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Relations between mentalization and emotional dysregulation in the developmental and clinical context

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Objectives: According to the vast research literature, the relationship between mentalization and the emotion regulation is mutual – they strengthen each other from early childhood, formed in the context of attachment relationships. Then they interfuse during adolescence and adulthood, causing specific difficulties in the emotional and interpersonal functioning when not sufficiently developed. Two studies describe the relationship between mentalization and the emotion dysregulation from developmental and clinical perspectives. The first study considered emotion dysregulation, mentalization and romantic attachment in the nonclinical adolescent female sample. The second study verified the relationship between mentalization and emotion dysregulation in individuals with borderline personality oragnization (BPO). Method: Study 1. (N=92): Adolescents were examined using the Experiences in Close Relationships Scale (Brennan et al., 1998); Difficulties in Emotion Regulation Scale (Gratz and Roemer, 2004) and Mental States Task (Beaulieu-Pelletier et al., 2013). Study 2. (N=60): The clinical and control groups were examined using The Mental States Task and The Difficulties of Emotion Regulation Scale. Results: The first study revealed that the level of emotion dysregulation in adolescent girls is partially explained by mentalization and attachment anxiety. The second study showed that individuals with BPO performed worse than the control group in terms of mentalization and emotion regulation and the relationship between BPO and mentalization was mediated by emotional dysregulation. Conclusions: The results are discussed in terms of a possible interactive effect that mentalization and emotional dysregulation have on the formation and perseverance of personality pathology during lifetime.
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Two studies explored the relationship between
mentalization and emotion dysregulation from
developmental and clinical perspectives.
Study 1. considered emotion dysregulation,
mentalization and romantic attachment in the
nonclinical adolescent female sample. Healthy
adolescents (N=92) were examined using the
Experiences in Close Relationships Scale
(Brennan et al., 1998); Difficulties in Emotion
Regulation Scale (Gratz & Roemer, 2004) and
Mental States Task (Beaulieu-Pelletier et al.,
2013).
Study 2. verified the rela tionship between
mentalization and emotion dysregulation in
in div idu al s w it h b or de rli ne pe rs on ali ty
organization (BPO). The BPO group (N=30) and
matched controls (N=30) were examined using
The Mental States Task and The Difficulties of
Emotion Regulation Scale.
Study 1. the level of ED in girls during late
adolescence can be partially explained by
mentalization and levels of anxiety (but not
of avoidance) regarding a romantic partner,
though attachment anxiety is more important
for explaining ED than the l evel of
mentalization. Two aspec ts of ED show
relationships with mentalization in particular:
nonacceptance of emotional responses and
lack of emotional clarity.
Study 2. showed that individuals with BPO
(clinical group) performed worse than the
control group in terms of two aspects of
mentalization and emotion regulation in
general. The relationship between BPO and
mentalization was mediated by emotional
dysregulation (for MST-LDL only).
The studies confirm that the specific deficits in
mentalization are associated with the decrease
in emotion regulation, both in developmental
and clinical context.
The possible mechanism may be as follow:
when the content of representation is
threatening, the activation of these
rep re se nt at io ns b ec om es e xc es si ve ly
overwhelming. Recognition and reflection on
them becomes too painful and causes an
affective arousal that cannot be neutralized or
processed in appropriate manner (as a result of
high level of attachment anxiety) and manifests
in reduced level of mentalization. The result is
emotional dysregulation that manifests in
emotional symptoms.
The study suggests a possible mechanism for
the development of person ality pathology:
insecure attachment, together with a reduced
level of ment alization, l eads to a wor se
functioning in the regulation of emotions (Fig.
4).
Mentalization is defined as one’s attitude toward
subjective experience, and may be measured by the
proportion of primitive and more reflective mental
states (Bouchard et al. 2008). These mental states
are the re sults of in terac tions be tween tw o
proces ses : r epr esen tat ion (the op enn ess to
potentially threatening representational contents)
and modulation (the defens ive and regulat ory
strategies used to limit one’s openness) (Fig. 1).
The relationship between mentalization and emotion
regulation is mutual they strengthen each other
from early childhood, formed in the context of a
secure attachment and interfuse during adolescence
and adulthood, causing specific difficulties in the
emotional and interpersonal functioning when not
sufficiently developed. The results of the recent
studies (Fossati et al. 2014; Sharp et al. 2011,
2015) indicate that emotion dysregulation (ED),
mentalization, and attachment are important factors
that can affect the mental functioning in the period
pri or to adu ltho od. In p erso nalit y di sorde rs,
es pe ci al ly bo rd er lin e, i ns ec ur e a tt ach men t
contributes to distortions of mentalization, which in
turn lead to the intrapersonal and interpersonal
difficulties characteristic of borderline personality
disorder (BPD), which manifest mainly in the form of
pro ble ms in co ntrolli ng emotio n ( Fona gy &
Bateman, 2007). Studying those mechanisms in
adolescents (developmental context) and borderline
patients (clinical context) may contribute to better
understanding the dynamic relations between ED
and mentalization.
Background
Method
Conclusions
Results
Study 2
Question
Study 1
Relations between mentalization and
emotional dysregulation in the
developmental and clinical context
Dominika Górska, PhD, domigor@amu.edu.pl
Monika Jańczak, PhD, mmarszal@amu.edu.pl
Adam Mickiewicz University in Poznan, Poland
Table 1.Sum mary of linear reg ression analysis f or attac hment a nxiety and
mentalization as predictors of emotion dysregulation in adolescent girls
Figure 2. Group differences in emotion dysregulation (DERS) and mentalization
(MST)
Figure 3. Emotion dysregulation (DERS) as a mediator of the relation between Low
Defensive Level (MST-LDL) and borderline personality organization (BPO)
Limitations and future
directions
References
The generalization of the results
should be limi ted by ou r wa y o f
understanding both capabilities
it would be necessary to design a
longitudinal study that would take into
account the dynamic changes taking
place in the adolescents and patients
functioning
self-report measures were used that
may be affected by self-presentation
bias
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development, validation, and correlates of a self-report measure of mentalization. Journal of
Clinical Psychology, 69, 671-695. Fonagy, P., & Luyten, P. (2009). A developmental,
mentalization-based approach to the understanding and treatment of borderline personality
disorder. Development and Psychopathology, 21, 1355-1381. Fossati, A., Feeney, J., Maffei,
C., & Borroni, S. (2014). Thinking about feelings: Affective state mentalization, attachment
styles, and borderline personality disorder features among Italian nonclinical adolescents.
Psychoanalytic Psychology, 31(1), 41–67. Gratz, K. L., & Roemer, L. (2004). Multidimensional
Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and
Initial Validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology
and Behavioral Assessment, 26, 41-54. Sharp, C., Pane, H., Ha, C., Venta, A., Patel, A. B.,
Sturek, J., & Fonagy, P. (2011). Theory of mind and emotion regulation difficulties in
adolescents with borderline traits. Journal of the American Academy of Child and Adolescent
Psychiatry, 50, 563-573.e1.
What is the relation between
mentalization and emotion
dysregulation?
Note. MST-CT – Concrete Thinking, MST-LDL – Low Defensive Level, MST-IDL – Intermediate Defensive Level, MST-OR – Objective-
Rational, MST-HDL – High Defensive Level, MST-RT – Reflective Thinking, MST-GS – general score. !
Statistical significant differences: Emotion Dysregulation, MST-LDL, MST-IDL (p<.05).
Figure 1. Six mental states as the results of interactions between representation and
modulation of subjective experiences (measured by Mental States Task (Beaulieu-
Pelletier et al., 2013)
Figure 4. Hypothetical mechanism of the interplay between mentalization i ED as a predictors of BPO
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