2024/02/15 by Sterkenburg, Paula, Andries, Veerle
#Social and Behavioral Sciences
paper · doi:10.17605/osf.io/2xf3p
A secure attachment relationship between clients and caregivers forms the foundation for the cognitive and emotional development of clients and creates the ideal circumstances for encouraging optimal mentalization in clients (Fonagy et al., 2002). However, fostering this attachment relationship can be challenging and requires a mentalizing approach from caregivers (Dekker-van der Sande & Sterkenburg, 2015). Mentalization refers to the ability to reflect on our own thoughts and feelings, as well as those of others, to be able to understand behaviours of ourselves and others (Allen et al., 2008). Mentalization in the context of care for people with intellectual disabilities refers to paying attention to the emotional meaning of the behaviour of the client, while being aware of the own emotions and behaviour and the internal reactions that the own emotions and behaviour elicit in the client. In order to mentalize adequately, it is essential to apply the basic elements of a mentalizing attitude. This includes flexibility, tolerance, non-judgment, honesty, openness, curiosity, asking open-ended questions, mirroring the reactions of the client, and being mindful of imbalances between oneself and others (Dekker-van der Sande & Sterkenburg, 2015). By applying this basic mentalization approach, clients learn to recognize and name their own mental states as well as those of others, leading to an improvement in their mentalizing abilities (Verheugt-Pleiter et al., 2005; Midgley et al., 2017). However, misunderstanding others' intentions or finding it challenging to understand our inner states can lead to confusion, misinterpretation, and difficulties in interpersonal relationships (Locati et al., 2022). Such difficulties may contribute to anxiety, insecurity, and challenging behaviour in clients, while caregivers may experience feelings of powerlessness, inadequacy, and insecurity (Sterkenburg et al., 2022; Dekker-van der Sande & Sterkenburg, 2015). For caregivers of people with intellectual disabilities, the ability to adequately mentalize is a crucial skill, essential for meaningful interactions with their clients. Caregivers have the responsibility to support people with intellectual disabilities to better understand and manage their thoughts and emotions, given that mentalizing abilities are less developed in this target group (Dekker-van der Sande & Sterkenburg, 2015). Due to the limited capacity to mentalize and the challenges in social information processing in people with intellectual disabilities, difficulties in social functioning may arise, causing more stress and consequently making learning mentalizing skills more difficult (Van Nieuwenhuijzen et al., 2007; Janssen et al., 2006). By providing mentalizing support, caregivers enable their clients to navigate stressful situations more effectively (Dekker-van der Sande & Sterkenburg, 2015). However, caregivers are only able to do this when they themselves maintain a "mentalization state", demonstrating the ability to respond flexibly and tolerantly, even when faced with difficult situations and emotions (Dekker-van der Sande & Sterkenburg, 2015). Research shows that caregivers feel an excessive amount of pressure and stress (Ryan et al., 2021), impacting their capacity to mentalize (Dekker-van der Sande & Sterkenburg, 2015). Work-related stress can stem from various factors, including the growing complexity of the target group, characterized by more complex health and support needs, as well as exposure to challenging behaviour (Nouwens et al., 2020; Ryan et al., 2021). Research highlights that the impact of the last factor, exposure to challenging behaviour, is influenced by a person's belief in their own abilities and effectiveness (self-efficacy) (Ryan et al., 2021). Elevated work expectations, a diminished sense of autonomy, and a lack of adequate support have also been found to be associated with heightened stress and burnout levels among caregivers of people with intellectual disabilities (Ryan et al., 2021). Research of Hussein (2017) state that training is considered crucial in minimizing the impact of stress in caregivers. There is a growing number of training programs to facilitate and train mentalization (Welstead et al., 2018; Satran et al., 2020; Sterkenburg & Braakman, 2019). To allow aspiring healthcare professionals to develop mentalizing skills from the outset of their careers, it is crucial for mentalization to be incorporated into their educational programs. A promising tool that promotes learning-by-doing, elevating student interest and motivation while facilitating skill acquisition and transfer, is Virtual Reality (VR) (Mantovani et al., 2003). VR introduces innovative possibilities for visual representation, reducing the cognitive demands associated with creating mental representations in scenarios such as role-playing (Cornet & Van Gelder, 2020). Additionally, utilizing a VR environment in training can closely simulate real-life situations that future caregivers may encounter with clients (Schaarsberg et al., 2023). Numerous studies have highlighted the effectiveness of VR simulation in facilitating knowledge acquisition, yet there is a lack of research specifically addressing the role of VR in mentalization and the development of soft skills (Cerciello et al., 2022). Therefore, we investigate whether the use of a VR mentalizing group session contributes to promoting mentalization in future healthcare professionals.