# Improvements in Mentalizing as a Mechanism of Change in Psychotherapy for Depressed and Suicidal Adolescents

> **NIH NIH R03** · DREXEL UNIVERSITY · 2022 · $75,453

## Abstract

As the second leading cause of death for U.S. teens, adolescent suicide is a significant
public health concern. A number of recent studies show that deficits in “mentalizing,” or the ability
to make generally accurate inferences about the thoughts, emotions, behaviors, and intentions of
others, are linked to adolescent suicide risk. One study also demonstrated that mentalization-
based treatment reduced rates of adolescent non-suicidal self-injury (NSSI). However, none of
these studies used the Adult Attachment Interview (AAI), the gold standard for deriving estimates
of mentalizing, and no treatment studies have examined whether improvements in adolescent
mentalizing reductions in suicide risk symptoms (e.g. decreases in frequency and intensity of
ideation, intent, number of attempts). The objective of the proposed study is to determine whether
improvements in adolescent mentalizing predict suicide risk symptom reduction over the course
of 16 weeks of psychotherapy. The study has two specific aims: 1) Determine whether adolescent
mentalizing improves over the course of psychotherapy for adolescent suicide risk; and 2)
Determine whether improvements in mentalizing predict and mediate improvements in suicide
risk symptoms. The study will capitalize on secondary data from a recently completed RCT
examining two treatments for adolescent suicide risk (Attachment Based Family Therapy and
Family-Enhanced Non-Directive Supportive Therapy) (N = 129). Both treatments were similarly
efficacious in reducing suicide risk symptoms. All adolescents completed pre and post-treatment
AAIs, which will be coded for mentalizing. The data set includes pre- and post-treatment data
(weeks 0 and 16), mid-point data (weeks 4, 8,12), and data through 1-year of follow-up (weeks
20, 32, 40, 52). This rich data set will allow for pre-post-test analyses, longitudinal growth curve
modeling, and mediation analyses.
 Mentalizing is a core component of social understanding and synonymous with the “ability
to understand mental states,” identified a key NIMH research domain sub-construct, under the
broader construct of “perception and understanding of others. Accomplishing the aims of the
proposed study will significantly impact knowledge about a treatment target that may be
particularly important for adolescents at risk for suicide and will be a first step towards a future
R01 submission aimed at: 1) building provider-friendly tools to assess mentalizing as a marker of
treatment progress for youth suicide; and 2) refining youth suicide interventions to target and
measure improvements in mentalizing.

## Key facts

- **NIH application ID:** 10452865
- **Project number:** 1R03MH119528-01A1
- **Recipient organization:** DREXEL UNIVERSITY
- **Principal Investigator:** Ellen Stephanie Krauthamer Ewing
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $75,453
- **Award type:** 1
- **Project period:** 2022-02-01 → 2024-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10452865

## Citation

> US National Institutes of Health, RePORTER application 10452865, Improvements in Mentalizing as a Mechanism of Change in Psychotherapy for Depressed and Suicidal Adolescents (1R03MH119528-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10452865. Licensed CC0.

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