Current Research

Menninger researchers are discovering insights about the human mind and human behavior by blending brain and behavior studies

Menninger's research strategies are developed through the Menninger Child & Family Program and an international research consortium that consists of The Menninger Clinic, the Yale Child Study Center and the Anna Freud Centre at the University of London. Projects are designed to develop a better understanding of the mind in order to more effectively treat mental disorders. Menninger treatment is informed by brain and behavior research that draws upon the expertise of clinicians and researchers who work hand-in-hand with colleagues at Baylor College of Medicine, a major medical center that houses neuroscience practitioners and such cutting-edge scientific tools as functional magnetic resonance imaging (fMRI).

Joining behavioral expertise with cutting-edge technology
A key behavioral function called mentalizing is the current focus of Menninger research. Strategies include:

• Collaborations uniting the high technology of human neuroimaging with Menninger's expertise in behavioral sciences;
• Consortium projects that share the resources of several research centers; and
• A focus on mentalizing as a critical subject of inquiry. Mentalizing shapes Menninger's overall research efforts. Mentalizing is the fundamental human mechanism that is a key to resilience.

Leading the strategic plan
A strategic plan that strengthens research administration and solidifies projects has been approved for the internationally acknowledged Menninger Child & Family Program, directed by Peter Fonagy, PhD, a recognized authority in the field of infant and child development.  

The Menninger Child & Family Program at Baylor College of Medicine and Behavioral Sciences reports to Menninger child psychiatrist Efrain Bleiberg, MD, as Director of Child and Adolescent Psychiatry at the Menninger Department of Psychiatry & Behavioral Sciences.  Dr. Fonagy chairs an international research consortium that includes Menninger, the Anna Freud Centre, University College of London (UCL), represented by Mary Target, PhD, and the Yale Child Study Center, represented by Linda Mayes, MD.

Dr. Target is a psychoanalyst and clinical psychologist, a teacher at UCL and a co-director of the Anna Freud Centre, London. Her research expertise concerns parent-child relationships. Dr. Mayes is a developmental pediatrician and psychoanalyst, and the Arnold Gesell Associate Professor of Child Psychiatry, Pediatrics and Psychology at the Yale Child Study Center, where she directs the early-childhood programs. Dr. Bleiberg serves as the consortium's coordinator and representative from the Menninger Department of Psychiatry at Baylor College of Medicine.

Areas of focus:

In search of peaceful schools
The Peaceful Schools Project, which collected data from 3,000 Topeka, Kansas school children over a three-year period, is headed by co-investigators Stuart Twemlow, MD, and Dr. Fonagy. The study has already resulted in developing interventions effective in subduing the act of bullying in schools, which reduces schoolroom violence and improves the learning atmosphere. The project has garnered international attention, both from academic professionals and the media.

Dr. Twemlow, who is also the medical director of Menninger's Hope treatment program, reports that research officials plan to implement another multi-site study to begin exploring possibilities for implementing the project in the greater Houston area.

Neuroimaging and enhancing resiliency
Researchers are studying how to better understand why a small number of mothers-often with histories of severe trauma-have difficulty in establishing a secure relationship with their newborn infants, thus putting their child's future development at risk. Efforts will result in a treatment protocol focused on mentalizing that can be contained in a manual. That team involves Dr. Fonagy, along with Glen Gabbard, MD, director of the Baylor Psychiatry Clinic who was trained at Menninger and remained there for more than 25 years, P. Read Montague, PhD, a theoretical neuroscientist from the Baylor College of Medicine and Director of the Human Neuroimaging Laboratory, pediatric researcher Lane Strathearn, MBBS (bachelor of medicine/bachelor of surgery), and Dr. Bleiberg, a 27-year veteran of Menninger.

Baylor's Human Neuroimaging Laboratory is dedicated exclusively to brain-behavior research. The lab is equipped with two functional magnetic resonance imaging (fMRI) machines for brain imaging experiments designed to help understand the origins of neural behavior. 

fMRI technology 
The Human Neuroimaging Laboratory at Baylor College of Medicine is a state-of-the-art facility dedicated to basic research investigations into the physiology and functional anatomy of the human brain using functional magnetic resonance imaging (fMRI). The lab houses two 3 T, head-only, Allegra Siemens fMRI scanners, and supports several full-time neuroscientists, a physicist, computer programmers, technicians, a distinguished visiting scientists program and administrative support.

A treatment for children
Another project involves developing a treatment protocol focused on mentalizing for children with severe emotional disorders. A manual will be produced outlining the treatment.  In addition to Dr. Bleiberg, fellow co-investigators include John Sargent, MD, a professor of psychiatry at Baylor College of Medicine and director of child and adolescent psychiatry at Ben Taub Hospital.  Dr. Sargent is the former director of education and research, and dean of the Karl Menninger School of Psychiatry & Mental Health Sciences at Menninger.  The third member of the team is Jackie McGregor, MD, who directs child and adolescent psychiatry at the Baylor Department of Psychiatry.

Also in the planning stages is the development of a treatment protocol focused on mentalizing for the Professionals in Crisis Program at The Menninger Clinic.

Dr. Bleiberg said he was excited by the prospect of  "joining forces to build a new level of integration with Baylor's neurobiological and medical resources, with the psychological and developmental strengths that Menninger brings."

The concept of mentalizing
At the heart of Menninger's research is mentalizing, a critically important subject at The Menninger Clinic, Dr. Bleiberg said.

"I see mentalizing as an organizing thread for treatment at the Professionals in Crisis program, as well as an organizer of the research in the Child & Family Program."

So what is this concept and why is it considered so important?

"Mentalizing refers to a biologically prepared mechanism to help one engage in spontaneously sensing and reading human behavior-our own and others-mostly without conscious effort," said Dr. Bleiberg, author most recently of Treating Personality Disorders in Children and Adolescents, a relational approach.

Mentalizing is the sense we have of ourselves and others, the ability to understand how we are according to how we see ourselves perceived. This ability normally develops in childhood as an infant interacts with caregivers. Mentalizing provides each of us a balanced emotional life based on a secure foundation of safe attachments or positive emotional bonds. How this ability develops depends a great deal on the environment in which a child is raised. What is important to understand about this concept is that a child's sense of his inner world forms from how he sees himself according to how he sees others see him.

John's safe attachment
For example, John is four months old. His mother cuddles with him, makes happy facial gestures, says soothing things. John experiences all of these actions in a positive way. But what researchers have learned is that these actions are not being processed as a mirror of events.

John is seeing something else. He's not only seeing his mother laugh at him, John is seeing a reflection of himself in his mother's gestures. Much of this ability is conducted as an assessment that goes on automatically and unconsciously, while other times, John's development assures that when required he can gauge his emotional state in a thoughtful way and react in a similar manner. 

The sense of safety and security that is created through the positive experience of interacting with his mother and others time and again over his lifetime affords John the opportunity to develop the ability to determine his own inner world by how he sees himself in others. As a result, he most likely will be left with a balanced emotional life. He will attain resilience against negative emotional forces such as stress and trauma, he will have coping skills, he will have the ability to sustain meaningful relationships and he will generally be able to confront adversity armed with self-awareness and a sense of identity. Even with genetic vulnerabilities to any psychological disorder, John is still better prepared to meet the challenges of mental illness should they develop over his lifetime because John has attained the ability to mentalize.

Researchers believe that the capacity for mentalizing is a significant development in human life and is a necessary development for a healthier emotional life.

"By mentalizing," Dr. Bleiberg said, "we manage such feelings as frustration, anger, sadness, anxiety, shame and guilt without resorting to automatic fight-or-flight responses or efforts to cope that are ultimately self-destructive or maladaptive."

Sara's challenge
Sara is also four months old, but her mother is distant. She rarely picks Sara up or holds her or cuddles with her. Her father drinks to excess and is rarely in the home and when he is he speaks loudly and often strikes Sara's mother. Frequently, Sara finds herself alone in her room hearing her parents arguing in the distance.

How does Sara define herself? Her environment is chaotic. Sometimes she remains hungry for significant periods. Without positive caretakers in her world, what kind of world does Sara see and how does she envision herself in it?

Looking into her mother's face Sara sees distance and detachment, fatigue and weariness. Sara gauges her own sense of self by what she sees. There is little humor and rare play. Sara's reaction to much of this is distress and she cries as a result. The more she cries, the more her mother avoids her. Because of her father's outbursts and her mother's lack of attention, Sara's world is neither safe nor secure. She has little bonding with others.

Who does Sara see when she looks in a mirror? That is a view that is also a reflection of Sara's inner world, where her own evolutionary capacity for fight-or-flight in the face of danger may drive her to bang her head on her crib or tear her toys apart or to simply internally withdraw into herself for protection from external circumstances.

Sara's experience has left her with a confused sense of herself. Researchers believe that the lack of a secure attachment, that is, a close emotional bond, leaves children adrift. And while it appears an obvious observation that children learn about themselves by first becoming internally aware of their own minds, the exact opposite is true. Children develop their minds from the outside in, not from the inside out. A child sees how he feels in the face of his mother and begins to understand his own feelings.

We learn to mentalize through seeing and sensing our thoughts and feelings and being thought about by being mentalized in a secure and safe relationship. A child sees a loving mother's facial reaction to his distress and he feels felt; he can see outside himself what he feels inside himself. A child who is frightened of caretakers has no secure attachments and, consequently, no calm environment where she can explore her own mind with a sense of safety. She will turn away from that individual and avoid exploring how she sees herself in the caretaker's face. Mentalizing is inhibited at this point in development and without some secure bonds in the future, chances are Sara will be less armed to cope with adversity as an adult.

Feeling 'insights'
"Our focus on mentalizing in psychiatric research and treatment," Dr. Bleiberg said, "is based on a growing body of evidence that points to mentalizing as the key to resilience, the ability to adapt successfully to adversity, challenges and stress. Mentalizing is emphasized in treating individuals as a way of promoting coping with vulnerabilities, including the genetic vulnerability to psychiatric disorders such as depression, bipolar disorder, anxiety disorders and addictive disorders. Research is demonstrating, for example, that persons who can mentalize in the face of trauma-including childhood trauma-are less vulnerable to psychiatric disorders. Research is also demonstrating that adjustment and quality of life of people with various psychiatric disorders is ultimately determined by abilities that result from mentalizing."

Consequently, Menninger clinicians are interested in developing scientifically proven treatment protocols involving mentalizing that can be adopted and used throughout the mental health community.

Menninger clinicians help patients establish the capacity to mentalize so that patients are better equipped to manage their illnesses. Menninger provides an environment in which patients can begin to feel the safety and security necessary to foster mentalizing and to practice mentalizing.

"The process of mentalizing," Dr. Bleiberg said, "is going well when patients feel 'felt,' having a sense that their clinician has their mind in mind. Mentalizing is built around communication-not just in words, but also in feelings as communicated in facial expression and body posture."

The intent of Menninger treaters is to help a patient make better sense of himself and help him achieve greater insight into himself and others. Success is achieved when a patient who has been stymied in his progress becomes unstuck, finds a future direction for managing his challenges and no longer feels at the mercy of his illness.   

What is needed to achieve this? Plenty of professional understanding, human relationships and an environment that focuses on the mind.

Additional information
History of Research
Child & Family Program