Mentalisation is a psychological ability that influences our capacity to understand and process our own and others’ mental and emotional states. Initially introduced in psychoanalytic theory, this skill is a crucial factor in determining our psychological well-being and resilience. Fundamentally, mentalisation involves being conscious of our emotions, thoughts, and beliefs and mindfully interpreting other people’s actions. The ability to mentalise plays a significant role in regulating our emotions, coherence of thought, coping with stress, empathy, and interpersonal relationships.
The development of mentalisation as a crucial aspect of social cognition is a continuous process that spans our lives. However, for individuals experiencing chronic or acute depression, mentalising becomes considerably more challenging. Symptoms such as persistent low mood decreased well-being, and reduced engagement with the world can impede their ability to remain mindful of their internal states and social dynamics. Consequently, regulating one’s emotions and thoughts while maintaining a satisfying social life can pose significant challenges.
Origins in childhood attachment experiences
The ability to mentalise originates from having a secure and consistent attachment with a caregiver during childhood. Parents who remain attentive to their child’s daily experiences, offer feedback and exemplify skills for regulating emotions teach their children to contemplate and comprehend their complex internal states. Children who receive such support can maintain a more balanced perspective on the intentions underlying social interactions and remain receptive, adaptable, and considerate towards themselves and others. However, individuals who were not provided with such training are more susceptible to emotional dysregulation under stress and can lose their ability to mentalise when their nervous system becomes hyperactivated.
Physiologically, mentalisation skill is determined by the organisation of neural circuits in the brain through synaptogenesis, which refers to the formation of synaptic connections. Underdeveloped neural circuits can lead to rapid emotional overwhelm when one’s nervous system is under stress. Inherited genetic vulnerability can also predispose individuals to have limited mentalising capacity. Fortunately, due to the brain’s inherent neuroplasticity, the skill can be enhanced through mindful practice.
The connection between mentalising and depression
Hypomentalising and hypermentalising are unhelpful mentalisation habits. Hypomentalising occurs when an individual is easily overwhelmed by their own thoughts, feelings, and motivations, which makes it difficult for them to discern those of others. On the other hand, hypermentalising involves overestimating one’s ability to interpret behaviours, often leading to black-and-white thinking about the intentions of others. Hypomentalising can lead to apathy and a diminished sense of self-confidence and identity, while hypermentalising can result in feelings of emptiness and alienation. Although these habits can serve as protective mechanisms when faced with stress, they are ultimately oppressive and can lead to self-sabotage. Within relationships, a decreased ability to conceptualise and empathise with others’ emotions can increase emotional reactivity and lead to cutoff and withdrawal.
Over time, these habits can create or reinforce symptoms of depression. For instance, a 2019 literature review found that mentalisation deficits are often associated with chronic, severe depression. Conversely, strengthening one’s mentalising skills is a crucial moderating factor for depressive symptoms, including disconnection from one’s feelings and thoughts, ruminating on particular thoughts, and difficulty emotionally differentiating from others
Having a strong ability to perceive and understand the mental and emotional states of others is crucial for building healthy relationships. Negative beliefs and experiences of rejection can significantly harm this ability. In 1996, psychologists Geraldine Downey and Scott Feldman identified the phenomenon of rejection sensitivity, where individuals develop anxious expectations of social rejection. This sensitivity can make it difficult to form fulfilling relationships. Fortunately, mentalisation can aid in navigating intricate social dynamics and the nuanced emotions they entail.
Mentalisation-based therapy
There are evidence-based therapy treatments designed to support those struggling with the challenges outlined above. For example, mentalisation-based therapy (MBT) is a psychodynamic approach that is designed to improve mentalisation skills. MBT therapists frequently utilise elements of object-relations, existential, narrative, and affect theory. While originally designed to help individuals with borderline personality disorder, recent research has demonstrated that MBT can also augment the treatment of depression.
The aim of MBT is to encourage individuals to adopt a more compassionate and adaptable approach towards exploring their inner worlds, and to enhance their ability to regulate their actions. Through MBT interventions, individuals can improve their social cognition and intersubjectivity, which is the interaction between our emotions and thoughts with those of others to form healthy relationships. As a result of developing these skills, individuals can experience a more stable sense of self, improve their ability to regulate their emotions, recover from emotional setbacks more easily, and reduce interpersonal conflicts. This process of skill development also leads to changes in the brain’s neurological functioning through consistent practice.
The MBT therapy process
During both short-term (20 weeks) and long-term (18 months) MBT treatment, the therapist aims to create a secure and supportive environment by providing consistent attunement, sensitivity, and validation. The therapist achieves this by reflecting back to clients what they share and offering different perspectives, which help clients regulate their emotions. This often involves gaining insight into the attitudes and assumptions that influence their instinctive emotional reactions. By articulating their internal experiences, clients strengthen their internal representation of their mind’s activity. This process helps to reduce amygdala activation and gradually rebalance synaptic functions. Since discussing emotionally charged situations can trigger the attachment system, treatment may also include the use of grounding techniques such as breathwork and meditation.
Furthermore, the therapist also encourages clients to challenge automatic reactions such as self-blame, black-and-white thinking, catastrophising events, and assuming others’ motivations. This is achieved by cultivating mindfulness and promoting new ways of relating to themselves, which helps to strengthen the orbitofrontal function of the brain responsible for decision-making. In terms of relationship interventions, the therapist may employ techniques such as interpersonal problem-solving and identifying alternative interpretations of others’ behaviours. As a result, clients experience less internal confusion and develop a more integrated sense of self.
Simple MBT strategies
Although MBT techniques are intended to be learned within a supportive therapist-client relationship, there are strategies that can be applied on a personal level. Here are some practices that can be applied to our own lives.
Nurturing yourself
During depressive episodes, it can be especially challenging to maintain self-compassion and prioritise self-care. Negative self-talk, criticising one’s reduced ability to function and enjoy life, often reinforces this challenge. To prevent internal spiralling, it is important to distrust your self-view and remain curious about your needs at any given time. Try to stay mindful of impulses to make significant decisions or life changes and choose to put them on hold. Additionally, practice positive self-talk to combat automatic critical thoughts. For instance, in response to thoughts such as “I am a failure for struggling with my emotions,” say, “I have demonstrated my strength by coping with depression, and it is okay to take a break when these challenges become overwhelming.” Or, when thinking, “No one can tolerate me when I am depressed,” consider, “What would make me feel more seen and heard by my loved ones?” It can be useful to imagine what a compassionate friend might say in response to your painful thoughts.
Slowing down thoughts and feelings
When feeling depressed, thoughts, emotions, and behaviours can often become intertwined. To slow down these processes and maintain a compassionate, conscious awareness, regularly ask yourself what you are thinking, wishing, and feeling. Additionally, since emotions are signals stored in the body, consider how your body feels and what it is making you want to do. These instincts can reveal and clarify our internal states. If there are unhelpful behaviours that you are trying to change, take note of when they occur and try to identify triggers. Reflect in hindsight on the role of antecedent thoughts, feelings, or events that led to the consequent behaviour.
To illustrate, getting out of bed may become more difficult due to the automatic thought that “Today is going to be as painful as yesterday was.” Alternatively, the desire to connect with a trusted friend may be hindered by thoughts such as “They won’t be able to relate anyway, so it’s pointless to share.” By reflecting on your mental state in this manner, you can more easily identify any limiting thoughts that are making it more challenging to cope with depression. Additionally, when separating thoughts and emotions becomes particularly challenging, consider breathwork techniques such as box breathing, diaphragmatic breathing, and alternate nostril breaths. These techniques can soothe your limbic system and help you access your prefrontal cortex, which supports emotion regulation and decision-making.
Stay as curious as possible
When experiencing depression, one may struggle to interpret the actions of others due to low energy and internal judgements, leading to narrow-minded thinking. Negative interactions can become magnified and trigger significant distress. To combat this, try imagining yourself as an objective observer of a difficult interaction you experienced. Rather than feeling wronged and reinforcing negative beliefs, ask yourself what reasons could explain the person’s behaviour. If they seemed dismissive, perhaps they were preoccupied with a personal issue. If they acted confrontational, they could be struggling with personal problems or grief. If they didn’t respond to your needs, maybe they lack empathy due to their upbringing. And if they responded with aggression, they may be projecting their insecurities onto you.
To adopt a not-knowing stance, it is important to acknowledge that we cannot be sure of the thoughts and feelings of other people. This approach leaves room for curious exploration rather than passing judgement. When we maintain an open attitude, it becomes easier to express our thoughts mindfully if it becomes necessary to address the person directly or to simply process our experiences in a healthy way. Additionally, this approach can help us avoid acting impulsively and engaging in self-sabotaging behaviours. By remaining curious, we can create opportunities to maintain meaningful relationships.
Rest in the unknown
Finally, as author and business owner Scott Galloway reminds us, “Nothing is ever as good or bad as it seems.” This mindset reminds us that it is natural to focus on the negatives and that we can also view happier memories through rose-coloured glasses. Remembering this can help us maintain a balanced view of life and our experiences, reducing internal judgement. To hold multiple perspectives, practice radical honesty with yourself, creating space to develop a non-judgemental focus on the present moment and the possibility for positive action.
For instance, by mindfully slowing down thoughts and paying attention to one’s body, one may generate ideas such as taking a comforting bath or checking in with a friend. Additionally, as a simple mindfulness practice, try to avoid using the word “just” in thoughts and conversations, as this often indicates closing down mental processes. Instead, state perspectives simply and honestly, and notice how defensiveness is replaced by greater feelings of self-acceptance. These straightforward mentalization practices can help sustain hope while navigating the journey of depression.
Marian Ting is an associate marriage and family therapist who is passionate about articulating phenomena, theories, and research related to the social sciences.
