothers’ mentalization about their early attachment relationships has important implications in the transition to becoming parents themselves. Mentalization appears to be particularly important in helping mothers screen and inhibit negative parenting behaviours that would otherwise undermine infant attachment security and organization.