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Background: Federal deregulation of opioid agonist therapies are an attractive policy option to improve access to opioid use disorder care and achieve widespread beneficial impacts on growing opioid-related harms. There have been few evaluations of such policy interventions and understanding effects can help policy planning across jurisdictions. Methods: Using health administrative data from eight of ten Canadian provinces, this study evaluated the impacts of Health Canada's decision in May 2018 to rescind the requirement for Canadian health professionals to obtain an exemption from the Canadian Drugs and Substance Act to prescribe methadone for opioid use disorder. Over the study period of June 2017 to May 2019, we used descriptive statistics to capture overall trends in the number of agonist therapy prescribers across provinces and we used interrupted time series analysis to determine the effect of this decision on the trajectories of the agonist therapy prescribing workforces. Results: There were important baseline differences in the numbers of agonist therapy prescribers. The province with the highest concentration of prescribers had 7.5 more prescribers per 100,000 residents compared to the province with the lowest. All provinces showed encouraging growth in the number of prescribers through the study period, though the fastest growing province grew 4.5 times more than the slowest. Interrupted time series analyses demonstrated a range of effects of the federal policy intervention on the provinces, from clearly positive changes to possibly negative effects. Conclusions: Federal drug regulation policy change interacted in complex ways with provincial health professional regulation and healthcare delivery, kaleidoscoping the effects of federal policy intervention. For Canada and other health systems such as the US, federal policy must account for significant subnational variation in OUD epidemiology and drug regulation to maximize intended beneficial effects and mitigate the risks of negative effects. [ABSTRACT FROM AUTHOR]

This commentary reviews the Journal of Personality Disorders special issue "Interpersonal Trust and Borderline Personality Disorder: Insights From Clinical Practice and Research," published in Volume 37, Number 5, October 2023. [ABSTRACT FROM AUTHOR]

ObjectiveMethodResultsConclusionNo systematic review was identified investigating the influence of perceived therapist credibility on treatment outcomes. Extant treatment credibility reviews have focused on early perceptions without considering influence of various therapy phases. This study aimed to examine the relationship between perceived treatment and therapist credibility and treatment outcomes, while considering the timing of the credibility assessment as a potential moderator.Articles published in English peer-reviewed journals containing at least one quantitative measure of credibility and treatment outcome regarding face-to-face therapist-delivered interventions were eligible. PsycINFO, MEDLINE and Embase online databases were last searched on April 5th, 2023, and the Effective Public Health Practice Project tool was used to assess the study quality. Correlations between treatment credibility and outcomes, and therapist credibility were calculated separately.Analysis of 27 studies revealed a positive association between perceived treatment credibility and treatment outcome (r = 0.15,95%CI = 0.09,0.21,p < 0.001,n = 2061). Nine studies showed a strong association between perceived therapist credibility and outcome (r = 0.35,95%CI = 0.18,0.51;p < .001,n = 1161). No significant moderator found in both meta-analyses.Findings suggest that clients’ perceptions of higher credibility – whether concerning the treatment or the therapist – are associated with better therapeutic outcomes. Constraints in inclusion criteria and the small sample size in eligible studies were notable limitations. [ABSTRACT FROM AUTHOR]

This article reviews the current status of research on the relationship between attachment and trauma in developmental psychopathology. Beginning with a review of the major issues and the state-of-the-art in relation to current thinking in the field of attachment about the impact of trauma and the inter-generational transmission of trauma, the review then considers recent neurobiological work on mentalizing and trauma and suggests areas of new development and implications for clinical practice. [ABSTRACT FROM AUTHOR]

Focusing on imagination and the social context in the generation of conviction narratives, we propose that these elements are dynamically related to one another, and crucially that it is the nature of this relationship that determines individuals' level of epistemic openness and capacity to respond adaptively to update their narratives in a way that increases the possibility of more successful decision-making. [ABSTRACT FROM AUTHOR]

This paper proposes a model for developmental psychopathology that is informed by recent research suggestive of a single model of mental health disorder (the p factor) and seeks to integrate the role of the wider social and cultural environment into our model, which has previously been more narrowly focused on the role of the immediate caregiving context. Informed by recently emerging thinking on the social and culturally driven nature of human cognitive development, the ways in which humans are primed to learn and communicate culture, and a mentalizing perspective on the highly intersubjective nature of our capacity for affect regulation and social functioning, we set out a cultural-developmental approach to psychopathology. [ABSTRACT FROM AUTHOR]

A theoretical paper in which the theory of mentalizing and epistemic trust are applied to thinking about the relationship between social systems and individual subjective experiences, and how this relationship may be shaped by developmental history, such as attachment experiences, exposure to childhood adversity, and the experience of being mentalized. We suggest that the experience of being mentalized and openness to epistemic trust may be the mechanism by which individual experiences of psychic distress, perception of self-agency and perceptions of others, are both influenced by and shape wider social phenomena and social change. We consider the impact of social inequalities and the breakdown of political legitimacy on mentalizing, epistemic trust and psychopathology, and argue that optimal individual outcomes cannot always be achieved without adaptation of the wider social environment. [ABSTRACT FROM AUTHOR]

Mentalizing is the human capacity to understand actions of others and one's own behavior in terms of intentional mental states, such as feelings, wishes, goals and desires. Mentalizing is a transtheoretical and transdiagnostic concept that has been applied to understanding vulnerability to psychopathology and has attracted considerable research attention over the past decades. This paper reports on a pre-registered systematic review of evidence concerning the role of mentalizing as a moderator and mediator in psychological interventions in adults. Studies in adults were reviewed that address the following questions: (a) does pre-treatment mentalizing predict treatment outcome; (b) do changes in mentalizing across treatment predict outcome; (c) does adherence to the principles or protocol of mentalization-based treatment predict outcome; and (d) does strengthening in-session mentalizing impact the therapeutic process via improved alliance, alleviated symptoms, or improved interpersonal functioning? Results suggest that mentalizing might be a mediator of change in psychotherapy and may moderate treatment outcome. However, the relatively small number of studies (n = 33 papers based on 29 studies, totaling 3124 participants) that could be included in this review, and the heterogeneity of studies in terms of design, measures used, disorders included, and treatment modalities, precluded a formal meta-analysis and limited the ability to draw strong conclusions. Therefore, theoretical and methodological recommendations for future research to improve the quality of existing research in this area are formulated. • Mentalizing is the capacity to interpret oneself and others in terms of intentional mental states. • Mentalizing is a transtheoretical and transdiagnostic concept implicated in vulnerability to psychopathology. • A pre-registered systematic review of evidence concerning the role of mentalizing as a moderator and mediator in psychological interventions in adults is presented • Mentalizing might be a mediator of change in psychotherapy and may moderate treatment outcome. • The relatively small number of studies and their methodological heterogeneity limited the ability to draw strong conclusions. [ABSTRACT FROM AUTHOR]

Epistemic trust (ET) refers to trust in communicated knowledge. This paper describes the development and validation of a new self-report questionnaire, the Epistemic Trust, Mistrust and Credulity Questionnaire (ETMCQ). We report on two studies (Study 1, n = 500; Study 2, n = 705) examining the psychometric properties of the ETMCQ and the relationship between EMTCQ scores (i.e., an individual's epistemic stance) and exposure to adverse childhood experiences, mental health symptoms, attachment, mentalizing and general self-efficacy. The factor structure of the ETMCQ was examined using Exploratory and Confirmatory Factor Analyses, and its reliability and test-retest reliability were tested. Both studies yielded three correlated yet distinct factors–Trust, Mistrust and Credulity–and confirmed the reliability and validity of the ETMCQ. Preregistered hypotheses were confirmed and replicated across both studies. Main findings suggest intriguing links between the ETMCQ and developmental psychopathology constructs and are consistent with thinking on the role of epistemic stance in undermining adaptation and increasing the developmental risk of mental health problems. Mistrust and Credulity scores were associated with childhood adversity and higher scores on the global psychopathology severity index and both factors partially mediated the link between early adversity and mental health symptoms. Mistrust and Credulity were positively associated with difficulties in understanding mental states and insecure attachment styles. Post-hoc analysis identified that different attachment styles were associated with differences in epistemic stance. In addition, Trust was not associated with reduced levels of mental health symptoms and did not moderate the impact of childhood adversity–findings are congruent with the suggestion that the reduction of mistrust and credulity may be crucial common factors in promoting resilience and the effectiveness of psychotherapeutic interventions. This investigation and the ETMCQ provide an empirical measure of what until now has been largely a theoretical concept and open new avenues for future research. [ABSTRACT FROM AUTHOR]

Borderline personality disorder (BPD) is a relatively highly prevalent psychiatric disorder that is associated with very high personal and socioeconomic costs. This paper provides a state-of-the-art review of the relationship between complex trauma and key features of BPD, with a focus on problems with self-coherence and self-continuity. We first review evidence for the high prevalence of complex trauma in BPD patients. This is followed by a discussion of emerging knowledge concerning the biobehavioral mechanisms involved in problems related to self and identity in BPD. We emphasize three biobehavioral systems that are affected by complex trauma and are centrally implicated in identify diffusion in BPD: the attachment system, mentalizing or social cognition, and the capacity for epistemic trust-that is, an openness to the reception of social communication that is personally relevant and of generalizable significance. We formulate a new approach to personality and severe personality disorders, and to problems with self and identity in these disorders, rooted in a social-communicative understanding of the foundations of selfhood. We also discuss how extant evidence-based treatments address the above-mentioned biobehavioral systems involved in identity diffusion in BPD and related disorders, and the supporting evidence. We close the paper with recommendations for future research. [ABSTRACT FROM AUTHOR]

The article offers update on diagnostic issues for borderline personality disorder for continuing medical education (CME) intended for psychiatrists, psychologists, primary care physicians, physician assistants, nurse practitioners and other health care professionals. It outlines the learning objectives of the CME activity and states the policy of CME Outfitters LLC in all its CME and continuing education (CE) activities.

This commentary argues the case for developmental psychopathology in understanding social learning. Informed by work on "epistemic disruption," we have described difficulties with social learning associated with many forms of psychopathology. Epistemic disruption manifests in an inability to move between innovation and conformity, and arises from poor mentalizing, which generates difficulties in identifying social cues that trigger the correct stance. [ABSTRACT FROM AUTHOR]

This article attempts to trace the intellectual history of the relationship between attachment theory and psychoanalytic thinking, and considers where we are now in the discourse between the two fields. We describe some of the points of convergence, as well as areas of continuing contention, and suggest future directions for attachment work which have a bearing on its relationship with psychoanalysis. In particular, mentalizing theory is discussed as a line of thinking that draws on both attachment ideas and psychoanalysis; recent developments in mentalizing are described within an argument about the future development of attachment thinking. Two constructs connected to attachment and mentalizing, epistemic trust and the concept of a general factor in psychopathology, are discussed along with the implications of these ideas for thinking about the common factors that effective psychotherapeutic interventions share. [ABSTRACT FROM AUTHOR]

This article begins with a reflection on the tensions that have existed at the intersection of attachment theory, psychoanalysis, and the use of empirical research methods. This discourse is described as having evolved considerably, involving some elements of intellectual détente and other elements of entrenchment (on both sides). It is suggested that future debate may revolve around the idea that many forms of psychopathology may be understood as fundamentally social in nature. Recognizing the salience of the communication of social knowledge—transmitted via epistemic trust—may be key to reconceptualizing both the origins of psychological disorder, and the processes that underlie effective treatments. [ABSTRACT FROM AUTHOR]

An interview with Chloe Campbell, Dental Operations Assistant, Genix Healthcare Ltd, is presented. She mentions that at school as she was good at sports and athletics and wanted to be a physical education teacher. She says it was delightful after being offered a job at this place and also because the role felt like a great opportunity.

An overview of the work the approach taken by the Anna Freud National Centre for Children and Families in the rapid transition to remote working in response to the coronavirus lockdown. We outline some of the challenges of remote working and how we are seeking to mitigate them, informed by the over‐riding principle that individual relationships and the experiences of the child, young person and family must remain the central concern. The importance of maintaining a mentalising stance in remote working is discussed. We argue that a mentalising relationship which generates epistemic trust is possible in remote working, but this will require particular thought and effort on the part of the therapist. In particular, it is suggested that mentalising processes can be supported in remote working through, in the absence of the more implicit communications that are possible in face‐to‐face work, more explicit communications about mental states. [ABSTRACT FROM AUTHOR]

Examines the policy towards juvenile delinquency in colonial Kenya. Impact of crime and disorder on the community; Effect of urbanization and detribalization on young people; Issue on the regulation of working class families and childhood.

Introduction: In recent years, the concept of epistemic trust has emerged as a critical factor in understanding psychopathology, particularly within the context of personality disorders. A self-report instrument, the Epistemic Trust, Mistrust, and Credulity Questionnaire (ETMCQ), has demonstrated its validity among English and Italian adult populations. However, extending its applicability to adolescents is essential for comprehending the role of epistemic trust in the development of mental disorders. The aim of this study was to validate the ETMCQ within the Italian adolescent demographic. Methods: Data were gathered from a wide selection of middle and high schools across Italy. The data collection started on 01/03/2022 and ended on 30/06/2022. Besides the ETMCQ (Study 1 = 662 participants, 12–18 years old, M = 15.56, SD = 2.20; 324 females, 338 males), we also administered other self-report instruments measuring mentalization, emotional dysregulation, general levels of psychopathology, and interpersonal trust in a smaller groups (Study 2 = 417 participants, aged from 12–19 years old, M = 15.64; SD = 2.08; 249 females, 168 males). Results: Our findings provide empirical validation for the theoretical framework concerning the role of epistemic trust in psychological functioning and substantiate the validity of ETMCQ as a measure to assess it among teenagers. Conclusions: The ETMCQ is a valid and promising instrument for adolescent populations; its ease and brevity of administration could make it a valuable tool both in clinical and research contexts, shedding light on the role of epistemic trust in mental health. [ABSTRACT FROM AUTHOR]

Introduction: Mentalization, operationalized as reflective functioning (RF), allows individuals to interpret actions as caused by intentional mental states. Previous research highlighted the gender‐specific associations between adolescents' internalizing and externalizing difficulties and mentalizing impairments. In addition, research suggested that mentalizing facilitates the creation of epistemic trust (ET) to evaluate social information as accurate, reliable, and relevant. However, few investigations explored the concurrent associations between RF, ET, and adolescent psychopathology. Methods: A sample of 447 Italian cisgender adolescents (57% assigned females at birth; age range 12–19 years old; Mage = 15.54, SD = 1.98) self‐reported RF (RFQY‐5), ET towards mother, father, and peers (IPPA) and mental health problems (YSR‐112). Gender‐specific structural equation modeling explored the associations between RF, ET, and internalizing/externalizing problems. Results: Results suggested an excellent fit for the theoretical model and revealed gender‐related associations. In females, findings suggest that ET mediates the association between RF and psychopathology, with indirect associations from RF through ET to lower internalizing and externalizing problems. However, in males, RF and ET display independent associations with psychopathology. Conclusion: Overall, findings suggest that ET might be a transdiagnostic factor playing different roles associated with adolescent psychopathology. Indeed, links between RF and ET might help to explore gender differences in mental health problems in this developmental phase. [ABSTRACT FROM AUTHOR]

Building on the notion of epistemic trust as facilitating social learning, in this article we clarify how interventions from mentalization-based treatment (MBT) for borderline personality disorder generate this process. We suggest first that being mentalized is a critical cue in interactions to establish epistemic trust and second that epistemic mistrust may represent a final common pathway through which aversive relational experiences in the past may exert their influence on treatments—both as a disposition of the patient and as a characteristic of the therapist-patient encounter. By charting MBT interventions from the initial assessment and formulation, through individual and group therapy sessions, to re-engaging with the wider social environment, we examine how each of these can establish a "we-mode," an interpersonal experience associated with being mentalized that unlocks the barrier posed by epistemic vigilance. In addition, implications for relational mentalizing and rupture and repair within the therapeutic relationship are discussed. [ABSTRACT FROM AUTHOR]

Recently, researchers from developmental and clinical psychology highlighted epistemic trust (ET) as a key factor for personality disorders. ET is intended as the mental openness to information coming from others during social exchanges. ET develops from signals called ostensive cues, delivered through facial expressions during interactions in a secure attachment context. Similarly, interpersonal trust (IT) refers to the perception of others as not harmful, which is also developed through secure attachment relationships. Our purpose was to suggest a conceptualization of ET as a specific facet of IT. We hypothesize that positive experiences of caregiving promote IT development that includes a specific sense of trust toward others' knowledge. Moreover, we suggest that the early ability to infer a judgment of trustworthiness from facial cues is the starting point for developing both IT and ET. This conceptualization supports the role of considering both IT and ET in the development of borderline pathology. [ABSTRACT FROM AUTHOR]

Objectives: To explore the feasibility and effectiveness of telehealth-supervised exercise for adults with Systemic lupus erythematosus (SLE). Methods: This was a non-randomised controlled pilot trial comparing telehealth-supervised exercise (8 weeks, 2 days/week, 45 min, moderate intensity) plus usual care with usual care alone. Mixed methods were used to assess change in fatigue (FACIT-fatigue), quality of life (SF36), resting fatigue and pain (11-point scale), lower body strength (five-time sit-to-stand) and endurance (30 s sit-to-stand), upper body endurance (30 s arm curl), aerobic capacity (2 min step test), and experience (survey and interviews). Group comparison was performed statistically using a two-sample T-test or Mann–Whitney U-test. Where known, we used MCID or MCII, or assumed a change of 10%, to determine clinically meaningful change within groups over time. Interviews were analysed using reflexive thematic analysis. Results: Fifteen female adults with SLE were included (control group n = 7, exercise group n = 8). Statistically significant differences between groups, in favour of the exercise intervention, were noted for SF36 domain emotional well-being (p = 0.048) and resting fatigue (p = 0.012). There were clinically meaningful improvements over time for FACIT-fatigue (+6.3 ± 8.3, MCID >5.9), SF36 domains physical role functioning (+30%), emotional role functioning (+55%), energy/fatigue (+26%), emotional well-being (+19%), social functioning (+30%), resting pain (−32%), and upper body endurance (+23%) within the exercise group. Exercise attendance was high (98%, 110/112 sessions); participants strongly agreed (n = 5/7, 71%) or agreed (n = 2/7, 29%) they would do telehealth-supervised exercise again and were satisfied with the experience. Four themes emerged: (1) ease and efficiency of exercising from home, (2) value of live exercise instruction, (3) challenges of exercising at home, and (4) continuation of telehealth-supervised exercise sessions. Conclusion: Key findings from this mixed-method investigation suggest that telehealth-supervised exercise was feasible for, and well-accepted by, adults with SLE and resulted in some modest health improvements. We recommend a follow-up RCT with more SLE participants. [ABSTRACT FROM AUTHOR]

Objective: Mentalizing is the ability to interpret one's own and others' behavior as driven by intentional mental states. Epistemic trust (openness to interpersonally transmitted information) has been associated with mentalizing. Balanced mentalizing abilities allow people to cope with external and internal stressors. Studies show that social isolation imposed by the COVID‐19 pandemic was highly stressful for most people, especially for adolescents. Here we examine whether mentalizing and epistemic trust were protective factors in relation to emotional distress during the lockdown. Method: A total of 131 nonclinical adolescents, aged between 12 and 18 years, were evaluated during the lockdown using the Reflective Functioning Questionnaire for Youth, Inventory of Parent and Peer Attachment, Perceived Stress Scale, and Difficulties in Emotion Regulation Scale. Results: Results from network analysis showed that epistemic trust and mentalizing were negatively associated with perceived stress and emotion dysregulation. Epistemic trust in fathers was associated with level of perceived stress, and epistemic trust in mothers with emotion dysregulation. Conclusion: These findings suggest that epistemic trust and the capacity to mentalize were low in adolescents during lockdown, and this was associated with high levels of stress. However, robust levels of epistemic trust and mentalizing may have acted as protective factors that buffered individuals from the risk of emotional dysregulation during the lockdown. [ABSTRACT FROM AUTHOR]

The construct of epistemic trust has received much consideration in recent psychological literature, even though mainly from a theoretical perspective. The overall aim of this study was to validate the first self-report measure of epistemic trust–the Epistemic Trust, Mistrust, and Credulity Questionnaire (ETMCQ)–in an Italian sample. Our primary goal was to test the factorial validity of the instrument, also exploring the influence of age, gender, and level of education on epistemic trust (Study 1, n = 843). Secondarily, we investigated the associations between epistemic trust, mistrust, credulity, and other aspects of psychological functioning, as well as with the presence of adverse childhood experiences in a smaller number of participants (Study 2, n = 445). Besides the ETMCQ, the survey included an ad hoc questionnaire investigating socio-demographic characteristics and self-report measures of reflective functioning, mentalized affectivity, traumatic experiences, attachment, and psychological symptoms. Statistical analysis showed a three-factor hierarchical structure similar to the model proposed in the original validation, with some differences that suggest an influence of cultural factors in determining individuals' epistemic stance. Our results corroborate previous theoretical contributions regarding the association between epistemic trust and psychological wellbeing, and between epistemic disruptions and higher levels of psychological suffering. Both Mistrust and Credulity were significantly related to the presence of childhood traumatic experiences, attachment avoidance and anxiety, lower levels of mentalization, lower abilities in emotional regulation, and higher levels of psychopathological symptoms. The ETMCQ represents an easily administered and time-effective tool. Its use could pave the way for interesting clinical and theoretical findings. [ABSTRACT FROM AUTHOR]

Although the theory of epistemic trust has started informing research in clinical populations and psychotherapy, no study has yet explored the phenomenon of epistemic trust and mistrust in depressed adolescents receiving psychotherapy. The present study aims to address this gap by creating a typology of depressed adolescents' experiences regarding their different journeys through the course of psychotherapy in relation to issues of epistemic trust and mistrust over a 2-year period. This study is based on a post hoc analysis of interview data collected for a broader purpose. A total of 45 semistructured interviews at three time points were conducted with 15 adolescents (80% female; Mage = 15.28, SD = 1.79) who entered treatment with indications of epistemic mistrust or hypervigilance. These interviews were qualitatively analyzed using ideal type analysis. Three distinct journeys of adolescents' experiences were identified. Some experienced a shift from epistemic mistrust to epistemic trust which seemed to be associated with the experience of therapy; other adolescents also showed a shift but did not consider it as an outcome of therapy; and finally, some adolescents reported continued mistrust over the 2-year period. An interpersonal component within or beyond therapy may be the key to breaking the vicious cycle of epistemic mistrust and generating epistemic trust; but not all depressed adolescents in therapy achieve this. Particular attention should be drawn to depressed adolescents who have difficulty making use of therapy and/or their broader social environment. Psychological interventions may need to openly address their issues of mistrust in early sessions as epistemic mistrust or hypervigilance may hinder paths to learning both within and beyond therapy. Treatments that intervene at the level of the wider social system are encouraged. [ABSTRACT FROM AUTHOR]

Childhood neglect is the most common type of maltreatment, ranging from minor isolated incidents to consistent failures in emotional/physical caregiving. It has been associated with developmental impairments and considered a risk factor for the emergence of psychopathology, particularly internalizing disorders. This study aimed to explore individual differences in response to the continuum of severity of neglect in community adolescents, as well as the role of specific cognitive emotion regulation strategies (CERSs) as mediators between childhood neglect and current internalizing symptoms. Low-risk adolescents (12–19 years old; M age 15.88 years; N = 123; 64 Females) completed questionnaires assessing these experiences. We employed a regression model and a simple mediation analyses. Findings indicate a positive association between childhood neglect, internalizing behaviors, and the adoption of self-blame as CERS. Moreover, the use of self-blame in response to everyday stress partially mediated the relationship between neglect and internalizing behaviors (effect size:.28). Findings support the hypothesis that even in a low risk sample, neglect is associated with internalizing symptoms, and highlight the importance of assessing individual differences in the experience of neglect. Moreover, the mediation effect of the CERSs of self-blame might serve as a potential target for psychotherapeutic interventions aimed at reducing internalizing symptoms. [ABSTRACT FROM AUTHOR]

tRNA nucleotidyl transferase 1 (TRNT1) is an essential enzyme catalyzing the addition of terminal cytosine-cytosine-adenosine (CCA) trinucleotides to all mature tRNAs, which is necessary for aminoacylation. It was recently discovered that partial loss-of-function mutations in TRNT1 are associated with various, seemingly unrelated human diseases including sideroblastic anemia with B-cell immunodeficiency, periodic fevers and developmental delay (SIFD), retinitis pigmentosa with erythrocyte microcytosis, and progressive B-cell immunodeficiency. In addition, even within the same disease, the severity and range of the symptoms vary greatly, suggesting a broad, pleiotropic impact of imparting TRNT1 function on diverse cellular systems. Here, we describe the current state of knowledge of the TRNT1 function and the phenotypes associated with mutations in TRNT1. [ABSTRACT FROM AUTHOR]

Background: Over 600 RCTs have demonstrated the effectiveness of psychosocial interventions for children and young people's mental health, but little is known about the long-term outcomes. This systematic review sought to establish whether the effects of selective and indicated interventions were sustained at 12 months. Method: We conducted a systematic review and meta-analysis focusing on studies reporting medium term outcomes (12 months after end of intervention). Findings: We identified 138 trials with 12-month follow-up data, yielding 165 comparisons, 99 of which also reported outcomes at end of intervention, yielding 117 comparisons. We found evidence of effect relative to control at end of intervention (K = 115, g = 0.39; 95% CI: 0.30–0.47 I2 = 84.19%, N = 13,982) which was maintained at 12 months (K = 165, g = 0.31, CI: 0.25–0.37, I2 = 77.35%, N = 25,652) across a range of diagnostic groups. We explored the impact of potential moderators on outcome, including modality, format and intensity of intervention, selective or indicated intervention, site of delivery, professional/para-professional and fidelity of delivery. We assessed both risk of study bias and publication bias. Conclusions: Psychosocial interventions provided in a range of settings by professionals and paraprofessionals can deliver lasting benefits. High levels of heterogeneity, moderate to high risk of bias for most studies and evidence of publication bias require caution in interpreting the results. Lack of studies in diagnostic groups such as ADHD and self-harm limit the conclusions that can be drawn. Programmes that increase such interventions' availability are justified by the benefits to children and young people and the decreased likelihood of disorder in adulthood. [ABSTRACT FROM AUTHOR]

This paper seeks to elucidate the phenomenological experience of psychotherapy in the context of the theory of mentalizing and epistemic trust. We describe two related phenomenological experiences that are the domain of psychotherapeutic work. The first is the patient's direct experience of their own personal narrative being recognized, marked and reflected back to them by the therapist. Secondly, this intersubjective recognition makes possible the regulation and alignment of the patient's imaginative capacity in relation to phenomenological experiences. In describing three aspects of the communication process that unfold in effective psychotherapeutic interventions – (1) the epistemic match, (2) improving mentalizing and (3) the re-emergence of social learning – the way in which any effective treatment is embedded in metacognitive processes about the self in relation to perceptual social reality is explained. In particular, attention is drawn to wider social determinants of psychopathology. We discuss the possible mechanism for the relationship between the socioeconomic environment and psychopathology, and the implications of this for psychotherapeutic treatment. [ABSTRACT FROM AUTHOR]