Certain and Uncertain Reflective Functioning in Mothers with Substance Use Disorder: Investigating the Associations between Reflective Functioning, Trauma and Executive Functions

Abstract Authors: Tore Bergby Handeland and Vidar Roald Kristiansen Title: “Certain and Uncertain Reflective Functioning in Mothers with Substance Use Disorder” Main supervisor: Merete Glenne Øie. Co-supervisor: Bjørn Lau. Background: Impairments in reflective functioning (RF) are known to have adverse effects on the ability to exhibit sensitive parenting as a caregiver. Several factors are associated with impairments in RF, such as level of executive functioning (EF), degree of trauma experienced and having a substance use disorder (SUD). However, no studies have investigated in what way these individual factors contribute to the specific RF impairments, such as pathological certain RF (RFQc) or uncertain RF (RFQu). Neither has there been studies investigating the relationship between these two forms of impaired RF and general measures of RF. Methods: In the current thesis, EF, RF and degree of trauma experienced in 43 mothers diagnosed with SUD were assessed. The occurrence of maternal (general) RF was assessed by administering the Parent Development Interview, while RFQc and RFQu were assessed using the Reflective Functioning Questionnaire 8 (RFQ-8). EF, trauma and SUD were assessed by administering various questionnaires, interviews and neuropsychological tests. The data used in this thesis are based on data already collected as part of an ongoing doctoral thesis called the “Mosaic Project”1. The data are cross-sectional and the relationships between the constructs of interest are investigated through covariate and multivariate analyses and descriptive data. Results: The results revealed that RFQu was significantly associated with maternal RF, while RFQc was not. The analyses revealed several significant associations between RF and trauma. High RFQu was more than twice as common in mothers reporting high amounts of trauma in adolescence, and almost three times as common in mothers reporting high amounts of trauma across the lifespan, compared with mothers reporting low amounts of trauma. When investigating the relationship between EF and RF, working memory, cognitive flexibility and planning turned out to be significantly associated with RFQu, with lower levels of EF correlating with higher levels of RFQu. The RFQc did, however, not show any significant associations. Conclusion: Results from this thesis indicate that trauma and EF are associated with uncertain RF style in mothers with SUD. Further, we suggest that EF may impair RF through the impediment of proper affect regulation. More research is needed in order to assess the relationship between RFQc and maternal RF, EF, trauma and SUD. 1The “Mosaic Project” is a collaborative project between Lillehammer University College and Sykehuset Innlandet HF. The project aims to generate knowledge about important aspects in promoting competence development and well-being for children residing in families with parental substance abuse problems and/or parental mental illness