Does Improving Mentalizing Skills Help Reduce Depression During Therapy?

What you need to know

• The study examined how changes in mentalizing ability related to reductions in depressive symptoms during 3 months of intensive inpatient psychodynamic therapy.

• Mentalizing is the ability to understand one’s own and others’ mental states, including thoughts, feelings, and intentions.

• Patients’ depressive symptoms decreased significantly over the course of therapy and continued to improve at 1-year follow-up.

• Patients with higher initial mentalizing ability showed greater reductions in depressive symptoms during therapy.

• However, improvements in mentalizing during therapy did not directly predict session-by-session changes in depression, suggesting mentalizing may not be a primary mechanism of change.

Understanding mentalizing and depression

Mentalizing refers to our ability to understand the mental states - thoughts, feelings, wishes, and intentions - of ourselves and others. It allows us to make sense of social interactions and regulate our emotions. Researchers have proposed that difficulties with mentalizing may play an important role in depression.

People with depression often struggle to reflect on their own thoughts and feelings or to consider alternative perspectives. They may become stuck in negative thought patterns and have trouble understanding the intentions of others. By improving mentalizing skills, the hope is that people can gain more flexible ways of thinking about themselves and their relationships.

How the study worked

The researchers studied 56 patients receiving 3 months of intensive inpatient psychodynamic therapy for depression at a psychiatric hospital in Norway. The patients completed weekly questionnaires measuring their depressive symptoms and mentalizing abilities throughout treatment. They were also assessed again at a 1-year follow-up.

The study looked at two key aspects of mentalizing:

1. Certainty about mental states - How confident people feel in their ability to understand thoughts and feelings

2. Uncertainty about mental states - How much people recognize the limits of their ability to know what others are thinking and feeling

By measuring these factors each week, the researchers could examine how changes in mentalizing related to changes in depressive symptoms over the course of therapy.

Key findings on depression and therapy outcomes

Overall, patients’ depressive symptoms decreased significantly during the 3 months of intensive therapy. On average, symptoms continued to improve in the year following treatment as well. This suggests the therapy had lasting benefits for many patients.

Interestingly, depressive symptoms tended to temporarily increase in the first few weeks of therapy before declining. The researchers note this may be due to the emotional challenges of beginning intensive therapy and confronting difficult feelings.

The role of mentalizing skills

The study found that patients who started therapy with higher mentalizing abilities tended to have better outcomes:

• Those with greater certainty about mental states showed faster reductions in depressive symptoms.

• Patients who were better able to recognize the uncertainty of mental states also improved more quickly.

This suggests that having more developed mentalizing skills may help people engage more effectively in therapy and make use of therapeutic insights.

However, the relationship between mentalizing and depression was complex. On average, patients’ mentalizing abilities did not show significant improvement over the course of therapy. There were individual differences, with some patients improving their mentalizing while others did not.

Importantly, session-by-session improvements in mentalizing did not directly predict subsequent reductions in depression. This indicates that enhancing mentalizing may not be the primary mechanism driving symptom change in this type of therapy.

Conclusions

• Intensive inpatient psychodynamic therapy was associated with significant reductions in depressive symptoms that were maintained 1 year later.

• Higher initial mentalizing ability predicted better outcomes, suggesting it may help patients engage more effectively in therapy.

• However, improving mentalizing does not appear to be the main factor driving symptom change during therapy sessions.

• More research is needed to understand how mentalizing skills interact with other therapeutic processes to influence depression outcomes.

The findings highlight the complex relationship between mentalizing abilities and depression. While better mentalizing skills seem to support the therapy process, simply improving mentalizing may not be sufficient to alleviate depressive symptoms. The study underscores the need for further research to clarify how different therapeutic processes work together to help people recover from depression.