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Biomedical subjects

Peter Fonagy

Publications and source records attributed to Peter Fonagy.

At least 19 recordsLinked to original sources
PubMed2006

Mechanisms of change in mentalization-based treatment of BPD.

There are very few less contentious issues than the role of attachment in psychotherapy. Concepts such as the therapeutic alliance speak directly to the importance of activating the attachment system, normally in relation to the therapist in individual therapy and in relation to other family members in family-based intervention, if therapeutic progress is to be made. In group therapy the attachment process may be activated by group membership. The past decade of neuroscientific research has helped us to understand some key processes that attachment entails at brain level. The article outlines this progress and links it to recent findings on the relationship between the neural systems underpinning attachment and other processes such as making of social judgments, theory of mind, and access to long-term memory. These findings allow intriguing speculations, which are currently undergoing empirical tests on the neural basis of individual differences in attachment as well as the nature of psychological disturbances associated with profound disturbances of the attachment system. In this article, we explore the crucial paradoxical brain state created by psychotherapy with powerful clinical implications for the maximization of therapeutic benefit from the talking cure.

Borderline Personality Disorder↗
PubMed2006

In search of shared and nonshared environmental factors in security of attachment: a behavior-genetic study of the association between sensitivity and attachment security.

The current article presents results from a twin study of genetic and environmental components of maternal sensitivity and infant attachment and their association. The sample consisted of 136 twin pairs from 2 sites: Leiden, the Netherlands, and London, UK. Maternal sensitivity was assessed in the home at 9-10 months, and infant attachment security was observed in the laboratory at 12 months. The study yielded little evidence that genetic factors are involved in variations between twins in maternal sensitivity ratings but did find that shared variance in maternal sensitivity was able to account for some of the similarity between twins in attachment security. Weak nonshared associations between sensitivity and attachment appeared to suppress the magnitude of the correlation between attachment and sensitivity in twin children. The results could indicate that the attachment security of one twin may depend on the relationship the parent has with the other twin. The results are brought to bear on the validity of attachment theory as a theory of primarily shared environmental effects in children's development and the continuing challenge posed to attachment theory by within-family differences in socioemotional processes.

Adult↗
PubMed2006

Teachers who bully students: a hidden trauma.

OBJECTIVE: The study examined teachers' perceptions of bullying by other teachers to see what causes and characteristics were attributed to such bullying teachers, and how often teachers were themselves bullied by students. METHOD: 116 teachers from seven elementary schools completed an anonymous questionnaire reflecting their feelings and perceptions about their own experiences of bullying, and how they perceive colleagues over the years. RESULTS: Results confirmed that teachers who experienced bullying themselves when young are more likely to both bully students and experience bullying by students both in classrooms and outside the classroom. Factor analysis revealed two types of bullying teacher: a sadistic bully type and a bully-victim type. CONCLUSIONS: The implications for the mental health of children and for effective teaching are discussed, in the light of widespread recognition of the traumatic effects of bullying on childhood development.

Adult↗
PubMed2006

Progress in the treatment of borderline personality disorder.

We outline recent evidence suggesting that the natural course of borderline personality disorder is more benign than formerly believed. We explore possible reasons for the change in findings which include both the iatrogenic effects of earlier treatment models and the recent availability of effective interventions. Clinicians should be optimistic about improvement and long-term outcomes.

Borderline Personality Disorder↗
PubMed2006

The relationship between parenting dimensions and adult achievement: evidence from the Whitehall II Study.

This article examines the association between three dimensions of perceived parenting--warmth, strictness, and expectation--and adult cognitive and socioeconomic achievement outcomes. Structural equation models (N = 7,035) were used to examine simultaneously the influence of parenting on adult achievement while controlling for the influence of parental socioeconomic circumstances. Very low and very high level of parental warmth was associated with poor adult achievement. Strictness had a negative and parental expectation a positive relationship with adult achievement. These associations were independent of parental socioeconomic circumstances. Own education was found to mediate 27-56% of the relationship between parenting dimensions and adult achievement. Parental expectation was most strongly related to adult achievement. We conclude that parenting plays a significant role in the development of adult achievement: both cognitive ability and socioeconomic achievement. Moderate levels of warmth, low levels of strictness, and high parental expectation are associated with high adult achievement.

Achievement↗
PubMed2006

Six-year follow-up of three treatment programs to personality disorder.

Previous studies of long-term outcome for personality disorder (PD) were either retrospective in design or did not include a control condition. In this paper we report results for three PD cohorts (N = 111) treated in two different specialist psychosocial programs (step-down and long-term inpatient) and in general psychiatric treatment as usual (TAU), which were prospectively followed up for 72-months after intake. The three PD samples were compared on symptom severity, social adjustment, global functioning and other clinical indicators (self-mutilation, parasuicide and readmission rates) at intake, 6, 12, 24, and 72 months. Results indicated that a specialist step-down model showed significantly greater change than a purely inpatient model and TAU in most key dimensions of functioning, a difference maintained at 72-months follow-up. Improvement in the samples was not associated with amount of intercurrent treatment received in the year prior to the follow-up assessment. This study confirms that a step-down program retains significant improvement associated with a specialist psychosocial approach for PD. However, this conclusion should be qualified by design limitations. The samples were not randomly allocated to the three conditions and the naturalistic geographical allocation used in the study created a potential for a number of confounds. Whilst we used extensive statistical controls, the possibility that the differences found between the groups may be due to population differences cannot be discounted.

Adult↗
PubMed2005

Creating a peaceful school learning environment: the impact of an antibullying program on educational attainment in elementary schools.

BACKGROUND: The impact of a bullying and violence prevention program on education attainment was studied in five elementary schools (K-5), over a 5-year period. MATERIAL/METHODS: A multiple baseline design was used and academic attainment test scores of 1,106 students were monitored before and after the introduction of the program across the school district. This sample was contrasted with an equivalent control sample of 1,100 students from the school district who attended schools that did not join the program. RESULTS: Program participation was associated with pronounced improvements in the students' achievement test scores. Notable reductions in the scores of those students who left schools with active programs were also observed. CONCLUSIONS: This simple, low-cost anti-violence intervention, involves all those who work in schools, not just students. It appears to significantly benefit educational performance of children in the participating elementary schools. The program focuses attention on the interaction between the bully, victim and audience of bystanders who are seen as pivotal in either promoting or ameliorating violence. Buy in to the philosophy by teachers & administration is high, because the format allows each school to create materials with its own personal stamp, and since there is no classroom curriculum add on, the burden to teachers is vastly reduced. Psychiatrists who work with schools could easily assist a school to put the program in place as part of their consultation work.

Child↗
PubMed2005

Using the SWAP-200 in a personality-disordered forensic population: is it valid, reliable and useful?

BACKGROUND: Treatment and risk management of forensic patients relies heavily on diagnosing psychopathology, yet the reliability of clinical diagnoses of personality disorder has been found to be only fair to low. Structured instruments for the global assessment of personality disorder are infrequently used in clinical assessments possibly due to their limited validity and clinical utility. AIMS/METHODS: The Shedler-Westen Assessment Procedure-200 (SWAP-200) was developed in an effort to address these limitations. Although good reliability and validity in relation to clinicians' diagnosis of personality disorder has been reported, to date the validity of this instrument has not been assessed in relation to other standardized instruments or in a personality-disordered, forensic population. This study aims to establish the reliability and validity of the SWAP-200 against other diagnostic instruments and measures of interpersonal functioning in a personality disordered forensic population. RESULTS: This paper reports the results of 30 subjects from a high secure hospital in the UK who were assessed with the SWAP-200, the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II), the Adult Attachment Interview (AAI) and the Chart of Interpersonal Reactions in Closed Living Environments (CIRCLE). Preliminary results suggest that the SWAP-200 is a reliable instrument for the diagnosis of personality disorder in forensic patients. CONCLUSIONS: Although the small sample size allows only preliminary conclusions about the validity of this instrument, early results show a reduction of the diagnosis of comorbidity compared with the SCID-II, together with an increased number of expected associations between independent measures of interpersonal functioning and categories of personality disorder.

Adult↗
PubMed2005

Homeless near a thousand homes: outcomes of homeless youth in a crisis shelter.

Clients who received crisis services at a homeless shelter for transition-aged youth were recruited for a study to describe the youth served, to track outcomes of care, and to examine factors associated with differing outcomes. Participants were 202 men and women who completed a battery of interviews and self-report measures at intake and at 3 follow-up points. Youth served had experienced high levels of adversity and trauma and typically had poor educational and vocational preparation. A multidisciplinary array of services was provided, and overall, participants showed significant improvement from intake to discharge and in the 6 months after discharge. Background, service, and psychological factors did not predict housing outcomes. Better vocational outcome was associated with more recent work experience. Results point to the need for providers of services to the homeless to be aware of the distinct needs and characteristics of transition-aged youth.

Adolescent↗
PubMed2005

The prevalence of teachers who bully students in schools with differing levels of behavioral problems.

OBJECTIVE: This study looked for a relationship between the prevalence of teachers who bully students and school behavioral problems reflected in suspensions from school. METHOD: A convenience sample of 214 teachers answered an anonymous questionnaire about their perceptions of teachers who bully students and their own practices. Teachers were grouped into whether they taught at schools with low, medium, or high rates of suspensions. Analyses of variance were used to analyze continuous variables, and chi-square statistics were used to study categorical variables. RESULTS: Teachers from schools with high rates of suspensions reported that they themselves bullied more students, had experienced more bullying when they were students, had worked with more bullying teachers over the past 3 years, and had seen more bullying teachers over the past year. CONCLUSIONS: These findings suggest that teachers who bully students may have some role in the etiology of behavioral problems in schoolchildren.

Adult↗
PubMed2005

A developmental approach to mentalizing communities: I. A model for social change.

A developmental model is proposed applying attachment theory to complex social systems to promote social change. The idea of mentalizing communities is outlined with a proposal for three projects testing the model: ways to reduce bullying and create a peaceful climate in schools, projects to promote compassion in cities by a focus of end-of-life care, and a mentalization-based intervention into parenting style of borderline and substance abusing parents.

Adult↗
PubMed2005

A developmental approach to mentalizing communities: II. The Peaceful Schools experiment.

This paper summarizes a theoretical argument for the use of a mentalization-based approach to the systemic problem of school bullying. The Peaceful Schools Project of the Menninger Department of Psychiatry, Baylor College of Medicine, is an experimental test of this model. Data is presented from a randomized controlled trial of this intervention in nine elementary schools in the Midwest.

Attention Deficit and Disruptive Behavior Disorder↗
PubMed2005

Psychodynamic psychotherapies: evidence-based practice and clinical wisdom.

This article is based on an exhaustive review of the psychotherapy outcomes literature, undertaken originally at the instigation of the UK Department of Health by Roth and Fonagy (Department of Health, 1995). We have recently updated this review (Fonagy, Target, Cottrell, Phillips, & Kurtz, 2002; Roth & Fonagy, 2004) and extended it to identify all studies of psychoanalytic psychotherapy. The usual methods for identifying studies were employed (Fonagy, Target, et al., 2002; Roth & Fonagy, in press). The key questions that should be asked of this literature given the current state of research in this area (also see Westen, Morrison, & Thompson-Brenner, 2004) are: Are there any disorders for which short-term psychodynamic psychotherapy (STPP) can be considered evidence-based, Are there any disorders for which STPP is uniquely effective as either the only evidence-based treatment or as a treatment that is more effective than alternatives, and Is there any evidence base for long-term psychodynamic psychotherapy (LTPP) either in terms of achieving effects not normally associated with short-term treatment or addressing problems that have not been addressed by STPP? In this context, short-term therapy is conceived of as a treatment of around 20 sessions delivered usually once weekly.

Humans↗
PubMed2005

Rethinking adult attachment: a study of expert consensus.

Self-report questionnaires designed to assess attachment in adulthood potentially confound global valence of relationships (e.g., liking and disliking) with attachment. The authors surveyed an international panel of experts to develop items for a new measure of attachment that systematically distinguishes between attachment and non-attachment aspects of relationships. The survey yielded a large set of items on which there is consensus in five domains: secure attachment, dismissing attachment, preoccupied attachment, positive non-attachment, and negative non-attachment. This report presents a content analysis of the core themes in each of these five domains and discusses implications of these results for conceptualizing and researching adult attachment.

Adult↗
PubMed2004

Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data.

BACKGROUND: Questions concerning the safety of selective serotonin reuptake inhibitors (SSRIs) in the treatment of depression in children led us to compare and contrast published and unpublished data on the risks and benefits of these drugs. METHODS: We did a meta-analysis of data from randomised controlled trials that evaluated an SSRI versus placebo in participants aged 5-18 years and that were published in a peer-reviewed journal or were unpublished and included in a review by the Committee on Safety of Medicines. The following outcomes were included: remission, response to treatment, depressive symptom scores, serious adverse events, suicide-related behaviours, and discontinuation of treatment because of adverse events. FINDINGS: Data for two published trials suggest that fluoxetine has a favourable risk-benefit profile, and unpublished data lend support to this finding. Published results from one trial of paroxetine and two trials of sertraline suggest equivocal or weak positive risk-benefit profiles. However, in both cases, addition of unpublished data indicates that risks outweigh benefits. Data from unpublished trials of citalopram and venlafaxine show unfavourable risk-benefit profiles. INTERPRETATION: Published data suggest a favourable risk-benefit profile for some SSRIs; however, addition of unpublished data indicates that risks could outweigh benefits of these drugs (except fluoxetine) to treat depression in children and young people. Clinical guideline development and clinical decisions about treatment are largely dependent on an evidence base published in peer-reviewed journals. Non-publication of trials, for whatever reason, or the omission of important data from published trials, can lead to erroneous recommendations for treatment. Greater openness and transparency with respect to all intervention studies is needed.

Adolescent↗