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Does improvement in maternal attachment representations predict greater maternal sensitivity, child attachment security and lower rates of relapse to substance use? A second test of Mothering from the Inside Out treatment mechanisms.
J Subst Abuse Treat. 2018 02; 85:21-30.JS

Abstract

In this study, we replicated a rigorous test of the proposed mechanisms of change associated with Mothering from the Inside out (MIO), an evidence-based parenting therapy that aims to enhance maternal reflective functioning and mental representations of caregiving in mothers enrolled in addiction treatment and caring for young children. First, using data from 84 mothers who enrolled in our second randomized controlled trial, we examined whether therapist fidelity to core MIO treatment components predicted improvement in maternal reflective functioning and mental representations of caregiving, even after taking fidelity to non-MIO components into account. Next, we examined whether improvement in directly targeted outcomes (e.g., maternal mentalizing and mental representations of caregiving) led to improvements in the indirectly targeted outcome of maternal caregiving sensitivity, even after controlling for other plausible competing mechanisms (e.g., improvement in maternal psychiatric distress and substance use). Third, we examined whether improvement in targeted parenting outcomes (e.g., maternal mentalizing, mental representations of caregiving and caregiving sensitivity) was associated in improvement in child attachment status, even after controlling for competing mechanisms (e.g., improvement in maternal psychiatric distress and substance use). Finally, we examined whether improvement in maternal mentalizing and caregiving representations was associated with a reduction in relapse to substance use. Support was found for the first three tests of mechanisms but not the fourth. Implications for future research and intervention development are discussed.

Authors+Show Affiliations

Yale University School of Medicine, Department of Psychiatry, United States; Yale Child Study Center, United States. Electronic address: nancy.suchman@yale.edu.Yale University School of Medicine, Department of Psychiatry, United States.University of California, Irvine, Department of Psychology and Social Behavior, United States.Yale University School of Medicine, Department of Psychiatry, United States; Yale Child Study Center, United States.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

29291768

Citation

Suchman, Nancy E., et al. "Does Improvement in Maternal Attachment Representations Predict Greater Maternal Sensitivity, Child Attachment Security and Lower Rates of Relapse to Substance Use? a Second Test of Mothering From the Inside Out Treatment Mechanisms." Journal of Substance Abuse Treatment, vol. 85, 2018, pp. 21-30.
Suchman NE, DeCoste C, Borelli JL, et al. Does improvement in maternal attachment representations predict greater maternal sensitivity, child attachment security and lower rates of relapse to substance use? A second test of Mothering from the Inside Out treatment mechanisms. J Subst Abuse Treat. 2018;85:21-30.
Suchman, N. E., DeCoste, C., Borelli, J. L., & McMahon, T. J. (2018). Does improvement in maternal attachment representations predict greater maternal sensitivity, child attachment security and lower rates of relapse to substance use? A second test of Mothering from the Inside Out treatment mechanisms. Journal of Substance Abuse Treatment, 85, 21-30. https://doi.org/10.1016/j.jsat.2017.11.006
Suchman NE, et al. Does Improvement in Maternal Attachment Representations Predict Greater Maternal Sensitivity, Child Attachment Security and Lower Rates of Relapse to Substance Use? a Second Test of Mothering From the Inside Out Treatment Mechanisms. J Subst Abuse Treat. 2018;85:21-30. PubMed PMID: 29291768.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does improvement in maternal attachment representations predict greater maternal sensitivity, child attachment security and lower rates of relapse to substance use? A second test of Mothering from the Inside Out treatment mechanisms. AU - Suchman,Nancy E, AU - DeCoste,Cindy, AU - Borelli,Jessica L, AU - McMahon,Thomas J, Y1 - 2017/11/21/ PY - 2017/08/18/received PY - 2017/11/15/revised PY - 2017/11/17/accepted PY - 2018/1/3/entrez PY - 2018/1/3/pubmed PY - 2019/10/17/medline SP - 21 EP - 30 JF - Journal of substance abuse treatment JO - J Subst Abuse Treat VL - 85 N2 - In this study, we replicated a rigorous test of the proposed mechanisms of change associated with Mothering from the Inside out (MIO), an evidence-based parenting therapy that aims to enhance maternal reflective functioning and mental representations of caregiving in mothers enrolled in addiction treatment and caring for young children. First, using data from 84 mothers who enrolled in our second randomized controlled trial, we examined whether therapist fidelity to core MIO treatment components predicted improvement in maternal reflective functioning and mental representations of caregiving, even after taking fidelity to non-MIO components into account. Next, we examined whether improvement in directly targeted outcomes (e.g., maternal mentalizing and mental representations of caregiving) led to improvements in the indirectly targeted outcome of maternal caregiving sensitivity, even after controlling for other plausible competing mechanisms (e.g., improvement in maternal psychiatric distress and substance use). Third, we examined whether improvement in targeted parenting outcomes (e.g., maternal mentalizing, mental representations of caregiving and caregiving sensitivity) was associated in improvement in child attachment status, even after controlling for competing mechanisms (e.g., improvement in maternal psychiatric distress and substance use). Finally, we examined whether improvement in maternal mentalizing and caregiving representations was associated with a reduction in relapse to substance use. Support was found for the first three tests of mechanisms but not the fourth. Implications for future research and intervention development are discussed. SN - 1873-6483 UR - https://www.unboundmedicine.com/medline/citation/29291768/Does_improvement_in_maternal_attachment_representations_predict_greater_maternal_sensitivity_child_attachment_security_and_lower_rates_of_relapse_to_substance_use_A_second_test_of_Mothering_from_the_Inside_Out_treatment_mechanisms_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0740-5472(17)30375-6 DB - PRIME DP - Unbound Medicine ER -