2013.04.18 Peter Fonagy Creating Connections
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Transcript of 2013.04.18 Peter Fonagy Creating Connections
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Mentalizing and the
attachment process
Peter Fonagy FBADirector, Mental Health Program, UCLPChief Executive, Anna Freud Centre
Menninger Clinic, 22nd March 2013
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Some of the Mentalizing Mafia UCL/AFC/Tavistock
Prof George Gergely
Dr Pasco Fearon
Professor Mary Target
Prof Anthony Bateman
University of Leuven
Dr Patrick Luyten
Dr Liz Allison
Professor Alessandra Lemma
Professor Eia Asen
& UCL/AFC
Dr Trudie Rossouw
Dr Dickon Bevington
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Some more mafiosi (The USA branch) Menninger Clinic/Baylor Medical College (The USA branch)
Dr Jon Allen
Dr Lane Strathearn
Dr Brooks King-Casas
Dr Read Montague
YaleChild Study Centre
Prof Linda Mayes
Dr Carla Sharp
Dr Efrain Bleiberg
Professor Nancy Suchman
Professor Flynn OMalley
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And European recruits to the Family
Dawn Bales
Dr Mirjam Kalland
And Rose Palmer for help with the preparation of this presentation.
Professor Finn Skrderud
Professor Sigmund Karterud
Cindy Decoste
Catherine Freeman
Ulla KahnMorten Kjolbe
Benedicte Lowyck
Tobi NolteMarjukka Pajulo
Svenja TaubnerBart Vandeneede
Annelies Verheught-PleiterRudi VermoteJoleien Zevalkink
Bjorn Philips
Dr Peter Fuggle
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Numberofa
rticlesonWebof
ScienceDatabase
Source: http://apps.webofknowledge.com, Data collected 10.3.2013
Articles using mentalization in title or abstracts
http://apps.webofknowledge.com/http://apps.webofknowledge.com/ -
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The latest from the Mentalizing Mafia
American Psychiatric Publishing, Inc 2012
JUST RELEASED!
NEW!IMPROVED!
Washes brains
whiter!
Longer than all
previous
versions!
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Let the boy
dream Ivan,
He is a born
dilettante!
You will never
amount to anything
if you hold a balllike that!
I want to write my
PhD on the Use
of low signal-to-noise ratio stimuli
for highlighting the
functional
differences
between the two
cerebralhemispheres.
You look smug
now but youwill lose yourhair just like
Dad
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Mentalizing: Cognitive vs. Emotional
Emotional MentalizingThe capacity to experience affective reactions
to the observed experiences of others
Cognitive MentalizingRole-taking ability: The capacity to engage in the
cognitive process ofadopting anotherspsychological point of view.
Makinginferencesregarding the others
affective and cognitive mental states
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Distinguishing Emotional and Cognitive Mz
Level of
Comparison
Emotional Cognitive
Behaviors
Emotion recognition,emotional contagion,motorempathy, sharedpain
Cognitive ToM, AffectiveToM, Perspective-taking
Neuroanatomical
networksIFG, IPL, ACC, AI
vmPFC, dmPFC, TPJ,
MTL
Phylogenesis Rodents Primates
Developmental
stageInfants Adolescence
Neurochemical
mechanism
Oxytocin Dopamine
Shamay-Tsoory 2011
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Mentalizing brain networks
Shamay-Tsoory 2011
M
E
NT
A
LI
ZI
N
G
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Neurochemistry of Mentalizing
Cognitive empathy is related todopaminergiccircuits
This neurotransmitter plays a crucial role in thematuration of the frontal lobe from preschoolyears (Lackner, et al., 2010)
Emotional empathy is related tooxytocinergicfunctioning (Hurlemann, et al., 2010)
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Emotional Mentalizing and Oxytocin
Facilitates empathic facial recognition and in-group trust(Bakermans-Kranenburg, in press)
It increases perceived salience ofsocial cues(Shamay-Tsoory etal., 2009)
It improves empathic accuracy for less socially proficientindividuals (Bartz et al., 2010)
Emotional empathic approach recruits mainly lef t frontalareas. Oxytocin improves altruistic behaviorinindividuals with relatively higherr ight fron talactivity(Huffmeijer et al., 2012)
By enhancing activity in the Insula and IFG, it improvesunderstanding of others emotions, and reducesanxiety by decreasing amygdalaractivity, facilitating
contingent responses of help and compassion(Bakermans-
Kranenburg, in press)
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The Empathic Brain MechanismsEmotional empathy: Simulation
Inferior frontal gyrus
(IFG)
Inferior parietal lobule
(IPL)
Both zones are rich in mirror neurons
Implied in emotionalcontagionsince infancy
Implied in emotion recogni t ion
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The Empathic Brain MechanismsEmotional empathy: Shared emotion and pain
Anterior cingulate
cortex(ACC)
Insula
These areas respond to bothobserved and feltpain
Their intensity of theiractivation correlates with the explicitjudgment aboutseverity of pain
Observed pain activation decreases depending on the context: unfamiliarpeople, people ofdifferent race, alexithymia, and in medical practitioners
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TemporoparietalJunction (TPJ)
Medial PrefrontalCortex (mPFC)
Gweon, et al., 2012; Shamay-Tsoory, 2011
Mainly responsible for
transient mentalinferences aboutother people, their
goals, desires and
beliefs.
Attribution ofmore enduringtraits and qualities.
dmPFC: understandingothers beliefsvmPFC: others emotions
and the difference betweenself and others
The Empathic BrainCognitive mentalizing: Theory of Mind
Mainly responsible
autobiographicalmemory:past usedto understand
events happening to
the self and others
Hippocampus (HC)
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Other brain areas
implicated in ToM
Superior Temporal Sulcus
STS
PrecuneusTemporal Poles(TP)
The Empathic BrainCognitive empathy: Theory of Mind, Mentalizing
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The Mentalizing Brain
Inferior frontal gyrusThe mirror neuron
system is a first step:
Emot ional Con tagion
Temporo-parietal junction
& superior temporal sulcus
Visio-spatial and cognitive
perspective-taking
Temporal poles
Integration of perceivedinformationabout others,
learnt information about
unique persons andcontextual informationFrontal and prefrontal Cortex
Frith & Frith, 2006
mPFC: Anticipating what oneself or others will feel andbehavior predictionMedial orbital cortex: Emotional perspective-takingVentral regions of the medial frontal cortex: thinking aboutcommunicative intentions
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Mentalization and Overlapping Constructs
(Choi-Kain & Gunderson, Am J Psychiat 2008)
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Implicit-Automatic-Non -conscious-Immediate.
Explicit-ControlledConsciousReflective
Mental
interiorcuefocused
Mental
exteriorcuefocused
Cognitiveagent:attitudepropositions
Affectiveself:affect state
propositions
Imitativefrontoparietalmirror neuronesystem
Belief-desireMPFC/ACCinhibitorysystem
AROUSAL
Mentalizing Profile: A multidimensional modelFonagy, P., & Luyten, P. (2009). Development and Psychopathology, 21, 1355-1381.
amygdala, basal ganglia,
ventromedial prefrontal
cortex (VMPFC),
lateral temporal cortex (LTC)
and the dorsal anterior
cingulate cortex (dACC)
lateral and medial prefrontal cortex
(LPFC & MPFC), lateral and medial
parietal cortex (LPAC & MPAC),
medial temporal lobe (MTL),rostral
anterior cingulate cortex (rACC)
Associated with several areas
of prefrontal cortex
Associated with inferior prefrontal
gyrus
the medial prefrontal cortex,
ACC, and the precuneusfrontoparietal mirror-neuron
system
medial frontoparietalnetwork activated
recruits lateral fronto-temporalnetwork
AROUSAL
AROUSAL
AROUSAL
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Implicit-Automatic-Non -conscious-Immediate.
Explicit-ControlledConsciousReflective
Mental
interiorcuefocused
Mental
exteriorcuefocused
Cognitiveagent:attitudepropositions
Affectiveself:affect state
propositions
Imitativefrontoparietalmirror neuronesystem
Belief-desireMPFC/ACCinhibitorysystem
AROUSAL
Mentalizing Profile Associated with ArousalFonagy, P., & Luyten, P. (2009). Development and Psychopathology, 21, 1355-1381.
amygdala, basal ganglia,
ventromedial prefrontal
cortex (VMPFC),
lateral temporal cortex (LTC)
and the dorsal anterior
cingulate cortex (dACC)
lateral and medial prefrontal cortex
(LPFC & MPFC), lateral and medial
parietal cortex (LPAC & MPAC),
medial temporal lobe (MTL),rostral
anterior cingulate cortex (rACC)
Associated with several areas
of prefrontal cortex
Associated with inferior prefrontal
gyrus
the medial prefrontal cortex,
ACC, and the precuneusfrontoparietal mirror-neuron
system
medial frontoparietalnetwork activated
recruits lateral fronto-temporalnetwork
AROUSAL
AROUSAL
AROUSAL
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That handkerchief which I so loved and gave theeThou gavest to Cassio.By heaven, I saw my handkerchief in's hand.
Dimensions of mentalization: implicit/automatic
vs explicit/controlled in Othello
Controlled Automatic
Why, how now, ho! from whence ariseth this?
Are we turn'd Turks, and to ourselves do that
Which heaven hath forbid the Ottomites?
For Christian shame, put by this barbarous brawl:
Love
Spurned/Arousal
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That handkerchief which I so loved and gave theeThou gavest to Cassio.By heaven, I saw my handkerchief in's hand.
Dimensions of mentalization: implicit/automatic
vs explicit/controlled in Othellos brain
Controlled Automatic
Lateral PFC Medial PFC
Lateral
temporal
cortex
Amygdala Ventromedial PFC
Arousal
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Dimensions of mentalization: implicit/automatic
vs explicit/controlled
Psychological understanding drops and is
rapidly replaced by confusion about mental
states under high arousal
That handkerchief which I so loved and gave theeThou gavest to Cassio.By heaven, I saw my handkerchief in's hand.
Controlled Automatic
Arousal
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Dimensions of mentalization: implicit/automatic
vs explicit/controlled
Arousal
Psychotherapists demand to explore issuesthat trigger intense emotional reactions
involving conscious reflection and explicit
mentalization are inconsistent with the
patients ability to perform these tasks when
arousal is high
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Early Development of Mentalizing
6 and 10-month-old infants show preference forcharacters that help others over characters that arenot cooperative or hindering (Hamlin, Wynn, & Bloom, 2007)
Infants as young as 12 months of age begin tocomfort victims of distress (Warneken & Tomasello, 2009)
Children aged 14-18 months display spontaneous andunrewarded helping behaviours (Warneken & Tomasello, 2009)
Children aged 18-25 months are inclined tosympathize with others in strife, which implies anearly form of emotional perspective-taking (Decety, 2011)
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Development of empathy: Regression?
At 17 months of age,34.6% of children helpedanother child who was
feeling sick
A year after, 17% of boysand 12% girls stoppedshowing this behavior
19% of children who do notshow empathic behavior at 29months of age, had shown it 1
yearbefore
Ceasing to exhibit prosocialbehaviors during toddlerhood is anormative aspect of early socialdevelopment
Prosocial behaviors becomeregulated during preschool years
Children learn to inhibit
prosocial behaviors as theybecome aware of the implicitrules of social and moral conductThey learn where, when and
whom to help: reciprocity,
equity and deservednessBaillargeon et al., 2007; Baillargeon et al., 2011; Brownell, 2013; Hay, 1994
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Development of Empathy
Moral behavior
Empathic behaviortowards others
Rule-compatible behaviorwithout supervision
Empathic behaviorduring toddlerhoodprevents externalizingpathology and predictsdevelopmental
adaptation
It causes greaterpositive reciprocityin the relationship with
close figures
Positive relationshipfoster mental healthand positivesocializationtrajectories
Kochanska et al., 2010
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Development of empathyEmotional empathy develops very early It relies on somato-sensoriomotor resonance and mimicry
Newborns and infants become distressedshortly afteranotherinfant starts crying
Mimicry of facialexpressionsstarts around 10
weeks
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Development of EmpathyCognitive empathy develops later
It relies on more sophisticated functionsTheory of mind (ToM)
Executive function
Self-regulation
This allows for regulated responsesto others distress, without feeling
distressed oneself These are implemented in the prefrontal cortexIt develops more slowly than the rest of the brain
Reaches maturity during adolescenceGreimel, et al., 2010; Decety, 2011
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Sensitivity to others state of mind
M Kovcs et al. Science2011;330:1830-1834
False belief for babyTrue belief for Smurf
True belief for babyFalse belief for Smurf
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Published by AAAS
The infant but not theSmurf believes thatthe ball should be there
Infant knows ball is not thereBut Smurf believes it shouldbe there
Neither infant northe Smurf believe thatthe ball should be there
Neither infant northe smurf believethat ball is there
Ball Not There Ball Not There
M Kovcs et al. Science 2010, 330:1830-1834
The two key conditions in Smurf Study: Infant of 7 monthsconsiders what agent (Smurf) believes about the status of ball
Sensitivity to others state of mind
False belief for babyTrue belief for babyFalse belief for Smurf
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The social brain: pSTS/TPJ
mPFC
pSTS/TPJ Seeing the otherspoint of view
Prediction
o Biological motion, eye
gaze
o Predicting complex
movements
Perspective-taking
o Joint attentiono Different physical points
of view
Pelphrey et al., 2004a,b; Kawawaki et al., 2012 (review); Mitchell 2013
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Brain Regions forPerceiving and Reasoning AboutOther People in School-Aged Children (Saxe et al.)
Right TPJ
mPFC
Precuneus
Left TPJ
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Grace and her friend are taking a tour of a chemicalplant. When Grace goes over to the coffee machine toour some coffee, Graces friend asks for some sugarin hers. There is a white powder next to the coffee in acontainer marked toxic and Grace gives two spoonfulsto her friend.
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Disruption of the right temporoparietal junction withtranscranial magnetic stimulation reduces the role of
beliefs in moral judgments (Young et al., PNAS)
*
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Mentalizing can be taught Prosocial behaviors in children emerge around the 2 years of
age and are largely non-heritable(Deater-Deckard, 2003; Brownell, 2013)
They are linked with positivity in the relationship withparents(Spinrad, 2009)
Maternal responsivenessat childs 9 months of age predictschilds empathy at 22 moths of age(Kochanska, 1999)
Mothers with negative preconceptions about parenting havechildren who show less empathy towards their mothers(Kiang,Moreno & Robinson, 2004)
Punitive and harsh parenting is negatively related to prosocialbehaviors (Asbury et al., 2003)
Warm and sensitive attachment relationship encourages
empathy and perspective taking(Farrant et al, 2012)
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Empathy and Attachment
Avoidant attachment shows a characteristic way ofdetachment that impedes mentalization andtherefore empathy:
Avoidant children aged 4-5 years in play with peers,are eithermanipulative and exploitative or victims ofa manipulative relationship. They oscillate betweenbeing victims and victimizers
Empathy requires regulation of negative emotions:
Fearful and insecurely attached 16 and 22 monthsold girls show progressively less empathy forstrangers in distress
During that time span, empathic concern fortheir
mothers distress increasedVan Der Mark, Van Ijzendoorn & Bakermans-Kranenburg, 2002; Troy & Sroufe, 1987
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Empathy and Attachment
The development of empathy
requires an early attachment relationwith a warm and responsive adult
Reactivity to stress is present in youngchildren, but only some can regulateit and react empathically
Children ofresponsive mums showmore concernedattention and lowerpersonal distress when confronted to
distress of the motherand of a strangerKiang, Moreno & Robinson, 2004; Novartis Foundation, 2007; Spinrad & Stifter, 2009
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The Development of Affect Regulation
Closeness of the infant to another humanbeing who via contingentmarked mirroringactions facilitates the emergence of asymbolic representational system of affective
states and assists in developing affectregulation (and selective attention) secureattachment
For normal development the child needs toexperience a mind that has his mind in mindAble to reflect on his intentions accurately
Does not overwhelm him
Not accessible to neglected children
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High congruent & marked mirroring
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Empathy and Attachment
This effect of positive attachment is also observed in adults:
Primingattachmentsecurity in adults Empathic
reactions
Personal
distress
Gillath, 2005; Mikulincer et al., 2001; 2005
Attachment avoidance andanxiety are inversely related toempathy
Attachment anxiety is positivelyrelated to personal distress
When perceiving distress, insecurely attached people failto recruit cortical brainareas normally used to down-regulatenegativeemotions (ACC and MPFC), which
hinders empathic behaviors of help and comfort
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Empathy and Attachment Dismissively attached women when empathizing:
Show more activation in motor, limbic, and mirrorsystems Implies implicit andunmodulatedemotional involvement Impairment in self-other differentiation
Deactivation of fronto-medial areas: ACC and medialpre-frontal cortex
Implies emotional disinvestment towards social emotions,typical ofdismissive subjects
It compensates the overactivated implicit involvement
Emo tional overact ivat ionin dismissive subjects does notresult in empathy, butin the retrieval ofautobiographica l
memoriesofpainful attachment experiences, which t r iggeravoidance strategieswhen observing pain
Lenzi, et al., 2012
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Theory:Birth of the Alien Self inDisorganized Attachment
The caregivers perception is inaccurate or unmarked or both
Absence of a
representation of
the infants
mental state
Attachment
Figure The nascent selfrepresentational
structure
The child, unable to find himself as an intentional being, internalizes a
representation of the other into the self with distorted agentive character isticswhich disor anizes the self creatin s li ts within the self structure
Mirroring fails
Internalisation of a non-contingent mental
state as part of the self
Child
The Alien
Self
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Theory:Self-destructiveness andExternalisation Following Trauma
Attack from within is turned against body and/or mind.
Perceived
other
Unbearably painful
emotional states:
Self experienced
as evil/hateful
Torturing alien self Self representation
Self-harm state
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Self experienced
as evil and hateful
Theory:Self-destructiveness andSelf-destructive relationships
Projective identification is used to reduce the experience of unbearably painful emotional state of
attack from withinexternalisation becomes a matter of life and death and addictive bond and
terror of loss of (abusing) object develops
Perceived
otherUnbearably painful
emotional states:
Self experienced
as evil/hateful
Torturing alien self Self representation
Container Self experienced
as hated and attacked
ExternalizationTorturing alien self
Addictive bondSelf-harm state Victimized state
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Self experienced
as evil and hateful
Externalisation & Violence Following Trauma
Projective identification is used to reduce the experience of unbearably painful emotional state of
attack from withinexternalisation becomes a matter of life and death, the violent act protects
against experience of intrusion and addictive bond and terror of loss of abused object can
develop
Perceived
otherUnbearably painful
emotional states:
Self experienced
as evil/hateful
Torturing alien self Self representation
Container Self experienced
as hated and attacked
ExternalizationTorturing alien self
Addictive bondSelf-harm state Violent state
Self experienced
as righteously vindicated
Violent act
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Empathy deficits and attachmentIn children with disruptive behavior disorders
Children with higher levels ofcallous/unemotional traits
are more likely to show
disorganizedattachment
In line with impairments inattending to, recognizing andresponding to otherpeoples
emotions
Early attachmentdisturbancesimpair
childrens ability to reflect onand respond to other peoples
emotional states
Disrupted attachment amplifynegative effects of
temperamental aspects oncallous/unemotional traits
These traits are associated with emotionalrecognition deficits and lowlevels ofprosocia l
behaviorPasalich et al., 2012
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Implicit-Automatic-Non-conscious-Impressionistic
Explicit-ControlledConsciousReflective
Mentalinteriorcuefocused
Mentalexternalcuefocused
Cognitiveagent:attitude
propositions
Affectiveself:affect state
propositions
Imitativefrontoparietalmirror neuronesystem
Belief-desireMPFC/ACCinhibitorysystem
BPD
BPD
BPD
BPD
Mentalizing Profile of Prototypical BPD patientFonagy, P., & Luyten, P. (2009). Development and Psychopathology, 21, 1355-1381.
amygdala, basal ganglia,
ventromedial prefrontal
cortex (VMPFC),
lateral temporal cortex (LTC)
and the dorsal anterior
cingulate cortex (dACC)
lateral and medial prefrontal cortex
(LPFC & MPFC), lateral and medial
parietal cortex (LPAC & MPAC),
medial temporal lobe (MTL),rostral
anterior cingulate cortex (rACC)
Associated with several areas
of prefrontal cortex
Associated with inferior prefrontal
gyrus
the medial prefrontal cortex,
ACC, and the precuneusfrontoparietal mirror-neuron
system
medial frontoparietal
network activated
recruits lateral fronto-temporal
network
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Prementalizing Modes of Subjectivity Psychic equivalence:
Mind-world isomorphism; mental reality = outerreality; internal has power ofexternal
Intolerance of alternative perspectives concrete understanding Reflects domination ofself:affect state thinking with limited internal focus
Pretend mode: Ideas form no bridge between inner and outer reality; mental world
decoupled from external reality dissociation of thought, hyper-mentalizing orpseudo-mentalizing Reflects explicit mentalizing being dominated by implicit, inadequateinternal
focus, poor belief-desire reasoning and vulnerabilty to fusion with others
Teleological stance:
A focus on understanding actions in terms of theirphysical as opposed tomental constraints Cannot accept anything other than a modification in the realm of the physical
as a true index of the intentions of the other.
Extreme exterior focus, momentary loss of controlled mentalizing Misuse of mentalization for teleological ends (harming others) becomes
possible because of lack ofimplicit as well as explicit mentalizing
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Implicit-Automatic Explicit-Controlled
Mentalinteriorfocused
Mentalexteriorfocused
Cognitiveagent:attitude
propositions
Affectiveself:affect state
propositions
Imitativefrontoparietalmirror neurone
system
Belief-desireMPFC/ACCinhibitory
system
Impression driven
Appearance
Certainty of emotion
Treatment vectors in re-establishing mentalizing
in borderline personality disorderControlled
Inference
Doubt of cognition
Emotional sensitivityAutonomy
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Mentalizing and the
pedagogic stance and a
general theory for
psychotherapy?
Th d f h t l
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The need for human natural
pedagogy
We are born into a world populated with man-
made tools whose functional properties,
appropriate manner of application or method of
(re)production often remain in many respectsepistemically opaque
The cognitive opacity of kind or category-relevant
aspects of human-made functional artifacts raises
a learnability problem (of relevance-selection) for
the nave juvenile observational learner
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The Theory of Natural Pedagogy (Csibra &
Gergely, 2006; 2009, in press)
A human-specific, cue-driven social cognitiveadaptation of mutual design dedicated to ensure
efficient transfer ofrelevant cultural knowledge
Humans are predisposed to teach and learn
new and relevant cultural information from eachother
Human communication is specifically adapted to
allow the transmission of a) cognitively opaque cultural knowledge
b) kind-generalizable generic knowledge
c) shared cultural knowledge
D fi iti f O t i Sti li
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Definition of Ostensive Stimuli
(Sperber & Wilson, 1995)
The signals whereby an agent makes manifestto an addressee hercommunicative intention:to manifest some new relevant information for
the addressee (i.e. her informative intention). Infants display species-specific sensitivity to,
and preference for, some non-verbal ostensivebehavioral signals(see Csibra, 2010, Csibra & Gergely, 2009 for reviews)
Examples ofostensive communication cueseye-contact turn-taking contingent reactivityspecial tone(motherese)
S
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The Pedagogical Stance is triggered by
Ostensive-Communicative cues
Ostensive cues have in commonInfant recognized as a self
Paid special attention to (noticed as an agent)
Ostensive cues function to trigger:
Open channel to knowledge about social and
personally relevant world (CULTURE)
Go beyond the specific experience and acquireknowledge relevant in many settings
Triggers opening of an epistemic
superhighway for knowledge acquisition
O t i f ti l
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Ostensive cues referential
expectation in infant
6-month-olds followedan agents gaze-shift to one oftwo objects but only when it had been preceded by eithereye contact orinfant-directed speech (ostensivesignals) addressed to the infant (Senju and Csibra, 2008).
An automated eye-tracker based study used an infant-induced contingent reactivity paradigm to demonstratethat 8-month-olds gaze followan unfamiliar objectsbodily orientation response towards one of two targets,but only when the object had been reactingcontingently before (producing self-propelled bodymovements such as tilting) to being looked at by the infant(Deligianni et al., 2011).
E i t l ill t ti f t i
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Subjects : 4 groups of 18-month-oldsStimuli: Two unfamiliar objects
Experimental illustration of ostensive cues
Gergely, Egyed et al. (in press)
1 B li t l
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1: Baselinecontrol group
No object-directed attitude demonstration
Simple Object
Request by
Experimenter A
Subjects: n= 20 Age: 18-month-olds
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Ostensive Communicative Demonstration
Requester: OTHERperson (Condition 1)
Otherperson
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N O t i (N C i ti ) D t ti
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Non-Ostensive (Non-Communicative) Demonstration
Requester: OTHERperson (Condition 2)
Otherperson
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C diti 4 N O t i (N C i ti )
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Condition 4: Non-Ostensive (Non-Communicative)
Demonstration Requester: SAME person
Sameperson
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Epistemic trust and secure
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Epistemic trust and secure
attachment
Secure attachment is created by a system thatalso induces a sense ofepistemic trust thatthe information relayed by the teacher may be
trusted (i.e. learnt from) Evidence
Cognitive advantage of secure attachment
Contingentresponsiveness to the infants own (at first,automatic) expressive displays in secure attachment
During mirroring interactions, the other will mark
her referential emotion displays in a manifestative
manner to instruct the infant
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How Attachment Links to Affect Regulation
DISTRESS/FEAR
Exposure to Threat
Proximity seeking
Activation of attachment
The forming of an attachment bond
Down Regulation of Emotions
EPISTEMICTRUST
BONDING
S i l C th t C t E i t i T t
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Social Cues that Create Epistemic Trust Attachment is special condition for generating epistemic
trust
Generally any communication marked by recognition of thelistener as intentional agent will increase epistemic trustand likelihood ofcommunication being coded as Relevant Generalizable To be retained in semantic memory
Influential communicators use ostensive cues to maximum create illusion ofrecognizing agentiveness of listener
o Looking at audienceo Addressing current concerno Communicating that they see problem from agents perspectiveo Seeing Recognizing individual struggle in understanding
Massive difference in ability of individuals to influence(teachers, politicians, managers) explicable in terms ofvar in ca acit to enerate e istemic trust
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M t l ti t di f t h ff ti
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Meta-analytic studies of teacher effectiveness
John Hattie is Professor of Education at the University of
Auckland, New Zealand. 15 years research and synthesises over 800 meta-analyses
relating to the influences on achievement in school-agedstudents.
Builds a story about the power of teachers and of feedback,
and constructs a model of learning and understanding. Is there a set of predictors to good teaching outcomes based
on: The child?
The home?
The school?
The curricula?
The teacher?
The approaches to teaching?
Meta analytic studies of teacher effectiveness
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Meta-analytic studies of teacher effectiveness
Things that do not work:
Mobility (shifting schools) -0.34
Television -0.14
Summer vacation -.09Ability grouping 0.10
Ability grouping .10
Individualized instruction .20Homework .30
Meta analytic studies of teacher effectiveness
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Meta-analytic studies of teacher effectiveness
What makes a teacher most effective?
It is teachers seeing learning through the eyesof students; and students seeing teaching as thekey to their ongoing learning
The key ingredients are:Awareness ofthe learning intentions
Knowing when a student is (feels) successful
Having sufficient understandingofthe students
understandingKnow enough about the content to provide meaningful
and challenging experiences
Passion that reflects the thrills as well as awareness of the
frustrations of learning.
Implications: A mechanism of change
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Implications: A mechanism of change Mentalizing(seeing behavior
in terms of mental states)entails collaborationSeeing from others
perspectiveTreating the otheras aperson
Recognizing them as an
agentAssuming they have things
to teachyou since mental
states are opaque
Implications: The nature of psychopathology
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Implications: The nature of psychopathology Social adversity (most deeply trauma) is the
destruction of trust in social knowledge ofall kinds rigidity, being hard to reach
Cannot change because cannot accept newinformation as relevant (to generalize) to
other social contexts Personality disorderis not disorder of
personality (except by old definition of beingenduring) but inaccessibility to cultural
communication from Partner
Therapist Epistemic Mistrust Teacher
}
Implications: The nature of psychopathology
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Implications: The nature of psychopathology Epistemic mistrust follows experiences of
maltreatment or abuse Therapists ignore this knowledge at their peril
Personality disorder is a failure ofcommunication
It is not a failure of the individual but a failure of arelationship It is associated with an unbearable sense of
isolation in the client generated by epistemicmistrust
Our inability to communicate with client causesfrustrationin us and a tendency to blame thevictim We feel they are not listening but actually it is that
they find it hard to trust the truth of what they hear
Implications: The nature of psychotherapy
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Implications: The nature of psychotherapy
Mentalizingpatients may be a common factorto
psychotherapy not because we need to learnaboutourminds to learn about those of others
Mentalizingis a generic way of establishingepistemic trust and achieving changeOur subjectivity being understood is necessary key to
open up wish to learn about world including socialworld
Open a key biological route to information transmission
and possibility of change epistemic super-highway
Experience offeeling thought about makes us feelsafe enough to think about social world
Implications: The nature of psychotherapy
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Implications: The nature of psychotherapy Therapy is not just about the what but the
how of learning:Opening the persons mind via
establishing epistemic trust (collaboration)so he/she can once again trust the social
world by changing expectationsIt is not just what is taught in therapy that
teaches, but the evolutionary capacity forlearningfromsocial situation is rekindled
CAMHS interventions are effective becausethey open the child to social learningexperience which then feed back in virtuouscycle
Psychotherapy may be effective for two reasons
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Learning content by focusing on trustworthyaspects of context
We may have some wisdom that is worthcommunicatingOnce epistemic superhighway is open the client can
learn from us
Learning about sources of knowledge
byproviding a clearsocial illustration of trust weundo epistemic isolationBy using ostensive cues and establishing a sense that
we are concerned to see the world from the clients
standpoint we model a situation of interpersonal trustImproved understanding of social situation Leads
to better understanding of attachment figure moretrusting (less paranoid) interpersonal relationships itopens up the potential to feeling sensitively responded
to in virtuous cycle
Psychotherapy may be effective for two reasons
Implications: Learning beyond therapy
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Implications: Learning beyond therapy What is theprocess at work:Limitless therapies - 1,246 different ways to
understandBut each model capable to provide a content to
treatment that makes person feel understoodThe rationale of the treatment and the model of
pathology and the model oftherapeutic effectgives the treatment the content to create theprocessMentalizing by itself is not a realistic therapy it doe
not tell the therapist what to focus on,just focusingthe patient on theirthoughts and those of othersaround them will not achieve changeImprovement based on learning from experience
beyond therapy
Implications: Learning beyond therapy
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Implications: Learning beyond therapy The specific frame of the therapy around which
mentalizing occurs
the model ofmind, the model ofinteraction, the model ofunderlying dysfunction, the model oftherapeutic goals
The enhancing of mentalizing is also a common factothat achieves improved social relationships Improved sense of epistemic trust enables learning
from experiencechange due to what happensbeyond CAMHS
The enhancing of epistemic trust may be achieveby treatment but also a consequence of improvedsocial relationships and consequent on whathappened in the social world.
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Gaps in Therapy Outcomes Research
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Gaps in Therapy Outcomes Research
No solid evidence forwho will benefitfrom what type of psychotherapy
Inexact therapies partial
effectiveness
Attachment to methods
guildification of interventions
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To Sum Up
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Adapting to the social world is a steep learning curve
Getting comfortable in the social world
G i f bl i h i l ld
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Me playdrums??
For example, it is not obvious what is the true function of all
the objects we use.
Getting comfortable in the social world
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8
Luckily, humans have evolved to teach and learn fromeach other quickly and efficiently
Getting comfortable in the social world
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9
-..quickly and efficiently if certain conditions are met
Getting comfortable in the social world
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9
but this special interpersonal channel for learning
about the social world is not always tuned in.
Getting comfortable in the social world
Tuning in to the interpersonal channel
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Trust opens up the social communicationsuperhighway, enabling us to learn and change
9
When there is abuse, there is no trust, the mindis blocked and it is impossible to move forward
Tuning in to the interpersonal channel
Tuning in to the interpersonal channel
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Trust opens up the social communicationsuperhighway, enabling us to learn and change
and they will tune in to you!
9
Win the other persons trust by respondingcontingently to their feelings and thoughts, showingthem that you are hearing and thinking about whats
going on in their mind
Tuning in to the interpersonal channel
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MBT IS CHEAP AND COMFORTABLE
AND HELPFUL IN A RANGE OF WAYS!!!
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