Findings from the present study suggest that PRF and EF are associated in SUD mothers. The findings have implications for understanding how maternal EF contri-butes to differences in PRF, as well as how PRF abilities might help or hinder access to EF capacities, which together could affect the quality of caregiving. However, associati-ons between PRF and EF are not clear, but influenced by a number of confounding va-riables associated with maternal SUD. Our results demonstrate that mothers with ade-quate PRF have significantly better mental health status, started using substances later, and meet the criteria for dependency later in life compared to mothers with negative to low PRF. Furthermore, they exhibited EF capacities comparable to a normative sample, while mothers with negative to low PRF showed compromised EF. Moreover, mothers with adequate PRF reported less childhood adversities, and more adaptive experien-ces. Particularly adaptive experiences in early childhood were associated with adequate PRF. In addition, PRF mediated the relationship between EF and parental stress, and between EF and psychological distress. Of the EF components included in the study, cognitive flexibility was highly associated with PRF, which suggests that the capacity of cognitive shifting between oneself and the child is particularly important for parental mentalizing capacity.
We have significant evidence for associations between EF and PRF in this the-sis, and that has implications for interventions. Mothers with adequate PRF had a well-functioning EF system, better mental health status, met criteria for substance de-pendency in adulthood, and had access to functioning regulation strategies when facing parental stress. In addition, they reported fewer adverse experiences and more adaptive experiences, including a sense of safety. It is likely that their capacities lead them to be more receptive to interventions targeting PRF, EF and parental capacities directly, as they are less affected by aspects related to mistrust and emotion dysregulation, which could lead to higher engagement to psychotherapeutic treatment modalities. Mothers reporting high presence of adversities throughout childhood and adolescence, with few adaptive experiences in addition to a compromised PRF and EF, increased mental health issues and clinically high parental stress that were not regulated by PRF, might need a more long-term individually customized intervention targeting epistemic mistrust and EF before focusing on and improving PRF.
This study highlights the diversity in mothers with SUD and the need for indi-vidually adjusted interventions to heighten PRF and EF, which can possibly lead to improvements in parenting abilities.
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