Parental reflective functioning (PRF) refers to the capacity of caregivers to reflect upon their children's internal mental states and intentions, which is seen as crucial for parental sensitivity, defined as the adequate behavioral response to an infant's signals. In this study, the effect of maternal PRF on sensitivity during the mother-infant interaction was examined in a clinical sample of 50 mothers who were experiencing postpartum depression and their infants aged three to ten months. Mother and infant were exposed to emotional distress using the still-face procedure. It was hypothesized that low levels of PRF are associated with a decrease in maternal sensitivity in response to distress. Maternal PRF was assessed using the Parental Reflective Functioning Questionnaire (PRF). The subscales measured interest and curiosity in mental states, certainty about mental states (i.e., the recognition of the opacity of mental states), and pre-mentalizing modes (i.e., non-mentalizing modes), whereas sensitivity was evaluated using the Maternal Behavior Q-Sort (Mini-MBQS-V). The results revealed a significant overall decrease in maternal sensitivity. As expected, the higher the scores on the pre-mentalizing modes, which indicated low levels of mentalizing through the mothers' repudiation or defense against it, the greater the decreases in sensitivity. No effects with respect to the interest and curiosity in mental states or the certainty about mental states were found. Our findings determined that the pre-mentalizing modes are predictive of sensitivity to distress in mothers with postpartum depression.

Experience sampling method (ESM) studies have found an association between daily stress and paranoid symptoms, but it is uncertain whether these findings generalize to physiological indicators of stress. Moreover, the temporality of the association and its moderating factors require further research. Here, we investigate whether physiological and self-rated daily stress predict subsequent paranoid symptoms and analyze the role of emotion regulation as a putative moderator. We applied ESM during 24 h to repeatedly assess heart rate, self-rated stress, and subclinical paranoia in a sample of 67 psychosis-prone individuals as measured with Community Assessment for Psychotic Experiences (CAPE). Adaptive and maladaptive emotion regulation was assessed at baseline with the Emotion Regulation Skills Questionnaire (ERSQ-ES) and the Cognitive Emotion Regulation Questionnaire (CERQ). Linear mixed models were used to analyze the data. Heart rate (b = 0.004, p < 0.05) and self-rated stress (b = 0.238, p < 0.001) predicted subsequent paranoia. The reverse effect, paranoia as a predictor of subsequent heart rate (b = 0.230, p = 0.615) or self-rated stress (b = -0.009, p = 0.751) was non-significant. Maladaptive emotion regulation was a significant predictor of paranoia (b = 0.740, p < 0.01) and moderated the path from self-rated stress to paranoia (b = 0.188, p < 0.05) but not the path from heart rate to paranoia (b = 0.005, p = 0.09). Our findings suggest a one-way temporal link between daily stress and paranoia and highlight the importance of emotion regulation as a vulnerability factor relevant to this process.

Postpartum depression is related to inadequately sensitive caregiving, putting infants at risk for insecure attachment. Therefore, promoting sensitive maternal caregiving and secure child attachment is particularly important in postpartum depressed mothers and their infants. In this randomized-controlled-trial, we evaluated the efficacy of the Circle of Security-Intensive (COS-I)-intervention in supporting maternal sensitivity and mother-infant-attachment compared to treatment-as-usual (TAU) with unresolved-maternal attachment as a moderator of treatment effect. Eligible mothers with infants (N=72) 4-9 months-old were randomly assigned to treatment (n=36 dyads). Infant attachment was rated at follow-up (child age 16-18 months) (Strange-Situation-procedure). Maternal sensitivity was measured at baseline and follow-up (Mini-Maternal-Behavior-Q-sort). Maternal-unresolved-attachment was assessed at baseline (Adult-Attachment-Interview). We found no significant differences between treatments in infant attachment nor changes in mothers' sensitivity. However, in COS-I, unresolved-mothers exhibited significantly more change in sensitivity than non-unresolvedmothers, whereas in TAU, the opposite was true. These findings may help to optimize clinical use of COS-I.

Background Mentalization is defined as the human capacity to reflect upon one's own or others’ behaviors in terms of underlying mental states and intentions. Several concepts of mentalizing exist, which differ in content, assessment, and clinical prediction. Aims The present study examines the relationship between the three main concepts of mentalizing, namely, reflective functioning (RF), parental reflective functioning (PRF), and Mind‐Mindedness (MM), in mothers with postpartum depression. It was hypothesized that mentalizing concepts differ in their convergent and divergent variance, as well as their clinical validity regarding comorbid anxiety and personality disorders (PDs). Method Fifty clinically referred mothers with postpartum depression and infants aged 3–10 months were examined by means of the Reflective Functioning Scale, Parental Reflective Functioning Questionnaire, and Mind‐Mindedness Coding‐System. Results No significant associations were found between RF and PRF, or between PRF and MM; higher RF was associated with more MM‐nonattuned mind‐related comments. Increased depression and anxiety were linked to lower PRF in terms of higher PRF‐prementalizing. Lower RF, but not PRF, was associated with comorbid PDs. Specifically, obsessive–compulsive PD was associated to considerably fewer MM‐nonattuned mind‐related comments. Conclusion Distinct concepts of mentalizing represent divergent competencies, differentially linked to maternal postpartum psychopathology.