1.3 Early Parental Care, Reflective Functioning, and the Neural Markers of Maternal Sensitivity in Pregnancy

Abstract Background: After the birth of a child, many mothers and fathers experience postpartum mental disorders like depression, anxiety, obsessive-compulsive disorder, stress or other illnesses. This endangers the establishment of a secure attachment between the children and their primary caregivers. Early problems in parent-child interaction can have adverse long-term effects on the family and the child’s well-being. In order to prevent a transgenerational transmission of mental disorders, it is necessary to evaluate psychotherapeutic interventions that target psychologically burdened parents of infants or toddlers. The aim of this trial is to investigate the efficacy of Parent-Infant-Psychotherapy (PIP) for mothers with postpartum mental disorder and their infants (0-12 month).Methods: In this open randomized controlled intervention trial 180 mother-infant dyads will be included and randomly allocated to 12 sessions of PIP or care as usual. The interventions take place either in inpatient adult psychiatric departments or in outpatient settings with home visits. The primary outcome is the change in maternal sensitivity assessed by the Sensitivity subscale of the Emotional Availability Scale (EAS) through videotaped dyadic play-interactions after 6 weeks. Secondary outcomes are maternal psychopathology, stress, parental reflective functioning, infant development and attachment after 6 weeks and 12 months. In addition, maternal attachment (AAI) and reflective functioning (AAI) will be analyzed as potential moderators, and resource usage in the German health system as well as associated costs will be evaluated. Discussion: There is increasing demand for well-controlled studies on psychotherapeutic interventions in the postpartum period that do not only focus on particular risk groups. This RCT represents one of the first studies to investigate the efficacy of PIP in inpatient psychiatric departments and outpatient care centres in Germany. The results will fill knowledge gaps on the factors contributing to symptom reduction in postpartum mental disorders and improvements in mother-child relationships and help developing preventive and therapeutic strategies for the fragmented German health care system.Trial registration: German Register for Clinical Trials: DRKS00016353.

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Peri-partum psychosis: How does parental reflective function affect the quality of mother-infant interaction?

South African Journal of Psychiatry ◽

10.4102/sajpsychiatry.v24i0.1302 ◽

2018 ◽

Vol 24 ◽

Author(s):

Juane Voges ◽

Astrid Berg ◽

Daniel J.H. Niehaus

Keyword(s):

Maternal Sensitivity ◽

Reflective Functioning ◽

Small Sample ◽

Psychotic Symptoms ◽

Reflective Function ◽

Parental Reflective Functioning ◽

Play Interaction ◽

Attachment Difficulties ◽

Parental Reflective Function

Introduction: The purpose of this exploratory study was to examine the impact of peri-partum psychosis on parental reflective function and quality of mother-infant interaction in a South African sample at high risk of developing attachment difficulties. Besides the effects of physical separation, attachment difficulties may arise from other maternal factors, such as a lack of reflective capacity or negative symptoms affecting the warmth with which a mother interacts with her child. This study examined the quality of mother-infant interaction to determine how the presence of psychotic symptoms during pregnancy or shortly after delivery affects aspects like maternal sensitivity, child social involvement and dyadic engagement. Ultimately, the study aimed to investigate the association between psychosis, parental reflective functioning and quality of parent-infant interaction.Methods: The study followed a descriptive, observational design. Mothers were recruited if they experienced psychotic symptoms during pregnancy or within the first 6 months postpartum. Demographic information and psychiatric history were collected. Parental reflective function was assessed by the Parent Development Interview (PDI), and the quality of mother-infant interaction in an unstructured play interaction was coded using the Coding Interactive Behaviour (CIB).Results: Eight participants aged between 22 and 44 years, with diagnoses of bipolar disorder, schizophrenia and MDD with psychosis, were recruited. Parental reflective functioning showed significant variation with scores approaching and exceeding ordinary reflective functioning, typically found in non-clinical populations. At the time of the play interaction, infants were aged between 6 and 10 months. Play interactions were mostly parent-led, with some surprising findings, such as a lower than anticipated frequency of parental negative affect, moderate maternal sensitivity and wide variation in scores for infant withdrawal.Conclusion: The results found in this small sample of mothers with peri-partum psychosis have presented unexpected results, both in terms of higher than anticipated capacity for parental reflective functioning and aspects of the quality of interaction with their infants. Possible implications for future interventions will be discussed.

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Feasibility of a psychoeducational group intervention to improve parental reflective functioning and bonding in pregnancy: a randomised trial

Journal of Reproductive and Infant Psychology ◽

10.1080/02646838.2020.1786036 ◽

2020 ◽

pp. 1-17

Author(s):

Hannah Cox ◽

Alana James ◽

Crispin Day ◽

Nadja Reissland

Keyword(s):

Group Intervention ◽

Randomised Trial ◽

Reflective Functioning ◽

Psychoeducational Group ◽

Parental Reflective Functioning ◽

In Pregnancy

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The effectiveness of Nurture and Play: a mentalisation-based parenting group intervention for prenatally depressed mothers

Primary Health Care Research & Development ◽

10.1017/s1463423619000914 ◽

2019 ◽

Vol 20 ◽

Cited By ~ 1

Author(s):

S.J. Salo ◽

M. Flykt ◽

J. Mäkelä ◽

Z. Biringen ◽

M. Kalland ◽

...

Keyword(s):

Depressive Symptoms ◽

Group Intervention ◽

Intervention Group ◽

Maternal Sensitivity ◽

Reflective Functioning ◽

Repeated Measure ◽

Randomised Control Trial ◽

Control Group ◽

Treatment As Usual ◽

Optimal Parenting

Abstract Aim: This randomised control trial (RCT) study examined the effectiveness of a mentalisation-based perinatal group intervention, Nurture and Play (NaP), in improving mother–infant interaction quality and maternal reflective functioning and in decreasing depressive symptoms. Background: Few preventive prenatal interventions have been developed for primary health care settings for mothers with depressive symptoms. Furthermore, previous prenatal intervention studies have only concentrated on reducing depressive symptoms and have not directly addressed enhancing optimal parenting qualities. Methods: The participants were 45 pregnant women with depressive symptoms. Women in the randomly assigned intervention group (n = 24) participated in the manualised, short-term NaP intervention group from pregnancy until the baby’s age of seven months, whereas control group women received treatment as usual (TAU). Maternal emotional availability (EA), reflective functioning (RF) and depressive symptoms were measured before the intervention and at the infants’ 12 months of age, and changes were evaluated using repeated measure analyses of variances (ANOVAs). Findings: The results showed that the intervention group displayed higher maternal sensitivity and RF and more reduction in depressive symptoms than the control group when babies were 12 months old. These findings provide preliminary support for the effectiveness of the NaP intervention.

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Relación entre niveles de depresión, inteligencia emocional percibida y percepción de cuidados parentales en embarazadas. / Relationship between depression levels, perceived emotional intelligence and perception of parental care in pregnancy.

Revista Liminales. Escritos sobre Psicología y Sociedad ◽

10.54255/lim.vol4.num08.275 ◽

2015 ◽

Vol 4 (08) ◽

pp. 179-197

Author(s):

René Barraza López ◽

Daniela Heise Burgos ◽

Sandro Giovanazzi Retamal

Keyword(s):

Emotional Intelligence ◽

Parental Care ◽

Pregnant Women ◽

Emotional Regulation ◽

Biological Variability ◽

Emotional Skills ◽

Perceived Emotional Intelligence ◽

The Relationship ◽

Depression In Pregnancy ◽

In Pregnancy

La depresión en el embarazo es un problema creciente atribuible a la variabilidad biológica y a aspectos psicosociales como la percepción de vinculación parental y las habilidades emocionales autopercibidas, no obstante estas últimas presentan poca evidencia empírica, siendo variables aún poco exploradas. El objetivo de esta investigación fue determinar la relación entre la depresión, inteligencia emocional percibida y percepción de cuidados parentales en embarazadas. Los resultados indican que la percepción de una alta atención emocional, baja claridad emocional y baja regulación emocional, además de la percepción de las embarazadas de haber sido sobreprotegida por su padre, evidencian correlaciones con la depresión en el embarazo. Esto permite proponer la hipótesis vinculada a que la inteligencia emocional percibida como la reconstrucción de las experiencias vinculares tempranas podrían actuar como factores protectores, tendientes a disminuir la depresión en el embarazo, no obstante esto habría que corroborarlo con nuevos estudios en muestras mayores y con análisis más complejos. Depression in pregnancy is attributable to biological variability and psychosocial aspects such as perception of parental bonding and emotional skills self-perceived growing problem, however the latter have little empirical evidence, being variables still little explored. The objective of this research was to determine the relationship between depression, perceived emotional intelligence and perception of parental care in pregnant women. The results indicate that the perception of high emotional care, low emotional clarity and low emotional regulation, plus the perception of pregnant women have been overprotected by her father, show correlations with depression in pregnancy. This allows proposing linked to the perceived emotional intelligence as the reconstruction of early attachment experiences could act as protectors, aimed at reducing depression in pregnancy factors hypothesis, however this should be corroborated with further studies in larger samples and analysis more complex.

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